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[black small square] Team Approach to Treat Obesity


[black small square] Benefits to Breastfeeding


[black small square] Chocolate Milk?



The benefits of breastfeeding extend beyond providing basic nutrition for infants. A 2-part study published in The Lancet found that the practice could avert the deaths of more than 800 000 children and 20 000 mothers each year if virtually every new mother breastfed her baby. There are many health benefits associated with breastfeeding, including fewer incidences of colds and illnesses in children and a reduced risk of developing type 2 diabetes in mothers. Presently, about 20% of infants in high-income countries like the United States are breastfed for up to 12 months. This is compared with low- and middle-income countries, where only 37% of children younger than 6 months are breastfed. The importance of breastfeeding is recognized more in low- and middle-income countries than it is in high-income countries because there are often no safe alternatives. After reviewing 28 studies, researchers found that breastfeeding has dramatic effects on life expectancy. They claimed that in high-income countries, breastfeeding reduced the risk of sudden infant deaths by more than a third. And in low- and middle-income countries, breastfeeding reduced about half of all diarrheal episodes and a third of respiratory infections. Mothers' breastfeeding for more than 6 months seemed to lower the risk of dying of breast and ovarian cancer. The researchers suggest modifications in policies and breastfeeding interventions to improve breastfeeding rates. For example, breastfeeding rates in Bangladesh increased by 13% after the country implemented interventions that included 6 months of maternity leave, comprehensive health-worker training, community mobilization, and media campaigns promoting breast feeding. Those 6-month maternity leaves might also encourage more American mothers to breastfeed!


Sources: Victora C, Bahl R, Barros A, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 2016.


Victora C, Bahl R, Barros A, et al. Why invest and what it will take to improve breastfeeding practices? The Lancet. 2016.



Health disparities are common in industrialized countries, including the United States, but at what age those inequities take root and how they vary between countries are less clear. New research from the University of Washington compares the link between income, education, and low birth weight in the United States with those in 3 comparable countries: the United Kingdom, Canada, and Australia. Low birth weight is a primary risk factor for infant deaths and is considered a key predictor of health and socioeconomic status throughout life and across generations. The research, in the American Journal of Public Health, found that although low birth weight was linked to lower income and education levels in all 4 countries, the connection was most persistent in the United States. Researchers studied low birth weights among babies born to mothers in 5 income groups and with varying levels of education. In the United Kingdom, Canada, and Australia, disparities in birth weights were most pronounced between the highest- and lowest-income groups. But in the United States, birth weights dropped consistently with income level. Both national birth weight data from maternal reports and birth certificates in the 4 countries, as well as maternal education and income data from longitudinal studies, were examined. The researchers controlled for differences in marital status, infant gender, and mothers' race and ethnicity. They found that low birth weights-defined as 5.5 lb or less (2500 g regardless of maturity)-were highest overall in the United Kingdom (6.0%), followed by the United States (5.8%), Canada (5.5%), and Australia (4.8%). The data predate the Affordable Care Act in the United States; the other 3 countries have more generous healthcare and social support systems than the United States does. But the researcher Dr Martinson said that low birth weights in the United States are probably linked to factors beyond health insurance coverage, such as income instability, food insecurity, and residential segregation. The new study, she said, demonstrates that income and education matter more for health at birth in the United States than in other countries. Although the Affordable Care Act may mitigate low birth weight and other poverty-related health impacts, and rates have already benefited from advances in reproductive technology, dramatic decreases in smoking rates, and expanded prenatal care, lowering rates still further will take time.


Source: Melissa L. Martinson and Nancy E. Reichman. Socioeconomic inequalities in low birth weight in the United States, the United Kingdom, Canada, and Australia. American Journal of Public Health. 2016. e-View Ahead of Print.


