Fighting Obesity

Hold the Fries

By Barbara Fischkin

coverCUNY experts are gaining national attention for ideas on ending America's obesity crisis -- starting with healthier food in schools.

Healthy-food advocate Janet Poppendieck talks with student Igor Pikaliak and college lab technician Winnifred Johnson in a Kingsborough Community College training kitchen.

FAST FACTS In New York City, the statistics are startling and confounding. * 47% of households with children had a difficult time affording food in 2009. * 70% of food pantries and soup kitchens served more children this year than last. * 40% of children in grades K-8 are overweight or obese. Typically, the obesity epidemic has hit underprivileged neighborhoods far more intensely than prosperous ones. * New York City schools serve meals to more than 860,000 children. * To address this issue and recommend solutions, a report on improving food in the city's schools was issued in August by the Projects for Healthy Public Polices at CUNY's School of Public Health at Hunter College and City Harvest.

The report is available at http://web.gc.cuny.edu/che/NYCSchoolFood.pdf

Michelle Obama needed help. Seven hundred of the best chefs in America were heading to a meeting in Washington -- and then the White House -- to brainstorm over what they could do to help fight the national epidemic of childhood obesity. With 7 billion breakfasts and lunches a year served in public and private schools in grades K-12 and supported by federal funds, change could happen if these chefs, who know food and nutrition so well, also understood the culture of schools.

The chefs had been asked to "adopt" schools throughout the country where the challenge would be to revamp the meals to include fresh fruits and vegetables and other local ingredients "cooked on the premises" -- and to educate the children about the connection between health and food.

But change is hard and the chefs needed to know what they would be up against. So Share Our Strength, a national organization focused on childhood nutrition, summoned Hunter sociologist Janet Poppendieck, author of the acclaimed book, Free for All: Fixing School Food in America.

In June, Poppendieck stood before a sea of chefs in white toques and jackets. There was much for them to consider: Principals are overloaded with school-meals paperwork; food-service workers feel undervalued; custodians, beleaguered. There would be many teachers who would welcome the chefs into their classrooms for lessons on food and cooking. But teachers, she added, also need to budget their time so that they cover material on which students are tested. And students are not tested on their cooking skills.

Then, of course, there are the students themselves. How do you get them to even try "strange," but good food? Schools, in serving subsidized and partially subsidized meals -- as well as a la carte items they sell to help balance their books -- often have to sacrifice health for familiarity so that students will not reject what is offered.

As for parents, Poppendieck said some would welcome the chefs but "unfortunately the schools in which your 'chef-ness' is most likely to inspire parents are probably not the schools that most need your intervention."

William Telepan, chef and owner of the eponymous Telepan on Manhattan's Upper West Side, was among those who heard Poppendieck speak.

"I remember being mesmerized by Jan's speech, the way she broke it down," he says. "She made it very comprehensible, the severity of the problem and how we must help."

PoppendieckTelepan leads New York City's "Cook For Kids," which serves 6,500 children, introducing them to healthy food in their schools. Under Obama's program he will also "adopt" two schools with a total of about 2,000 students -- one in Manhattan, which his daughter attends, and another in the South Bronx.

"It doesn't matter that kids are bombarded by too much junk on the outside," the chef says. "We should take this as a responsibility to help teach these kids about healthy food and give them healthy choices while they are in school. Why should they get junk all the time? And remember, kids get 50 to 80 percent of their daily caloric intake from school. So, that shows you we can make a difference."

Poppendieck, who was awarded this year's Outstanding Book Award from the Association for the Study of Food and Society, is a key resource in nationwide efforts -- now led by the First Lady -- to eradicate obesity within a generation. The professor's cri de coeur is to make healthy, tasty school food free for all -- and a part of the curriculum so that the next generation embraces a better way to eat.

Currently children who qualify economically receive free or reduced-price meals, creating in many schools not only a segregated lunchroom atmosphere, but so much bureaucracy that for many schools it might ultimately make more sense to provide all the meals for free, she says.

In scores of schools in Philadelphia this is exactly what happened. In the 1990s, as part of a federal pilot project, free meals were offered to all students in 144 out of 272 schools in that city. Thousands of hours of staff time was saved and printing and money handling costs were reduced. Perhaps most significantly, high school student participation rose by 186 percent -- and some participating schools still offer free meals to students today.

Poppendieck, who details this pilot project in her book, does concede that it could cost an additional $12 billion a year for universal free school food to become a reality. But she notes that in dire circumstances money can be found: "The 'bailout' funded in response to the banking crisis would have been enough to pay for a conversion to universal free school meals for more than half a century."

There are other crucial benefits to be reaped if schools succeed in teaching children to eat better. For example, medical costs for obesity-related illnesses are currently estimated to be about $147 billion a year, with $14.1 billion for children.

Money issues aside, Poppendieck is adamant that food should be varied, creative and interesting. Asked about some dishes she would like to see in school meals, she suggested vegetable chili and whole grain corn bread. She is also a loyal fan of the wide variety of healthy food available throughout the five boroughs, so much more appealing than the fast, overly processed fare consumed by so many.

