Reducing Obesity: Not Simple But Doable

Photo via k lachshand
Eating these is one way to reduce obesity.

James R. Knickman President & CEO at the New York StateHealth Foundation  asked the million dollar question in his Huffington Post piece, “What's Workingto Reduce Obesity?” In his post Mr. Knickman reveals that researchers from Drexel University studied a range of experiments aimed at reducing obesity, assessing how effective those strategies were. Researchers concluded that measures such as improving sidewalks and banning trans fats had strong impact but other approaches such as restaurants posting nutrition information had very little, to no impact.

So what does work to reduce obesity?

Mr. Knickman believes reducing obesity comes down to the following points:

- Better and more research will provide a better sense of the impact of various strategies reducing obesity in communities

- Different populations require different strategies so research can determine which approaches are most effective for high risk populations

- Seek out the economic and social benefits of interventions

- Success happens when communities and neighborhoods make it easy and affordable to be physically active and eat healthy foods, rather than one method such as banning trans fats

- All these healthy components add up to create “a neighborhood value, a point of pride” and becomes a part of the culture.

Mr. Knickman asks, “What is the best bang for your buck?” Here at the Bronx Health REACH Coalition we have launched the Towards A Healthier Bronx initiative using policy, systems and environmental improvements that increase access to healthy food, healthy beverages and opportunities for physical activity for over 75% of 675,215 residents residing in 12 high need South Bronx zip codes. Many public health campaigns rely heavily on clinical evidence, but fail to research the motivating factors relevant to that audience. To avoid this our campaign emphasizes actionable health behaviors.

Led by the Institute for Family Health, Bronx Health REACH was formed in 1999 to eliminate racial and ethnic disparities in health outcomes in diabetes and heart disease in African American and Latino communities in the southwest Bronx. Since then the Bronx Health REACH coalition has grown to include over 70 community-based organizations, 47 faith-based organizations, and health care providers. Bronx Health REACH serves as a national model of community empowerment demonstrating ways to build healthier communities by promoting healthy life-style behaviors.

The plan behind Towards A Healthier Bronx is:

- Increasing the number of bodegas and restaurants involved in incentive programs offering and promoting affordable healthy foods

- Increasing the number of farm stands making healthy food more affordable and available to the community

- Increasing the number of public and charter elementary schools emphasizing nutrition education and supporting related school policies

Partnering with bodega, deli and restaurant owners by providing them with training and education makes these initiatives not only a healthy benefit for their customers, but an economic benefit for the business owner. Encouraging chefs to attend monthly trainings on healthy food preparation results in offering patrons 2 to 3 healthier menu options. As New York City neighborhood demographics change, the restaurants and bodegas can now more easily adapt to the healthy choices their new customers are seeking resulting in those restaurant and bodega owners seeing more customers come into their stores and restaurants and gaining more revenue.

Mr. Knickman also states, “So if menu labeling isn't working for the target population--as the Drexel research and other studies suggest--we need to find and test other ways to make the healthy choice the easy choice.” Euny C. Lee, Evaluator and Policy Analyst at Bronx Health REACH agrees with Mr. Knickman citing a New York University study, “Calorie Labeling Has Barely Any Effecton Teenagers' or Parents' Food Purchases” which revealed that posting calories for food items at fast food restaurants had no impact on what consumer purchased.

Euny has moderated several focus groups with our faith-based coalition members to determine which types of messages encourage healthy behavior such as healthy eating and physical activity. Findings reveal educating the community about daily calorie intake to be important as most were not aware that you should consume no more than 2000 calories a day to maintain a healthy lifestyle.

Messaging matters as well. Signs and posters promoting a health benefit rather than a scare tactic elicit more positive behavior changes. Interventions have to be customized to a specific demographic/ethnic group so that it is culturally and linguistically understandable and appropriate. Other results include social support such as having a friend or family member who you are accountable to for your actions to reach the desired health goals.

Focus group members felt this ad was not accurate saying the soda bottle should be bigger and would be more effective if other ailments such as diabetes and heart disease that causes stroke were listed.

Focus group members felt the above ad was actually a real advertisement selling juice boxes and a better message would have been the child drinking from a water bottle.

But the question still remains. “What is doable in the fight to reduce obesity?” Bronx Health REACH can point to a few projects. A city wide campaign was created to serve only low-fat and fat-free milk rather than whole milk at New York City public schools. Bronx Health REACH educated policy makers, Coalition members and residents from the community about obesity and the benefits of reduced fat milk. This led to the New York City Public school system adopting the policy and impacting over 1.1 million children in 1,579 schools as well as a model for public schools in 15 other states.

