Be Our Voice Blog

Blog Entries in General Childhood Obesity

Thursday, May 17th, 2012

Kids, Food, and TV Characters: What Advocates Can Do

Posted by: NICHQ

Healthcare professional advocates beware! Your patients not only see Cartoon Network, Nick Jr., and Disney Channel characters on TV and online, but also at grocery and convenience stores on food packaging.

The list of characters that can all be found in the aisles of supermarkets seems endless: Dora the Explorer, My Little Pony, Disney Princesses, Madagascar’s Penguins, Nemo, Super Mario, Veggie Tales, Alvin and the Chipmunks...And these particular characters are just the ones gracing packages in the fruit snack and cereal aisle.

But why should we care? What is the impact of putting cartoon characters on food packaging? Research has shown this marketing tactic leads to a lot of results, and most of them aren’t good for kids’ health.

First, kids as young as 2 or 3 can recognize and identify the characters1, and these character-covered boxes are often placed on lower shelves so it’s easy for kids to notice these food items (and to beg mom and dad to buy them). Second, when they see character-covered boxes, many kids automatically prefer these foods over and above the same foods marketed without the characters. 1 In one prominent study, researchers gave children three pairs of identical foods, and within each pair there was one package with TV characters on it. Guess which foods 50-55% of the children thought tasted better? You guessed it: the ones with recognizable characters on the packaging.1

Young children can’t understand the persuasive intent of advertising, and they can’t think critically about marketing messages. Kids see their favorite characters on food packaging and automatically equate the food with being good and “cool.” The food industry knows this all too well, and they also know that children are big influences on their parents’ wallets.

The food industry has repeatedly fought regulation of advertising aimed at kids, sometimes defending this kind of marketing as a First Amendment right. But a recent article in Health Affairs argued that case law history shows the First Amendment does not offer protection to “inherently misleading” commercial speech, that all commercial speech is “inherently misleading” to children who can’t understand its messages, and that it can be regulated by government.2 

However, currently, there is little regulation of this massive industry. Food marketing to kids is big business:  $1.6 billion is spent per year, much of it on TV commercials.3 Kids see 11 ads for every hour of TV watched, and more than 80% of ads in children’s programs are for fast food or snacks.4 Many of the foods advertised—and many of the packaged in character-covered boxes— are processed foods high in fat, sugar, and salt. And as any healthcare professional can tell you, foods like these contribute to childhood obesity.

So what can healthcare professional advocates do? In the office, talking with families about media literacy and screen time is a good starting point. At a practice-wide level, TV’s viewable in waiting rooms can show DVDs instead of TV stations to reduce exposure to food commercials. Community advocacy could involve urging grocery stores to practice responsible marketing, such as not putting junk food at kids’ eye level and keeping healthy foods in the checkout aisles instead of candy. 

Advocacy on a broader level could yield changes in how marketing practices are used, perhaps to market healthier foods instead of junk food. In a previous Be Our Voice blog post, we explored a few companies that have found novel, profitable ways to package and advertise healthy foods. Regulating, limiting, and eliminating unhealthy food marketing to kids is not easy, but it is necessary and possible, with the combined efforts of many advocates. After all, TV characters belong on TV—not on our food. 


  1. Roberto et al. “Influence of Licensed Characters on Children's Taste and Snack Preference.” Pediatrics. 2010; 126; 88-93.
  2. Graff et al. “Government Can Regulate Food Advertising To Children Because Cognitive Research Shows That It Is Inherently Misleading.” Health Affairs. February 2012 vol. 31 no. 2 392-398.
  3. Yale Rudd Center for Food Policy and Obesity. “Food Marketing to Youth.”          
  4. Council on Communications and Media. “Children, Adolescents, Obesity, and the Media.” Pediatrics. 2011; 128; 201.

Further Advocacy Resources & Information

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Thursday, May 10th, 2012

Serving the Most Vulnerable Kids: The Safety Net and Childhood Obesity

Posted by: Kristi Fossum Jones, MPH

Pediatric providers practicing in safety net settings—such as community health centers, free clinics, and public hospitals—face multiple and unique challenges when it comes to childhood obesity. First, they tend to care for more kids from low-income families, and since poverty and obesity are connected in multiple and complex ways,1-5 providers working in a safety net setting must address poverty-related barriers to healthy lifestyles. Second, safety net facilities are often themselves cash-strapped as a result of having to rely on uncertain federal grants and decreasing Medicaid payments, which makes sustaining obesity programming very difficult.

Pediatric providers and other healthcare professionals can have different roles within obesity programs.   Some working in safety net settings are actively involved in conducting such programs, while others in more mainstream settings might refer patients and their families to these programs. For example, a 5-year old child who is overweight, a US citizen, and enrolled in Medicaid may be eligible for a referral to a private hospital’s pediatric fitness program. But if his 12-year old sister, who is also overweight, was born in Mexico—and therefore not eligible for a referral to a private hospital through Medicaid—she could instead be referred to a community health center’s fitness program. 

