Two panel presentations aimed to identify and to engender dialogue among seemingly disparate organizations that may have common ground related to addressing the calorie imbalance issue that is at the heart of the obesity epidemic. Speakers for the two panels were chosen based on their representation of movements and/or organizations that the planning committee believed to have potential common ground with organizations interested in obesity prevention. Tom Robinson, moderator of the two panels, informed the audience that it was not necessary for all stakeholders to adopt or believe in every objective of each organization represented on the panels, but he encouraged participants to keep an open mind as potential common ground was explored.
In the first of the two panel presentations, summarized in this chapter, six speakers discussed how a wide variety of programs focused on food and agriculture issues could help prevent childhood obesity (the second panel presentation, on physical activity and the built environment, is summarized in Chapter 4). In some cases, such as gardening or farm-to-school programs, the connection is fairly direct. For other programs, such as those focused on climate change or animal welfare, the connection is less direct but can still be powerful.
The Environmental Working Group (EWG) does not work on any projects focused directly on obesity. Nonetheless, most of its projects have a strong link to obesity, according to EWG senior scientist Olga Naidenko,
because she believes they are designed to motivate people to take steps that will incidentally help support weight management. Naidenko described a number of EWG projects and how they may have common ground with obesity prevention.
For more than a decade, EWG has investigated the types of agriculture and food products that farm subsidies support. Most of these subsidies go not to small family farms but to large agribusinesses, said Naidenko. Furthermore, according to an analysis done by the Physicians Committee for Responsible Medicine (PCRM), most of this government aid supports meat and dairy production, with less than 1 percent going to the production of fruits and vegetables (PCRM, 2011). “If you want those fruits and vegetables to be on plates and to be affordable, we might need to change our subsidy patterns,” said Naidenko. This is a finding that also interests fiscal conservatives, she added, who think the government should not be supporting large agribusinesses when average Americans are struggling to pay their bills.
EWG has undertaken many projects in environmental health, including projects related to the use of synthetic chemicals in food. Establishing a health link between trace amounts of pesticides or food packaging chemicals and adverse health effects is much more difficult than establishing a link between the fat content of food and obesity, Naidenko acknowledged. But some groups of people care deeply about food chemicals and are natural allies in efforts to improve the nutritional value of food.
Climate change also has a relationship to obesity because the production of some protein sources produces more carbon dioxide and other greenhouse gases than the production of others (Hamerschlag, 2011). Combining the issues of food, health, and climate has resonated strongly with a number of audiences, Naidenko observed.
Currently, EWG’s major concern is the upcoming renewal of the Farm Bill,1 which authorizes the U.S. Department of Agriculture’s (USDA’s) Supplemental Nutrition Assistance Program (SNAP)2 (formerly known as the Food Stamp Program), agricultural subsidies, protection of water quality from agricultural runoff, and many other major programs. EWG is recruiting not only people interested in food but also fiscal conservatives to engage in Farm Bill politics. The goal, said Naidenko, is to turn the Farm Bill into the Food Bill. Naidenko believes that this and other channels she mentioned represent an opportunity for the environmental movement to work toward a social attitude and policies that accord well with obesity prevention.
America is a nation of animal lovers, observed Michael Greger, director of public health and animal agriculture at the Humane Society of the United States.3 Seventy million people are active wildlife watchers, and Americans own 160 million dogs and cats. This bond between animals and people can be a powerful force for fighting obesity in the United States, Greger said.
An obvious example is dog walking. Cross-sectional data suggest that dog walking is associated with meeting physical activity guidelines (Hoerster et al., 2011). People feel a sense of obligation toward their dogs’ physical and mental well-being, said Greger, which provides them with a sense of purpose and motivation. Alluding to the concept of “stealth interventions” (see Chapter 1), Greger noted, “This altruistic urge provides a kind of stealth motivation to effect behavioral change.” Yet, one-third of dog owners do not walk their dogs, so this can be a target for promoting physical activity for tens of millions of people. In this way, Greger explained, a better energy balance can be an unintended yet beneficial side effect of advocacy for animal well-being.
