A ban on new fast food outlets?

To help to fight the obesity epidemic new policies are considered to promote healthier eating. In Los Angeles, California, city officials are considering a two year moratorium on new fast food outlets in South LA, a lower socio-economic status part of the city with very high obesity prevalence (http://articles.latimes.com/2007/sep/10/local/me-fastfood10).

The Netherlands Nutrition Centre declared in a press release that the Netherlands should follow the LA initiative, especially restricting access to fast food outlets in school areas http://www.voedingscentrum.nl/Voedingscentrum/Nieuws/2008/Fastfoodbeleid.htm).

However, professor Sally McIntyre, from the MRC Social and Public Health Sciences Unit, Glasgow University, provided evidence that it is certainly not always true that poorer neighbourhoods have poorer access to healthy nutrition (http://www.ijbnpa.org/content/4/1/32). And although eating at fast food places has indeed been found to be associated with a higher body weight, higher fat intake and lower fruit and vegetable consumption, a study conducted by professor Robert Jeffery and others from the Division of Epidemiology & Community Health, University of Minnesota School of Public Health, also showed that proximity of fast food outlets was not associated with eating ate those places or with a higher body mass index (http://www.ijbnpa.org/content/3/1/2).

Furthermore, a recent study by professor David Crawford and colleagues from the Centre of Physical Activity and Nutrition Research (http://www.deakin.edu.au/hmnbs/cpan/) from Deakin University in Melbourne, Australia, found an inversre relation between proximity of fast food outlets and body mass index: having a fast food place close to the home was associated with lower BMI (http://www.ncbi.nlm.nih.gov/pubmed/18608630?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum).

As I have reported here before, there is certainly evidence suggesting that availability and accessibility of healthy and less healthy foods are associated with nutrition behaviours. The studies by Jeffery and Crawford indicate that these associations are, however, not as straightforward as we maybe would like them to be.

ENDORSE: ENvironmental Determinants of Obesity related behaviours in Rotterdam School ChildrEn; recent results.

Obesity prevalence is high and rising among children and adolescents in most developed countries. For obesity prevention, it is of utmost importance to identify the behavioural and environmental determinants of obesity among youth. The ENDORSE study was specifically designed to gain further insight in which family, school and neighbourhood characteristics predict obesity-related nutrition and physical activity behaviours among adolescents. ENDORSE is a longitudinal study with baseline measurements of BMI, waist circumference, a range of potential obesogenic behaviours, and questionnaire assessments as well as audits and observations of home, school and neighbourhood environments (for a full description of the study design and measurements, please see http://www.biomedcentral.com/1471-2458/8/142).

Recently two papers based on the baseline measurements of ENDORSE were published by Elling Bere et al. (http://www.ncbi.nlm.nih.gov/pubmed/18657568?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum) and by Klazine van der Horst et al. (http://www.ncbi.nlm.nih.gov/pubmed/18617354?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum).

Bere and colleagues explored differences in active commuting to school according to ethnicity and distance to school. Almost 50% of the adolescents reported to actively commute to school on most school days, and mode of commuting was associated with ethnicity and distance. Adolescents from Dutch ethnicity were 5 times as likely to be active commuters to school than youth from foreign ethnicity, and they were especially more likely to cycle to school. Walking to school was common up to a distance of 3k one way, while cycling was common up to a distance of 10k.
Van der Horst et al. explored associations between school environmental factors with soft drinks and snack consumption. Their study indicates that personal factors such as motivation and attitudes are more important for adolescents’ soft drink and snack intakes than availability and accessibility of these foods in the school environment.
These studies again show that different environments may have very different effects for very different energy-balance related behaviours.

The hundred mile diet or Prehistoric cooking?

We have been bombarded by a variety of diets over the last decades, mostly promising to help us loose weight. Concerns about the obesity epidemic are met and maybe even surpassed by concerns about global warming and other environmental issues. Agriculture and how and what we eat contributes strongly to green house gasses globally, and the CO2 ‘foot print’ of especially meat and other animal products is impressive.
The growth of the organic movement and the dissemination of organic produce in main stream supermarkets show that many people are willing to make changes in their food choices to contribute to a more sustainable way of feeding ourselves. However, now that organic foods and produce have become mainstream, the production has increased enormously, and a big challenge is to remain true to the real basis of ecological farming and production. Many organic product travel thousand of miles before they reach your supermarket, grocer or butcher, making their true contribution to a more sustainable environment rather doubtful. This issue is very nicely described and discussed in Paul Roberts (see http://the-end-of-oil.com/) book, ‘The end of food’.

Another interesting way to try to contribute to a more sustainable way of eating is to eat locally, and thus to reduce the transport-related CO2 fingerprint of the foods we eat. In Michael Pollan’s (http://www.michaelpollan.com/) books ‘The omnivore’s Dilemma’ and ‘In defence of food’ he very clearly illustrates the possible ecological differences between foods that may carry the organic label, and locally produced foods, and a case is build for buying locally. The growth in so-called farmers markets is a sign that buying locally is getting more and more popular.

The so-called ‘hundred mile diet’ (see http://100milediet.org/) is a way to strive to eating more locally. This ‘diet’ is based on the experiences of Alisa Smith and James MacKinnon (http://100milediet.org/contact-us/) who realised that the average food they ate had travelled at least 1500 miles. They decided to try to eat only foods that were produced within a hundred mile radius from their apartment in Vancouver, British Colombia. Since then, many other have decided to try similarly.

