News from Shape Up America!
December 2006
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 obesity.

Health in the Balance is a blueprint for action 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 Policy 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 life. 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 infrequently.
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 children; for 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 sports.
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 percentile. 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
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 10th 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 intake.

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 programs.

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 Safety brochure.

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 variety to 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 the video.

It is very important that when bending your leading leg:

  1. Your leading knee must not extend beyond the toes of that foot.
  2. Your leading knee must stay in line with your foot and must not deviate to the left or right.
These two tips will help ensure proper knee health throughout the movement.

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 your left.

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

BW Squat BW Squat Split Squat or Lunge
Beginner 2 x 10* 1 x 10 1 x 10
Intermediate 3 x 15 2 x 15 1 x 15
Advanced 4 x 15 2 x 15 2 x 15
* 2 x 10 means 2 sets of 10 reps

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.
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


  1. Preheat oven to 350º.
  2. Heat butter in a large skillet over medium-high heat. Sear chicken breasts for 1 minute on each side or until golden in color.
  3. Spread wild rice in the bottom of a glass baking dish. Top with chicken.
  4. In a small saucepan, combine tamari, cranberries and chicken stock over medium heat. Pour mixture over chicken.
  5. 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.

Order copies of the booklet for yourself, family, friends and business associates. It makes a great gift! Plus, proceeds of the sale of this colorful 60-page booklet ($10 plus S&H) will benefit the Shape Up America! childhood obesity campaign. To order online, go to:

phone: 406-686-4844

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Editor: Adrienne Forman, MS, RD

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