Category Archives: wellness

The hard life of kids

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Alec Fischer’s documentary about bullying in Minnesota’s schools is only 45 minutes long but it clearly packs an emotional punch, as a local audience saw for itself last week.

During a showing of the film at Ridgewater College, the room grew hushed while photos flashed across the screen of students who killed themselves after prolonged bullying by their peers.

One of the filmmaker’s messages: Kids are singled out by bullies for many different reasons, and it won’t stop unless more people, both kids and adults, speak up about it.

From the vantage point of adults, childhood and adolescence can seem like a golden time. But there’s mounting evidence that this no longer is the case for all too many kids (if indeed it ever was).

Take the Minnesota Student Survey. Conducted every three years for students in grades 6, 9 and 12, it tracks them as they progress through middle school and high school. It’s seen as a good barometer for risky behaviors such as alcohol and tobacco use and early sexual activity.

But look at what students are reporting about their state of mind. In 2010, the most recent year in which the survey was administered, 8 percent of sixth-grade boys and 9 percent of sixth-grade girls reported feeling almost more pressure than they could handle at some time within the past 30 days. Among 12th-graders, 11 percent of boys and 19 percent of girls said they felt this way. Many kids also reported distressing symptoms such as frequent headaches and stomachaches, sleep difficulties and feeling unhappy or sad.

To be sure, these weren’t the majority. Most kids in fact seemed to be doing OK, and the vast majority said they liked school and that they had parents and other adult relatives who cared greatly about them.

It’s disturbing, however, that so many young people are experiencing high levels of stress and anxiety. Bullying, which seems to have become much more pervasive than a generation ago, is only one of the problems that students encounter.

A recent Associated Press story, which explored what some high schools are doing to reduce kids’ anxiety, noted that adolescents have a lot on their shoulders these days. School officials pointed to hectic schedules, academic overload and pressure to achieve, and kids spoke of days packed with nonstop activity. Here’s a typical day for Abbie Kaplan, a student at Boston Latin School:

On a scale of 1 to 10, she places her stress level at a pretty steady 9. She regularly has four hours of homework a night, some done before swim practice. She eats dinner around 9:30 p.m., then finishes the rest of her homework and generally goes to bed at 11:30. Then she’s up at 6 a.m. so she can be at school by 7:45.

She calls her hectic schedule “the new normal.”

“You keep telling yourself that it will prepare you for the future,” Kaplan says. “It’s just sort of how it is.”

She, too, has had anxiety attacks related to her workload, she says.

And a rising tide of stress among the younger generation was highlighted in yet another recent survey, this one by the American Psychological Association, that found stress levels have increased for Americans of all ages but are being felt most keenly by young adults. The study also found that younger adults seem to have more difficulty managing their stress and that their stress has increased in the past year.

Some of this may simply be how the human psyche matures and ages. Other studies have found that the years past middle age, when people tend to have accumulated life experiences and learned to cope with them, are often the happiest.

But as many observers have pointed out, the stresses faced by kids today are different than their parents’ or grandparents’ generations. The world is a more complex place than it once was, the economy is more difficult and the future more uncertain – and it’s all being intensified by the pervasive presence of the social media.

When kids are stressed and not managing it well, does it put them on the path to becoming tomorrow’s stressed adults, with all the unhealthy and potentially destructive behaviors this entails? While adults can’t always make the world an easier place for kids, acknowledging that there’s far more pressure on kids than there used to be seems like the first step toward taking this issue seriously and helping them develop coping mechanisms that can carry them into a healthier adulthood.

Parents, overweight kids and a minefield of blame and judgment

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When Dara-Lynn Weiss wrote an article for Vogue magazine last year about putting her then 7-year-old daughter on a diet, she created a firestorm of controversy. “One of the most (bleeped) up, selfish women to ever grace the magazine’s pages” is how Jezebel summed it up.

Weiss described policing everything that went into her daughter’s mouth, depriving her of meals as a punishment for overeating, and humiliating her in public.

“I stopped letting her enjoy Pizza Fridays when she admitted to adding a corn salad as a side dish one week,” she wrote. “I dressed down a Starbucks barista when he professed ignorance of the nutrition content of the kids’ hot chocolate whose calories are listed as ’120-210′ on the menu board. Well, which is it? When he couldn’t provide an answer, I dramatically grabbed the drink out of my daughter’s hands, poured it into the garbage, and stormed out.”

Ultimately her daughter lost 16 pounds, and mother and daughter celebrated with a shopping spree for new clothes.

