ATLANTA - With childhood and adolescent obesity and overweight in the U.S. on the increase and attracting the attention of public health and other government organizations, the vending industry has come under fire as a purveyor of snack foods and soft drinks. A panel discussion entitled "Obesity and the Attack on Vended Food" addressed this issue during the recent National Automatic Merchandising Association National Expo here.
NAMA senior vice-president and chief council Tom McMahon led off the discussion by emphasizing that obesity is a complex and deep-seated problem. "Unfortunately and unfairly, the vending industry has been targeted. To come up with a comprehensive solution, we need to start with the facts," said McMahon. "This is not a debate, but a forum for learning about a serious problem in America and what our industry can do to help devise a solution."
He introduced Janet Collins, Ph.D., director, National Center for Chronic Disease Prevention and Health Promotion, Department of Health and Human Services, Centers for Disease Control and Prevention, who underscored the complexity of the obesity issue.
"Many illnesses, including heart disease, cancer and diabetes, have been linked to obesity," she explained; and obesity results from the interaction of personal choice, behavior and environment.
"It isn't only the vending industry's problem, or only the CDC's problem, but you are one of many industries that can partner with us to attack and solve the obesity issue," Dr. Collins told the audience. "I recently went to Hollywood to talk with writers of kids' shows; they wanted to heighten the story line to help stem obesity. Every industry that relates to kids can do something to help."
The health expert emphasized that, simply put, overweight and obesity result from the intake of more caloric content than is expended by conversion into energy. "It's not genetic; it's social," she emphasized; the dramatic changes that created the present problem have taken place over the past 20 years. "Obesity has become a nationwide epidemic over the past decade," Dr. Collins reported.
The number of overweight and obese children and adolescents has doubled since the 1980s, according to the speaker. The consequences of overweight and obesity in kids can be detrimental, not only in the short term but throughout an individual's entire life. The condition impedes psychosocial development and leads to increased risk of heart disease, as well as abnormal glucose metabolism.
The latter is especially troubling. "A diabetes epidemic is going right along with obesity," said Dr. Collins. What once was termed "Adult Onset Diabetes," which manifested itself at age 40 or 50, is now called "Type 2" diabetes, because more and more people develop the disease in their teens. The speaker added that adult obesity usually is far more severe and persistent if in begins in childhood.
What has given rise to this new public health problem? Two obvious contributors are trends toward altered dietary intake and decreased physical activity.
Dr. Collins cited an increase in fast food consumption, reduced frequency of family meals, increased consumption of soft drinks and increased portion sizes as contributors to America's growing waistline. Mealtimes have become shorter and spottier, and there is a trend toward skipping meals, she added; "If kids skip breakfast, they're likely to make up for it later by consuming many more calories." And with 30,000 products lining supermarket shelves and multi-million-dollar marketing campaigns to back them, food , but usually not fruits and vegetables , is much more visible and prominent now than ever before.
"The combination of all these factors underlies today's weight issues. There's no proof that it's any one factor, but this food environment is clearly playing a role," stated Dr. Collins.
Compounding the problem has been a growing trend toward balancing school budgets by reducing or eliminating physical education programs. And adults who find themselves increasingly pressed for time might have once taken 20 minutes to walk to a destination less than a mile away, but today opt for the speed and convenience of a car.
Parental concerns over safety also may play a role in decreased physical activity among school-aged children. "When we were kids, it was okay to play outside with a bunch of friends until dark. Parents today would rather have their kids inside and safe than running around the neighborhood, out of range of their watchful eyes," Dr. Collins pointed out.
Increased hours spent watching television, and the accompanying curtailment of physical activity, is another obvious culprit contributing to obesity. Dr. Collins reported that, in the late 1960s, 12- to 17-year-olds watched two to three hours of television per day, at most. In 1990, that figure soared to five-plus hours.
"Studies show that the more television youngsters watch, the more likely they are to be obese due to lack of exercise, lots of snack food eating, and watching commercials that promote food," said Collins. "During kids' programming, 60% of the commercials are for food , and it's not fruits and vegetables being promoted."
Given the complexity of the issue, it's clear that it will take a team effort to combat the rising incidence of obesity. Medical professionals, schools, workplaces, and community organizations are banding together to come up with a comprehensive solution, Dr. Collins emphasized. Vending operators can join these efforts too, and many resources are available to help them do it.
The speaker said that some schools promote "walk to school" programs, for instance, and others impose "TV turnoffs" to reduce sedentary viewing hours. Vending operators can play a role by supporting or spearheading initiatives like these at the schools with which they do business.
As vendors are well aware, more comprehensive school-based interventions include restricting competitive foods during meals, eliminating certain products from vending machines and limiting the hours of operation of vending machines, Dr. Collins added. Of course, operators do not set school policy in these regards, but conform to the wishes of the location.
The speaker noted that while 50% of elementary schools, 75% of middle schools and 100% of high schools have vending machines, only 56% of them sell juice. And, while 45% of vending machines that vend milk offer 2% or whole milk, only 24% provide 1% or skim milk.
