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Pat Crawford: Co-Founder and Director Dr. Robert C. and Veronica Atkins Center for Weight and Health
HC2020 Interview Summary
Interviewer: Andrea Bloom Date: March 20, 2009
Pat Crawford: Co-Founder and Director Dr. Robert C. and Veronica Atkins Center for Weight and Health, Adjunct Professor and Cooperative Extension Nutrition Specialist, Adjunct Professor, Department of Nutritional Science & Toxicology School of Public Health
1. Pat’s work
Pat has 25 years of Public Health/Epidemiology Experience. Studying factors of the development associated with the study of childhood obesity. In 1999 took on a new position at Center for Weight and Health. Opportunity to be dedicated towards implementing programs, evaluating programs, translating university information for the public, working to provide information to policy makers. Know what the factors are that contribute to obesity, now it is a matter of using the information in the community. Application of the science – very hard to do. Hard to make these changes happen quickly. We are moving in the right direction, but a slow process of reversing the trend. Will not get the randomized control trials, the science is trying to change as well, need different parameters and expectations in this new field. Beginning to see the benefits of the information being put to use in the community.
Focus on obesity, 70% of people are overweight. Pat has worked on programs to bring the information regarding interventions around weight control in the community. Creating information on best practices.
California – WIC – The Nations Largest nutrition program for low income women – vouchers are given to young low-income women during pregnancy, vouchers for healthy foods, good until the children reach the age of 5. Very significant state program that receives Federal funding to do nutrition education. Obesity initiative, bring obesity education into the nutrition education program. Worked with 5 different states, different methodologies. One of the barriers is that people did not want to talk about the word “obesity.” The staff hired to help to relate well with the client, ends up that the counselors had weight issues as well. Hard for a counselor who is overweight to counsel a young woman on these health issues – in a trap about who should be sending these messages. Focus groups with the staff – best way for the counselors to help was to start a work-site wellness program for the staff. The nutrition and weight education paid off in the counselors’ ability to positively influence the women they were counseling. California WIC has now instituted a very large wellness work-site program.
Legislative Task Force – one of the recommendations was to support work-site wellness programs for the state
Upcoming Obesity Conference June 9: schools, after school programs, marketing organizations, community efforts, policy players – group effort, experts from around the country.
Doing 20 different studies at Cal, research office off campus. The following are examples on current and past studies.
• Evaluating calorie labeling in Kaiser Hospitals. One of the roles of the center is to help push policy forward.
• California Endowment has supported a project with Food Banks and Food Pantries to help support healthier food selection. Providing technical support for these institutions, so many of the donations consist of foods that are not considered optimal for a nutritional balance of food.
• Examine what children are being served in childcare. HeadStart, Licensed institutions, non-licensed institutions, family day care, etc.
• Working in schools, USDA has a project in 3 states (IO, PA, CA) if schools receive Federal funding, the schools need to have a wellness policy, means that school districts need to put together a program. Big environmental change for the schools.
• Senate bill 12 and 965 – nutrition standards for food and beverages for K-12 schools – signed in 2005 and it was very controversial. Evaluating pre and post bill – first state in the country to have this type of mandate (no sodas, chips, candy).
• Large pilot study with DoE and DoA: perception that the schools would do worse financially without these food and beverages, but this was not reality. When the schools take out the bad foods and replace with healthy options, the kids spent money on healthy options and the schools did not lose money, the school food service actually did better than when the unhealthy options were available in vending machines. Going for free choice among the healthy foods, limit freedom to select from the healthy foods. Kids adjusted well, more feasible than anticipated. There was a perceived barrier to make this happen. Offering viable choices for children that are acceptable.
• Alice Waters – researching her programs in the Berkeley schools where students garden, cook and then eat the food they grew.
• Water survey – students at Cal surveying the water fountains
• Food Stamp Diet – students at Cal living on the food stamp diet and learning that it is hard to eat healthy on the food stamp allotment
TRENDS/CHALLENGES
2. How optimistic about future of health/healthcare in 2020?
Pat is an optimist by nature. Given all the movement that is going on the ground, in the groups and communities, eventually there will be normative changes
• Changes in social norms
• More regulation – the governor has been a proponent of this (e.g. foods in schools, PE, nutrition standards for children)
• Kids don’t learn to make good choices with bad choices available
• Modeling of physical activity, if a child sees her parent exercising then a child will more likely do it
• Good nutrition, will be analogous to immunizing your children – need to immunize children against chronic disease by offering a healthy diet
• It becomes like smoking – 5 things had to happen concurrently to put in motion the effort to stop smoking. In 1950 had the information on tobacco consequences – information is not enough. It took years later to make a shift: policy, medical providers talked about smoking with patients, limitation on the media
• People are beginning to look down on soda drinking similar to people looking down on smoking – the social norms are just starting to shift, a value association. E.g. Soda free summer campaign in Alameda. Starting to make the soda companies think about making new products.