MachucaAs for that fast food, Poppendieck admits that she herself has been tempted by the seemingly wholesome old-fashioned aroma of an airport Cinnabon. But that aroma, she says, is deceptive since it comes from a fat- and chemical-laden product -- and the classic Cinnabon has 880 calories. Even the "Minibon" has 350 calories, more than three times the amount of a typical apple. Not, Poppendieck says, the kind of fare that should be served in schools, although she did visit one in California that had Cinnabons on its a la carte menu.

At CUNY, Poppendieck is one of many, including more than a dozen professors, who are working to help people at the University -- and in the community, country and the world -- eat healthier, with more environmental consciousness, and exercise more. At the University this has become a focus of teaching, research and public service. And there are more initiatives at the colleges including nutritional counseling and support and exercise groups.

According to a 2005 report in the New England Journal of Medicine, unless current trends in obesity and diabetes change, our children and grandchildren are likely to have shorter life spans than the current generation, reversing more than a century of public health progress. Unfortunately, little headway has been made since that study. In August, the United States Centers for Disease Control reported that more than a quarter of American adults were overweight and that the obesity rate had increased by 1 percent in 2007.

In September, the New York City Department of Health reported that 40 percent of New York City children in kinder-garten through the eighth grade had been found to be overweight or obese in the 2008-2009 school year, with no decline from the previous year.

In regard to the obesity-related illnesses causing those astronomical medical costs, at least one-third of all children born in 2000 are expected to have diabetes at some point in their lives. Diabetes is among the most serious health problems caused by obesity and many children are now contracting a form of the disease once only seen in adults. Asthma, heart disease, high blood pressure and cancer are also linked to obesity.

Researchers

In addition to the campaign to educate students and encourage better eating, researchers at the University are also trying to find out what causes obesity and how it can be cured.

Among those working on the problem are Kathleen Axen, a Brooklyn College professor of health and nutrition sciences; Hunter associate professor of public health Ming-Chin Yeh; Diane Gibson, an associate professor of public affairs at Baruch College; and also at Baruch, Angela Marinilli Pinto, an assistant professor of psychology. That these scholars work in three different areas is significant; the puzzle of the epidemic appears to demand that. Or, as Distinguished Professor of Public Health Nicholas Freudenberg says: "CUNY has a wide cross-section of disciplines and perspectives. If we are going to be successful in addressing obesity, we'll need an interdisciplinary approach."

PintoAxen is studying obese rats, which are fed purified laboratory versions of the food we eat, to determine the effectiveness and safety of very low-carbohydrate weight-loss programs such as the Atkins Diet. Many individuals have lost a great deal of weight, oddly, by limiting carbohydrates but not such food choices as juicy steaks, butter and real ice cream. Some on this diet have eschewed carbohydrate-packed beer for white liquors such as vodka and gin. Could this be healthy?

Axen, who has written three papers on this topic and awaits additional data, started experiments on more rats this summer. Her research so far has shown that "taking in more fat does not make you burn more fat away." While it may not show on an individual's physique, "it stays in your liver and in your muscle," she says. She adds that "even when rats lose weight on the very low-carbohydrate diet, they don't show the improvement in diabetes risk factors that rats losing weight on a high-carbohydrate one do." She adds that her research has not been conducted without some protests from the industry that has sprung up around Atkins-like diets.

"There are some researchers who have conducted studies on humans, prescribing the Atkins-type diet and have reported promising effects," says Axen. "Often the studies overstate their findings since they can't document what and how much people ate, that is, whether subjects consistently followed the regimen and whether the effects simply came from eating less in contrast to whether the diet had 'special properties' that let you eat a lot of calories but still lose weight." Critics of Atkins-type diets have said that since there is less variety of food, people eat less and lose weight. Proponents said that the diet sparks a chemical reaction in individuals that enables them to burn fat more efficiently. Axen has a $471,000, four-year grant from the National Institutes of Health for her work.

In another laboratory, at Baruch College, where the only equipment is a professional digital scale, Pinto is also looking at diet but in a different way. In a study that appears to be the first of its kind, she is evaluating the clinical and cost effectiveness of an approach that combines University-based behavioral weight-loss treatment with a commercial weight-loss program. A total of 144 overweight and obese adults, ages 30-65, are enrolled in this study and were randomly assigned to one of three different programs for one year. There will be a follow-up six months later. In one model, subjects attend a traditional Weight Watchers program, in another they are part of a University-based program led by a behavioral psychologist -- Pinto herself in this case. In a third, innovative model, a group begins with Pinto and then moves into Weight Watchers to determine if transitioning from one program to another will work. This research is in keeping with a trend to evaluate commercial diet programs using scientific methodology.

While the programs deliver similar messages for losing weight through balanced nutritional and lifestyle changes and physical activity, there are differences in how they are structured that may impact outcome.