If all of this sounds over the top, brace yourself because Weiss recently published a full-length book, “The Heavy,” that chronicles in much more detail her efforts to help her daughter lose weight. And I’m beginning to think she doesn’t deserve the vitriol that’s been heaped upon her, because it’s often incredibly difficult for parents to know how to address a child’s weight in ways that are constructive rather than shaming, bullying and falling prey to America’s collective horror of excess pounds.

Full disclosure: I didn’t read Weiss’s article in Vogue last April and the magazine’s website doesn’t appear to have it available for nonsubscribers. So I’m relying on excerpts, secondhand accounts and published interviews with Weiss herself.

What comes across is a mother who’s trying to make her way through an emotional minefield of food, obesity, other people’s judgments and expectations, and her own desire to help her daughter without being either too permissive or too rigid.

She tells New York magazine that she accepts much of the criticism that erupted in the wake of her essay in Vogue: “I am strict. I was abrasive at times. I made a million mistakes.”

She talks about the awkward position parents find themselves in when they have a child who’s overweight: “Parents of obese children have this extra standard that’s very uncomfortable: If you tell a child he can’t have a piece of cake you’re embarrassing him by drawing attention to his problem; the same limit-setting would be considered fine for parents of normal-weight children.”

She points out how hard it can be to tackle a child’s weight issues: “It’s so awkward to talk to a child about food and weight, that’s why so many parents don’t do it.”

She’s candid about her own issues with food and body image and her fear of passing them on to her daughter.

Elsewhere, she discusses the “darned if you do, darned if you don’t” dilemma foisted on  the parents of children who are overweight. “You can’t get it right, you can’t be perfect – you’re going to make some people feel like you’re denying your kid her childhood, while others are standing there staring at every cupcake she eats,” she tells Motherlode, the New York Times parenting blog.

She expresses frustration with school lunches and children’s party menus that often undermine parents’ efforts to help a child adopt healthier eating habits. She describes how some of the common advice – “make better choices”, “stop when you’re full” – was too unstructured to be helpful.

And she challenges people to examine their assumptions about overweight children. Her daughter wasn’t lazy and didn’t eat unhealthy food, she said in a recent interview with USA Today: “She was a child with an enormous appetite… She has a brother a year younger, same parents, same food, who doesn’t want to eat sweets.”

Public opinion polls and research seem to back up Weiss’s observations about how we view children and weight.

A study published last year in PLOS One, for instance, found that obese children are more likely to be stigmatized than middle-aged and older adults who are obese – and that obesity among children is more likely to be blamed on external factors such as parenting style or environment.

There has been public debate about whether extremely obese children should be removed from the custody of their parents. And a couple of years ago a legislator in Illinois went so far as to suggest that parents of fat children should lose their state income tax deduction (although he later backed down, saying he was only kidding).

At the same time, a billboard campaign in Georgia that used pictures of real children and messages such as “It’s hard to be a little girl when you aren’t” was widely criticized for its fat-shaming approach and the lack of evidence that this strategy even works; the billboards ultimately were taken down.

And a poignant story that appeared last month in the New York Times revealed that children often feel bullied by adults about their weight, sometimes at the cost of developing eating disorders and obsession with body image.

As Weiss told the Motherlode blog, “People are so critical of childhood obesity, and then you try to do something about it – to help your child – and they’re critical of that, too. Parents can’t win.”

Whether you applaud Weiss’s story or deplore it, it seems to have launched a conversation about parents, children and weight. Perhaps it can lead in a more rational direction that reduces the judging and the bullying in favor of approaches that are actually helpful, both for kids and their parents.

How sweet it isn’t?

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First it was fats, then carbohydrates. Now sugar has joined the ranks of nutritional villainy.

With Christmas approaching on a tidal wave of candy canes and gingerbread, one can’t help wondering: Is it OK to indulge in a little sweetness, or is sugar entirely bad?

There’s no denying a certain amount of hysteria when it comes to sugar. Critics claim sugar causes everything from hyperactivity to premature aging. A common – and inaccurate – belief about cancer is that cancer cells feed on sugar.

Some of this is hyperbole but there’s also a considerable amount of science that has examined the effects, both good and bad, of sugar consumption. Sugar has been linked, for instance, to increased risk of weight gain, diabetes and heart disease. Earlier this year, some U.S. health experts went so far as to declare that sugar is as addictive and dangerous as alcohol or tobacco and should be regulated accordingly.

Unfortunately it’s not always clear whether sugar itself is the culprit or whether something more complex is going on.

At least part of the reason why higher sugar consumption is linked to weight gain may simply be the extra calories. One of the issues with sugar-sweetened sodas and other beverages isn’t just that they contain lots of sugar, it’s that they often end up replacing water or milk in someone’s diet. Processed foods high in sugar also can be higher in fat and sodium, which are associated with negative health effects of their own.