"One recent school study showed that if you reduce the price of fruit and vegetables in the cafeteria, comsumption of those items goes up," Dr. Collins reported. "Is it possible to promote flavored low-fat milk, water, pretzels, yogurt and fruit in vending, perhaps at a low price? Maybe it's something to consider."
An audience member asked the public health expert just what items she considers "healthy" foods.
"It's not so much a matter of 'healthy' or 'not healthy,' but we have a list of what's preferred," the speaker replied. Given the average American lifestyle today, she instanced, 1% milk usually is preferable to 2% or whole milk. Pretzels are preferable to potato chips, because they contain no fat. "Look at sugar and fat content, and consider options that are not all high in salt or sugar. You can get very creative if you think about it," she suggested.
Next to speak was Dick Elder, senior director of the International Food Information Council, who agreed with Dr. Collins that the challenge is real, substantial and stubborn. "Obesity is a big issue, and it's getting bigger," he said. "It will change a lot of our lives before there's a solution."
IFIC's mission is to communicate science-based information on food safety and nutrition issues to heath professionals, the media, educators and government officials. IFIC has established partnerships with a wide range of professional organizations and academic institutions, and is supported primarily by the many sectors of the food, beverage and agricultural industries.
With childhood obesity at the top of its agenda, IFIC conducted more than two years of consumer research to determine how 9- to 12-year-olds, their parents and their teachers think about food, physical activity and health. The findings revealed that kids are not sure what "being fit" means, nor how to go about achieving personal fitness.
"More alarming is that a great many parents do not see overweight as a health issue; they believe the child will outgrow it. They often lack the information and skills to discuss the problem with their kids, and they're not necessarily good role models," commented Elder. "We have a big job ahead of us."
Teachers who participated in the study reported observing the impact of overweight on self-esteem in school, and believe change must begin in and be supported by the home.
To make this happen, IFIC has concluded that fitness and healthy eating must be redefined. Kids must perceive a healthy lifestyle as fun and "cool," while their parents need a program that is quick, easy to use and credible, the speaker observed.
The result is the "Activate" program (see sidebar, Page 18), the centerpiece of which is a website , kidnetics.com. The site is designed to be fun and engaging for kids and quick and easy for parents to use; to encourage dialogue between parents and youngsters and, above all, to promote physical activity and good nutrition.
"Obesity is an evolutionary problem," Elder observed. Today's society, characterized by a high standard of living and convenient, year-round availability of all kinds of food to an unprecedented number of people, is a new phenomenon. The present may the first time in history that obesity is a society-wide problem, Elder said; never before have so many people been obese.
Over the past decade, obesity has clearly become a public health challenge that has spread nationwide. While deaths supposed related to tobacco use are declining, obesity-related deaths are rising at such a rate that the two trendlines soon may cross, the IFIC senior director reported.
Especially alarming is the rising rate of childhood and adolescent obesity, with the number of overweight or obese children in the U.S. up 50% since 1991. A staggering 25% of children in the U.S. are overweight or at risk for becoming overweight, and 60% of overweight children ages 5 to 10 have at lease one risk factor for heart disease. Elder cited the December 2001 issue of the Journal of the American Medical Association, which stated: "Overweight is the most common health problem facing U.S. children."
The encouraging news is that at both the federal and state levels, governmental entities are tackling obesity head-on with a series of initiatives and task forces (See sidebar). Elder cautioned, however, that the vending industry's purported role in contributing to obesity will continue to be a topic of discussion as organizations set forth to devise a solution. Operators should do all they can, he urged, to emphasize the valuable part vending can play in implementing a solution to obesity, as opposed to contributing to the problem.
A "Healthy Schools Summit" was held this October in Washington, DC, with representatives from schools across the country convening to devise a game plan for addressing the obesity issue. Elder noted that, while 32% of states recommend schools include fruits and vegetables among the foods offered in vending machines, none require it. For after-school feeding programs, 50% of states recommend that schools include fruits and vegetables, but only 4% require it; and for a la carte school foodservice during breakfast or lunch periods, 43% recommend fruits and vegetables as part of the mix, while none require it.
According to Elder, those attending the Healthy Schools Summit want to see all of those requirements go up to 100%; and vending operators should be thinking along the same lines, he suggested. Being proactive can put the operator in the vanguard of a change that certainly is coming, while building goodwill.
Other recommended actions discussed at the Summit included adopting policies to ensure that all foods and beverages available on school campuses and at school events contribute to eating patterns that are consistent with the Dietary Guidelines for Americans, issued by the U.S. Department of Agriculture and U.S. Department of Health & Human Services. School administrators also discussed providing choices that are low in fat, calories and added sugars, such as fruits, vegetables, whole grains and low-fat or non-fat dairy foods; and ensuring that "healthy" snacks and foods are provided in vending machines, school stores and other channels under the school's control.
Another hot topic at the Summit was prohibiting student access to vending machines, school stores and other outlets that purvey foods of minimal nutritional value and compete with healthy school meals, in elementary schools; and restricting student access to such products in middle, junior and high schools. Elder added that other discussions during the conference included proposals to impose restrictions in advertising on vending machines, and even taxing high-calorie, low-nutrient foods.