A very different way of eating, but that links to local food production, that has received attention here in the Netherlands is the ‘Oerdis’ (see http://www.innovatienetwerk.org/nl/concepten/view/16/Oerdis.html/ for a description in Dutch) which is prehistoric cooking (see http://www.channel4.com/history/microsites/T/timeteam/snapshot_cooking.html and ) and eating. Oerdis reconstructs the way of eating and cooking of our prehistoric ancestors based on archaeological, anthropological and historical research. Some research indicates that our hunting and gathering prehistoric ancestors had similar height as we do today and may have enjoyed long and healthy lives, suggesting that such prehistoric eating habits, with, for example, more animal protein from wild omega-3 fatty-acid rich animals and fish, and less carbohydrates, contributed to a healthy diet.

Cycling in the Alps

The past week I have been cycling the Alps together with my wife and two friends, and my mother in law as the team director. With, among others, the Joux Plane, the Colombiere, The Iseran, the Telegraph, the Galibier, the Sarenne, Glandon and Madeleine on the program we burned between 2500 and 4500 kcal on our bikes. Rather difficult to keep a neutral energy balance on such days...

Biofuel, the food crises and the Dutch policy on healthful nutrition promotion

Today the Guardian summarizes a confidential, 'secret' report from the World Bank based on a careful analyses of the causes of the causes of the present food crisis, i.e. the growing shortages in and higher prices of food, that leads to undernutrition and hunger, especially in underdeveloped countries. The World Bank report contradicts claims made by the US government that greater demand for biofuels contributed only 3% to the raise in food prices. The World Bank report states that the demand for biofuel pushed food prices up by 75%. See http://www.guardian.co.uk/environment/2008/jul/03/biofuels.renewableenergy

In the Netherlands, the minister of health has published his food and nutrition policy plan, called "health nutrition; from start to finish" (http://www.minvws.nl/kamerstukken/vgp/2008/voedingsnota.asp). In this plan the minister asks food producers and consumers to take their responsiblity, but the national government itself is not willing to do much. Two task forces will be formed to explore how food producers can reduce the salt and saturated fatty acid content of regular foodstuffs; information on food stuffs should be improved to enable consumers to make healthier choices. Food and nutrition experts as well as the Netherlands consumers organisation have expressed their disappointment with the published policy plans; they do not expect that implementation of these plans will make too much of a difference, given the voluntary nature of the measures that are proposed.

The policy plan also ask for a chance in nutrition education in the Netherlands, from a food-oriented approach, to a more total nutrition and dietary pattern oriented approach. However, one of the key recommendations is that the Dutch people should eat fish 2-3 times per week. This is clearly a food-based advise, and an advice that may be heart-healthy, but not very sustainable, given the worl-wide depletion of fish stocks because of over-fishing http://en.wikepedia.org/wiki/overfishing.

VU Children’s city; a fantastic playground for hospitalized kids.

Last Friday I had the pleasure of visiting VU Kinderstad, or in English: The VU University Medical Center’s VU Children’s city (http://www.vumc.nl/afdelingen/VU-Kinderstad-VU-Huis/VUkinderstad2/). This ‘city’ is in fact a two story ‘playgroud’ on the two top floors of the VU University Hospital (http://www.english.vumc.nl/patientcare/).
Prof. John Roord (http://www.vumc.nl/afdelingen/voor-journalisten/zoeken-op-naam/zoeken--naam/855401/), the chair of the VUmc Children’s hospital and one of VUmc’s Division heads, organised a tour of the Kinderstad for the members of VUmc’s board and the other heads of Divisions.
VUmc Kinderstad is meant for children who have to stay in hospital for a longer period. Kinderstad offers them and their parents the opportunity to leave the hospital setting to enjoy a range of play and entertainment activities, from virtual racing in a Spijker sports car (http://www.spykercars.nl/?pag=1), enjoying video’s from and writing directly to the Ajax soccer team (http://www.ajax.nl/) players, surfing the internet, ‘flying’ in an almost real-life KLM airplane, making radio shows, as well as more basic every-day play activities.

The Internet and health education: unfulfilled promises?

The introduction and growth of the WWW has enabled swift and inexpensive distribution of nutrition education expertise and materials. Furthermore, the WWW has also been used for tailoring nutrition education to personal characteristics of the user. With the growing availability and opportunities of mobile Internet, web-based tailored nutrition education can be provided when and where it is most useful or appropriate. However, two important challenges for web-based nutrition education interventions are to realise sufficient exposure and to ensure sufficient source reliability and credibility. Only few studies have investigated the effects of web-based computer-tailored nutrition education, with some promising but mixed results.
Two recent studies by Willemieke Kroeze et al. shed further light on the potential of web-based tailored nutrition education. Her studies published in the Journal or Nutrition Education and Behavior (http://ees.elsevier.com/jneb/) and the Journal of Medical Internet Research (http://www.jmir.org/) suggest that an electronic, interactive web-based version of a nutrition education program that provides users with individually tailored feedback and advice to reduce saturated fat intake was as effective as the original print version of the program (http://www.ncbi.nlm.nih.gov/pubmed/18565463?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). However, the print version was used and saved more often and was rated as somewhat more personally relevant (http://www.jmir.org/2008/2/e12/).