The Meatless Monday campaign,4 a public health initiative aimed at reducing the risk of chronic disease, including obesity, offers another example of how a bond with animals can be linked to obesity prevention. The latest ad for the campaign does not show someone lying on a gurney with crushing chest pain. Rather, it shows mistreated farm animals. The gaze of a crated sow biting the bars of her cage bloody after months of confinement “may provide transcendent, emotionally charged motivation” that may have long-lasting impact, said Greger.
In general, media attention to animal welfare has significant negative effects on U.S. meat demand (Tonsor and Olynk, 2011), Greger observed. For example, when the media covered the use of food from animals that were too sick or injured to walk, the consumption of meat fell, and regulations were passed to force farmers to take better care of their animals. Furthermore, the consumption of all meat fell, not just the meat highlighted in the story (Tonsor and Olynk, 2011; Wald, 2008). “Just as human health concerns ended up furthering animal welfare goals, animal welfare concerns can end up furthering human health by decreasing meat consumption,” said Greger.
Exposure to images of the plight of farm animals also may affect the eating habits of youth, Greger continued. For example, the National Pork
Board5 reported that one-third of 9- to 14-year-olds surveyed who reported watching YouTube6 videos on animal care indicated that the videos affected their meat-eating habits (Pork Checkoff, 2010). Also, a recent research review suggests that the morality of the treatment of animals is a greater motivation than health reasons for people who decide to become vegetarians (Ruby, 2011). “One way to a person’s stomach may be through their heart,” remarked Greger.
Although the Humane Society of the United States is not a vegetarian organization, its efforts to ban the most egregious factory farming practices could lead to higher consumer prices and decrease meat consumption in the same way that tobacco tax hikes have curbed smoking. “Anything that increases production costs for these industries” may have beneficial side effects for obesity prevention, Greger stated. For example, when the Humane Society works with unions to slow line speeds at slaughter plants to prevent worker injuries, or with environmental groups to effect better manure management, or with public health groups to stop the feeding of millions of pounds of antibiotics to farm animals, it is involved in cross-movement alliances that can improve both animal and human welfare.
The Community Food Security Coalition (CFSC)7 is a national nonprofit coalition of more than 500 organizations working from the local to the international level to build community food security. Its member organizations focus on issues ranging from hunger, to public health, to sustainable agriculture, to community economic development. “Our work is about building alliances and finding common ground,” said the coalition’s policy director, Kathy Mulvey.
Mulvey highlighted several programs that have goals converging with obesity prevention. In the area of anti-hunger and anti-poverty campaigns, people and organizations in Detroit are reclaiming 100,000 vacant lots for food production. For example, the Detroit Black Community Food Security Network8 established a 4-acre organic farm in Rouge Park. As part of this initiative, it led efforts with the Detroit City Council to approve a food policy council and a food security policy, which affirmed the city’s commitment to nurturing the development of a community in which all members have easy access to adequate amounts of affordable, nutritious,
culturally appropriate food. The network also organized the Ujamaa Food Cooperative Buying Club9 and provided leadership for combating racism in the food system. “That is one community organization that is oriented primarily toward hunger and poverty and is also helping to increase access to healthy food for people around the city,” said Mulvey.
At the national level, other organizations are working to increase food stamp redemption under SNAP at farmers’ markets. Fewer than one in five farmers’ markets accepted SNAP benefits in 2010, and SNAP transactions at farmers’ markets plummeted after the transition to electronic benefits. “This is a really important area to help increase the access of low-income people to healthy, local produce in their communities,” Mulvey observed.
In the area of job creation and economic development, 334 community food projects created more than 2,500 jobs nationwide from 2005 to 2010 and created or strengthened more than 3,800 micro-enterprises (CFSC, 2010). In 2010 alone, community food projects created 91 farmers’ markets, generating $1.7 million in sales. And according to a study by the Union of Concerned Scientists (2011), approximately 13,500 jobs could be created over a 5-year period with yearly public funding of 100 to 500 otherwise unsuccessful farmers’ markets. “Rebuilding local and regional food systems and infrastructure, and reversing the consolidation of the food system from production through distribution to retail, is good for people’s health as well as for the economy in urban and rural areas,” Mulvey said.