A certain amount of sugar is necessary in order for the human body to function, but moderation seems to be called for here. Consuming large quantities of sugar each day also tends to be a marker for an overall diet that may not be optimal for health.

This brings us to the real vexation: the proverbial sweet tooth. Why do so many people love sugar and why can it be so hard to consume less of it?

I admit to not totally understanding the whole sweet tooth thing. If you were to invite me to your holiday buffet, I would go directly to the spinach dip and the shrimp cocktail. Cookies and candy, not so much. But this wouldn’t necessarily be the case for other guests.

There’s debate about whether so-called sugar addiction is real or imagined. Some studies have found clinical similarities between food cravings and drug dependence. A study published this year in the Journal of Psychoactive Drugs found, for instance, that when people binge on sugar-dense foods, it increases the amount of extracellular dopamine in their brain which has the potential to lead to addiction.

The authors wrote, “There appear to be several biological and psychological similarities between food addiction and drug dependence, including craving and loss of control.” They also note that for some people, consuming these foods is comforting and therefore might be regarded as a form of self-medication.

So far, however, the sugar addiction theory has mostly been tested on rats and mice, with implications for human behavior that are unclear at best. A 2010 review in the Clinical Nutrition journal examined the evidence and concluded there’s nothing yet in the literature suggesting that humans can become addicted to sugar or that sugar addiction plays a role in obesity or eating disorders.

The bottom line is that when it comes to “sugar addiction,” the jury still seems to be out.

In the meantime, here’s some guidance. The U.S. Department of Agriculture’s 2010 dietary guidelines recommend limiting consumption of added sugars and solid fats to somewhere between 5 and 15 percent of total daily calories. The American Heart Association suggests no more than 100 calories a day of added sugar for most women and no more than 150 calories a day for most men. That’s about 6 teaspoons for women and 9 for men.

Here’s something else to keep in mind. For most Americans, the main source of the sugar they consume isn’t in that spoonful they dump into their coffee, or a homemade dessert or even a Christmas cookie. Most of our dietary sugar comes in the form of added sugar – sugars and sugar-based syrups that are added to food during processing. Although the tendency is to single out highly sugared products, such as sodas, as the problem, added sugar can show up in a variety that may not be readily recognized – chicken nuggets, for instance, or ketchup or children’s breakfast cereals, all of which are often surprisingly high in sugar.

So go ahead and have that reindeer-shaped holiday cookie if you want. If you’re worried about the sugar, just take one.

The exercise conundrum

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We all know physical activity is supposed to be good for us, yet approximately 40 percent of the American population reports not exercising at all. How come?

The New York Times reported a couple of days ago on some intriguing research that might shed a little light on this riddle: When people avoid exercise, maybe it’s because some forms of physical activity leave them feeling bad rather than good.

How this works seems to be complicated. In a series of studies, the researchers found that people had different reactions to the increasing intensity of exercise. Some felt better the harder they exercised; others felt worse. The majority of them felt bad when they surpassed their “ventilatory threshold,” or the point at which they were breathing too hard to talk – and this threshold was different for everyone.

In another study, volunteers were asked to exercise for 20 minutes at a level that felt unpleasant to them. In one session they were given a five-minute cool-down afterwards that restored their sense of well-being. In the other session, they were told to stop exercising without cooling down. When asked later which of the two workouts they preferred, most chose the one that left them feeling more pleasant.

In some ways this shouldn’t come as a surprise. People tend to pursue activities that make them feel good and avoid those that don’t.

The more intriguing part is that we seem to be learning that exercise, like weight management, may not be a one-size-fits-all matter of “just do it.”

While the vast majority of people derive health benefits from regular physical activity, there clearly are differences in how it’s perceived and experienced.

Some people seem wired to enjoy exercise more than others do, and research suggests there indeed may be individual variations in how the body responds physically and emotionally to exercise. Some runners, for instance, experience the fabled “runner’s high,” while others don’t. Then again, perhaps individual behavior is largely to blame for why so many people don’t engage in exercise.

Or is it more complicated than this? Reader responses to the New York Times article provide a wider perspective on what might be going on in people’s lives to make the recommended 30 minutes of daily physical activity so difficult for many of them.

One person lived in San Francisco for many years, didn’t own a car and walked everywhere. Then he moved to Florida, to a town where “a car is needed for even the smallest errand,” and watched his weight, cholesterol and blood pressure soar. Others described neighborhoods with no sidewalks, streets that are poorly lit at night, bike paths littered with glass, and gyms and fitness centers that are either unaffordable or only open during the day.