"The training of the leader, or leaders, is different in each model, which may have implications for effectiveness and cost," says Pinto, who studied eating disorders earlier in her career. Another difference is that in the University-based program participants attend group meetings with the same people each week while Weight Watchers meetings are open so members may change from week to week.

GibsonPinto's research is funded by a $640,000 four-year grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health and she expects to have some data available in the spring. Diane Gibson, Pinto's colleague at Baruch is examining obesity through a public-affairs lens, focusing on the most affected communities -- the economically disadvantaged. This is also an issue which one of Ming-Chin Yeh's students studied under his guidance; that student's work has been cited in Michelle Obama's report on childhood obesity. Gibson has been trying to find out why women often gain weight when they use "food stamps," subsidies now provided by the federal Supplemental Nutrition Assistance Program. The program now allocates these subsidies to about 40 million individuals a month, although generally people use much of their own money for food as well since the average monthly benefit is about $125 per person.

Gibson has also found that young daughters -- but not sons -- of women on food stamps often gain weight. She thinks this might be explained by the fact that mothers seem to be more controlling about the foods their daughters eat, which can backfire and result in increased calorie consumption.

Gibson's studies, which used longitudinal data going back to 1979, may in one sense be emblematic of the entire obesity issue since there are more questions than answers.

"The public policy person in me would love for there to be easy fixes," she says candidly. Instead she is enmeshed in an area in which conventional wisdom often does not hold up under scientific scrutiny. And scientific findings differ. Gibson's work doesn't support a common belief supported by other research that neighborhoods with supermarkets -- and the accompanying fresh produce they sell -- reduce the incidence of obesity, as opposed to neighborhoods with only delis and bodegas. "Even if you live in a disadvantaged neighborhood without a supermarket almost everyone gets to a supermarket to do their shopping," she says.

FreudenbergIt gets even more complicated, says Gibson, since ZIP codes or census tracts are often, for convenience, used to define neighborhoods. But residents may use different guidelines in viewing the boundaries of their neighborhood. How can researchers accurately determine if residents have neighborhood supermarkets if they don't know where the neighborhood begins and ends for the people who live there?

With this in mind, Gibson hopes to take a crucial step back and examine whether the way a neighborhood is defined influences research results. With her interdisciplinary leanings playing a role, Gibson will publish a paper next year on neighborhood food environment and adult weight status in the American Journal of Public Health.

Gibson says she wishes she could use her research to explore whether people gain weight because they buy unhealthy items on food stamps. But her data do not have the details to test this explanation.

"Food insecurity may produce disordered eating patterns," Gibson adds, referring to large swings in calorie consumption that occur when funds are available for food after a period of limited resources.

Individuals who have not had enough money for food for a while may make inexpensive but unhealthy choices. "This disordered eating may account for obesity and not food stamps per se," she says. She adds that food stamps, though, are a way to study people most affected -- and examining the "family food and activity environment" is vital. Food insecurity is also in the forefront of much of Poppendieck's research.

Gibson poses the question of whether restrictions should be placed on the food people can buy with the stamps. It's understandable that people can't use the stamps for alcohol or tobacco, but Gibson questions whether restrictions against some foods are useful. For example, stamps can't be used to buy a ready-to-eat meal, Gibson says, while a potentially far less healthy microwave meal that does involve the heating of ingredients could be purchased. Nicholas Freudenberg, Distinguished Professor of Public Health at the new CUNY School of Public Health at Hunter College, is one of the leaders of the effort to end the obesity epidemic. "Our faculty is engaged in research on obesity at every level -- from animal studies on fat metabolism to evaluation of community and school programs to analyses of local, national and global food policies," he says. "And as the university that trains more teachers, nurses, social workers, nutritionists and public health professionals than any other institution in the region, CUNY can prepare the work force needed to bring obesity under control."

Throughout the University professors and students -- and their courses, workshops, research studies, advocacy projects and counseling groups -- are bringing slow but real change. The University's cafeterias are beginning to address complaints that healthy food in their facilities is both too expensive and too hard to find. Walking groups for exercise are being formed and more posters now urge people to burn extra calories by taking the stairs. At Queens College, students are lobbying for more healthy choices in vending machines. And these choices do exist. For example, the baby-carrot industry recently unveiled its own vending machines Iris Mercado, who teaches health education and nutrition at Hostos Community College, leads a group, Healthy Weight. "One day that you overeat does not erase everything that you have done for three or four months," the assistant professor recently told the group's members. And she has some tips, too: Fill up on some plain yogurt or skim milk before a party, for example. "And remember," she adds, "a pina colada has more than 600 calories. A rum and Diet Coke? Only 150."

Obesity Today

In the United States, the rate of obesity doubled between 1980 and 2000 and according to federal statistics, continues to rise.

While adults in New York City have slightly lower rates of obesity than elsewhere in the United States, children here are obese and overweight at higher rates -- nationally the rate is 35 percent. In addition, obesity is increasingly concentrated in the city's poorest neighborhoods, where healthy food is hard to find and opportunities for physical activity are more limited.

