APHJ Obesity, Food Insecurity and Education
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APHJ Obesity, Food Insecurity and Education

March 10, 2020


Obesity affects more
than 1/3rd of adults and 17% of youth, in
the United States that is. That means 78 million adults and
12 million children are obese. This is important because
obesity increases the risk of heart disease,
type 2 diabetes, and cancer. At the same time, more
than 42 million Americans, 29 million adults
and 13 million children, are food insecure, meaning that
they don’t have reliable access to a sufficient quantity
of nutritious food even though
United States farmers are producing nearly 4,000
calories per person per day, which is twice
the recommended daily intake. Obviously,
there is a major disconnect in our food
and nutrition system. We’ve got enough food but it’s
not being distributed well, and some are consuming too much
or the wrong kind of food. And the impacts on children and
their development is profound. We’re going to talk about food
and food insecurity, especially among children,
on today’s episode of “A Public Health Journal.” Stay tuned because it should be
a good discussion. (man) Welcome to
“A Public Health Journal,” a program that explores
the public health issues facing our society today
and tomorrow. The host of our show
is Dr. Ed Ehlinger, Commissioner of Health
for the State of Minnesota. “A Public Health Journal”
is sponsored by the Minnesota Department
of Health, the Hennepin County Human Services and
Public Health Department, and the Minnesota
Public Health Association, all working together
towards the goal of healthy people living and
thriving in healthy communities. Welcome to “A Public Health
Journal.” Hunger and food insecurity
among children negatively affects their health, cognitive development and school
performance. And nearly 13 million children
are food insecure. At the same time, almost an
equal number of children 12 million, are obese. What does this mean for children
and for our society, and what’s being done to address
those problems? That’s going to be the focus
of our discussion today. And joining me
in that conversation are Terri Swartout,
School Health Coordinator at the Minnesota Department
of Education and Bertrand Weber, Director of
Culinary and Wellness Services for the Minneapolis
Public Schools. Terri and Bertrand, welcome to
the program. (both) Thank you. (Ed) I’m looking forward
to our conversation because this is really an
important topic that’s sort of front and center
in public health, nutrition, school readiness,
school improvement, these are the things
that really impact health. I’m going to start off by first
talking about the big picture before we start talking about
specifically what you do, and that is, as I mentioned
in my introduction, we have obesity and food
insecurity at the same time. Terri, how are those related? They’re absolutely related. When we talk about giving kids
a good start, we know that education plays
a huge role throughout their whole
life span. We know that there is a direct
link between health, as well as academics, and food
plays an important part of that. And so, of course, we know that
for kids to be fueled effectively at school,
their brains need to be fueled, and, of course, we’re dealing
with kids that sometimes aren’t given the amounts
that are needed, so food insecurity, yes,
a huge issue. At the same token, we know that
good food also plays a role with regards to their academic
indicators and strengthens the relationship between their
academic success in school. And so there’s many programs
out there and we can talk about
some of those this morning. But we know that 95% of youth
attend schools here in Minnesota and we have a job to make sure
that they are fueled to do the best that they can
in school. And you’re responsible for the
schools throughout the state, so you see–
you’re not personally
responsible! [laugher] You work with schools throughout
the state, food insecurity, tell me how that plays out, how
do you see that in the schools? Kids who
just don’t get enough to eat
or get the wrong kinds of food– how do you see that affecting
people throughout the state? Well, we know that, of course,
children, young adults, can’t function
to their peak if they’re not
nutritiously satisfied. So we have children
that sometimes when they leave school
on Friday afternoon, that’s the last meal
that they’re going to get before they arrive to school
on Monday morning. So I do work with a lot of
different decision makers and people that work
in local school districts and one quote that really sticks
out to me is, a superintendent had talked about how within her
budget, she has to, of course, provide transportation
and fuel for her children
to get to school, and she said it’s also my job
to make sure that all my children are fueled
with regards to brain power. And I thought that was really
a good, strong statement. We need to understand
that not every child is
given 3 meals a day, and we know as adults
that if you haven’t eaten in 12, 24 hours,
how are we functioning? So it definitely impacts
children. And Bertrand, I know you’ve