Opportunities for small and midsized farmers are created by farm-to-school programs and other institutional purchasing that can greatly increase demand for local produce. In Portland, Maine, for example, the Communities Putting Prevention to Work10 initiative has given every student in the Portland public schools access to a fruit and vegetable bar or a more traditional salad bar as part of the lunch program. According to Mulvey, such initiatives not only increase fruit and vegetable consumption but also create a demand for locally grown food, which supports small and disadvantaged farmers. Indeed, farmers who participate in a community food project report diversifying their farm products, increasing their number of customers, and increasing the size of their local markets.
Finally, improving democratic decision making about food and preserving cultural diversity can converge with obesity prevention goals. CFSC is encouraging its members to provide input on priorities for the upcoming Farm Bill and is seeing an unprecedented level of involvement, said Mulvey.
9A cooperative is a business organization owned and operated by a group of individuals for their mutual benefit. Food cooperatives enable members to save money by purchasing in bulk and eliminating the overhead associated with most retail stores.
10For more information on the Communities Putting Prevention to Work Initiative, see http://www.cdc.gov/communitiesputtingpreventiontowork/.
Food policy councils are booming at the local level, numbering more than 100 nationwide (CFSC, 2011). Provisions of the Farm Bill could have a tremendous impact on the capacity of low-income people to access healthy foods, for better or worse, said Mulvey. She emphasized that “there are some real opportunities to mobilize new alliances and look at ways that people can leverage their input into policy change.”
Mulvey issued cautions for organizations considering whether to enter into an alliance. If alliances are to be sustainable, the groups involved must have convergent long-term goals. Also important is to institute safeguards against conflicts of interest, Mulvey noted.
The Campaign for a Commercial-Free Childhood (CCFC)11 seeks to support parents’ efforts to raise healthy families by limiting commercial access to children and ending the practice of child-targeted marketing. Based in Boston, CCFC started in 2000 with nine people and now has more than 43,000 members. Its theory of action is based on four general strategies: change public attitudes, change children’s environments, change how children spend their time, and change rules. Most important, said Susan Linn, director and co-founder of CCFC, the organization’s work builds on evidence-based advocacy and an ongoing presence in the media.
For an organization with a name like Campaign for a Commercial-Free Childhood, the active involvement of the media appears unlikely, Linn acknowledged. In reality, she said, CCFC has a good relationship with the press. “They take our actions seriously and write about them,” said Linn. “We have a tiny staff and no marketing budget, so we rely on the press to promote and publicize the things that we do as a way of raising awareness and building the public will to foment change.”
CCFC takes an activist approach. It looks to the civil rights movement, the women’s movement, the gay rights movement, and the environmental movement for inspiration on how to proceed. One strategy the organization pursues is changing public attitudes so that marketing to children is seen as socially irresponsible and unprofitable for corporations. Another strategy involves changing the daily environments children experience. As an example, Linn shared her perspective on a recent initiative in which CCFC partnered with educational and environmental organizations to convince Scholastic,12 through a letter-writing campaign, to stop offering teaching materials underwritten by the coal industry. CCFC believed these materials failed to address the environmental concerns surrounding coal. The
letter-writing campaign caught media attention. Subsequently, Linn said, Scholastic stopped offering this curriculum and announced that it would examine its other corporate-sponsored teaching materials.
CCFC works through every possible legal means to halt the commercial exploitation of children. With parents and educators, for example, it seeks to stop state legislation that would allow more marketing in schools. CCFC also has engaged in a number of food-related campaigns. In 2007, for example, the U.S. Department of Health and Human Services (HHS) announced that Shrek was going to be the “poster ogre” for health. CCFC pointed out that the Shrek III movie was about to come out and that its producers had partnered with more than 70 junk food companies to promote the movie and sell the companies’ food. The organization wrote a public letter to HHS asking it to fire Shrek; the letter received voluminous press coverage. “Being able to point out that kind of hypocrisy is very helpful for people to understand that there is a problem and that we need to do something about it,” Linn explained.
Much marketing occurs under the radar, according to Linn, and CCFC tries to help people understand the techniques being used and realize what is happening. In 2006, CCFC partnered with the Center for Science in the Public Interest13 to launch a lawsuit against the Kellogg Company14 for marketing junk food to children under the age of 8. In that case, Kellogg’s had a campaign to market Froot Loops in preschools by mailing packages of the cereal to be used for art projects. “We got Kellogg’s to stop that program, and also to say they wouldn’t be marketing in preschools.”