3-4. Biggest trends or challenges & responses
• Health care reform – with a stronger prevention piece. Now we spend a lot of HC dollars on pharma and surgery – move those dollars over to prevention and won’t need as much pharmaceuticals and surgery.
• Transforming lifestyles will change when social norms change (kids to be active, kids to eat the right foods). The Obama administration is creating movement towards National Change – White House Garden
• Food companies need to be part of the solution
o Too many unhealthy options for children
o Food companies have lost sight of the big picture, looked at the nutrient level and have moved away from the source. Manufactured food for taste, shelf life, appearance to not be too expensive and include nutrients vs. pure food. Food companies are an able partner but working at the nutrient level. E.g. beta carotene was put into vitamin pills, but the trials showed that it did not help cancer risk it actually increased cancer risk, the trial was stopped – it is no longer in vitamin supplements, but beta carotene in carrots is very helpful for cancer prevention. Now we are learning about phytochemicals – these are found in foods and have health benefits beyond the vitamins. Healthy foods are all along the border of the grocery store, in the middle are the processed foods, companies looking towards increasing market share look to new products, these products are not contributing to the healthy options. Food companies need to rise to the occasion to meet the challenge.
o Candy and cupcakes has become pervasive and normative – this has to change. Too much frequency and availability. Sports drinks are not necessary for kids – kids need water and beverages that give them nutrients.
• Education – nutrition needs to be part of education, mandated nutrition education in curriculum, this policy impacts school children and it is critical for their learning. This type of education is as needed as the other parts of the cirriculum. Policy that impacts school children. Nutrition is now the most popular undergraduate class at Cal. People want this information. Needs to be institutionalized earlier in child education.
• Linking education with environment. Alice Waters’ approach. Modeling it in schools.
• Kaiser Permanente – committed and leading prevention, community efforts, operationalizing prevention, provide support to community projects
• California Endowment, another leading organization supporting communities to make the changes, has a vision to support communities to make changes, achieving success one task force at a time. $26m dollars directed towards childhood obesity in CA.
• Social movement for change
o Robert Wood Johnson Foundation - $500 million, largest donation ever for the cause, goal to reverse childhood obesity by 2025
o RWJF grant to fund Yale Center for Marketing to Children – protect children from this type of advertising. Marketing to kids is powerful, this needs to be addressed. Children are a vulnerable population and need to protect them.
5. Have these trends surfaced before?
Never happened before – obesity in children is new. Children have to be eating large amount of foods to get obese as they burn a lot of energy. The technology in foods have made food so dense that it has become much easier for kids to consume too many calories. We are at the tipping point – 1 in 2 Hispanic kids are going to get diabetes, 1 in 3 Americans to get diabetes. We have to come together to deal with this.
6. Challenges/responses not on radar now?
o Reponses – connection with environment and health. If people create less waste, then they might want to eat better – e.g. refillable water bottles vs. throw-away sports drinks.
o Given the high cost of food, people will begin the cook. Healthier options if cook and it could be less expensive
FUTURE SCENARIOS
7. Most preferable scenario
o Diverting the dollars to prevention
o Covered visits to dietician to provide nutrition
o Counselors in nutrition
o Counselors in strength training, avoiding osteoperosis
o Fitness training
o Food preparation
This will create innovation in prevention, this will decrease overall health care expenditures.
8. Most plausible scenario
It is plausible, some people in Congress are advocates for prevention. People are seeing the linkages, having the political will to bring this along. Need hard decisions on budget, will happen with the Federal Government. Need Federal legislations to set the baseline. States can make higher standards than the Federal government
9. Most negative scenario
o Economic recession drains the efforts of food/nutrition and PE programs. Hard hit, will lose some of the gains we have made. Won’t get that environmental change we are looking for.
o Poor education: people don’t understand the value of nutrition and health, the linkages of healthy food and prevention.
10. Wrap-up
Other people to interview
Tom Robinson– Stanford Pediatrician – very thoughtful visionary and looks at the environment
Alice Waters – visionary, well thought out, this has been her passion for years
Dick Jackson – MD, UCLA Visionary
Kaiser – Scott Gee MD, Lowel Solomon Health PhD – leading Kaiser’s efforts
California Endowment – Marian Standish JD
Ken Hecht – JD – Food policy expert, recent testimony to Congress