hungry and heavy: what ingredients are needed for change?

first annual Southeastern

Executive Chef’s Table on February 24th.

For: Southeastern Executive Chef’s Table

February 24-26, 2012

Smithgall Woods State Park - Helen, GA

Presenter: Debra Kibbe, MS

Georgia Health Policy Center [email protected] 404-413-0287

Hungry and Heavy: What ingredients are needed for change?

The Paradox

of Food

Insecurity &

Obesity in the

Southeastern

United States

Objectives

• Examine issues related to the hunger and obesity paradox

• Explore existing initiatives

• Discuss the Executive Chef’s ingredients for change to address hunger and obesity

This [event] will be a tremendous opportunity for us

to leverage our passion and our positions.” Holly Chute

The Hunger-Obesity Paradox

• Research findings are complex – do not illustrate direct relationships

• Food insecure women are at greatest risk for obesity

• Factors related to both food insecurity and obesity stem from poverty!

– Stretching the food dollar

– Feast or famine (binge eating, storing)

– Lack of safe places to play

3

Issue: Hunger/Food Insecurity

GOAL: FOOD SECURITY FOR ALL

―Access by all people at all times to

enough food for an active, healthy life."

C.C. Campbell

Issue: Food Insecurity & Obesity in SE US

Source: 1) Food Research & Action Center. 2) F as in Fat Report, 2011

State Food Insecurity % (Rank) 1

Adult OB % (Rank)2

Alabama 15% (7) 32.3% (2)

Arkansas 17.7 (1) 30.6 (9)

Florida 14.2 (14) 26.1 (29)

Georgia 15.6 (4) 28.7 (17)

Kentucky 13.4 (22) 31.5 (6)

Louisiana 10 (45) 31.6 (5)

Mississippi 17.1 (3) 34.4 (1)

N Carolina 14.8 (9) 29.4 (14)

Tennessee 15.1 (6) 31.9 (4)

Texas 17.4 (2) 30.1 (12)

W Virginia 13.4 (22) 32.2 (3)

Prevalence of

Household-

Level Food

Insecurity

2007-2009

Southeastern U.S.:

• 7 of top 10 food

insecure states

• 8 of top 10 most

obese

Issue: Hunger & Food Access

Sources: 1) The Food Trust. Food for Every Child: The need for more supermarkets in Georgia.

June 2011, p. 9. 2) Treuhaft S, Karpyn A. PolicyLink and The Food Trust. The Grocery Gap: Who

has access to healthy food and why it matters. Oakland (CA), 2010.

Low Sales, Low Income, High Deaths

Other

Major Cities

Park, forest or non-residential

Recommendation:

Southeastern states must address

the critical need for more super-

markets in many communities, both

rural & urban.

Issue: Obesity

Source: HealthyPeople.gov, 2020 Objectives

GOALS: Healthy People 2020

• Increase proportion of Adults 20+yrs who are healthy

weight (from 30.8% to 33.9%)

• Reduce the proportion of adults who are obese (from 34%

to 30.6%)

• Reduce the proportion of children and adolescents who

are considered obese (from 16.2% to 14.6%)

Issue: Obesity & Disparities

Source: 1. CDC, Child Overweight and Obesity. http://www.cdc.gov/obesity/childhood/data.html

2. Ogden CL, Lamb MM, Carroll MD, Flegal KM. NCHS Data Brief, No. 51, Dec 2010. Obesity

and Socioeconomic Status in Children and Adolescents: United States, 2005-2008.

Among 2 to 19 year olds1 in 2007—2008:

• Boys: Hispanic more likely to be OB than non-Hispanic

white.

• Girls: Non-Hispanic black more likely to be OB than non-

Hispanic white.

Low income children & adolescents are more likely

to be obese than higher income youth...‖2

Obesity & Food Insecurity1

People with unreliable access to food are:

• Not getting healthy affordable food,

• More likely to be obese, and

• Exposed to higher levels of stress.

1. Food Insecurity and Obesity: Understanding the Connections.

Washington: Food Research and Action Center, Spring 2011.

Obesity & Food Insecurity1,2

Food-insecure households tend to:

• choose foods high in fat,

• choose foods that may satisfy hunger more easily, but they typically do not provide sufficient nutrients, and

• overeat when they do have access to food.

1. Dinour LM, Bergen D, Yeh M. “The Food Insecurity-Obesity Paradox: A Review of

the Literature and the Role Food Stamps May Play.” American Dietetic Association,

107(11): 1952-1961, 2007. 2. Food Research and Action Center.

Obesity: Energy Gap Among U.S. Children

• Excess weight gain estimated based on 1988-1994

normal weight distribution1

• All adolescents: excess 0.43 kg/yr over 10 yrs ( .95 lbs)

• Energy gap = 110-165 kcals/day

• OW adolescents: excess 2.65 kg/yr over 10 yrs ( 5.8 lbs)

• Energy gap = 678-1017 kcals/day

1) Wang et al, Pediatrics 2006;118:e1721.

2) Butte NF et al. Obesity 2007;15:3056.