CCFC also launched a national campaign when children in Florida began bringing their report cards home in envelopes that advertised McDonald’s fast food. The story received international press attention before McDonald’s agreed to stop the program.
Finally, CCFC works against the marketing of videos for babies as educational. It convinced Disney15 to provide refunds on Baby Einstein videos after the company marketed the videos as educational without any evidence for the claim (Lewin, 2009). With the support of a grant from the David Rockefeller Fund, CCFC is also conducting interviews with new mothers to discover what messages will convince them not to put their babies in front of screens and to limit screen time for older children. And it created and promotes the annual Screen-Free Week16 in schools. Linn concluded
16For more information on Screen-Free Week, see http://www.commercialfreechildhood.org/screenfreeweek/.
by suggesting that limiting screen time is an ideal focus for collaboration because it is an area of general consensus.
Gardening has many positive effects on children, adults, and the community (Box 3-1), but its most enduring effects may be the least tangible. “Go back to a time when you found yourself in a garden. What does that bring to mind?” asked Mike Metallo, president and chief executive officer of the National Gardening Association (NGA). “For me, it hits a reset button. It helps me put everything in perspective. I have a sense of place. I understand myself in relation to the world.”
Many children today, especially in the inner cities, lack opportunities to experience a garden. They live in an environment of concrete, asphalt, and maybe a few scraggly trees and other plants. “They are not experiencing the benefits of having a connection with nature,” said Metallo.
Urban gardens can be any collection of plants with which children or adults are engaged. It can be herbs in pots on a fire escape. It can be plants in a raised bed indoors or outdoors. “There are all types of gardens, and each garden has its place and its purpose and its uses,” said Metallo.
NGA, a leading authority and resource for gardeners of all ages, has a grant program through which it works with corporate donors to install gardens in schools. The observed effects of these gardens are increased fruit and vegetable consumption, increased physical activity, and decreased sedentary behavior. Children also learn more about the sources of the foods they eat. “People don’t understand where their food is coming from because they don’t live in an environment where [unprocessed] food is easily accessible,” Metallo said. “It comes to them packaged, it comes to them in cans, it comes to them sorted out. But they have no idea what happened to get it there. And that is a serious issue.”
Besides its demonstrated potential to increase fruit and vegetable consumption and boost physical activity (see Box 3-1), gardening changes the relationships among children, parents, and the community. In this way, gardening contributes to a variety of social, cultural, and educational goals. For example, NGA has developed a curriculum that uses gardening to teach the academic content specified in education standards so teachers can achieve the same outcomes as they would using their usual curriculum.
Data compiled from educator observations of NGA’s garden grant program point to a variety of benefits, including better attitudes toward school, greater self-confidence, and improved social skills. Two of the attitude changes cited most frequently are in attitudes toward nutrition and the environment. “The children didn’t mean to learn about nutrition this way, but they did, just by engaging in the experience,” Metallo said. He ended by
Research Supporting Positive Effects of Garden-Based
Education and Gardening
• Increased fruit and vegetable consumption (Lautenschlager and Smith, 2007; McAleese and Rankin, 2007)
• Increased moderate to intense physical activity (Domenghini, 2011)
• Increased knowledge about food systems (Lautenschlager and Smith, 2007)
• Increased nutrition knowledge (Morris and Zidenberg-Cherr, 2002; Parmer et al., 2009)
• Increased preference for and better attitude toward vegetables (Lineberger and Zajicek, 2000; Morris and Zidenberg-Cherr, 2002)
• Increased willingness to try vegetables (Morris et al., 2001)
• Improved science achievement (Klemmer et al., 2005; Smith and Motsenbocker, 2005)
• Increased life skills—working with groups and self-understanding (Robinson and Zajicek, 2005)
• Increased self-efficacy for gardening (Domenghini, 2011; Poston et al., 2005)
• Increase in asking for fruits and vegetables to be made available at home (Heim et al., 2011)
• More positive environmental attitudes (Waliczek and Zajicek, 1999)
• Skill development and increased empowerment (Bhatia et al., 2001)
• Increased home availability and accessibility of fruits and vegetables (Heim et al., 2011)
• Increase in perceived parental value of fruit and vegetable consumption (Heim et al., 2011)
• Increased parental involvement as children share their gardening experiences with parents (Alexander et al., 1995)
• Higher job satisfaction when green space is visible from one’s office desk (Kaplan, 1993)
• Moderate form of physical activity for older adults (Park et al., 2008)
• Improved food security (Corrigan, 2011)
• Increased social networking (Sullivan et al., 2004)
• Fewer crimes and instances of graffiti (Kuo and Sullivan, 2001)
• Increased fruit and vegetable consumption (Alaimo et al., 2008)
• Increased property values (EPA, 2011)
• Improvement in psychological well-being (Barnicle and Midden, 2003)
• Better understanding of food systems (Corrigan, 2011)
mentioning NGA’s initiative “A Garden in Every School,”17 a manifestation of the organization’s belief that school gardens are a component of positive change that will lead to achieving positive outcomes, such as a reduction in obesity.
