A review of the evidence: most promising policy opportunities to promote healthy eating and active l

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A review of the evidence most promising policy
opportunities to promote healthy eating and
active living among CALIFORNIANS
Pat Crawford, DrPH, RD University of
California at Berkeley Dr. Robert C. Veronica
Atkins Center for Weight and Health
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University of California at BerkeleyDr. Robert
C. Veronica AtkinsCenter for Weight and Health
Mission
Provide leadership for the development of
interdisciplinary, science-based solutions for
preventing excessive weight and nutrition-related
health problems
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The Center is a resource providing current
reviews of the literature

• Determinants of energy imbalance
• Pediatric overweight interventions
• Prevention of type 2 diabetes in youth
• Environment and policy interventions to promote
  healthy lifestyles

AMERICAN DIETETIC ASSOCIATION
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Developing culturally relevant materials for
communities working to prevent pediatric
overweight
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Conducting community interventions
FitWIC 5 State Child Obesity Intervention Project
FitWIC Worksite Wellness
SOS High School Beverage Study
Randomized controlled intervention to reduce
the risk of Type 2 diabetes in overweight African
American children.
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Evaluating school-based policies

• Senate Bill 19, Nutrition Standards for schools
• Senate Bill 12 965, Food and Beverage Standards
• Senate Bill 281, California Fresh Start
• Team Nutrition

www.cnr.berkeley.edu/cwh
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Evaluating community-wide interventions

• Healthy Eating Active Communities (California
  Endowment)
• Healthy Eating Active Living (Kaiser Permanente)
• Menu Labeling in hospital cafeterias (Kaiser
  Permanente)

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Environmental settings surrounding Californias
families
Worksite

Schools
Communities
Families
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School physical activity interventions
Best Evidence

• Improved Physical Education (PE)
• Enhanced playgrounds

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School food nutrition interventions
Best Evidence

• Nutrition education activities with integrated
  curriculum
• Implementation of comprehensive food policy
• Food subsidies to encourage healthy food
  consumption e.g. fruits and vegetables

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School Case in Point Shape Up SomervilleSchool
Strategies

Non-randomized, controlled trial in 3 communities
in MA

• During School
• Staff training
• Classroom curriculum
• Enhanced recess equipment
• School foodservice
• School wellness policy

• Before School
• Foodservice
• Taste tests
• Walk to school campaign
• After School
• Staff training
• Curriculum
• Walk from school campaign
• Home
• Parent education
• Family events
• Childs health report card

(Source Economos, 2007) Also community
activities
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School Case in Point Shape Up SomervilleImpact

1 lb difference
(Source Economos, 2007)
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School Case in Point Fruit Vegetable Pricing

• Design convenience samples
• 2 high schools
• Middle-income, white - suburban
• Mixed income/ethnicity - urban
• Intervention
• 50 price reduction
• fresh fruit baby carrots
• Impact
• ? 4x fresh fruit sales
• ? 2x baby carrot sales
• gt in urban school
• ? sales once prices returned

Fruit Sales

Items/wk
(Source French, 1997, 2005)
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Case in Point California Fresh Start SB 281

• Design of evaluation
• -69 randomly selected schools
• -Fruits and vegetable quantity, variety, and
  cost evaluated during program implementation
• Intervention
• -.10 reimbursement for an additional servings
  of fruit and vegetable for students participating
  in school breakfast
• Impact
• -Quantity of f v offered doubled
• -Quantity of f v taken increased by 130
• -Variety of f v offered and taken increased
• -Schools with better food prep and serving
  facilities were more successful

(Source Woodward Lopez, et al 2008 Center for
Weight and Health)
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Worksite physical activity interventions
Best Evidence

• Multi-level interventions
• Point-of-decision prompts
• Walking clubs/active transport

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Stair appeal point of decision prompt
Youths designed art in the stairs at The Chambers
Hotel, Minneapolis, 2008
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Worksite Case in Point HIPOP-Occupational
Physical Activity Promotion

• Strategies
• Weekly mini-poster presentations website
• Pedometers and physical activity campaign
• Work area walking maps
• Walking path created at work
• Impact
• Significant increase in daily walking
• Significant improvement in HDL cholesterol

(Source Naito, 2008)
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Worksite Case in Point Parking cash-out

• Strategy
• Choice between parking subsidy and
• its cash value
• Study design
• Case study of 8 California firms complying with
  Parking cash-out program
• Impact
• Increase in active transport
• Decrease in solo car commuting