I don't know if the day will ever arrive where the only thing one needs to do is take a miracle pill that sheds those excess pounds without any physical effort while drinking a large vanilla milkshake every day. What I do know is these healthy initiatives together will begin slowing the overweight/obesity epidemic we now face.

Over 20 Bronx Bodegas Participate in Two Day Healthy Bodega Initiative to Promote Healthier Food and Beverages

Bodega owners attending the Healthy Bodega Training.

Mitch Klein casually walked around the television studio housed discreetly inside Lebron's Restaurant Equipment and Business Machines store awaiting the bodega owners to attend the first ever, Healthy Bodega Training seminar. Mitch would be the trainer for the two day, nine hour sessions that were held on the evenings of Tuesday, August 4 and Wednesday, August 5. Getting to this starting point of the Healthy Bodega Initiative had been many months in the making. Launched by Bronx Health REACH, a program of the Institute for Family Health, in partnership with the Hispanic Information and Telecommunications Network, Inc. (HITN) and The Bodega Association of the United States (ASOBEU), the Healthy Bodega Training is a new and important part of the Healthy Bodega Initiative to address the obesity epidemic plaguing New York City’s most vulnerable neighborhoods.

This in-depth Healthy Bodega training was created to focus on business strategies, food handling and marketing/promotion practices. It is anticipated that the training will lead to an increase in the supply and demand for healthier food and beverages for customers by providing bodega owners with the tools and information to make offering healthy food and drink options a successful business in the high need, low income communities in which they are located. The training focused on best practices for becoming a H.E.R.O. bodega (healthy, educated, responsive, and operational). Topics covered included: the requirements of being a vendor for the SNAP and WIC programs, compliance with alcohol and tobacco vendor licensing, and appropriate responses to dealing with New York City agencies if a bodega receives a fine. The two day training was videotaped and will be accessible online through a password protected link.

Mitch expressed his confidence in the impact of this training. He said, "I have been doing trainings for forty years all across the country, and over the next two evenings I will be talking about how the small bodega can make a difference and compete against the big box stores. We have great success stories after doing similar programs in Miami, Orlando, and Philadelphia, and these bodegas can thrive and grow their business."

Mr. Ramon Murphy, who is not only the President of The Bodega Association of the United States, but has owned his bodega for twenty years noted, "I hope to see those bodega owners attending the training realize that they can have more healthy food offerings for the community. He went on to point out that “a partnership between bodega owners and the community can help to make the Bronx healthier."

While many bodega owners have been willing to participate in efforts to stock healthy food at the behest of healthy food advocates like Bronx Health REACH and others, many owners have not been able to succeed at selling healthy food because they lack the necessary information and tools to market and sell these healthy foods. The training not only provided much of the needed information, but plans are underway to develop and implement education and incentives to make healthy foods affordable and desirable.

The work is funded by a three year REACH (Racial and Ethnic Approaches to Community Health) grant from the U.S. Centers for Disease Control and Prevention (CDC). The Institute for Family Health/Bronx Health REACH is a founding member of ‘Not62 – The Campaign for a Healthy Bronx’, a new initiative, responding to the Bronx being ranked 62 out of the 62 counties in New York State by the Robert Wood Johnson Foundation’s County Health Ranking Report since 2009.

Just a few minutes past the scheduled start time the studio was filled with over twenty bodega owners taking their seats and donning headphones since most would need the presentation to be translated into Spanish. Mr. Murphy greeted the bodega owners and thanked them for taking time out of their busy schedule to attend the training. He spoke about how the Healthy Bodega initiative would not only be an economic benefit for their bodegas, but also a healthy benefit for the community. 

Prior to holding the training one of the stated goals Bronx Health REACH, HITN and the Bodega Association had was that the training should be practical and useful for the bodega owners. Following the two day training Julia Mair from HITN expressed how the Bodega Association Board members were excited about the fact that the Healthy Bodega training was useful and meaningful to them and the other bodega owners in attendance.

The feedback from the bodega owners was positive. Some of the bodega owners requested more training and expressed their willingness to participate in more training sessions since the topics discussed could be applied to the day to day work in their bodegas. Attendance for the second evening increased as some of the bodega owners brought in people who also worked in the stores. Those bodega owners felt that the information at the seminar was worth having others from their bodegas attend.

The Healthy Bodega Training seminar is a significant step towards offering the community a better selection of healthy food choices. As more bodega owners attend future Healthy Bodega Training seminars, the changes they make in their bodega will enable them to create sustainable practices that mean good business for them and the health for the community.