doi: 10.2105/AJPH.2015.303007



Tackling the issue of childhood obesity in the United States is paramount because during the past 30 years, childhood obesity has more than doubled in children and quadrupled in adolescents. A new study makes a simple suggestion for launching the attack on this widespread epidemic: "water jet" machines (pretty much like water fountains!) placed in schools. It may sound simple, but "sometimes, a very simple intervention can have a powerful effect," write researchers in a related editorial to the study, which is published in JAMA Pediatrics. The researchers note that water is not only essential for human function, but also it prevents dehydration and is "critical to a nutritious diet." In addition, water provides a healthy alternative to sugar-sweetened beverages and high-calorie snack foods, which have been linked to obesity in children. The researchers explain that in 2009, New York City's Department of Health and Mental Hygiene and Department of Education introduced water jets into schools. The so-called water jets are large, clear, electronically powered jugs with a lever for dispensing water. Each of the water jets costs around $1000, and about 40% of schools in the area received a water jet during the study's duration, which ran from 2008 to 2013. The researchers wanted to assess the effect the water jets had on student body mass index (BMI), overweight, and obesity. They also looked at milk purchases. Although milk is promoted as a healthy beverage for children because it provides both calcium and vitamin D, it still contains food energy; for example, fat-free chocolate milk has 140 calories per 8 oz, low-fat chocolate milk has 158 calories per 8 oz, and full-fat chocolate milk has 208 per 8 oz cup. In total, the study included 1227 public elementary and middle schools, with over 1 million students. Of the schools, about 40% received a water jet and 60% did not. Among the boys, water jets were linked with a 0.025 decrease in standardized BMI units, a 0.9% reduction in the likelihood of being overweight, and 0.5% reduction in likelihood of obesity. For girls, there was a 0.022 reduction in BMI and 0.6% decrease in the likelihood of being overweight. The water jets were linked with a decrease of half-pints of chocolate milk students purchased. In detail, there was a decrease of 12.3 half-pints per student per year, which researchers attributed to students switching from it to water. What was not taken into account was whether there were other explanations, such as the proximity and availability of the water jets versus the milk dispensers. Also possible was that although the decreases in calories from milk might be desirable, declines in consumption also meant declines in calcium and vitamin D intakes, nutrients that many of these children may be falling short of. Although the study benefits from a large group of participants, the authors admit some limitations. They used administrative data on water jet delivery, rather than observing use in the cafeteria. Also, they used administrative data on kitchen milk purchases and therefore lack data on actual milk consumption. But nobody can quarrel about the need for potable water in schools and that this is a good idea that may contribute to weight management.


Source: Brian Elbel et al. Effect of a school-based water intervention on child body mass index and obesity. JAMA Pediatrics. January 19, 2016. doi:10.1001/jamapediatrics.2015.3778.



Believe it or not, the issue of whether to allow chocolate milk in schools has become highly contentious. Those in favor of allowing it like its contributions of calcium and vitamin D along with a package of other nutrients; those opposed are concerned about the calories and added sugars. So where does the evidence lead us? An Australian researcher has done an extensive systematic review of 53 studies on the effects of flavored milk versus plain milk on total intake of milk and nutrients in children. She concludes that there is no association between flavored milk intakes and weight status among normal-weight children and some mixed and contradictory effects of it on subgroups of overweight children. Flavored milk is a palatable beverage choice that helps children to meet calcium targets. Children drink more flavored milk than plain, and when the flavored milk is not available, they drink less plain milk and, thus, less milk overall. Although further research is needed to test the effect of flavored milk among overweight children, flavored low-fat milk has much to recommend it, even if, in addition to the sugar that all milk contains, it has calories as well from added sugars.


Source: Faye Moore. Effect of flavored milk vs plain milk on total milk intake and nutrient provision in children. Nutrition Reviews. 2016;74(1):1-17



Excessweight and obesityamong adults result frommany influences, including personal factors and environmental factors, such as the communities in which people live and government policies. It is now apparent that successful weight loss must include multiple strategies addressing each of these influences, and the expertise of registered dietitian nutritionists, according to an updated position paper from the Academy of Nutrition and Dietetics in its journal entitled "Interventions for Treatment of Overweight andObesity in Adults." It states: "It is the position of the Academy of Nutrition and Dietetics that successful treatment of overweight and obesity in adults requires adoption and maintenance of lifestyle behaviors contributing to both dietary intake and physical activity. These behaviors are influenced by many factors; therefore, interventions incorporating more than one level of the socio-ecological model and addressing several key factors in each level may be more successful than interventions targeting any one level and factor alone." The position paper updates the academy's 2009 position on this issue to include revised science-based weight management guidelines from the academy's Evidence Analysis Library, the American Heart Association, American College of Cardiology, and The Obesity Society. The "socioecological approach" included "provides a framework that proposes that multiple levels of influence can impact energy balance behaviors and weight outcomes." According to the position paper. "Levels of influence include intrapersonal factors, community and organizational factors, and government and public policies." The paper also claims that the most effective treatment of overweight and obesity requires a team of health professionals that includes a registered dietitian nutritionist. "As no one profession has all skills required for multi-level, multi-factor interventions, registered dietitians nutritionists need towork collaborativelywith other disciplines to effectively implement interventions." "Within these teams, the RDNprovides expertise in nutrition and utilizes evidence-based strategies that help individuals eat fewer calories andincrease their physical activity."


Source: Raynor HA, Champagne, CM. Position of the Academy of Nutrition and Dietetics: interventions for the treatment of overweight and obesity in adults. J Acad Nutr Diet. 2016;116:129-147.