APPLYING NEW RESEARCH, DG 2010, SSB’S, and SOFAS · Soda 30.8 35.5 4.7 gal Fruit drinks 10.2 13.9 3.7 gal 29. University of California, Berkeley How many calories are in soda? Fl

Pat Crawford, DrPH, RDCE Nutrition Specialist,

Adjunct Professor and DirectorAtkins Center for Weight & HealthUniversity of California, Berkeley

1

APPLYING NEW RESEARCH, DG 2010, SSB’S, and SOFAS

December 17, 2011

University of California, Berkeley

Then andNow

University of California, Berkeley3

University of California, Berkeley4

University of California, BerkeleyNHANES


0

2000

4000

6000

8000

10000

12000

1975 1980 1985 1990 1995 2000 2005 2009

Num

ber o

f Pub

Med

ent

ries

Publication Year


Obese individuals Are at increased risk of disease

including diabetes, cardiovascular disease, arthritis, asthma and cancer.


$147 billion



Why is diet so critical to consider when addressing obesity?

10


Energy Out

Energy In

11


One big Mac = 564 Kcal

Energy Expenditure : (50 Kg /110 Pounds child)

Basketball Cycling ( 5.5 mph ) FootballSwimming , crawl, slow Walking normal pace

Minutes

821778588141

Courtesy of Dan Nemet, UC Irvine

12


How can the research evidence be synthesized on the dietary determinants of obesity?

13


1. Dietary fat2. Whole grains3. Sugar4. Protein5. Reduced fat foods6. Eating out7. Fast foods/eating out8. Caloric intake9. Energy density10. Portion size

11. Fruits and vegetables12. Dairy and calcium13. Breakfast skipping14. Sweetened beverages15. Fruit juice16. Eating frequency17. Dietary variety18. Snacking19. Parental restriction20. Breast feeding

14

First, identify likely suspects


1. Dietary fat2. Whole grains3. Sugar4. Protein5. Reduced fat foods6. Eating out

7. Fast foods/eating out8. Caloric intake

9. Energy density10. Portion size

11.Fruits and vegetables12.Dairy and calcium13.Breakfast skipping14.Sweetened beverages15. Fruit juice16. Eating frequency17. Dietary variety18. Snacking19. Parental restriction

20.Breast feeding

15

Key dietary factors




• New focus on environmental factors influence individuals choice

• More focus on foods (vs. nutrients) • Language simplification and more examples

provided• Obesity prevention theme throughout


Strong evidence:1. Sweetened beverages2. Eating out (fast food restaurants)3. Portion sizes4. Screen time (particularly television)Moderate to strong evidence:5. Total energy intake6. Energy dense foodsModerate evidence:7. Breakfast skipping8. Dietary fat9. Low whole grain10. Food environment and fruit and vegetable access


SodaDessertsPizza

Reedy, J and S. Krebs-Smith, JADA 2010


•“Discretionary Calories from the 2005 Guidelines are invisible”•An understanding of discretionary calories is key to understanding how to select healthy foods•“It is clear that all foods don’t fit”

*Briefel, RR, JADA 2009


Timing Foods & Beverages Extra Calories

AM Snack Donut (vs Toast) 99Lunch 12 oz soda (vs non-fat milk) 50Lunch Tater tots (vs mashed potatoes) 69PM Snack 20oz Sports Drink (vs water) 140Dinner Chicken nuggets (vs baked chicken) 96Dessert 1 cup Vanilla ice cream (vs NF vanilla

yogurt)61

Evening Snack

2 choc chip cookies (vs 1 cup plain popcorn)

86

discretionary calories eaten 601

Discretionary Calories Limit 200


SOFAS


Only 1-2% of children meet the dietary guidelines with almost 40% of children’s calories coming from solid fat and added sugars.

Reedy, C and S. Krebs-Smith. JADA 2010

University of California, Berkeleycenter foreight &

ealthh University of California, Berkeley


Selection criteria:Conducted in industrialized nationsLocated through PubMed database

and other cited articles

Four types of evidence:

National intake trends Mechanistic studies

Observational studies Prevention trials+

26


What is the evidence on sweetened beverages as a determinant of obesity?

27


0

10 0

2 0 0

3 0 0

4 0 0

50 0

# of

12-

oz s

vgs/

pers

on

1954 1974 1994 2003

(Source: USDA/ERS, 2003, 2008)

>Tripled!

28

Soft drink production


Annual gallons per capita

1985 2005 Increase

Soda 30.8 35.5 4.7 gal

Fruit drinks 10.2 13.9 3.7 gal

29


How many calories are in soda?

Fl oz 20 32 44 64

400550

800

250Calories

30

University of California, Berkeley(Source: Harnack, 1999)

19842149 2312

2604

0500

10001500200025003000

0 0.1 - 12.9 13.0 - 25.0 26+Soda Consumption (oz/day)

Kca

l/day

31

323232

3333(Source: Mattes, 1996)

Liquid Sugar<9%

compensationSolid Sugar

64%compensation

33

3434

Absorbed quickly—fail to stimulate satiety Insulin response is unique Metabolic rate in response to eating lower with

fluid calories Thirst & hunger mechanisms not fully

integrated Cognitively not as satisfying; not seen as a

dessert or “extra food” High palatability

34

3535

For each additional serving of sweetened beverage consumed over 1.5 years, the risk of overweight increased by 60% in children

(Source: Ludwig, 2001)

35

3636

3-fold increase in soda consumption between 9 and 19 years. High soda intake predicts increase in BMI.