BMI, or body mass index -- although an imperfect indicator because it doesn't look at muscle or the lack of it -- is the way in which obesity rates are currently measured. According to the National Institutes of Health, BMI is "a measure of body fat based on height and weight that applies to adult men and women," while in children BMI is measured by comparing children to others of their age and gender.

Although there are many theories about how and why the obesity epidemic has occurred, it remains open to intense debate. Most experts agree that multiple factors contributed to the increase and hence there is no single remedy. The numerous ones purported to work range from the most invasive of bariatric surgeries -- a trend which concerns many public health officials -- to generally slow, steady commercial weight-loss programs, like Weight Watchers and others that are free such as the Healthy Weight groups at CUNY.

Freudenberg was asked why there are no solutions that really work. Why isn't there a pill to fight fat?

Obesity, he explains, has so far defied solution because it occurs as the result of "an immensely complicated process involving a wide range of body systems, including metabolic, immune and psycho-cognitive."

The veteran public health professor adds that we live in an "obesogenic environment," overflowing with advertising directed at young people who have too much readily available fast food and not enough opportunity for physical activity. As an example, he cites Hardee's which, when it determined its sales were the lowest among fast-food chains, created a new bacon cheeseburger targeted to tempt young men. Freudenberg says that advertisements for Mountain Dew have been directed at young men, as well -- African Americans in particular.

Soda, generally, is believed to be a major cause of obesity. Its consumption has increased sharply in recent decades and its effect is not only due to the extra calories in the sweetened drinks. Carbonation, according to some experts -- even in diet soda -- fools the body into believing it is hungry when it isn't. According to the Mayo Clinic Women's HealthSource, artificial sweeteners in diet drinks may actually increase sugar cravings. In August the publication, which examined various studies on the health effects of soda, linked it not only to obesity and diabetes but other health problems including osteoporosis and increased risk of kidney disease.

Because of all of these influences, the solution to curing obesity may be as difficult to find as a neighborhood without a fast-food palace or a chain restaurant. In these establishments, according to a book recommended by Freudenberg, The End of Overeating, by David A. Kessler, industry scientists have insidiously concocted products that layer and blend salt, sugar and fat, making them, in effect, addictive. Kessler, also known for battling the tobacco industry, served as commissioner of the United States Food and Drug Administration under two presidents and has been the dean of Yale and the University of California at San Francisco medical schools.

Important research is focusing on what people already know about their food -- and how to help them make meaningful changes in their diets. These are questions now being pursued by students in CUNY's new doctoral program in public health, directed by Freudenberg.

In this morass, one thing is clear. People can lose weight but far too many cannot maintain that loss. Baruch psychology professor Pinto, a researcher in this area, says that when weight loss is charted "it looks like a big check mark," with a decline at first and then an increase over time. Motivated people lose weight quickly and then, more often than not, regain it. Gibson, the Baruch public-affairs professor says that people have a "mean biology," referring to research conducted at Columbia University that shows individuals can gain weight far more easily than they can lose it.

"It's a major health concern. It affects so many people and it is also something people have trouble maintaining success in," says Pinto. "If people follow any program they are able to lose weight but adherence is a key piece of the puzzle." She adds, as many in the field suggest, that in the past the human body was programmed to gain weight when there was plenty to ensure survival in times of famine and other crises -- and perhaps that is still the way our system operates.

Combating Obesity and Diabetes at CUNY

With this epidemic raging in the United States and other developed and developing nations, it's no surprise that CUNY is also working on the problem throughout the University. A CUNY survey of 1,579 students from Hunter, Hostos and Medgar Evers found that 14 percent are obese and 23 percent overweight; 5 percent said they have diabetes and more than 20 percent live with someone who has it; and 16 percent care for someone with the disease. Freudenberg says that the rates of excessive weight, obesity and diabetes at CUNY are similar to those found for all young adults in New York City. He adds this suggests that CUNY students are similar to their peers who do not attend college.

Although Poppendieck's research examines school-age children, not college students, her philosophy is much like that embraced by CUNY. It emphasizes that individuals who are overweight and obese should be supported and helped rather than blamed. Neither Freudenberg nor Poppendieck negate personal responsibility -- eating well, exercising, losing weight, testing and monitoring diabetes and blood pressure, and controlling sodium intake. But they do blame the food and advertising industries for turning people away from eating the way they used to when string beans were plucked from gardens for the next meal, people went berry picking, the sweetness in treats didn't come from high fructose corn syrup and animals were not pumped up with hormones and antibiotics.

Like many scholars and activists, they emphasize that obesity disproportionately affects economically underprivileged individuals, including many CUNY students. They firmly believe that help should come, as Freudenberg puts it "from the top down as well as the bottom up."

At CUNY, in part, that means the cafeterias should sell healthier food at a lower cost and display it more prominently. That the University's cafeterias, many of which are run by different contractors, have already begun to take action, was prompted in part by a report entitled "What's for Lunch at CUNY." It was published by the University's Campaign Against Diabetes, a five-year effort, and the campaign leaders are now planning a broader initiative that builds on lessons they learned.