been interested in obesity, and you brought a slide along that shows kind of the obesity
rates as they’ve increased and we’ll put that on the screen
here in a second, that shows over the last 50 years or so,
we’ve really increased, tell us what’s going on
in that slide. (Bertrand) Well, I’m not sure
I’m the expert to tell you what’s going on, but it’s obviously staggering to see the increase of obesity between 1985 and now, 2016. And one of the fact that’s
really relevant to this is that about a 3rd of obese
children are also starving because of lack
of nutritious food. They consume an increased amount
of calorie-dense food as opposed to
nutrient-dense food. Part of it is just how our food
system has evolved over time. If you go back to 1985, there was still quite a bit
of whole food or I like to call it food made
from food, and over the time, we’ve graduated to
a lot more processed food. So a lot of food-insecure
children access to food is only processed food or
gas station food, if you will. So high calories,
very low density of nutrition. So a lot of obese children
are actually starving. So you’re saying that kids,
poor families with the limited resources
that they have, they buy high-calorie things, not
necessarily the most nutritious, and that’s why the obesity rates
go up in lower-income folks. And part of the issue
is education. If you take a family on a low
income that walks into a grocery store, that sees
a pineapple, say, for $3, $4, or they’ll see
a bag of chips for $2, they’ll buy 2 bags of chips
as opposed to the pineapple, not realizing that the pineapple
offers actually much higher density of nutrition
and will fill their family even higher than
the bag of chips. But because of some of maybe
their inability to even understand how to cut a
pineapple or dice a pineapple or even take a baked potato–
you can buy 2 baked potatoes for less than a bag of chips,
which would provide much higher nutrition-dense food
than calorie dense. So I think part of what we need
to do is really help families understand the value of fresh
food and how simple it can be. So how did we get
to this situation, from the time when we had
food made out of food to where we now are buying
a lot of convenience food? What happened
in the last 30 years? Again, not being an expert
in this, I can only give you my views, and I don’t think there’s
anything to blame but just society moving forward. If you think about the invention
of the microwave, or the invention
of the corn flake, all of a sudden you have
2 families working and the introduction
of highly convenience food. Even in schools, we removed
teaching kids how to cook. Why would you make soup when you
have a tomato soup in a can? Why would you bake even a
cookie, I know it’s not healthy, but it’s still a good,
it’s a nice treat, when you can buy something? Why would you cook chicken when you can buy processed,
fully-cooked chicken. Freezers, microwave, convenience
food, the marketing of come home, throw something
in the microwave, it’s 5 minutes,
and you can have a meal, has shifted our view on food. Schools followed
the same pattern. They were not, schools did not
create the problem, the obesity problem,
but school can be a solution by reintroducing whole foods
into kids. Alright, I want to talk
about that because I’ve been around long enough to see
the shift in the schools from kitchens in every school
to central organization and everything processed, now
it’s starting to go back again. So I want
to talk about that, but first
we need to take a little break. I’ll be back
right after this message. [whistling, finger-snapping and
piano play in bright rhythm] [music only; no spoken words] Love it! I love it! I’m trying to be like the
little kid in that segment. Welcome back. We’re talking about obesity and food
insecurity, particularly the role that
schools play in addressing 2 major problems,
with Terri Swartout, School Health Coordinator
in the Minnesota Department
of Education and Bertrand Weber, who is
the Director of Culinary and Wellness Services for
the Minneapolis Public Schools. So Terri, let’s start with you,
I want a little history. Could you tell me how
school nutrition programs, culinary programs,
have evolved over the last
quarter century or so? Well, I don’t know if I can
bring you back that far, but what I can tell you is that
schools have seen a shift and we’re dealing with now
childhood obesity like we’ve never seen before and
what hits me as a parent, what hits me in my role is,
we know that children today, their life expectancy is about 5 years shorter
than their parents. This has never been seen before. So we have a duty to start
changing, of course, some of the behaviors
that we can change. And we know that access to
healthy foods, as well as increased physical activity,
played a huge role in that. And so with regards to food
within schools, again schools being a great setting to reach
all children and young adults, we’ve seen a shift
with regards to what we are providing
to our students. And we want to make sure
that the messages that schools are providing
to students are backed up
by communities, by parents, by outside of the food service
departments. They’re doing a great job