He emphasized that tackling obesity is a top priority for the American Cancer Society, American Diabetes Association, American Dietetic Association, American Heart Association, American Medical Association and American Public Health Association. And the news media have dramatically increased their coverage of obesity in recent years, moving the problem toward the center of public awareness. This is all the more reason vending operators must take part in finding and deploying a solution, before the decisions are made for them.
Elder concluded by stressing that obesity is "top of mind" in the medical and health profession, public policy, health insurance, consumer advocacy groups, health educators, food and beverage industry and the media. "It's a very complex issue and everyone has a role to play. If you're not helping push with your interests in mind, you can be sure someone else is pushing the other way," he warned.
Nancy Quinn, vice-president of Chartwells School Dining Services, offered an operator's perspective on the question of obesity and American youth. Chartwells, a division of Compass Group, provides dining services in 500 school districts, including 3,000 individual schools
"Obesity is not a new issue, but it's certainly in the forefront," said Quinn. "Everyone doing foodservice in schools needs a nutrition education program, and ours has been very successful so far."
For grades K-6, the company created "Pyramid Pete and the Creatures" , a group of friendly, colorful dinosaurs , with each creature communicating a different message about food choices. The program consists of monthly promotions, posters, contests, games and an educational video for faculty. Quinn added that all of the company's beverage vending machines in elementary schools feature milk, bottled water and juice.
For grades 7-12, Chartwells promotes "Healthy Bodies, Hungry Minds," to help students identify better-for-you foods. As part of the program, Chartwells features a "celebrity chat board" in the student dining rooms, a bulletin board that communicates a lifestyle message from top teen celebrities and provides accompanying brochures relating to the topic.
"Kids today are much more exposed to the retail food environment, so we pay a lot of attention to food presentation, quality and choices, to encourage them to eat a well-balanced meal," said Quinn.
She added that, since foods of minimal nutritional value are prohibited from sale during meal hours, Chartwells focuses on offering items in its vending machines that do not fall into that category. "We have to help the customer make the right choices. We're proud of our efforts, but there's still a long way to go," she emphasized. "With the rising attacks on vended food and restrictive competitive foods policies, we need to get involved. Tackling obesity is about eating a variety of foods, making the right choices, and striking the right balance with physical activity. We have to do our part to educate the children, the teachers and the parents."
FOOD MANUFACTURER'S TAKE
Speaking on behalf of leading snack supplier Frito-Lay, Bob Brown, group manager, nutrition and regulatory affairs, emphasized that the company is concerned about obesity and doing its part to get to the heart of a solution. "I've worked in health and nutrition for 20 years and so much of it is about parents dealing with it in the home. We're talking about five hours in front of the television and we're not even seeing the data on the impact of Internet and computer use on physical activity," he said. "Nancy [of Chartwell's] has a great program; talking to kids in terms they understand, and using role models and characters. It's important to get the message out."
He added that Frito-Lay is doing its part by removing the trans fats from its core salty products by eliminating hydrogenated oil and converting to corn oil. "We're working hard to develop healthier choices," he commented. "We're developing food choices , like 'Cheetos Reduced Fat' , and the next step is working to get the kids moving towards them."
Frito-Lay supports the "Activate" program, and Brown sees the program as major a step in the right direction towards a solution. "With federal and state government and school PTAs and media targeting vending, we need to be in the forefront of dealing with obesity and we need to offer choices. And we need to give the kids the education so they can choose healthier options."
According to Brown, Frito-Lay has partnered with the American Heart Association and Colorado on the Move to promote the value of aerobic exercise for a healthy lifestyle. "It will take a lot of collaboration, and everyone in the industry should understand that it's an issue we all have to attack," he emphasized.
"Obesity is a question that will be with us for years or decades to come, and NAMA will have many more seminars devoted to being part of a solution," added McMahon.
An audience member asked McMahon what he thinks the chances are of a tax being imposed on snack foods.
"At the federal level, no chance," the NAMA chief counsel replied. "At the state level, we have seen taxes on snack foods; most were enacted in the early '90s and later repealed. But with the anti-'junk food' mentality, there may be a good chance that we'll see snack tax initiatives. We don't think that's the answer; taxing salty snacks isn't going to get people to stop eating them. But I can imagine tax proposals at the state level. That's why NAMA has lobbyists. It's something we have to watch carefully."
A spokesperson for Masterfoods attending the seminar added that there is a lot that suppliers can do in partnership with existing causes to battle obesity. "We support 'Activate' and Colorado on the Move, and we're working with the Centers For Disease Control. We're looking for guidance to be responsible marketers and, at the same time, to give consumers what they're looking for," she noted.
Speaking from the audience, industry veteran Morris "Tiny" Weintraub urged operators to participate in government affairs at the local and state legislative level. "You have to give some time, and get involved politically," he emphasized. "You can help come up with exercise programs, get parents involved. If you don't get involved in being part of a solution, you'll lose."