As the nation’s largest food retailer, Walmart was invited to the workshop to speak about how the private sector can be an ally for obesity prevention. The 140 million people who shop at Walmart stores in the United States each week must make difficult choices, said Andrea Thomas, Walmart’s senior vice president of sustainability. They want more information because they are confused—walking up and down the aisles, they get mixed messages about health and nutrition. They have limited time, spending on average less than 25 minutes in the store. And they have tight budgets. Thomas explained, “We see trends at the beginning of the month, around paydays, and at the end of the month, showing that many of our customers are living paycheck to paycheck and actually run out of money before they get that next paycheck.”
Walmart has established a 5-year goal of making it easier for its customers to be healthy by bringing better nutrition to dining room tables. Thomas discussed the five commitments that Walmart established in January 2011 to achieve that goal:
1. Reformulate thousands of packaged foods, such as by reducing sodium and added sugars in selected Great Value products. Walmart is reformulating its own Great Value products and expects the national brands it sells to be reformulated as well. The company has committed to reducing sodium by 25 percent and added sugars by 10 percent and to eliminating all remaining industrially produced trans fats over the next 5 years. Its focus is on the food categories that are the largest contributors of dietary sodium and added sugars, weighted by sales. An online survey will collect information on these substances from suppliers of those food categories, with the results to be published in an annual report.
2. Save customers $1 billion per year on healthier items, including reduced prices for produce. As the chief executive officer of Walmart’s U.S. operations, Bill Simon, said in announcing the initiative, “No family should have to choose between foods that are healthier for them and foods that they can afford.” Walmart is
taking several steps to provide healthier food, including reducing costs of fresh produce by doing more local sourcing and increasing supply chain efficiency and working with suppliers to ensure that healthier versions of foods do not cost more than the base versions. In some cases, the healthier versions use more expensive ingredients, while in other cases, said Thomas, “it is because they can get away with it.”
3. Develop a simple front-of-package seal that will debut on selected products in 2012, making it easier to identify healthier foods. Walmart is rolling out a food icon on its Great Value products that meet the nutrition criteria developed in consultation with nutrition and health stakeholders. The icon is not meant to rate every product, and it will appear only on qualifying foods, directly on the packaging. Unlike a shelf label tag, said Thomas, the icon will stay with the food and continue to provide guidance for a family once the product has entered the home’s pantry.
4. Open between 275 and 300 stores in urban and rural food deserts by 2016 to increase residents’ access to fresh, healthier foods. These stores will provide access to groceries for more than 800,000 people in both urban and rural areas, as well as about 40,000 jobs. Walmart also is working with growers who are within 400 miles of its 42 distribution centers so the supply chain is shorter, the food is fresher, and smaller farmers have the ability to work with Walmart at the local level. Walmart informs its customers when a product is locally sourced, and that program is growing. Also, through a program called Heritage Agriculture, the company is putting crops back into communities where they were traditionally grown, which will reduce costs and promote sustainability.
5. Increase charitable support for nutrition education programs through Walmart Foundation donations. For example, the Walmart Foundation has donated more than $2 million to the Sesame Street Workshop program to educate children, including those from low-income families that are experiencing food insecurity, about healthy food choices. It also has partnered with the American Heart Association on Simple Cooking with Heart, a program that encourages Americans to cook low-cost, heart-healthy meals at home.
“This is a 5-year commitment, so it is going to take us some time to accomplish everything, but we are making really good progress,” Thomas concluded. “We want to be held accountable.”