(Source: Striegel-Moore & Crawford, 2007)

What about adolescents?

36

3737

Women who drink soda or sweetened fruit drinks every day more likely to gain weight & develop type 2 diabetescompared to women who drank less

(Source: Schulze, 2004)

37

3838

Adults were given 3.5 servings/day soda for 3 weeks:

Increased total energy intake Increased body weight

(Source: Tordoff, 1990)

38

3939

Intake Trend?

Plausible Mechanism?

Positive Association with

Overweight?

Prevention Intervention

Impact?

Yes Yes Yes Yes

Conclusion:Reducing sweetened beverage intake is an excellent intervention strategy.

39

4040

• Provide nutrition education programs• Create greater financial incentives to consume vegetables

and fruit, whole grains, seafood, low-fat milk products, and lean meats

• Improve access to affordable fresh produce and food;• Encourage restaurants and the food industry to offer

health-promoting foods that are low in sodium, solid fat and added sugars, refined grains, and served in smaller portions;

• Remove sugar-sweetened beverages and high-calorie snacks from schools and recreational facilities;

• Promote zoning policies that limit the location of fast food restaurants near schools and places where children play

402010 Dietary Guidelines

414141

Multiple nutrition education activities (curriculum including parent/family outreach)

linked withPrograms and policies

424242

• During School• Staff training• Classroom curriculum• Enhanced recess

equipment• School foodservice • School wellness policy

Economos C. 2007)

• Before School• Foodservice• Taste tests• Walk to school campaign

• After School• Staff training• Curriculum • Walk from school campaign

• Home• Parent education• Family events• Child’s health report card

434343

Economos C. 2007)

0

1

2

3

4

5

6

lbs

Boys Girls

Weight Gain in School Year

WithoutInterventionWith Intervention

~1 lbdifference

444444

Linked nutrition education activities

and

food policy changes

CWH Intervention Review, 2009

454545

social marketing campaigns

andFood store access, in-store

promotion and/or price alterations

CWH Intervention Review, 2009

464646

Conclusions Focused multi-channel interventions of high

intensity were the most successful

Environmental and policy change + social

marketing and/or education

Synergy ( same population exposed to multiple

strategies)

Sustainability: institutional change and

accountability (policy with teeth)

4747

Basic, Clinical, Epidemiological

Research

InterventionsPolicy

Evaluations

Neighborhood

School

Family

Community

Children’s Health

4848

Tips from community folks:Provide guidance on what constitutes a healthy food.

Be simple, specific, clear, and give examples.

If guidance is not provided, others will fill in the blanks.

4949

Out of 124 chain restaurant websites –33 say they have healthy menus

7 have claims regarding low calories 19 have claims regarding low-fat or fat-free 8 have low-carb claims 4 have claims about sugar 1 claims their entire menu is healthy(

5050

Snack may have no more than:•35% of its calories from fat (excluding legumes, nuts, nut butters, seeds, eggs, vegetables that have not been deep-fried, and cheese packaged for individual sale);•10% of its calories from saturated fat (excluding eggs and cheese packaged for individual sale);•35% sugar by weight (excluding fruits and vegetables);•250 calories (middle and high schools).

5151

Frito Lay - munchies flamin’ hot snack mix General Mills – chex mix traditional snack mix Propel flavored fitness water Gatorade fruit punch Nature Valley – strawberry yogurt granola bar Nature Valley – crunchy-oats ‘n honey granola bar Tropicana strawberry melon drink Dole apple juice Nabisco – wheat thins crackers Corn nuts – ranch flavor Nabisco – oreo-100 calorie pack cookies

Samuels et al., 2010

5252

Frito Lay - munchies flamin’ hot snack mix General Mills – chex mix traditional snack mix Propel flavored fitness water Gatorade fruit punch Nature Valley – strawberry yogurt granola bar Nature Valley – crunchy-oats ‘n honey granola bar Tropicana strawberry melon drink Dole apple juice Nabisco – wheat thins crackers Corn nuts – ranch flavor Nabisco – oreo-100 calorie pack cookies

5353

An elementary teacher in Oregon City wanted her students to bring only healthy snack foods to school. Not knowing how to find a practical definition of a healthy food, she defined it herself: any food that does not list sugar (in any of its forms) as one of the first three ingredients.

5454

California Plate developed by UC Cooperative Extension Body Weight and Health Workgroup, 2007

Documents

APPLYING NEW RESEARCH, DG 2010, SSB’S, and SOFAS · Soda 30.8 35.5 4.7 gal Fruit drinks 10.2 13.9 3.7 gal 29. University of California, Berkeley How many calories are in soda? Fl