Shape Up America! Newsletter
Progress in Prevention of Childhood Obesity: The Home
by Barbara J. Moore, PhD
Throughout 2003 and 2004, Shape Up America!
President and CEO, Dr. Barbara J. Moore, served on a
committee appointed by the Food and Nutrition Board
of the Institute of Medicine (IOM) that generated a
landmark evidence-based report: Preventing
Childhood Obesity: Health in the Balance. When
Health in the Balance was published in 2005,
former U.S. Surgeon General C. Everett Koop, founder
of Shape Up America!, stated that this report is the
equivalent of the Surgeon General's 1964 landmark
report on the health effects of smoking —
destined to forever change the way we view childhood
Health in the Balance is a blueprint for
parents, schools, communities, local, state and
federal governments, and industry — especially
the food, beverage, restaurant, fast food and
entertainment industries. In September 2006, the IOM
published a follow-up report, Progress in
Preventing Childhood Obesity, which measures the
progress that has been made in preventing childhood
obesity in the previous two years.
Some of the news
is good in that the food and beverage industry
issued voluntary guidelines to distributors of
school vending machines to make the school
environment healthier and to self-regulate marketing
practices that target children. Many schools,
communities and organizations are instituting
programs and policies to encourage children to make
healthier food, beverage and activity choices. (See
Madison, Wisconsin Adopts a School Wellness
below.) But some of the news is not good since
billions of marketing dollars are spent on inducing
young children to eat high fat or high sugar foods
and beverages, and there is little evidence that
this is changing. The prevalence of childhood
obesity is still increasing and the chronic diseases
caused by obesity are now afflicting children in
unprecedented numbers — especially type 2
diabetes, polycystic ovary syndrome, sleep
disorders, high cholesterol and high blood pressure.
In the home, parents serve as role models for their
children. A top priority for parents who wish to
prevent childhood obesity in their own children
should be to choose healthier foods and beverages
and pursue a more active lifestyle in order to
achieve and maintain a healthy weight. Parents also
play a critical role as policymakers in the home.
Parents need to make and consistently enforce rules
that insure healthful eating and regular physical
activity on a daily basis.
The IOM recommendations for the home are
summarized below.1 The explanation of
the recommendations is provided by Shape Up America!
To Prevent Childhood Obesity, Parents Can:
What It Means
Choose exclusive breastfeeding as the method of
feeding infants for the first four to six months of
Exclusive breastfeeding means offering no formula,
juice, cereal or solid foods to your baby for the
first four to six months of life. Wean infants onto
wholesome foods over the next 18 months of life.
Provide healthful food and beverage choices for
children by carefully considering nutrient quality
and energy density.
Once the child is weaned and is two years or older,
offer plenty of vegetables, fruits, whole grain
cereals and dairy and protein foods that are
naturally rich in nutrients but low in fat and
sugar. If your child is thirsty, offer water instead
of soda, juice drinks or teas that
offer sugar and few nutrients. Cookies, cakes,
candies and sweets should be offered
Assist and educate children in making healthful
decisions regarding types of
foods and beverages to consume, how often, and in
what portion size.
|| Children should be offered
smaller portions of
food (for types of food and beverages, see above).
Children can eat small meals or snacks, but will eat
more frequently. Dessert is not usually necessary,
but if desired, offer fruit.
Encourage and support physical activity.
|| Take daily walks with your
birthdays or gifts, offer items (like a ball or jump
rope) that promote activity; plan vacations and
holidays around activity; experiment to learn which
activities your child enjoys and promote activities
(or sports) that are fun for your child. Be aware
that some, but not all, children enjoy competitive
Limit television viewing and other recreational
screen time to less than two hours per day.
||To limit recreational screen
time, announce and
enforce the rule that TV, computer, video games and
other electronic devices will not exceed a
total of two hours per day. This does not apply to
doing homework on the computer. Also, turn off the TV
during meal times and, if applicable, move the TV
out of the
bedroom if enforcement is undermined.