Joseph Thompson, surgeon general for the State of Arkansas, director of the Arkansas Center for Health Improvement, associate professor at the University of Arkansas, and a member of the workshop planning committee, opened the discussion period by asking the panelists how the infrastructure needed to get local products into food distribution systems can be built. Mulvey replied that strengthening local and regional food systems and infrastructure is the greatest priority emerging from CFSC’s survey of its members and constituents regarding the most important gains that should be made in reauthorizing the Farm Bill. The growth of farm-to-school programs in recent years, now encompassing all 50 states, has helped create some of this infrastructure. Mulvey cited the example of the last Farm Bill,18 which included important provisions regarding geographic preferences for school meals, and said additional changes could help build local infrastructure. An example would be to facilitate the growth of regional food hubs, as they provide a way to aggregate products at the regional level. Thomas also responded to this question, saying that Walmart can contribute to this infrastructure by working with local farmers to provide them with a market for their products.
Kumanyika asked Naidenko how EWG is able to get groups with very different agendas to work together on issues on which their interests overlap. Naidenko replied that this question certainly applies to some of the groups with which EWG works, whether staunch vegetarians or fiscal conservatives. EWG is pragmatic, she said. “We know that we will not agree on every single issue with all the groups and multiple coalitions.” Nonetheless, EWG seeks to build coalitions and urges groups to publish reports jointly on issues on which they have common ground. “Yes, we have issues where we disagree, but if that is what we were thinking about, we would not be able to work together,” observed Naidenko.
William Dietz, Director of the Division of Nutrition, Physical Activity, and Obesity at the Centers for Disease Control and Prevention, asked each of the six panelists which obesity-related organizations they would be interested in aligning with. Naidenko said EWG’s first priority is the Farm Bill, so it would align with those members of the food movement associated with that legislation. Greger agreed that a focus on the Farm Bill would help eliminate subsidies that artificially lower the prices of foods tied to obesity. Mulvey also said the Farm Bill is a priority, especially given the emphasis on deficit reduction in Congress and the potential for the Farm Bill to create jobs and grow the economy. Metallo said NGA would align with any orga-
nization that believes in its goals and is interested in funding its programs because “for us, the limitations of our ability to help [achieve these goals] are pretty much financial.” Linn observed that CCFC accepts no corporate funding and is very interested in reducing screen time for children, and would work with health, education, environmental, or other organizations that share the same goal. And Thomas said Walmart is interested in working with organizations that can take advantage of the size and scale of the corporation to give its customers access to healthy, affordable food.
Russell Pate, associate vice president for health sciences and professor of exercise science at the University of South Carolina, observed that many of the food and agriculture panelists had mentioned physical activity. He added that another theme of the presentations was that children are more likely to be physically active if they are outdoors rather than indoors. Metallo responded that getting schoolchildren outdoors is always a challenge, especially with a major part of the school year falling during the winter. Nevertheless, he said outstanding indoor gardening programs are available, even if they do not provide as much exercise as outdoor programs would. Even indoors, children can move around the classroom, explore plants, and learn about plant systems. Also, most schools can offer a short outdoor program in the fall and in the spring. Linn observed that when children are outside, they are away from screens, so outside play is an important issue for CCFC.
The final question in the discussion period was asked by Amy Dawson Taggart, national director of Mission: Readiness, about how the corporate culture can be shifted toward the marketing of high-quality, healthy foods, especially in marketing to children. Linn responded that drawing nutritional lines around food marketing to children does not make sense. “What we need to do is to stop marketing food to children altogether,” she said. “We should be marketing food to parents. If we were marketing food to parents, companies would be marketing more around nutrition than around characters or exploiting children’s developmental vulnerabilities around peer pressure.” Marketing to children is unfair and deceptive, she said, and it harms their relationship to food “because what they are learning is to choose food based on who is on the box, or based on how it will advance them socially.” Linn ended by saying that banning food marketing to children would provide a level playing field for companies so they would not have to market to children to be competitive. “I understand that our position isn’t politically popular at the moment. But … that’s what we need to do. Kids don’t benefit from any kind of food marketing. If all of the marketing were cleared away, parents could be the gatekeepers and choose food without being pressured by corporations,” she concluded.