in serving our children more nutritious foods today. With the passing of the Healthy
Hunger-Free Kids Act in 2010, we know that one of the
first things that changed is the nutritional guidelines
for the lunch program. Many people saw
those nutritional standards come out with
some negative press with regards to schools
throughout the country really trying to meet
these new guidelines without extra money in a lot of
cases, without extra training. We know that good nutritious
food does at times cost more than, of course,
the convenience items that Bertrand was talking about
before. We had a lot of schools
not equipped with equipment to actually do scratch cooking
once again, because a lot of our kitchens
had been remodeled to just simply heat and serve. And so there was a shift,
and that shift played out and we know that there was
a lot of bad press, but what I can tell you is
that over 80% of parents really do value
these nutritional standards. And schools have really stepped
to the plate with regards to being the
forerunners in changing the dynamic, with regards to the foods that
our children are getting. So I really applaud districts
like Minneapolis, as well as districts throughout
the entire state, with regards to these changes. So are more schools preparing
their own foods now than they did 10 years ago? I would say that in the 1980s,
there were a lot of schools that were using deep fat fryers,
that were serving the same thing on the lunch menu day after day, that were using heat and serve, and really that was how it was
kind of set up and so I don’t want to place
blame, (Ed) I know federal policies
make a difference when you ask certain
requirements, you have to meet those requirements, you
have to do things differently, and I suspect
that was part of the change. Yes, yes, and they were really like I said,
the frontrunners in delivering some of these more nutritious
foods to our young people. And there was a change, a cultural shift
that took place there, and change is difficult, so we
know that it took many years before things
kind of settled down. But we know that the food
that kids are receiving today, there’s dense calories in there
and a sense of, you know, in the past we always had
a caloric amount that kids needed to receive. But now, with the new passing of
Healthy, Hunger-Free Kids Act, there’s actually a cap with
regards to those calorie counts. And we need to do that
because we know we’re dealing with
childhood obesity, and we know that we want to provide foods
to our children, but at the same token, we want
to really set the stage for what is a nutritious meal
so that they know throughout their life span
what they should be doing. So I don’t know if I can speak
necessarily to all the changes, but I know that we’re working
towards change and schools were really
kind of the pioneers in that. And it’s trickling down to
families, to communities, and our kids are really the
beneficiaries of these changes. Bertrand, let’s talk
specifically about what’s going in the Minneapolis
Public Schools, one
of the larger districts. How long have you been with
the Minneapolis Public Schools? I’ve been with Minneapolis
for 5 years now. Give me your perspective
of what was going on and how you’re
trying to change things. Well, I think to your point, there’s really no one to blame, but as I mentioned earlier, it’s really a societal shift in
our food system. Schools did not invent
ranch dressing to pizzas, we didn’t come up
with the chicken nugget, it was just,
our food system changed. The fast-food chains came out,
the convenience food came out and schools just continued in
the same way, in the same path. At the same time,
kitchens were stripped because of convenience food,
skills were removed, people, parents, food workers, that high-level skills
kind of slowly went away. Minneapolis in the mid ’70s
built a central kitchen as a way to provide a meal to all the children
within Minneapolis because a lot of schools didn’t
have kitchens at the time. So schools built
before the mid ’70s, a lot of them didn’t have
kitchen, schools built after the ’70s
no longer needed a kitchen because we had
a central kitchen. And the kitchen in the mid ’70s was built as
a state-of-the-art facility. They actually butchered meat,
they had fresh vegetables, they made their own bread, it
was just a beautiful facility, and over the course of the year,
like everything else, that central kitchen became
a repacking facility and all the cooking equipment
went away. When I started in Minneapolis,
and I looked at how we were representing food
to our kids and the type of food we were serving our kids
and how many kids were actually taking part
of the program, I realized that we needed
to make a drastic change to address food insecurity,
obesity, cardiovascular diseases,
and as you probably are aware, the substantial increase
in food allergies that is just popping up
everywhere. So I look at what we were doing and realized that the first
thing we needed to do was to change the food
integrity, if you will, start really looking at the food
we were serving and focusing on food made
from food as much as we could, look at ingredients, look at