Some commenters wrote that for many non-exercisers, the problem is in getting started. What they need is help, patience and encouragement, one person wrote. “There is so much anxiety tied up in this issue for people who are out of shape, they don’t know where to start and the idea of exercise feels overwhelming and genuinely terrifying.”

And what about the tendency for issues such as arthritis, chronic insomnia, low-level depression or long, stressful work hours to undermine people’s willingness to be more physically active? One commenter, who had frequent severe migraines and also worked long hours, wondered, “How is one supposed to exercise?!?! and eat? and sleep? and be a person… of sorts?”

Several commenters also complained about the sniffy elitism that can pervade the conversation about exercise – for instance, value judgments about what constitutes “real exercise.” Don’t shame people for not being able to engage in a high-intensity workout, wrote one woman, who said she’s over the age of 60 and has painful arthritis. “Judging other people’s exercise habits doesn’t make them want to exercise more, it just makes them feel bad.”

Someone else pointed to the unrelenting hideousness of phys ed classes in junior high that were rigid and competitive rather than fun. “Maybe that is why I came to hate exercise and it still feels like punishment,” she wrote.

So what’s the answer? It seems to come down to making physical activity more rewarding and less of a struggle. How this is supposed to be accomplished might be different for everyone – and, as with the national effort to reduce the incidence of obesity, some of the solutions will likely have to take place in the environmental and policy sphere. Figuring out why some people genuinely enjoy exercise and find it pleasurable and why others don’t might be a good start, though, at understanding these differences and coming up with effective strategies to help.

Holiday food guilt? Not on the menu

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Writer Ragen Chastain can think of several things that would be more fun than being under holiday surveillance by what she calls “the Friends and Family Food Police”: a root canal, a fishhook in the eye… you get the picture.

Chastain, who blogs at “Dances With Fat,” tackled the subject last year of holiday eating and the well-meaning individuals who comment, nag or react in other ways to someone else’s food choices, particularly if that someone is overweight.

She clearly hit a nerve, because the comment section quickly filled with stories about people’s experiences at the holiday dinner table.

One woman was scolded by a cousin for eating high-carb carrots. Someone else was told “You don’t need that!” when she reached for the bread.

For others, the guilt tactics were more subtle – for instance, people asking them if they’d lost weight, or commenting, “I’m really being bad, I shouldn’t be eating this” while downing a sliver of pie.

Maybe it’s the food, maybe it’s the family dynamics, maybe it’s the emotional expectations we have for Thanksgiving and Christmas. Whatever the reason, there’s something about the holidays that can bring out the worst in people’s guilt and disordered attitudes about eating. When I Googled the words “holiday food and guilt,” there were 7.9 million results.

If you’re on the receiving end of the guilt tactics, how do you cope?

Chastain, who teaches workshops on self-esteem and the Health at Every Size approach and has written a book, “Fat! The Owner’s Manual,” advises deciding where the boundaries lie and what the consequences are for those who overstep them.

She writes, “I give people clear information, and several chances, but I don’t keep anybody in my life who consistently fails to treat me with the level of respect that I require.”

This might mean, for instance, simply saying “yes” or “no” if someone asks whether you really need that second helping of mashed potatoes – and then proceeding to eat it. Or it might mean giving a pointed response when someone gets too persistent: “I have absolutely no interest in discussing my food intake with you.”

Although much of the food guilt is aimed at obesity, it’s a minefield for other people as well. Thin people can be equally likely to have their weight commented on at the dinner table, or urged to eat more. And for those dealing with or recovering from eating disorders, holiday meals can be doubly difficult. Not only must they cope with food, and lots of it, but they may also be subjected to intense scrutiny over how much, or how little, they’re eating and whether they’re sticking to their prescribed meal plan.

This isn’t to say people shouldn’t try to eat sensibly for the holidays. The amped-up food choices can be difficult for those who have diabetes, need to limit their sodium or cholesterol intake, or simply want to watch calories.

Some tips from the Duke University Health System: Sample a little of everything but balance it with more fruits and vegetables. Stock up on healthy snacks for when temptation hits. Eat before a party to avoid overdoing it. Drink moderately. Don’t be afraid to say no if someone applies pressure to eat more.

The real question about food guilt is whether it actually works. According to a new study by the Rudd Center for Food Policy and Obesity at Yale University, the answer is no.

Researchers asked 1,000 study participants to evaluate several public health obesity campaigns by rating how positive or negative the campaign messages were and whether they were motivating or stigmatizing.

The best ratings went to campaigns that promoted specific health behaviors, such as eating more fruits and vegetables, and campaigns that encouraged people to become confident and empowered. Those that ranked the highest didn’t even mention the word “obesity.”