Pediatric providers in mainstream settings can also collaborate with their safety net counterparts to meet the needs of a broader sector of the population beyond those normally seen in their clinics. So what can providers working in safety net settings do to support obesity programming for their patients? 

Some safety net facilities across the country are finding creative ways to implement childhood obesity programs in their neighborhoods and communities without relying on uncertain funding sources. These facilities are partnering with other organizations and groups to build on each other’s strengths, resources, and ability to reach kids and their families. Here are just a few examples of innovative childhood obesity programs being implemented at safety net facilities:

Educating Patients and Families:

  • Petaluma Health Center (California) has a garden onsite and pediatric patients in the Petaluma Loves Active Youth program help raise plants and harvest the food. There are weekly cooking demos, and classes on healthy eating with exercise for the kids.
  • Charles Drew Health Center (Omaha, NE) hosts a 12-week Healthy Families class so children and parents can learn about healthy eating and exercise, and benefit from the attention of multidisciplinary clinical teams. Incentives such as YMCA memberships are offered.
  • Community Health Center, Inc. (Meridien, CT) offers a six-week program for teen girls and women concerned about weight called “Food Smart and Fit.”

Infrastructure Projects:

  • The Community Health Centers Alliance (CHCA, Florida) plans to conduct electronic and chart surveillance of childhood obesity and to promote best practices among providers. They hope to create a Childhood Obesity Practice Manual with clinical guidelines and other resources.
  • CHAMPS (Community Health Association of Mountain/Plains States) has a website of obesity resources for member CHC’s and their providers.

There’s no need to reinvent the wheel when trying to build up an obesity program! Both Be Our Voice and the American Academy of Pediatrics provide childhood obesity advocacy resources that are relevant in safety net settings.  The Obesity Society and the National Association of Community Health Centers also created a resource specifically for providers in safety net settings entitled Childhood Obesity Resource Guide. The National Association of Children’s Hospitals and Related Institutions (NACHRI) developed the Survival Guide to Planning, Building, and Sustaining a Pediatric Obesity Program as a tool for healthcare professionals who are ready to roll up their sleeves and move their weight management program to the next level.


  1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among United States adults, 1999–2008. JAMA 303:235–41. 2010.
  2. National Institutes of Health. Clinical Guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-The evidence report. Obes Res 6 Suppl 2:51S–209S. 1998.
  3. Sobal J, Stunkard AJ. Socioeconomic status and obesity: A review of the literature. Psychol. Bull 105:260–75. 1989.
  4. McLaren L. Socioeconomic status and obesity. Epidemiol Rev 29:29–48. 2007.
  5. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey. Available from:

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Tuesday, May 1st, 2012

Promoting Obesity Prevention through Practice Design

Posted by: Kristi Fossum Jones, MPH

Most pediatric care providers talk about healthy eating and exercise when patients and families are in the exam room. And while this is an important part of obesity prevention, providers can actually start promoting healthy habits even earlier in the visit: when patients and families first enter the healthcare facility. Be Our Voice advocates can help to create a practice environment that is designed to support obesity prevention by making sure that their healthcare facility not only “talks the talk” but also “walks the walk.”

The AAP Policy Opportunities Tool lists evidence-based, practice-level interventions according to the 5-2-1-0-Breastfeeding-BMI healthy message framework. Some of these recommendations are discussed here, along with examples of facilities currently implementing them. But please note that these facilities are not the only ones putting these recommendations into practice—they are just examples! 

Healthy Eating Strategy: Require menu labeling in hospital cafeterias and vending sites to provide consumers with calorie information on menus and menu boards.
This strategy helps empower consumers to make healthier food choices. The information provided may range from complete nutrition information to a simple display of the number of calories in a particular food item. As part of a research study, Massachusetts General Hospital in Boston implemented a red-yellow-green stoplight system to help cafeteria customers know which foods and drinks were the healthiest (“green” items offered the best nutrition, “yellow” items offered nominal nutrition, and “red” items were the least healthy options). During Phase 1 of the study, there were statistically significant reductions in sales of “red” food items and increases in sales of “green” food items. Throughout Phase 1 and Phase 2, there were significant reductions in sales of “red” beverages and increases in sales of “green” ones.1

Screen Time Reduction Strategy: Limit the use of televisions in practice and hospital waiting rooms.
Many pediatric providers tell patients to limit TV at home, but this advice may ring a little hollow when patients are allowed to watch big-screen TV’s in waiting rooms or to spend their entire hospital stay glued to video games. Pediatric care providers will gain credibility with the “limit TV” message by following the AAP’s recommendation to “serve as good role models by using television appropriately and by implementing reading programs using volunteer readers in waiting rooms and hospital inpatient units.”2 Waiting room books and reading activities are frequently part of Reach Out and Read practices, but they are feasible in other practices as well.