the unnecessary ingredient in a lot of processed food
that we were doing and then shifting, hopefully, some of the habits,
eating habits of our students by introducing
fresh fruits and vegetables. We now have salad bars
in about 95% of our schools. So with the Healthy Hungry-Free
Kids Act with a calorie limit, salad bars offer them options
for nutrient dense without drastically increasing
the calories. And has it been challenging? It’s certainly been an uphill,
rocky road at times, but we have to stay the course. If a child doesn’t like
the curriculum, they don’t opt out
of their math class. Why should we do the same thing
in food? If we continue on the path
of creating kids’ food because as adults we believe
that’s what kids like, we will continue to offer them the same food
over and over again. So part of what we’re doing is
trying to teach them, to introduce new flavors, new
textures, and bring them back to appreciating whole food
in its natural form. Same with whole grain,
we’re really, with the regulation,
having to offer all grains served
have to be whole-grain rich, that’s great, but part of whole
grain is eating the brown rice and the quinoa and the
wheat berry and the red rice. It’s not the whole-grain bread
that’s going to really introduce whole grain
to kids. It’s shifting that paradigm
from processed to whole. I want to talk about some
of the specific examples and some stories you’ve got from
both you, and particularly about SHIP and how it’s helping
throughout the state, but we need to take another
little break. So we’ll be back
right after this message. [acoustic guitar plays softly] (man)
Every day, across America,
excess food is gathered by a network of good people
at local food banks. giving hope to millions
of children who struggle with hunger. They’ve earned their wings
and you can too. Together,
we can solve child hunger. Support Feeding America
and your local food bank at… Welcome back, we’re talking about obesity and food
insecurity as it relates to children
in schools with Terry Swartout from the Minnesota Department of
Education and Bertrand Weber from the
Minneapolis Public Schools. Terri, I want to start out in
the last segment that we’ve got, tell us about SHIP,
the Statewide Health Improvement Partnership,
and what it’s doing statewide with nutrition,
particularly among kids. Great, I’d be happy
to talk about SHIP. SHIP right now is in all
87 counties here in Minnesota and one of
the settings that SHIP works on is the school
setting. And SHIP is really out there to make the healthier choice
the easier choice. And so when working
with young people, SHIP is really kind of
focused on 2 key strategies, and one of them is the healthy
food, trying to increase access, increase health literacy
around schools, and ultimately reach our goals. Our goals are increasing fruit
and vegetable consumption, as well as decreasing
sodium levels, decreasing saturated fat,
and we’re also looking at trying to get rid of,
kind of incorporating more healthier whole items,
like Bertrand said. We have children today
that think carrots do just come
in a packaged container and they’re only
about 2 inches long, and so the other strategy
that we work on is really getting kids
in the garden, and so school-based agriculture and
incorporating Farm to School. They don’t know about
adult carrots. Right? They only know about
baby carrots. Right? And they do know carrots
could be purple! Right? And so SHIP, like I said,
partners with schools in all 87 counties here
in Minnesota. We know that SHIP, over
the course of time has hit approximately,
or somehow touched about 40% of our K through 12
population, and again, I’m just focused on the healthy eating activities
that SHIP helps support. But we also support some active
school initiatives, and so we really do them
in tandem because we want that connection between health and education
that’s so vitally important. Bertrand, I know one of
the things, this Farm to School that SHIP really focuses on–
do you get engaged with that
in the Minneapolis schools? So we started 4 years ago; I have a full-time Farm to
School coordinator that actually actively works
with farmers. Every year we do an RFP
in December and we contract forward with
farmers. This year we’re going to have 14 farms that we have
contracts with that some of them grow
entire fields just for Minneapolis Public
Schools. We mentioned food insecurity
and often said, well, it’s great,
all those new regulations, if kids don’t eat it,
then it’s not any healthier. And I think again,
we need to stay the course in introducing good food, it’s not just healthy food,
it’s good food. And kids do appreciate
good food. It’s a shift in how they’ve been
introduced to food in the past, but the course is about
introducing good food, and kids do like good food. You even changed the name
of the program. You’re not
the nutrition program, you’re the Culinary
and Wellness Services. Was that part
of the rebranding? The initial was culinary and
then last year we added wellness because it takes a lot more
than books and nutrition for a kid to be successful. Physical activity is a big part
of their well-being. So are kids eating this stuff?
