IMPROVING THE NUTRITION AND PHYSICAL ACTIVITY ENVIRONMENT IN CALIFORNIA

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Prepared by Prevention Institute

Despite California having a superb natural environment for the cultivation of healthy food and excellent weather for engaging in outdoor activities, many Californians are inactive and eating badly. The reason for this is not the natural environment but the social environment. Norms have been shaped by effective industry sales and marketing strategies and by a government response that is frequently inactive at best. Low-income communities and communities of color are also particularly affected, with resultant high levels of nutrition-related disease contributing to tremendous disparities in health problems.

This environment is taking its toll on our health. The percentage of children and adolescents who are overweight or at risk has more than doubled in the past 30 years to nearly one-third.ⁱ The underlying nutrition and physical activity behaviors contributing to obesity are linked to a host of health problems including diabetes, heart disease, and stroke that are occurring at ever younger ages.ⁱⁱ People of color and people with low incomes have a disproportionate burden of death and disability from nutrition-related chronic disease. For example, compared to Caucasians of similar age, African Americans are 2.0 times as likely, Latino Americans are 1.9 times as likely, and Native Americans are 2.6 times as likely to have diabetes.ⁱⁱⁱ

The high rates of overweight are accompanied by measures of poor diet and inactivity. Compared to children who were not at-risk, children who were overweight/at-risk ate fewer servings of fruits and vegetables, were more likely to attend a school with a vending machine stocked with chips and candy, and spent 20 minutes longer per school day watching TV or playing video games or at a computer.^iv Only 30 percent of California's adolescents met the five servings a day daily goal for fruit and vegetable consumption and 68 percent of adolescents ate two or more high-fat, low-nutrient foods per day.^v Children in California are not physically fit; only 20 percent of tested children met the six fitness standards included in the Fitnessgram test administered by California schools.^vi

Public health efforts to improve nutrition and physical activity have been primarily limited to disseminating messages to the community about the importance of healthy eating and in building individuals skills in food purchasing and preparation. Rarely can messages promoting healthy behaviors compete with the billions of dollars the food and entertainment industries spend on advertising and marketing. Education is only one component of a successful strategy to change social norms and influence health behavior.

Given that the current food and activity environment is the result of industry practices and government policies, improving health behaviors requires changing this environment -- focusing on the very practices and polices of these institutions. Lessons can be drawn from other health-oriented successes that resulted from changing industry practices, government policies, and community norms. Examples include reductions in childhood rates of lead poisoning, decreases in traffic-related fatalities, and the decrease in smoking in California. In each case, only when diverse partners came together and focused on environmental changes were improvements in health outcomes achieved. The growing attention to nutrition and activity issues presents us with a similar opportunity. The time is ripe to organize these efforts and community concern into a strong coherent campaign aimed at changing the food and physical activity environment.

Key Environmental Factors

There are a number of community-level environmental factors that discourage physical activity and healthy eating, especially among children. These factors include:

• Intensive marketing of unhealthy foods
• Passive leisure time activities
• Overabundance of highly processed foods including fast food meals, snack foods, soda, and bakery goods
• Neighborhood design that discourages walking, biking, and active play
• Safety concerns that keep children indoors
• Community institutions that reinforce dominant cultural norms regarding nutrition and activity (schools, faith-based institutions, after-school programs, etc.)
• Social norms:
  • Junk/fast food tastes best
  • Technology-based activities including computers, videos, Gameboys, movies, and television are the coolest, most fun
  • Pressures contributing to a fast-paced, on-the-run lifestyle
  • Reductionistic view of good nutrition -- as long as you get vitamins, minerals, and fiber you don't need to eat real food
  • Fear of fat -- makes people vulnerable to consuming processed foods including diet sodas, shakes, power bars, etc.
• Government programs (WIC, surplus foods) that are responsive to food producers but often do not supply clients with foods that are in line with the dietary guidelines
• Lack of full service supermarkets and other healthy retail food outlets

Potential Mobilizing Issues

As described above, the enviromental factors are strongly influenced by government and industry actions. Therefore in order to change these community level factors we need to address:

• the practices of large corporations to develop and market their products
• legislative policy and administrative decisions that support these industry activities
• local government decisions regarding zoning and economic development; decisions that frequently favor business concerns over quality of life
• industry influences on official government information about nutrition and health

Past efforts to achieve these changes have involved legislative and legal strategies as well as advocacy campaigns to compel corporations or government agencies to change their practices. Advocates interested in improving the nutrition and physical activity environment need to determine the strategies that will ultimately lead to the greatest changes. This involves both finding issues that capture the imagination of the general public and policymakers and those that will make a real difference in nutrition and physical activity habits.