For the University, Freudenberg envisions "an integrated coordinated response where we can ensure that every student who wants to lose weight has an opportunity to get help, that the University is a leader in providing healthy food on our campuses and that we are doing everything we can to make sure our graduates have professional skills to help their patients, clients, students and family members to prevent or better manage diabetes and obesity." He adds that this is particularly important since weight issues have often been overlooked by colleges, as if this problem was one that should have been solved by elementary and secondary schools or families.

Although the University's anti-obesity initiative is relatively new, Freudenberg now works closely with faculty, students and staff in public health, nutrition, administration, food services, student health services, political science, sociology and culinary arts -- and more researchers who are doing related work have mentioned an interest in his work. There is also the realization that to solve the problem it will, to borrow an expression from an earlier First Lady, "take a village." Along with the efforts at Queens and on other campuses to change the content of vending machines, there are those reminders near elevators that walking the stairs burns more calories. A Hostos Community College student laminated cards detailing how many more calories people of different weights burn for each 15 minutes of stair climbing.

Mercado has perhaps set the bar for walking groups since she marches her Bronx students into Manhattan at lunchtime. In the community, professor Paul Fardy of Queens College, director of the Physical Activity and Teenage Health (PATH) program, has been running physical education programs in New York City schools for years, programs he has been asked to replicate in France and Spain.

And at a multifaceted workshop in June organized by Lorraine Mongiello, a doctoral student in public health, students learned to test their own blood sugar. The importance of that was underscored earlier when nearly all the students in a workshop said they knew someone who had diabetes.

There is an atmosphere at the University that each student's struggle with weight issues is important. Mercado cheers on a student who has lost a lot of weight and together they speak about the miniskirt she will wear when she reaches her goal. Fruits are handed out free at events, pedometers and instructions on how to use them are given as prizes. Professors speak openly about their own battles with weight.

In regard to obesity, Freudenberg sees CUNY not only as a microcosm of the city and many areas of the country but in an international context as well. "What we can learn at CUNY is relevant to a lot of places," he says. With this in mind, the professor spearheaded a collaborative project on the similarities regarding childhood obesity in New York and London. He also met with researchers and municipal officers in Cape Town, South Africa, and Lisbon, Portugal, cities which, like New York, are seeing an increase in the rates of weight gain in children. In Lisbon, his efforts helped inspire city officials to plan an interagency task force on childhood obesity. In October, researchers from these four cities were scheduled to present their findings at a meeting of the International Society of Urban Health at the New York Academy of Medicine.

CUNY's Student Advocates

Could someone who has lost more than 80 pounds but still has far to go be an effective advocate in the battle against obesity?

At a meeting of the Healthy Weight Group at Hostos Community College, that happened. A student trying to lose weight herself was able to get others to think about eating better and moving more.

From the window of the meeting room, the view was of a neighborhood where Subway is the only inexpensive quasi-healthy food choice. More prominent were the Golden Arches. For Lissette Machuca, the restaurants outside didn't matter. She spoke about cooking and said, "I am starting to eat more vegetables. More vegetables and salmon."

Machuca, a nursing student from Manhattan and the mother of an adolescent son, had lost 26 pounds in the months before that meeting and 80 pounds since September of 2009. Still, she knew she had a long way to go.

She decided to lose weight while taking a nutrition class with Mercado. And, when other students in her Hostos group asked her how she was able to do so well at cutting her weight, she talked about lifestyle changes, involving both diet and exercise. "I go to the gym 40 minutes a day," she said, noting that she uses the gym at the college and it's free. Soon after this meeting, Lorraine Mongiello, the graduate student who ran the Healthy CUNY workshop, was able to report to Machuca that her blood sugar, elevated before, is now normal.

Despite talk of exotic diets and confusion as to what causes obesity and what can cure it, there is also a wave of common sense that pervades the University and an insistence that the time-honored ways of losing weight -- move more, eat better and less -- are still the best weapons in the battle.

At the Healthy CUNY Workshop held over two weeks in June at the Graduate Center, students shared ideas. Steven McCartney, a student in York College's teacher physical education program spoke about walks he organizes for scores of people in the Rockaway community.

Melissa Anganu, a dietetics student who attends Queens College, spoke about her campaign to improve the quality of food in the school's vending machines. Other students at Queens say they would like the school to make microwaves available so they can warm up meals brought from home.

Another suggested a food bank for students who can't afford healthy meals. Wafa Hawamdeh, a mother of five who is getting her master's degree in public health at Brooklyn College, then suggested an effort aimed at all students. "Why don't we have a day when people like me can cook at home and bring it in," she offered.

In Janet Poppendieck's quest to improve school meals, she has seen all too much of what she calls "carnival food" served to students across America, often as those "a la carte" offerings. They range from the popular dish of pizza with french fries piled on top to those calorie-laden Cinnabons.

"The menus that have become commonplace are symptomatic of a food system gone mad," Poppendieck says, "a system in which snacks and fast food clones have replaced wholesome meals." Compounding this problem, vending machines with popular but unhealthy food have often been the only way some schools have raised funds for other purposes.