The least motivating? Messages that promoted shame, blame and stigmatizing.

Someone who truly cares about a friend’s or relative’s health should discuss it alone, at an appropriate time and in a way that invites dialogue, rather than shaming him or her at the dinner table, says Chastain. “Guilt is not good for your health. So I hope that if you choose to eat it, you also choose to enjoy it.”

The price of a good night’s sleep

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Getting a good night’s sleep apparently really matters to a lot of people. Just ask the  participants in a recent survey who said they’d be willing to forego a pay raise, extra vacation time or even a month of sex in exchange for sleeping well.

The phone survey, conducted in April with 1,000 U.S. adults, confirms what most Americans have known all along: Many don’t get enough zzz’s at night, and it’s affecting their ability to function during the day and their overall quality of life.

The survey was funded by Pfizer Consumer Healthcare, makers of Advil PM, so not surprisingly, pain ranked as the top reason respondents often found themselves tossing and turning at night.

What was a little more unexpected, at least to me, was the extent to which physical pain and stress were interfering with the survey participants’ ability to sleep well.

Nearly seven out of 10 said they lost valuable shut-eye because of aches and pains. About half said it was because of existing pain from problems such as back injuries. One-third cited stress-related aches and pains – headaches, shoulder aches, neck aches and so on. Another 19 percent were bothered by general aches and pains from a long day, household chores or putting in long hours at work.

Stress was a huge issue for many of the survey respondents as well. Nearly half said work-related stressors were causing them sleeplessness, and 60 percent said they were often sleepless because of family and relationship stress.

Participants could pick as many issues on the list that applied to them, so it’s likely that a number of respondents had multiple problems that kept them from getting a good night’s sleep.

Most of these folks were well aware of the fallout from inadequate sleep.  Eight out of 10 said it affected their performance at work and their romantic relationships; around three-fourths said it had a negative effect on their social life and parenting ability. The vast majority of the survey participants also felt that poor sleep made it more difficult for them to manage chronic or routine aches and pains.

What would they give up in exchange for a good night’s sleep? Just over half said it was important enough for them to be willing to make a trade. Giving up an extra day of vacation a year led the list of sacrifices, followed by small luxuries such as cable TV or a housekeeper or nanny. But get this: 34 percent said they would give up sex for a month in exchange for better sleep, and 32 percent said they’d skip a raise or bonus at work.

Some other nuggets from the survey:

- Half of the respondents said a sleepless night caused them to perform poorly at work, and nearly three-fourths said it caused them to fall behind on household chores.

- Nearly nine out of 10 said that when they had a bad night, they woke up dreading a rough day ahead and didn’t want to get out of bed.

- On average, survey respondents reported six to seven hours of sleep per night.

How much sleep is enough? Experts say the answer varies, depending on age and on the individual. Babies generally need 14 to 16 hours a day. For school-aged children, it’s 10 to 11 hours.

Seven to nine hours are recommended for most adults, but it’s clear from the Advil survey, as well as others conducted over the years, that a lot of people consistently get less than this. The impact extends well beyond a difficult day at work or skipping the laundry in exchange for crashing on the couch. Studies have linked inadequate sleep with everything from depression to obesity to shorter lifespan.

One study, published earlier this year, found that lack of sleep, coupled with disruption of the body’s circadian rhythms, can make people more susceptible to impaired regulation of their blood glucose and metabolism and increase their risk of type 2 diabetes.

In another interesting study, presented last month at the American Heart Association’s 2012 scientific sessions on high blood pressure, Italian researchers followed the sleep patterns of 234 adults with hypertension. The majority of the study participants slept six or few hours a night, and those who reported poor sleep quality were twice as likely to have resistant hypertension as those who slept well.

The cause-and-effect relationship between health issues and inadequate sleep isn’t entirely clear. Do people develop insomnia because they’re depressed, or do they become depressed because they aren’t sleeping enough? Do high blood pressure and lack of sleep influence each other in some way, or are they elements in a bigger, more complicated picture?

Researchers still have a lot to unravel about sleep, how it works, what disrupts it and how it interacts with overall health. In the meantime, getting a better night’s sleep ought to be a serious goal for more folks – without having to sacrifice a pay raise or cable TV.

Mutiny in the lunchroom

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In “We Are Hungry,” one of the latest You Tube videos to gain widespread attention, high school students are turned away empty-handed from second helpings in the cafeteria, collapse during volleyball practice and daydream in class about their mother’s mac ‘n’ cheese.