Discuss weight status with child’s health care
provider and monitor age- and gender-specific BMI
The following procedure should be done at least
once a year. Step 1: Have your child’s height and
weight carefully measured by a properly-trained
technician, doctor or nurse. This data will be used
to calculate BMI (body mass index). Step 2: Using a
CDC growth chart, a trained health professional
should determine BMI percentile and results should
be discussed with the parent or caregiver. (For more
information, see http://www.shapeup.org/oap/entry.php).
Serve as positive role models for their children
regarding eating and physical activity behaviors.
|| Demonstrate by your own
choices a commitment to
healthful eating and physical activity every day.
Sugar, Mental Distress and Hyperactivity: Are They Related or Just Hype?
by Danielle Greenberg, PhD
Headline: Umbrellas proven to cause rain. The
absurdity of that statement is obvious. It is true
that when it rains umbrellas are found in greater
numbers, but that doesn't mean the umbrellas are
causing the rain. Yet recent scientific studies are
making this type of claim and too often the
conclusions are not questioned. One example is the
study by Lien et al, "Consumption of Soft Drinks and
Hyperactivity, Mental Distress, and Conduct Problems
among Adolescents in Oslo, Norway".1 The
authors found that teens who consumed more than four
soft drinks a day had higher scores on two
self-reported conduct tests, with higher scores
indicating more anti-social behavior. The presence of
this reported association does not prove that the
soft drinks caused the anti-social behavior rating.
In addition, we don't know if these teens were
actually engaging in anti-social behavior since the
only measure of behavior was indirect — two
tests of self-reported behaviors. The actual
behavior of the subjects was never assessed directly.
The authors used The 10-item Hopkins Symptom
Checklist to measure mental distress, and they used
two subscales of The Strengths and Difficulties
Questionnaire to assess hyperactivity and conduct
problems. As noted above, these were self-report
measures and no observational or other corroborating
tests were used to verify that this self perception
translated into behavior. The study was of all
grade students who appeared on class lists in Oslo,
Norway in 2000 and 2001; 7,305 completed the study.
There are several confusing findings in this report.
One is that the authors found a "J" shaped
relationship between soft drink consumption and the
behavioral self-assessments. That is, teens who
consumed no soft drinks at all had higher
anti-social scores than teens who drank moderate
amounts of soft drinks — a finding that is
hard to explain. In addition, the number of teens
who consumed more than four glasses a day
represented only a very small proportion of those in
the study (less than 3% of girls and 11% of boys).
The relationship of high soft-drink intake and
anti-social behavior may have been the result of
some combination of variables that was not assessed.
For example, one could speculate that the home life
or parental oversight of the teens who were
consuming large amounts of soft drinks may be
contributing somehow to the higher anti-social
behavior scores. An entirely different explanation
might account for the higher scores associated with
those consuming no soft drinks at all.
The relationship of soft drink consumption and
behavior appears much more like the relationship of
umbrellas and rain than to true cause and effect
— something that this study was not designed
to assess. It is plausible that consuming more than
four soft drinks a day is associated with other
lifestyle choices that are relatively unwholesome
and those choices, taken in total, may explain the
mental distress evidenced by the self-report scales
used in this study.
Unfortunately, this article also attempts to revive
the disproven hypothesis that high sugar intake is
associated with "hyperactivity". The authors state
that "for many years parents and teachers have
claimed that high sugar intakes lead to attention
and conduct problems in children." The myth that
sucrose and certain additives induce hyperactivity
has not been confirmed by rigorous investigations.
When double blind, placebo-controlled trials are
conducted in children, no observable differences in
behavior in response to sugar-sweetened vs.
artificially-sweetened beverages are
found.2,3 Several important reviews
contradict the sugar-hyperactivity hypothesis and
some evidence exists that cognitive functions appear
to improve following sugar intake.4,5,6
The Institute of Medicine (IOM) in its report on
carbohydrates finds that a "meta-analysis of 23
studies conducted over a 12-year period concluded
that sugar intake does not affect either behavior or
cognitive performance in children".7 That
is why the IOM concluded that "altered behavior
cannot be used as a basis for setting a Tolerable
Upper Intake Level (UL) for sugars".7
Another interesting side issue from the study by
Lien et al. is that they claim that Norway has the
highest soft drink consumption in the
world.1 If true, this would argue against
the hypothesis that consumption of sugar-sweetened
beverages leads to obesity as Norway has one of the
lower overweight and obesity rates of developed
nations (15% men; 13% women).8
Overall this report adds little to our knowledge
about how sugar intake may affect behavior since the
relationship these authors find between soda
consumption and anti-social behavior is not linear.