A philosophy of good school food can work, Poppendieck says. Indeed, she has already seen it in action in public and private settings from Alice Waters's Edible Schoolyard in Berkeley to teachers eating with their students at the United Talmudic Academy in Brooklyn. She speaks of dozens of gardens at public schools in New York City, some linked directly to cafeterias. In Sweden, where all school food is free, the cafeterias described by Poppendieck are natural gathering places for students and their teachers to socialize.

"CUNY can help," Poppendieck says, "not only through the research carried on by its faculty, but also by modeling in our own campus food-service operations the sorts of choices we want to see more widely available." At a meeting of "Food Fight," an organization that is trying to fix New York City school menus, Poppendieck heard about the efforts of a teacher in the Bronx, who grows vegetables on the walls of his special education classroom. She also met CUNY graduates who now teach and came to pick her brain for ideas.

The curriculum she envisions would include "taste tests." She speaks fondly about kindergartners in a New Orleans teaching garden tasting a food for each letter of the alphabet, food that was not necessarily familiar to them. "D," for example was a Daikon radish. And it was a hit.

In speaking about changing school food in general, Poppendieck says, "There is an enormous level of interest. Far fewer people have said, 'we can't afford this,' than I had anticipated ... and the movement to reform school food is only a part of a broader movement for good food: healthy, sustainable, affordable and just."

Hostos nursing student Lissette Machuca works out at the college's free gym 40 minutes a day.

 


CUNY Goes to Washington

White HouseLet's Move!," is Michelle Obama's campaign to eradicate childhood obesity within a generation. Since its goals and philosophies are the same as CUNY's, the University has had a presence in Washington on this crucial initiative. Psychologist Nancy Romer, a professor at Brooklyn College and an experienced community activist, was invited to the White House last May when the campaign began. At home, Romer has worked to organize the Brooklyn Food Coalition, "a grassroots organization working to change the food system in Brooklyn, neighborhood by neighborhood." Romer was standing in for her friend, Hunter's Janet Poppendieck, author of Free for All: Fixing School Food in America. At the Washington conference, Romer was part of a "School Food Breakout Group," which identified priorities for school food.

Included among them were improving nutritional and other standards for school food, training educators and school employees on food studies and implementing a nutrition curriculum. These are also changes called for in professor Poppendieck's book.

Romer has written a detailed account of her experience at the White House conference on her blog, which can be found at http://brooklynfoodcoalition.ning.com/ profiles/blogs/dr-romer-goes-to-washington

The following month Poppendieck herself would be in Washington, speaking to 700 chefs who were adopting schools throughout the country. She then accompanied the chefs to the White House where they toured the First Lady's organic garden and heard her speak.

Additionally, a paper authored by three University public health scholars was mentioned in the First Lady's report to the conference: "Solving the Problem of Childhood Obesity Within a Generation." The authors are Hunter associate professor Ming-Chin Yeh and Hunter Master's of Public Health graduates Lauren Dinour and Dara Bergen. On page 61 the report states: "Still, a number of studies have suggested a possible correlation between food insecurity and obesity, especially in women." A citation then refers readers to footnote 240 and an article published in 2007 in the Journal of the American Dietetic Association entitled: "The Food Insecurity - Obesity Paradox: A Review of the Literature and the Role Food Stamps May Play." This is also an issue related to research by public policy expert Diane Gibson of Baruch College.

Although all three received credit on the report, Yeh emphasizes, "Lauren did all the work as it was her thesis. Dara also helped on some literature review and synthesis." As thesis adviser, the professor supervised the project.

Dinour, a registered dietitian, graduated from the Hunter program in 2006 and is currently pursuing a CUNY doctorate in public health with a concentration in nutrition. She is also an adviser to Food Fight, a New York City-based organization that works with high school students and teachers on a nutrition curriculum.

 


You Say Frijoles, I Say Habichuelas

In New York City, "more than half of all adults with diagnosed diabetes are Hispanic or black."

The speaker was Lorena Drago, a Queens-based dietitian and Certified Diabetes Educator, and the author of Beyond Rice and Beans: The Caribbean Latino Guide to Eating Healthy with Diabetes, which is available in both English and Spanish. Drago was among those invited to speak to nutrition students at the Healthy CUNY Workshop in June.

In describing how culture defines the way people view their own health, she told a story about her aunt who had moved from Colombia to the United States, and here she was informed she had high cholesterol. She wasn't worried. Where she came from that meant nothing at all. There was another disease that, in her youth, had the potential to be so much worse. "She was an elderly person and back when she was growing up anemia was the major health problem. Not cholesterol," Drago said.

Drago also spoke about a lack of understanding in the health professions regarding Hispanic people -- primarily that although a group of people can speak the same language, that doesn't make them the same. They can be from a wide diversity of countries, each with its own food culture, where very different eating choices are made every day. And, although a language is shared, names for the same food vary from country to country. Beans, for example, are called habichuelas in the Caribbean and frijoles in South America. What if a health-care professional who knows a little Spanish but not enough wants a patient to eat beans? Or avoid them?