There’s a mutiny brewing against the increasing regulations and restrictions governing what’s served to kids in the school lunchroom. The target of much of this groundswell of ire? The Healthy, Hunger-Free Kids Act of 2010, which limits school lunches to 850 calories, reduces carbohydrates and emphasizes loading up on fruits and vegetables. The standards took effect in August – and for many kids and their parents, it has been a rude awakening.

The protest video was made by students at Wallace County High School in Sharon Spring, Kan., who’ve had it with restrictive school lunches, which they say leaves them hungry and struggling to function in school.

Here’s how the Healthy Hunger-Free Kids Act has changed school meals: Before, lunch for an elementary student might have consisted of a slice of cheese pizza, half a cup of Tater Tots with ketchup, one-fourth of a cup of canned pineapple and eight ounces of low-fat milk. The same lunch, revamped: a slice of whole-wheat cheese pizza, half a cup of baked sweet potato fries, half a cup of applesauce, a quarter-cup of raw cherry tomatoes and low-fat milk. (Click here for other examples.)

“The size has gone down and I leave lunch hungrier than before I tried to eat anything,” one student lamented online at YouTube.com. “The food they offer at our school is NOT ENOUGH!” another student declared.

A school cafeteria manager weighed in at an online forum with her frustration over the new guidelines. Schools are being asked to introduce foods such as tofu, hummus and more beans, and the kids won’t eat them, she wrote. “They have all gone into the trash.”

Even some teachers are speaking up. Linda O’Connor, a high school English teacher in Sharon Spring who wrote the lyrics for “We Are Hungry,” told U.S. News and World Report, “I have been a teacher for 20 years, and this is the worst that it’s ever been. Our kids eat at 12:06 p.m., and they are hungry by 1:30 p.m.”

What’s a healthy number of daily calories for a child or teen? According to USDA dietary guidelines, a moderately active girl between the ages of 9 and 13 should consume 1,600 to 2,000 calories a day. An active teenage boy, on the other hand, needs 2,800 to 3,200 calories a day.

If you do the math, an 850-calorie school lunch would fulfill 25 to 50 percent of these needs, depending on the student.

You could argue there’s nothing wrong with serving more fruits and vegetables in the school cafeteria and downsizing portions into something less super-sized. Over time, kids and their parents will get used to it. After all, the Kansas students in the “We Are Hungry” video aren’t literally starving – and what about those stashes of chips and other snacks in their lockers?

The other side of this argument is that kids are a captive audience and one size shouldn’t fit all. Should students be expected (some would say forced) to eat school lunches they might truly dislike or not be able to tolerate? I’ve heard anecdotally about kids suffering through intestinal turmoil because their digestion is unaccustomed to the whole-wheat fare served at school.

Attempts to put more healthful, exotic food on the menu can flop when kids won’t eat it, as the Los Angeles school system discovered last year when it introduced entrees such as vegetarian curry and quinoa salad. Many students refused to eat it; instead, they loaded up their backpacks with snacks and soda. Meanwhile, uneaten food ended up in the trash. And what about kids for whom school lunch might be the most substantial meal they eat all day?

Finally, the evidence is mixed on whether healthier school lunches actually make a difference in what kids eat. In one of the largest studies to date, the impact was moderate at best. Other studies have found that simply redesigning the lunch menu isn’t enough, and that efforts need to be accompanied by other components such as nutrition, family education, activities that engage children’s interest in the food being served, and even the return of recess and gym class.

How about it, readers? Do you think the new school lunch guidelines have gone too far?

School lunch and the vegetable strategy

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Offer fruit and vegetables on the school lunch menu and kids will be inspired to try them, like them and maybe even start eating them on a regular basis – or so the theory goes.

But a new study has found this isn’t necessarily the case. Although bringing raspberries, asparagus, sweet potatoes and the like into the school cafeteria did seem to have an impact, the effect wasn’t particularly strong, researchers learned after scrutinizing the food choices of more than 26,000 children.

The study appears in the latest issue of the Journal of Clinical Nutrition. It’s one of the first times researchers have attempted to quantify whether school-based programs actually make a difference in how many fruits and vegetables children consume each day.

A bit of background about the study: It analyzed nearly two dozen previous studies involving a total of 26,400 children ages 5 to 12 in several countries, including the U.S., Britain and Australia. The researchers looked at two different kinds of food programs: those in which kids received free or subsidized produce, and those that included elements such as family and nutrition education and communicating with parents. They then compared them with school lunch programs that didn’t do anything specific to encourage more fruit and vegetable consumption.

The results were interesting or dismal, depending on your point of view.

On average, children in school-based food programs ate about one-fourth of a portion more of produce. The effect was especially low for vegetables – only a tenth of a portion more, or the equivalent of half a spear of asparagus.