They do report a linear relationship between sugar
intake and hyperactivity. Yet many investigators
have examined the sugar-hyperactivity relationship
and the majority of studies find no validity to this
claim and to date, no plausible mechanism linking
soft drinks and mental health has been identified.
Reports such as this one need to be interpreted with
caution lest we reach the mistaken conclusion that
umbrellas cause the rain to fall.
Danielle Greenberg, PhD, FACN, is Director of
Nutrition and Scientific Affairs at Pepsi Cola North
America. She previously was a Research Associate
Professor at Cornell University Medical College
where she studied satiety, and the control of food
Madison, Wisconsin Adopts a School Wellness Policy
"The evidence is clear that we have a serious
problem with obesity in our country," said Lucy
Chaffin, chairperson of the district’s Wellness
Committee and director of Madison School & Community
Recreation. "While schools cannot solve this
problem, schools are integral to the solution. The
food policy developed by students, parents, staff
and community members is a good start. We’ll
continue to assess and evaluate the policy’s
implementation; the policy is just the beginning of
our ongoing efforts to have healthy students and a
healthy school environment."
Many parents have questions about the new broad,
wide-ranging wellness policy now in place for all
Madison schools and school-related events. The
policy, passed in the summer of 2006 by the Board of
Education, is a federal requirement for all school
districts with federally funded breakfast and lunch
A committee of students, parents, staff and
community health professionals helped develop the
policy. The policy and related information are
available on the district’s Web site —
— under "Hot Topics." Some of
the policy’s key components include:
There will be no vending machines in elementary and
middle schools. All machines in high school common
areas will only serve milk, water, 100% fruit juices
and some sports drinks. All soda will be removed
from machines, including diet soda.
- No candy will be sold in vending machines.
- No foods — including candy —
will be used as rewards.
- Snack items sold in vending machines, at
school "stores" and carts will be limited to items
from an approved list developed annually by the
Wellness Committee. (The initial list will be
available by the end of September.)
- Candy will be permitted as a fundraising
item for the 2006-07 school year, but after
September 1, 2008 will not be offered for sale as
part of any school-related activity. During the time
while candy sales are still allowed, sales during
the school day on school grounds will not be permitted.
- Staff and parents will be encouraged to
consider non-food alternatives for birthday parties
and other celebrations, during which candy and soda
will not be allowed. The goal is to decrease the
frequency of celebrations that involve food.
- Schools will still be able to host events
that include food (potlucks, food fairs, cultural
nights). A School Potluck Food Safety brochure is
available with guidelines on foods to avoid due to
allergy concerns (peanuts, shellfish, etc.)
- Bake sales, offering home-produced food,
will be allowed after lunch but should be an
infrequent event and adhere to the Potluck Food
Source: East High Newsletter (October 2006),
printed in English and Spanish
by Michael Roussell
This month we are going to look at another terrific
exercise for the lower body — lunges. Lunges
have an undeserved bad reputation for being
detrimental to the knees; however, when done
correctly, lunges (and their variations) are
excellent for strengthening your legs and adding
your training program.
The two lunge variations that we are going to look
at are the traditional lunge and the split squat. To
begin the traditional lunge, stand up with your feet
together and your arms at your side (or with your
hands on your hips). Take a large step forward with
your left leg. Once you plant your left foot on the
ground, bend your left knee to allow you to drop
your body down until your right knee just barely
touches the ground. This is the midway point of the
movement. Pause, and then push down on your left
foot to return to the starting position. Repeat the
movement leading with the opposite leg and that will
be one repetition (or rep). This movement is shown in
It is very important that when bending your
These two tips will help ensure proper knee health
throughout the movement.