Judith Aponte, an associate professor at the Hunter-Bellevue School of Nursing, has conducted research on diabetes and has written about the need for providing health care to Hispanics that is "culturally competent."

Aponte says one concern she has is with research data from the National Health and Nutrition Examination Survey. It doesn't break down Hispanics sufficiently (e.g., Puerto Ricans, Dominicans) allowing different Spanish-speaking cultures to be studied effectively.

In speaking about Hispanics, Aponte, whose family comes from Puerto Rico, says: "Geograph-ically we are not [necessarily] located close to one another. Our diets are very different."

Baruch psychologist Angela Marinilli Pinto says motivated people lose weight quickly but often regain it.

 


Translating Labels

MingImagine being in a country where you don't know the language, and worse, can't even decipher any of the letters to attempt to make an educated guess. Imagine being there now, when processed food is a worldwide phenomenon. Imagine trying to figure out just what a food label says so you know what you are eating.

Westerners who have traveled in or moved to Asia often speak about being stymied this way. And, of course, it happens to people from other parts of the world every day in New York City. Newcomers from China and Taiwan and elderly individuals from those countries who, like thousands of older immigrants before them, prefer their own language, are frustrated by what they cannot know.

With this in mind, the University Settlement at the Houston Street Center in Manhattan teamed up with Hunter associate professor of public health Ming-Chin Yeh to present a lesson on American food labels for Mandarin speakers, most of them elderly, at a Senior Health Fare in June. It was organized by Ada Wong, director of the Chinese Community Partnership for Health at New York Downtown Hospital, and in the audience were white-haired Chinese grandmothers in silk, as well as some local senior citizens of other ethnic groups who wanted to learn more. Reading today's intricate food labels can be confusing to anyone, even if you know the language they're printed in.

The associate professor, who was born in Taiwan, arrived brandishing a bag of White Fudge Chewy Chips Ahoy -- and a large poster and handouts with the cookies' food label reproduced. Information from the label had been translated from English into Mandarin. It was, in effect, a translation guide showing what words commonly found on food labels such as "cholesterol," "carbohydrates," and "saturated fat" would look like in Mandarin.

The presentation and responses from the audience were in both Mandarin and English.

"What is the difference between saturated and mono-unsaturated fat," a woman asked in English. "Mono is a good fat, saturated is a bad fat. It's simple as long as you remember that," Yeh explained in English. And then he switched to Mandarin, explaining the difference between the fats. He also discussed the recommended daily percentages of fats, sodium and other ingredients and how easily you can exceed them. "If I have six cookies and then I have breakfast and lunch I am going to go over those percentages."

What about the soy or oyster sauce served by restaurants in hard-to-quantify bowls -- and without labels -- another woman asked. And what do you do, she added, about those roasted ducks hanging in windows? How do you know how many calories they have, how much sodium?

Questions about calories or salt plague many of us, no matter what restaurant we are in. But the effusive professor did not hesitate.

"Moderation," he advised. "Moderation."

Which in any language is perhaps the only answer.

 


Chefs Weigh In

Jonathan Deutsch is a chef, although sometimes he doesn't sound like one.

For example, he isn't totally adverse to fast food -- and can even advise how to put together a healthy meal at McDonald's.

Deutsch, director of Culinary Arts at Kingsborough Community College and an associate professor, did just that in a talk delivered to nutrition students who attended a Healthy CUNY workshop in June.

A modest hamburger, he says, a salad, skim milk or water and apple dippers, albeit without the low-fat caramel sauce, would be a good choice.

Then, Deutsch compared this meal -- health-wise -- to a meal at one of his favorite high-end restaurants, Per Se, in Manhattan. The foie gras appetizer, he says, has as many calories and fat as a Big Mac. A full meal at the restaurant, "two and a quarter Big Macs," says Deutsch.

Not that the chef/professor exonerates fast food for its lapses. He speaks of a common complaint among those advocating for healthy food: "Super-sizing" meals accounts for both major increases in obesity and profits for the fast-food business. By paying just a little bit more for these oversized meals, he says, consumers believe they are getting a bargain. But the cost of making more fast food is cheap.

Each year, he makes sure to talk to his students about the pros and cons of the food industry in general. "I paint a more complicated picture of school food and fast food. The industry does some very deplorable things with food, but it can also provide healthy food for a lot of people."

An innovation the chef particularly likes: those baggies filled with cubes of butternut squash that can be steamed and added to salads and other meals.

Deutsch also knows that his students will cook in many venues. "My argument has long been that the best way to improve the food system is to train the gatekeepers - cooks who cook in hospitals, nursing homes and neighborhood restaurants." Those gatekeepers have taken what they have learned in the Culinary Arts program to various venues around the city including a hospital, a program that teaches cooking techniques to Spanish-speaking cancer survivors, a day-care center and a nursing home.