Some potential issues that are being considered as targets for action or mobilization include:

Competitive Foods
Schools have become a place where kids have unlimited access to unhealthy products. Soft drink companies have targeted schools for exclusive marketing contracts which prominently feature their products and sometimes lead administrators to promote sales in order to increase revenue for the schools.^vii Fast food chains or their products have become a regular part of the lunchtime offerings in many California high schools.^viii School contracts with corporations like Pepsi or Coca-Cola encourage students to drink soda and are often part of a larger campaign by corporations to establish brand loyalty at a young age.

Physical Education
A growing number of schools do not provide children with regular physical activity or with limited activity periods. Even minimum state requirements for physical activity are not enforced. Gym and physical education classes are often eliminated when resources are scarce. Many times physical education teachers are the first to get terminated, leaving inexperienced teachers to provide physical activity leadership for children. Children are left for large amounts of time without adequate exercise and are also not being taught the value of physical activity or innovative ways to exercise.

Super Size Portions
Options to increase portion size, to "super size" meals or beverages, have become commonplace in many fast food chains. For a minimal price, customers can get double the amount of french fries or a huge soda to accompany their meals. This encourages people to consume more and also entices people to eat at fast food restaurants where a small amount of money can get a "super size" meal. Soda portions have also increased over the past few decades.

Access for Walking and Bicyling
One of the contributors to declining physical activity is an increasing reliance on the car as a primary form of transportation. Many people do not have access to safe routes where they can rely on biking or walking to reach work or school. Patterns of "suburban sprawl" often do not include safe, green spaces or adequate sidewalks and bike paths. Deteriorated urban areas also often lack safe spaces for people to walk or playgrounds where kids can play safely. This is a particular problem for people who do not have the resources to take expensive exercise classes or join gyms.

High-Sugar Cereals
Many cereals that are marketed as being healthy and nutritious are often no better than candy or other sweetened snacks. Frequently these "cereals" do not contain any of the nutritional value that actual cereal is accredited with. A cereal such as "Froot Loops" implies that there is a fruit component to the cereal. Far from having a fruit component, Froot Loops has no fruit and a very high sugar content. Sugar cereals are frequently marketed to children and use cartoon icons to attract child consumers.

Lack of Support for Breastfeeding
Infant formula is often distributed to new mothers while they are still in the hospital to discourage breastfeeding and encourage the use of a particular formula product. It has long been proven that breastfeeding is the healthier option for the child and sets an early pattern of good nutrition. Breastfeeding by working mothers is also discouraged by a lack of space for women to breastfeed and/or pump their breasts and store their milk.

Soda and Sweetened Beverages
Soda and sweetened beverages have been implicated as a cause of childhood obesity. In the last seven years, teenagers have tripled their consumption of soft drinks and this has been documented as one contributor to rising obesity rates.^{ix, x} These drinks have minimal, if any, nutritional content and are filled with additives, caffeine, and huge amounts of sugar. The sugar content of these fruit drinks is often hidden by marketing practices that make sure to include the word "fruit" or "juice" in the drink name.

Footnotes

ⁱ A Special Report on Policy Implications from the 1999 California Children's Healthy Eating and Exercise Practices Survey (CalCHEEPS) [online report]. The California Endowment Web site. Available at: www.calendow.org/pub/publications/calcheeps050701.pdf. Accessed April 5, 2002.

ⁱⁱ Wyshak G. Teenaged girls, carbonated beverage consumption, and bone fractures. Archives of Pediatrics and Adolescent Medicine. 2000;154:610-613.

ⁱⁱⁱ Centers for Disease Control and Prevention. National diabetes fact sheet 2002. Available at: www.cdc.gov/diabetes/pubs/estimates.htm#prev4. Accessed August 21, 2002.

^iv A Special Report on Policy Implications from the 1999 California Children's Healthy Eating and Exercise Practices Survey (CalCHEEPS) [online report]. The California Endowment Web site. Available at: www.calendow.org/pub/publications/calcheeps050701.pdf. Accessed April 5, 2002.

^v Foerster SB, Fierro MP, Gregson J, Hudes M, Oppen M, Sugerman S. 1998 California Teen Eating, Exercise, and Nutrition Survey. Berkeley, Calif: Public Health Institute; 2000.

^vi California Department of Education, Standards and Assessment Division. California Physical Fitness Test 1999: Report to the Governor and Legislature. Sacramento, Calif: California Dept of Education; December 1999.

^vii Nestle M. Soft drink pouring rights. Public Health Reports. 2000;115:308-319.

^viii Samuels and Associates. 2000 California High School Fast Food Survey: Findings and Recommendations. Sacramento, Calif: Public Health Institute; 2000.

^ix Jacobson MF. Liquid candy: how soft drinks are harming Americans' health. [Center for Science in the Public Interest Web site]. October 1998. Available at: www.cspinet.org/sodapop/liquid_candy.htm. Accessed April 26, 2002.

^x Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. The Lancet. 2001;357:505-508.

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