- Your leading knee must not extend beyond the toes
of that foot.
- Your leading knee must stay in line with your
foot and must not deviate to the left or right.
The second movement is the split squat. The main
difference between the split squat and the lunge is
that you do not return to the traditional starting
position (standing feet together) between
repetitions. (See second movement in the video.)
Start the movement with a large step, leading with
the left leg, as with the traditional lunge. Bend at
the knee and hips until your right knee touches the
ground. Instead of returning to the starting
position, standing with both feet together –
straighten your left leg, standing up so your legs
are “split” (hence split squat). This is one rep.
Bend your left knee again repeating the movement.
Once you have completed the desired number of reps,
return to standing with your feet together. Complete
the movement by leading with your right leg,
executing the same number of reps as you did with
How do you incorporate lunges into your training
program? The best way is to use lunges as an
alternate exercise for bodyweight
squats. For example, if you are doing 4 sets of
15 reps of bodyweight squats, you can do 2 sets of
15 reps of bodyweight squats and then 2 sets of 15
reps of lunges. Another idea is to use lunges on
different days. For example, if you currently do
bodyweight squats on Monday, Wednesday and Friday,
then insert lunges on one of those days so you
alternate between lunges and bodyweight squats. Your
training schedule might look like this:
- Monday: Bodyweight Squats
- Wednesday: Lunges
- Friday: Bodyweight Squats
* 2 x 10 means 2 sets of 10 reps
||Split Squat or Lunge
||2 x 10*
||1 x 10
||1 x 10
||3 x 15
||2 x 15
||1 x 15
||4 x 15
||2 x 15
||2 x 15
Lunges are a great way to add variety to your leg
training, so watch the demonstration video and put
them in your training schedule today.
Stories that Help, Stories that Heal
Against what sometimes feels like insurmountable
odds, many people find ways to eat better, make
healthier food and beverage choices, be more active,
lose weight, and enlist friends and family to be
more supportive of a healthier lifestyle. Some
people have suffered emotional wounds from their
obesity, yet overcame them to achieve weight loss
success. What made you decide you won’t take it
anymore? We want to hear what made you turn the
corner. Maybe you have a story that can help
someone else overcome a barrier or a story that can
heal other people’s wounds.
If you have a story you’d like to share, we invite
you to send it in to Shape Up America! Some of the
stories submitted will be excerpted for our
newsletter and some will be placed on our web site
in the Support Center. If you would like to share
your story, simply use our new story
submission system on our web site.
Recipe of the Month
This tasty recipe is a favorite of golfer Brittany Lang and is found in The LPGA Cooks with Canyon Ranch, a collection of delicious dishes by top players of the Ladies Professional Golf Association and the chefs at Canyon Ranch.
CRANBERRY CHICKEN & WILD RICE
Makes 8 servings
- 2 Tbsp. butter
- 8 4-oz. chicken breasts, boned and defatted
- 1½ cups cooked wild rice
- 6 Tbsp. low-sodium tamari sauce
- 2 cans whole cranberries (2 cups)
- 2/3 cup low-sodium chicken stock
- Preheat oven to 350º.
- Heat butter in a large skillet over medium-high
heat. Sear chicken breasts for 1 minute on each side
or until golden in color.
- Spread wild rice in the bottom of a glass baking
dish. Top with chicken.
- In a small saucepan, combine tamari, cranberries
and chicken stock over medium heat. Pour mixture
- Cover dish tightly with foil and bake for 1 hour.
Do not overcook.
Cook’s Note: Look for natural cranberries that do
not contain high-fructose corn syrup.
Nutritional analysis per serving: 220
calories, 11 grams carbohydrate, 6 grams fat, 80
milligrams cholesterol, 29 grams protein, 472
milligrams sodium, 2 gram fiber.
Source: The LPGA Cooks with Canyon Ranch,
LPGA and Canyon Ranch, 2006.
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Editor: Adrienne Forman, MS, RD