Ricaurte Silvera Jr., a Culinary Arts major who expects to graduate in January, runs the food-service department at Silverlake Specialized Care Center, a nursing home in Staten Island. Most of the residents, he says, have kidney disease, diabetes or heart conditions. Although food restrictions vary, Silvera says, "basically everyone needs a low-sodium diet." With everything cooked from scratch at the center, Silvera's chicken broth is made with "certain spices that will give it taste, but there is no salt."

Dylana Degannes, a chef assistant for four classes in the Culinary Arts Program and the mother of two small children, is also a part-time Food Service Supervisor at New York Downtown Hospital. She often has an opportunity to discuss the menu and mention important issues such as the freshness of fruit and vegetables.

"I try to make sure that if someone has just had a baby I give them more fruits or something healthy. Maybe it's because I'm a mother," she says. "One young guy who was working there put a piece of pound cake and a soda on a tray for a woman who just had a baby. I said, "Let's put on grapes or an apple and a bottle of water. Let's start right."

 


Do You Want Fruit with That?

Farmers MarketLaGuardia Community College dietetic technician students Miriam Benavides and Mei Yan Huang carefully poured two cups of peach tomato salsa for Iliana Quander and her 5-year-old daughter, Egypt Amparo Quander-Crenshaw, and explained to them why buying in-season fruits and vegetables is healthier.

"I think it's great that they have this going on," said Quander who actually came to the market to visit a friend but was drawn in by the salsa. "We're usually healthy food oriented but recently we have not been eating well and this reminded us that we really need to get back on track."

Benavides and Huang are two of 14 LaGuardia students who were working with Cornell University Cooperative's Extension's Farmers Market Nutrition Education Program throughout the summer to advocate a better way to eat. "Since there are a lot of people suffering from obesity, we're trying to make people aware that there is another way they can improve their meals by eating more vegetables," says Benavides. "If they eat healthier, they'll lose weight and feel better about themselves, and besides, it's delicious."

The students set up a table blanketed with recipe cards from CommunityMarkets.biz, and featuring a pot filled with recipes from the farmers' markets in Jamaica on Fridays, Elmhurst on Tuesdays and in Astoria on Wednesdays. The markets provide locally grown organic food to many low-income residents, and the students demonstrate how to use those foods to make a healthy meal.

"The students are here for their fieldwork experience and, we hope, to push healthier food and educate the people on how to buy food," says Bette Cohen, director of the food and nutrition programs at LaGuardia. "This experience also helps reinforce everything they've learned in class, as well as improving their communication skills."

Huang, who has used what she has learned to help her mother battle high cholesterol, also has gained enough confidence through this program to comfortably talk with the shoppers at the market.

"I never spoke in class before, but this experience has helped me be confident enough to talk to different people; it really encourages me to engage with people," says Huang, who is set to graduate in the Spring 2011 semester. "I now can help people by talking with them."

The success of the program is difficult to quantify because it doesn't survey or keep track of its participants, but many do return every week to learn a new recipe.

"I sure will make this salsa at home and I'll be back to learn other recipes," said Carol Hunt, an elderly frequenter of the Jamaica Farmers' Market. "It's quite delicious."

Everyone loved the peach tomato salsa, with not a cup left unfinished. And the children couldn't get enough. "Can I have more," asked the 5-year-old Egypt as she was handed another cup. "It's my third," she said with a big smile. -- Beethoven Bong

 


Soda Ban Proposed for Food Stamp Users

Should food stamp recipients be prohibited from buying soda and sugared drinks - identified as a major cause of obesity - with their subsidies?

New York City Mayor Michael Bloomberg thinks so.

In October he asked the United States Department of Agriculture for permission to put this ban into effect for two years to see if it results in recipients losing weight.

Two CUNY professors involved in research and advocacy to combat obesity both say they would prefer a "food stamp discount" for purchasing fruits and vegetables.

Distinguished Professor of Public Health Nicholas Freudenberg does support a tax on sweetened beverages. But he says that the mayor's proposal "unfairly focuses attention on poor people rather than on soda companies that profit by targeting children for their unhealthy products." Freudenberg would rather see the federal government withdraw subsidies for sugar and corn. As for that discount, he says: "For example, one dollar of food stamps could buy one dollar of processed food but two dollars of fresh fruits and vegetables." Freudenberg is one of CUNY's leaders in efforts to combat obesity and teaches at the new CUNY School of Public Health at Hunter.

Diane Gibson, an associate professor of Public Affairs at Baruch College - whose research focuses on food insecurity issues, including food stamps - does not think that the ban proposed by the mayor would decrease soda consumption significantly. She points out that most individuals on food stamps spend beyond their subsidies for food and "with a ban families could just use cash to continue to purchase the same amount of soda as before." She adds she is not opposed to a ban, if only because it might prompt individuals to think more about soda consumption and other food choices. Still, like Freudenberg, she believes that a discount on fruits, vegetables and other healthy foods would be far more effective.

-- Fischkin

Distinguished Professor Nicholas Freudenberg, not a fan of fast food, is a leader in the effort to improve Americans' health.