Does Soda Need a Warning Label?

Image from Public Health Advocacy website

The harmful effects of cigarettes have been well documented, requiring them to have warning labels on the package. With  recent studies revealing the harmful health effects, should soda also have a warning label? New York State Assembly Member Jeffrey Dinowitz and state Senator Gustavo Rivera believe so and have introduced legislation (Assembly Bill 2320-B& Senate Bill S 6435)  requiring that any sugar sweetened beverages sold in New York State have a warning labels.

The label would state:

SAFETY WARNING: Drinking beverages with added sugar contributes to obesity, diabetes and tooth decay.

The label would be affixed to any carbonated or noncarbonated sweetened nonalcoholic beverage that has seventy-five calories or more per every twelve fluid ounces. Warning labels would not be needed for beverages consisting of one hundred percent natural fruit juice or natural vegetable juice that does not contain caloric sweeteners. A larger sign/poster would be posted in places such as restaurants and any establishment that dispenses sodas.

California lawmakers tried to pass similar legislation (SB203) but the bill died in committee in April 2015. CalBev, the California arm of the American BeverageAssociation, argued against the California bill by stating that soft drinks are not “uniquely responsible for weight gain,” and added that affixing a warning label would not change behaviors or teach people about healthy lifestyles.

But contrary to what CalBev has stated, various studies have confirmed that a warning label for soda is warranted. The California Center for Public Health Advocacy (CCPHA) states in a factsheet, “An overwhelming body of scientific research shows that liquid sugar is uniquely harmful because it gets absorbed so quickly, and much faster than solid food. When sugar floods the bloodstream, it overloads the pancreas and causes the liver to store much of the sugar as fat – which leads to fatty liver disease. Both of these conditions contribute directly to diabetes. Research shows that drinking one or two cans of a soda a day increases the risk of developing diabetes by 26 percent.”

Nutrition experts agree that sweetened beverages, such as soft drinks, energy drinks, sweet teas and sports drinks, offer little or no nutritional value, and contain large quantities of added sugars. A 20 ounce bottle of soda contains the equivalent of approximately 17 teaspoons of sugar, whereas the American HeartAssociation recommends consuming no more than five to nine teaspoons of sugar daily.

In New York City the harmful effects of soda consumption are more acute. Providing testimony before the New York State Assembly Standing Committee on Consumer Affairs and Protection on April 13, 2015, Christine Johnson, Assistant Commissioner of the Bureau of Chronic Disease Prevention and Tobacco Control at the New York City Department of Health and Mental Hygiene stated, “In New York City, 56% of adults are overweight or obese and over 10% have diagnosed diabetes. Rates are even higher in New York City’s poorest communities, which also bear a greater burden of chronic disease.

Nearly a quarter of adults drink at least one sugary drink per day, and consumption rates are nearly double in New York City’s lowest-income communities compared to the highest-income communities, and over 40% of New York City public high school students report drinking one or more sugary drinks daily. The proportion of New Yorkers regularly consuming sugary drinks has declined in recent years; however, these rates are still too high.”

A studyfunded by the Healthy Eating ResearchProgram of the Robert Wood Johnson Foundation, and conducted by University ofPennsylvania, Harvard T.H. Chan School of Public Health and the University ofWaterloo asked 2381 parents to select a beverage from a simulated vending machine containing a variety of were sweetened and unsweetened drinks. The study revealed that those drinks with warning labels were three times as effective in making parents less likely to purchase a sweetened beverage. The warning labels also were effective among parents of varying educational backgrounds revealing that not just the most educated parents read the labels, but all parents read and considered the labels.

Assembly Bill 2320-B & Senate Bill S 6435 is important. Having that warning on soda labels means that each time a consumer goes to buy or drink that soda they would know of the danger to their health and hopefully, would put that soda down.  We know, however, that getting these two bills passed will not be easy. It will draw the ire and enormous money and power of the Soda Beverage industry to defeat it. The Bronx Health REACH Coalition knows how critical it is to reduce the overweight and obese epidemic in the Bronx  where 2 in 3 adults are overweight or obese, and where 4 in 10 public school elementary students are either obese or overweight. Efforts of our policy makers to make it easy for residents to make healthy choices is extremely important.

Should warning labels be placed on soda? Join in the conversation below.

El Diario Features Healthy Bodegas

Photo: Gerard Romo/El Diario

Hylonkys LaChapelle, owner of Gerard Minimarket is participating in the Healthy Bodega Initiative.