Notably, this wasn’t confined to school lunch programs in the U.S.; the researchers found similar results in Europe and Australia.

Counting juice as a fruit raised the average consumption a little higher but not by much.

It’s hard to gauge whether such small increases have an overall benefit on children’s nutrition. Perhaps it did help in some subtle, long-term way. Tracking whether these same kids also ate slightly more fruits and vegetables at home and whether they continued these habits into adulthood was outside the scope of the studies selected for the analysis, but even slight changes could have added up over time.

The researchers dug up some especially interesting conclusions regarding the strategies used by schools to encourage more fruit and vegetable consumption.

It seemed to make a difference when schools included more education about nutrition and when they communicated more with families about nutrition. School garden programs also seemed to help.

There’s been a fair amount of study on what schools can do to get children to eat more fruits and vegetables. Should they restrict access to chips, soda and other less desirable foods in the hope that the slack will be picked up with fruits and vegetables? If kids are given more fruit and vegetable options, will they be more likely to try at least one of them? Does it work to offer rewards when kids choose fruits and vegetables in the school lunch line? What about marketing fruits and vegetables to make them cool and fun?

The evidence suggests that most of these strategies may help in some way, albeit moderately. But school lunch programs are only one component in a food environment that also extends to how children eat at home and what they see and experience in the community around them.

On the basis of the Journal of Clinical Nutrition study, it would be easy to conclude that school-based interventions are, at best, only mildly successful and perhaps not worth the effort. There’s another way of looking at it, though: In order to positively influence children’s eating behavior, there may not be the blockbuster solution that many are looking for. It more than likely will take multiple strategies on many fronts – each of them small but adding up to a whole that’s greater than the sum of the parts.

Downsizing the mega-soda

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If there was any doubt that New York City was serious about downsizing the giant sugary drinks sold at restaurants and concession stands, it was erased Thursday with the enactment of a new rule by the city’s Board of Health.

The rule places a 16-ounce limit on the size of non-diet sodas, sweetened teas and other sugar-laden drinks sold at restaurants, theaters, workplace cafeterias and other venues that offer prepared food.

Many public health experts have wrung their hands over the amount of sugared beverages consumed by the average American. Few entities, though, have gone so far as to impose an outright ban on super-sized drinks.

Those who support the measure see it as an important – and pioneering – step for public health. Here’s the take by the Associated Press:

They say the proposal strikes at a leading cause of obesity simply by giving people a built-in reason to stop at 16 ounces: 200 calories, if it’s a regular Coke, compared to 240 in a 20-ounce size. For someone who drinks a soda a day, the difference amounts to 14,600 calories a year, or the equivalent of 70 Hershey bars, enough to add about four pounds of fat to a person’s body.

Beyond the numbers, some doctors and nutrition experts say the proposal starts a conversation that could change attitudes toward overeating. While there are many factors in obesity, “ultimately it does come down to culture, and it comes down to taking some first steps,” said Dr. Jeffrey Mechanick, a Mount Sinai School of Medicine professor who has studied the effect of government regulation on the obesity epidemic.

The ban goes into effect March 13, assuming it isn’t struck down before then.

Supporters of the measure have a point. Soft drinks are large and getting larger. Consider the 7-Eleven Big Gulp series: The Double Gulp contains 50 (!) ounces – more than the capacity of the average human stomach. We have become culturally accustomed to supersized portions of everything from soft drinks to french fries to bagels, with the result that it’s increasingly difficult to gauge what a normal-sized serving should be.

But here’s the big question: Will New York’s ban on the largest sugary drinks actually make a difference in people’s health? The answer is not at all clear.

For one thing, the rule contains a multitude of exceptions. It doesn’t apply to beverages sold in retail grocery stores, vending machines or most convenience stores, allowing people to continue to buy their favorite large sizes without restriction.

It exempts beverages that are 100 percent fruit or vegetable juices, even though these can be, ounce for ounce, almost as full of sugar as a soft drink. (For a comparison, check out this chart compiled by the federal government; a 12-ounce serving of grape juice contains 12 teaspoons of sugar – more than a same-sized serving of either cola or root beer.)

Nor is there anything in the rules that prohibits consumers from short-circuiting the intent by simply buying more smaller drinks to equal a large one. And New Yorkers can continue to drink as much soda in the privacy of their homes as they please (at least for now).

Although this is, strictly speaking, a New York City story, it matters to the rest of us as well. Indeed, the Board of Health’s action has captured wide interest across the United States. Seattle lies the width of the continent from Manhattan, but when the Seattle Times offered an online poll on what readers thought of a similar ban in their own city, folks were quick to weigh in.