That’s the question. (Bertrand) Yes, they are.
(Ed) How are you noticing that? Well, it’s interesting, since
the introduction of salad bar, we’ve actually seen
reduction in waste. And although we don’t have
a scientific way to measure it, we see reduction in food waste
in our trash cans. So by empowering kids
to take food and making the salad bars
really attractive, kids will take the food, and if they take it themselves,
there are exceptions, I’m not going to say that every
kid is going to load their plate and eat the whole thing,
but for the most part, what they put on their plates,
they will eat. So how do you educate? Part of
this is about health literacy. Are the schools and the culinary
arts trying to work together to educate kids
a little differently, and how do you do that? We only have about 30 seconds. Go ahead Bertrand. So in our department,
we make resources available for schools to teach their kids. We’re not in the classroom, but we provide all the resources
from Farm to School, to nutrition education
to specific class, we have a registered dietician that actually is available for
schools, to do presentations, she’s done presentation
to our athletic teams and kind of changed
the way they view food so that she can really
explain to them the value of whole foods. So ours is more the resource for
teachers and school students. We really just scratched
the surface, we just got
the basic ingredients, we haven’t started making
this great creation. This has been an interesting
conversation. Thanks for the work that you’re
doing and I look forward to the outcomes as we see,
as we bend the obesity curve and get kids
to live longer than their
parents, that is startling, so thanks for your work.
(both) Thank you. I’ll be back
with a closing comment
right after this message. (Asha Ida Bell)
It’s fine that other people
like you, it’s more important
that you like yourself, And I’m comfortable
with every part of me. Meals On Wheels
coming to my door as someone whose housebound assures me that I’m not
forgotten. They care that I’m okay. My name is Asha Ida Bell, America, Let’s Do Lunch! (woman) Drop off a hot meal
and say hello. Volunteer by donating
your lunch break at… In the last few decades,
diet-related health issues, including obesity
and related diseases like type 2 diabetes,
have surged. Data show that
unhealthy food consumption costs Minnesotans $2.8 billion
annually. In addition, 20% of families
with children face hunger or food insecurity
that also costs Minnesota $1.6 billion annually
in preventable direct and indirect health
and education costs. There is a growing consensus that Minnesota
can no longer afford an obesity rate of 25%,
a food insecurity rate of 11%, and the resulting economic and
health impacts on our society. Among the challenges
to providing good nutrition to everyone is the fact that
our food system is complex and every step from the growing
of the food to its consumption and even dealing
with its leftovers has many complex parts. And there are
often competing interests that make healthy eating
difficult. That is why a diverse group
of individuals and organizations came together to develop
the Minnesota Food Charter– a guide for policymakers
and community leaders in providing Minnesotans
with equal access to affordable, safe,
and healthy food, regardless of where they live
or how much money they make– access that not only improves the health and well-being
of residents, but that also significantly
improves the state’s economy. The Minnesota Food Charter shows
policymakers, community leaders, and individuals how they can
provide all Minnesotans with equal access to affordable,
safe and healthy food regardless of where they live. But that can only happen
if communities and partners from agriculture, business,
transportation, government, and education come together
and work for the common good. I have no doubt
that if any state in the nation
can do that, Minnesota can. And by doing that
we can achieve the goal of a prosperous, economically
vital food system that also promotes healthy,
affordable, food. We can make the healthy choice,
the easy choice. That’s all for today,
Thanks for joining us. I hope you can
join us again next time
on “A Public Health Journal.”

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