• Energy imbalance in Hispanic children2:

• median weight gain 6.1 kg in 1 yr ( 13.4 lbs)

• 244 to 267 kcals/day (considers P.A. levels)

Issue: Diet Quality

Source: Food Research and Action Center poll of 1,013 registered voters.

Conducted by Hart Research Associates, January 11-17, 2012.

Don't dig your grave with your

own knife and fork.

~ English Proverb

Top Sources of Calories Among Americans 2 Years & Older

1. Grain-based desserts – Cake, cookies, pie, cobbler, sweet rolls, pastries, donuts

2. Yeast breads – White bread and rolls, mixed-grain bread, flavored bread,

whole-wheat bread, bagels

3. Chicken and chicken mixed dishes – Fried and baked chicken parts, chicken strips/patties, stir-fries,

casseroles, sandwiches, salads, other chicken mixed dishes

4. Soda/energy/sports drinks – Sodas, energy drinks, sports drinks, and sweetened bottled

water/ vitamin water

5. Pizza

Source: NHANES 2005-2006, Available at http://riskfactor.cancer.gov/diet/foodsources/

Top Sources of Calories by Age Group

Alcoholic beverages are a major calorie source for adults

Sodas & pizza contribute more calories among adolescents than younger children

Fluid milk is a top calorie source for younger children

Source: NHANES 2005-2006, Available at http://riskfactor.cancer.gov/diet/foodsources/

Comparison of Consumption to Recommendations

U.S. Department of Agriculture Center for Nutrition Policy and Promotion

*solid fats and

added sugars

*

Reduce: Sodium Intake


Reduce: Solid Fats

Food Sources of Solid Fats U.S. Department of Agriculture

Center for Nutrition Policy and Promotion

Food Sources of Added Sugars

Reduce: Added Sugars


Food Sources of Refined Grains

Reduce: Refined Grains (especially

those w/ solid fats, added sugars, and sodium)


Issue: Food Assistance Programs



“Nutrition programs provide a safety net.”

Executive Director, Greater

Chicago Food Depository

Income Eligibility for WIC* Benefits

WIC Family Size

Annually Monthly Weekly

Family of 1 $20,147 $1,679 $388

Family of 2 27,214 2,268 524

Family of 3 34,281 2,857 660

Family of 4 41,348 3,446 796

*Special Supplemental Nutrition Program for Women, Infants

and Children. Target: Women and their children 0-5 yrs.

WIC contributes approximately $3.3 billion to the GA’s economy.

TX is the 2nd and GA is the 5th largest WIC programs in the U.S.

WIC Food Package & Farmers Market Program

In 2009, USDA introduced a new set of WIC food

packages based on IOM recommendations:

• More fruits and vegetables

• Increased whole grains

• Increased farmers market vouchers

• Reduced juice allowance

• Reduced dairy & egg allowance, only reduced fat milk

• More healthy food for breastfeeding mothers

Source: USDA FNS

SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP):

AVERAGE MONTHLY BENEFIT PER PERSON

(Data as of February 1, 2012)

State/Territory FY 2008 FY 2009 FY 2010 FY 2011

Alabama 96.79 119.14 126.90 135.18

Arkansas 95.17 115.53 122.59 123.72

Florida 101.87 126.70 141.40 139.55

Georgia 104.19 125.95 134.35 135.37

Kentucky 97.66 119.00 127.05 127.60

Louisiana 108.04 128.86 129.77 130.59

Mississippi 92.59 113.83 122.54 123.29

Tennessee 101.95 124.66 133.86 133.82

“We put healthy food on the table for more than 46

million people each month.” USDA Food & Nutrition Service

Why Change SNAP?

• Virtually all food items allowed (no hot foods)

• Long-term FSP* participation is positively and significantly related to1:

– obesity and BMI for low-income women

– BMI for low-income married men

1. Gibson D. Food Stamp Program* Participation and Obesity: Estimates from the NLSY79.

Jan 2002. On-line: http://www.ipr.northwestern.edu/jcpr/workingpapers/wpfiles/gibson_obesity.pdf

Website: http://www.fns.usda.gov/snap/



Explore existing initiatives

Objective #2

Eat more fingernails. They’re nutritionally more valuable than soda pop.

Brought to you by the University of Minnesota School of Public Health.

Social Marketing: TACOS

• Yr 1 - the # of promotions conducted in schools was significantly

associated with % lower-fat food sales.

• Yr 2 - the duration of promotions was significantly associated with %

lower-fat food sales.

• Conclusion: School-based environmental interventions to increase

availability and promotion of lower-fat foods can increase purchase of

these foods among adolescents.

Site: http://www.do-groove.com/

Social Marketing Campaign:

“do”

• For Worksites & Community

• Billboards, posters, TV ads,

handouts, & other resources

Social Marketing: Champion Moms (CA)

Build support for and create a message campaign for Moms in your state

Examples from Southeastern States

• Kentucky – Delta HOPE Initiative

• Tennessee – Funded Coordinated School Health, TAKE 10!