There’s considerable – and valid – debate over whether regulation and government enforcement are an appropriate strategy for influencing health-related behavior.

Ethically speaking, it’s a murky area. Should government be making people’s food choices for them? Do consumers have the right to make their own decisions about what they buy and drink, or is this outweighed by the public health impact? If the target today is sugared drinks, what’s going to be next?

In the months before the New York City Board of Health voted on the mega-soda ban, a handful of studies attempted to quantify what the health results might be. In one study that involved analyzing the receipts of 1,600 fast-food customers on the East Coast, researchers concluded that if everyone who had been buying a large-sized drink cut back to a single 16-ounce beverage, they would consume 63 fewer calories per meal. But at least 40 percent of consumers had to take this step, otherwise the impact would be negligible, concluded the study.

Finally, banning giant-sized drinks at some commercial venues does little to address other areas of health-related behavior that may be just as important – physical activity, stress, alcohol use and timely access to appropriate medical care, to name just a few.

It’s going to be interesting to watch how the soda ban plays out. Perhaps this is what it takes to begin changing a community environment into one that fosters better health – the proverbial snowball that gathers speed and mass as it rolls downhill. On the other hand, this is still an experiment with unknown results. It’s to be hoped that the New York City Board of Health will watch this closely and collect some real evidence to help decide whether it was worthwhile or not.

The snack habit

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I’ve noticed it for some time, in a vaguely-paying-attention sort of way. But it wasn’t until seeing a news article in the Star Tribune of Minneapolis this weekend that it really hit home: For better or worse, snacking has become a mainstream American way of eating.

From the article:

Two studies from 2010 by University of North Carolina researchers looked at snacking trends between 1977 and 2006 and found that children now eat three snacks a day and adults snack twice a day. That is one additional snack for each group compared with 30 years ago.

Three square meals don’t exist anymore, said Larry Finkel, director of food and beverage research at Packaged Facts, a publishing company that focuses on consumer product research. “Meals and snacks have become all blurred together.” The authors of the report concluded that “our children are moving toward constantly eating.”

What is up with all the nibbling between meals? More to the point, how did we get this way?

Finkel attributes it to the American on-the-run lifestyle which has led to the decline of structured mealtimes. Instead of sitting down to dinner together, dinner has become what you eat in the car on the way to work or soccer practice, he said.

Once you start noticing, the signs are everywhere that snacking is an eating behavior that’s widely accepted and even expected. Manufacturers have developed hundreds of “snack-sized” products meant to be eaten at your desk or on the run. Restaurants are open late into the night or, increasingly, 24 hours a day. Few kids’ events are complete anymore without a snack of some kind. Even diet plans now include recommendations for morning and afternoon snacks, on the assumption that this is part of people’s daily routine.

In an indication of how entrenched the snack habit has become, a study that appeared in Health Affairs in 2010 found that nearly one-third of the daily calories consumed by American children now come from snacks.

It all raises the question: Is this a trend we should be welcoming?

There in fact seems to be no universally agreed-upon definition of what constitutes a snack. Are snacks a replacement for a full meal or are they something that’s consumed in addition to a meal? How many calories can a snack contain before it stops being a snack and becomes a meal?

There’s some limited evidence that “grazing,” or consuming half a dozen small meals a day, may be more effective for losing weight, curbing hunger and controlling blood sugar levels than the traditional three squares a day. But the research findings so far have been somewhat contradictory. At least two studies have found that for those who want to lose weight, what ultimately matters is how many calories they consume, not how often they eat. According to other studies, however, grazing can be beneficial, especially in helping people feel more sated throughout the day and less likely to overeat.

Grazing might also benefit some groups more than others. Athletes and active children often need snacks to replenish the calories they burn. Some studies involving older adults, an age group at risk of malnutrition, have found that large meals can be unappetizing for them and that they fare better on smaller meals throughout the day.

What it seems to come down to is the quality and amount of snacking that takes place. There’s a difference, after all, between snacking on carrot sticks vs. a bag of chips. And there’s a difference between snacks that are part of an overall healthy eating plan vs. snacks that add to one’s daily calorie load. Munching on something a few extra times a day might not seem like much but the calories can add up in ways that might astonish many people.

Left unanswered in all of this are the social implications of replacing structured mealtimes with grazing and snacks eaten on the run. Are we losing something when we don’t sit down at the table together, or doesn’t this really matter? What happens when the whole world becomes our dining room?

I’m not sure we’ve pondered these questions, and in any case it’s too late. This particular train has already left the station. The challenge, it seems, is how to manage this cultural shift in eating in ways that are healthful rather than toxic.