The January 30, 2016 issue of El Diario featured an article about the Healthy Bodega Initiative, a partnership between Bronx Health REACH, The Bodega Association of the United States (ASOBEU), and the Hispanic Information and Telecommunications Network, Inc. (HITN). The article featured the owner of Gerard Minimarket, a bodega that participated in the August training, and featured conversations with  Bronx Borough President Ruben Diaz Jr., ASOBEU President Ramon Murphy, and Bronx Health REACH Director Charmaine Ruddock.

Hylonkys LaChapelle, the owner of Gerard Minimarket located at 740 Gerard Avenue, Bronx, New York spoke of making changes to her bodega after attending the August training. She described re-arranging and moving the best looking apples and bananas to more prominent areas of shelf space.  The result is shoppers purchasing more fruits. “Now, two boxes of bananas (approximately 30 pounds of product) is sold in a matter of a day,” said LaChapelle.

Bronx Borough President Ruben Diaz Jr. spoke about the #Not62 campaign (the Bronx is ranked as the least healthy of 62 of 62 counties in New York State) and how those healthy bodegas that participated in the August Healthy Bodega Training will now be a “part of the solution offering healthy alternatives to their customers.”

Charmaine Ruddock, Director of Bronx Health REACH provided background on how the training program emphasizes the importance of including healthy alternatives at the deli counter such as low fat cheese and low fat mayonnaise in sandwiches, and water offered rather than soda.

You can read the full article here.

The next two- day Healthy Bodega Training will be held on March 8th and March 9th from 5 to 9:30 p.m. If you know a bodega in your community that would benefit from this training, please contact Zulay at the Bodega Association at (212) 928-0252.

Gada Dickerson - Doing All That She Can to Help Improve the Health and Well-being of Bronx Residents

As the Health and Wellness Ministry Chairperson for Thessalonia Worship Center in the Bronx, Gada Dickerson always had an interest in health; not just her health, but improving the health and well-being of others. Her mother and father worked in a hospital, so it seemed natural for Gada to pursue a job as a hospital nurse. She enrolled and graduated from a nursing program, but as fate would have it, her nursing career was not to be. After completing the nursing program a hiring freeze went into effect at New York City public hospitals, which quickly limited her options. As a result, she changed her career focus and, instead, pursued a health services administration degree.

When Gada began attending Bronx Health REACH meetings, she discovered that Bronx Health REACH offered various health programs at Bronx churches. In time, Thessalonia Worship Center joined Bronx Health REACH's Faith Based Outreach Initiative. This Initiative helps faith organizations – of all denominations – raise their congregations awareness of racial and ethnic health disparities; provide health programming around nutrition and fitness, and diabetes prevention and management. The first program launched at Thessalonia Worship Center was Fine, Fit and Fabulous. It was well received by the congregation with 20 church members participating in the program. Gada pointed out that the reason for the success was, “Our late pastor, Dr. Rev. Shellie Sampson, Jr. was a big supporter of maintaining a healthy lifestyle. He viewed obesity as a daily struggle, and allowed us to use the banquet hall whenever we needed it for our Fine, Fit and Fabulous classes. Our current pastor, Reverend Malobe Sampson is also a big supporter."

Following on Fine, Fit and Fabulous, Thessalonia Worship Center implemented the culinary ministry which provided information on selecting, preparing, and serving healthy versions of favorite meals at church events. "Our church provided traditional fare such as macaroni and cheese, fried fish, fried chicken, and collard greens which are not the healthiest options. A Bronx Health REACH nutritionist spoke to the church kitchen staff that had been preparing the meals, and eventually there were changes made that included using less fat and salt, offering fruit and salad at the start of the buffet table, and reducing portion sizes," Gada noted.

As a lifelong South Bronx resident Gada sees many health challenges faced by those living in the community. “When I go grocery shopping and see other shoppers filling their shopping carts with unhealthy items such as frozen pizza and hot pockets, I wonder, where are the fruits and vegetables? If you eat fruits and vegetables as a child, you will continue eating them as an adult. People have to make health a priority in their life.”

For now, Gada is focused on improving the health of her fellow church members. “Our church is always doing a healthy program, and since I am on various email lists, I am able to get Thessalonia Worship Center involved in a variety of health programs. Currently our church is doing blood pressure readings every Sunday for church members.” Whether it be at her church, or a #Not62 – Campaign for A Healthy Bronx! Town Hall event, you can be certain that Gada is doing all that she can to help improve the health and well-being of her fellow Bronx residents.