• Louisiana – Smart Bodies

• Georgia –Youth Fit for Life (YMCA), Tons of Fun,

• Arkansas – Delta Healthy Kids Project

• Texas – Juntos y Saludables, CATCH

Since 2000, documenting OB, PA & Nut

programs – list is 35 pages long!

GA DPH Nut & PA Initiative

Healthcare Work Group /

Obesity Action Network

Early Childhood Work Group

/Bright from the Start DECAL: Day cares, Head Start,

WIC, etc.

Community Work Group: Cooking

Matters, Healthy Vending Project – includes Parks & Rec, Boys & Girls Club, Boys & Girl

Scouts, 4-H

Worksite Work Group: Health Matters Toolkit

developed

Faith Work Group: Annual

Conference (Jan) & Toolkit

developed

School Work Group - Action for

Healthy Kids, HealthMPowers,

Alliance for Healthier

Generation, Dept of Education

Policy / Education: GA Health Policy

Center & PLAY Initiative &

GPAN Coalition

Georgia Dept. of Public Health CDC-funded Obesity Grant

Focus areas:

Policy,

Systems, &

Environmental

Change

Steering Committee

Production

Processing

Distribution Waste Recycling

Consumption

Policy Level Action:

Georgia Food Policy

Council

GA DPH-funding

Deliverables:

• Expand members

• Develop state plan

• Host info gathering

meetings: 3

regional & 1

statewide

Share Our Strength’s Cooking MattersTM

Georgia Coalition for Physical Activity and Nutrition receives support from GA DPH Nutrition & PA Initiative

to implement

Cooking Matters in Georgia

GA DPH-funding Systems Level Action

Cooking Matters Teaches…

33

…Cooking

…Nutrition

Cooking Matters Teaches Shopping & Food Budgeting

34

A family meal for 4 for $10

Grocery Store Tour

Cooking Matters Uses Volunteer Chefs & Nutrition Educators

What are the ingredients for change to address hungry and heavy?

Objective #3

Source: Las Vegas Sun. The Associated Press. Monday, Feb. 20, 2012.

Web: http://www.lasvegassun.com/news/2012/feb/20/us-white-house-chef/

Consider the Food System

• Availability Roadblocks

– Affordability

– Access

• Structural Roadblocks

– Transportation Infrastructure

– Retail Models

– Supply Chain Development

– Adequate Healthy Food Supply

Ingredient #1: Family Meals1,2,3,4

Family meals provide opportunity for:

• modeling food behavior,

• influencing nutrition beliefs, and

• controlling the family food environment by offering healthy foods

Example -- Project EAT:

M.S. & H.S. youth who had more frequent family meals:

• ate more fruits, vegetables, grains, and calcium-rich foods

• drank fewer soft drinks

Key: help families address scheduling issues re: family meals

(1) Neumark-Sztainer, Hannan, Story, Croll, & Perry, 2003; (2) Johannsen & Johannsen,

2006; (3) Neumark-Sztainer et al., 2003; (4) Story M, Neumark-Sztainer D, 2005.

Ingredient #2: Food Quantity

Never order food in excess

of your body weight.

-- Erma Bombeck

Ingredient #3: Participation in Federal Food

Programs ↓ Food Insecurity

• SNAP benefits must be used for food & for plants and seeds to

grow food for a household to eat.

• Work with state SNAP, Cooperative Ext & Master Gardeners

groups to encourage purchase of plants & seeds for gardens

• Promote Wholesome Wave double value coupon program at

farmers markets

• WIC, SNAP & CACFP require nutrition education.

• Work with programs like Cooking Matters, Community

Gardens, etc. to improve the growing & cooking skills of

low income families.

• Support HHF Kids Act & School Nutrition: Chef’s Move in

School, Farm to School, School Gardens; Quality of breakfast,

lunch, dinner, summer meals & afterschool snacks

Sources: USDA FNS, Let’s Move

Governor Deal Launches 'Feeding For A Promising Future - No Kid Hungry Campaign‘*

(November 16, 2011)

Ingredient #4: Access and Hunger

Take a lead role in your state’s

―No Kid Hungry Campaign.‖

* with Share Our Strength and Georgia Food Bank Association

http://strength.org/press_release/20111116/

Ingredient #5: Access to & Adequate Food

Supply through Grocers/Markets

Work with your state governments and food

vendors/grocers:

create a grant & loan program to support

local supermarket development projects

incent grocers to place a store or help to

establish farmers markets in a low access

area (and price products fairly!)

which increases availability of affordable

& nutrition food in underserved areas.

e.g. Pennsylvania’s Fresh Food Financing Initiative –

since 2004, 83 stores in 27 rural and urban counties

Our Goal: Healthy, hunger free families & communities

in the Southeastern United States

Convene.

Collaborate.

Catalyze.

This [event] will be a tremendous opportunity for us

to leverage our passion and our positions.” Holly Chute

Final Quotes…

“Children have never been very

good at listening to their elders, but

they have never failed to imitate them.‖

-- James Baldwin

Thank you!

Questions?

Comments?

How To Weigh Yourself

Contact: Debra Kibbe

[email protected]

404-413-0287

hungry and heavy: what ingredients are needed for change?

Health & Medicine