(Source Shoup, 1997)
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Worksite food nutrition interventions
Best Evidence

• Multi-level nutrition education and food
  environment changes
• Classes/workshops/videos
• Peer learning, self help materials
• Posters/newsletters
• Water promotion
• Improving healthy meal appeal
• Menu labeling/point of purchase prompts
• Lower pricing for healthy foods
• Healthy catering meeting policy

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Worksite Case in Point Treatwell-5-A-Day Study

• Design
• Randomized, controlled trial
• 22 worksites

• Strategies
• Education
• Environment
• Promotion
• Family Outreach (? interactive activities)

• Impact
• ? FV intake 0.5 servings/d
• ? intervention activities gt employee
  participation
• ? participation gt ? FV intake
• Significant increase for worksite family group
  only

(Sources Sorenson, 1998, 1999 Hunt, 2000)
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Community physical activity interventions
Best Evidence

• Comprehensive multi-level interventions with
  social marketing
• Point-of-decision prompts throughout community

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Community food nutrition interventions
Best Evidence

• Comprehensive social marketing campaigns such as
  Fruit Veggies More Matters
• Access to grocery stores and in-store promotion
  of healthy foods
• Price reductions promoting healthy foods

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Community Case in Point Supermarkets

• New supermarket in disadvantaged communities
  served
• Fruit vegetable intake increased
• 2.88 ? 2.92 servings/d
• Largest increase in consumers with lowest intake
  0.6 ? 1.4 servings/d

Source Wrigley, 2002
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Community Case in Point Price Reduction or
Subsidy

• WIC vouchers for fruits and vegetables intakes
  increased 1.4 svgs/1000 kcal
• Free farmers market fruit vegetable basket
  delivery to elderly intakes increased 1.0 svgs/d

Sources (Anderson, 2001 Herman, 2008)
(Johnson, 2004)
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A review of the evidence most promising policy
opportunities to promote healthy eating and
active living among CALIFORNIANS
Recommendations
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First, recommended policy opportunities in

• SCHOOLS
• Nutrition education integrated into curricula for
  K-12
• Designed by Ca Dept Ed, Nutr Services in
  collaboration with Ca Dept Public Health
• Continued efforts to promote healthier food
  environment in schools
• Extend menu labeling into schools

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Second, recommended policy opportunities in
WORKSITES Comprehensive wellness
intervention (California WIC worksite wellness
intervention 2008-2009)
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Third, recommended policy opportunities in
COMMUNITIES Coalitions with local governments,
food businesses, farmers, and the health sector
policies and programs for a supportive food and
activity community environment
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Fourth, recommended policy opportunities in
LEADERSHIP Public Health Nutrition/Physical
Activity leadership training
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A 4- pronged approach for increasing the synergy,
reach, dose, and likelihood of success for State
obesity interventions
LEADERSHIP
SCHOOLS
WORKSITES
COMMUNITIES
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Actionable Steps

• Convene a meeting of Public Health Nutrition
  leaders from Univ. Schools of Public Health and
  State agencies to discuss State workforce
  leadership needs in obesity prevention and
  develop a strategy for strengthening training

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Actionable Steps

• Author legislation that will mandate adapting
  Calif K-12 curriculum to include age-appropriate
  integrated nutrition education
• Convene a meeting of State departments in which
  DHS WIC will describe its worksite wellness plan
  with other State Departments. Discuss incentive
  systems to offer similar employee wellness plans.

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Actionable Steps

• 5. Conduct a hearing with business leaders and
  local government leaders to identify local
  multi-level interventions to include social
  marketing, development of community coalitions to
  promote walkable community programs and food
  retail access improvements

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Actionable Steps

• 5. Convene the County Superintendent of Education
  and all the Superintendents of the School
  Districts in the County to develop an agenda to
  improve and expand the school nutrition programs
  (school lunch, school breakfast, summer lunch).
  Calif Food Policy Advocates can provide state of
  the County school food report as the basis for
  recommendations. This could be a model for other
  counties to address local school nutrition
  issues. Additionally a meeting of child care
  providers could be convened to discuss nutrition
  quality in child care (see attached CFPA report).

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Acknowledgements UC Berkeley Center for Weight
and Health Lorrene Ritchie, PhD, RD Karen
Webb, PhD, MPH Gail Woodward-Lopez, MPH, RD
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For more information
Dr. Robert C. Veronica Atkins Center for Weight
and HealthUniversity of California, Berkeley
www.cnr.berkeley.edu/cwh
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