Physical Activity Strategy: Create opportunities for physical activity in clinical settings for employees, patients, and their families via events or design/built environment.
Practice-level interventions to increase physical activity may differ depending on the target audience, whether it consists of employees or patients. But all interventions should be designed to get people to move more! For employees, there are many ways to support exercise and to promote physical activity. One example comes from Cleveland Clinic, which offers exercise classes and discount/free health club memberships as part of employee wellness efforts. In pediatric settings, patient-focused events will, out of necessity, target parents and families as well as children. These events could include walks and runs that offer opportunities for fun family exercise and health education, such as the Super Kids Sunday 5K and Fun Run organized by Miller Children’s Hospital in Long Beach.

Limit Sugar-Sweetened Beverages Strategy: Restrict sugar sweetened beverages from cafeterias and mobile vending machines in practices and hospitals.  
Pediatric care providers can ensure that their practices set good examples by providing healthy beverages. This means limiting the availability of soda and other sugar-sweetened beverages while increasing more nutritious options. A practice could start on a small scale by having a Soda-Free Summer event and go soda-free for one summer along with other community organizations. Hospital-wide possibilities include no-soda policies, such as the one implemented in January 2011 at Nationwide Children’s Hospital in Columbus, Ohio. In Boston, 10 hospitals recently pledged to get rid of all high-sugar beverages, offer healthier beverage options, install free water dispensers, and educate patients and staff about nutritious beverages. 

Breastfeeding Strategy: Provide lactation room and adequate breaks for nursing mothers. 
Providing private lactation rooms and sufficient breaks to pump breast milk are ways for practices to support breastfeeding, both among mothers of patients and among employees. This is becoming an increasingly common practice in healthcare facilities. One of the first milestones in Boston Medical Center’s journey to Baby-Friendly Designation was opening a breastfeeding and pumping room in 1998—their Breastfeeding Center is now one of the foremost programs of its kind in the country. A simple Internet search will yield many other examples of places that do it (and do it very well)!

BMI Strategy: Advocate for payment by public and private insurance for obesity related services.
This practice-level intervention for BMI involves advocating for insurance and Medicaid plans to cover ongoing, multidisciplinary obesity care. Two studies conducted by the Robert Wood Johnson Foundation found that the groundwork is in place for Medicaid, but most state Medicaid manuals do not provide clear or adequate information about coverage levels and appropriate reimbursement codes for specific elements of care. 3 Therefore, providers remain uncertain about which services they can provide and if they can be reimbursed.  Individual practices can make use of the AAP’s Obesity Practice Management Resources that provide information and tools so providers can ensure payment for multidisciplinary obesity care for their patients.

The strategies mentioned above are only a sampling of the many practice-level interventions recommended by the AAP. There are also other interventions related to the 5-2-1-0-BF-BMI areas that are not mentioned in the Policy Opportunities Tool. For instance, several of the teams participating in NICHQ’s Collaborate for Healthy Weight initiative aren’t focusing on payment models in their BMI-related interventions, but rather on aiming to consistently assess BMI, help patients understand it, and incorporate it as part of obesity prevention efforts for both children and adults.   

Practices can, and should, think creatively when it comes to creating an office environment that supports healthy eating and active living for their patients. While the interventions recommended in the AAP Policy Opportunities Tool are by no means exhaustive, they are a great place to start thinking about ways you can transform your practice into a part of your obesity prevention strategy!


  1. Thorndike, AN et al. American Journal of Public Health. 2012 Mar;102(3):527-33. Epub 2012 Jan 19. Erratum in: Am J Public Health. 2012 Apr;102(4):584.
  2. AAP Committee on Public Education. “Children, Adolescents, and Television.” Pediatrics Vol. 107 No. 2. 02/2001. pp. 423 -426.
  3. Robert Wood Johnson Foundation. “Study of State Medicaid Resources for Childhood Obesity Prevention.” 2005/2006.

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Thursday, April 5th, 2012

The Importance of Advocating for Supportive Breastfeeding Policies

Posted by: Kristi Fossum Jones, MPH

Historically, the decision to breastfeed has primarily been between mothers, infants, and—sometimes—doctors. But increasing evidence suggests that, even if a mother wishes to breastfeed her infant, the current healthcare system does not always provide the resources, policies, and knowledge to support her. According to a 2011 Vital Signs report published by the CDC, “less than 4 percent of U.S. hospitals provide the full range of support mothers need to be able to breastfeed.”1

And this issue isn’t isolated to primary care providers. In its most recent policy statement, the American Academy of Pediatrics (AAP) wrote that “Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.”2 Breastfeeding has been shown to have a wide array of health benefits for both baby and mom, from lowering the infant’s risk of developing diabetes and ear infections to lowering the mother’s risk of developing breast and ovarian cancers.1 But while most infants start off breastfeeding in the US, within the first week half have already been given formula; and by 9 months, only 31% of babies are breastfeeding at all.1 And low rates of breastfeeding add $2.2 billion a year to medical costs.1

Breastfeeding targets were included in the Healthy People 2010 goals set forth by the US Department of Health and Human Services. But despite this effort to promote the importance of breastfeeding as both a public health and personal health issue, the 2010 targets for breastfeeding duration and exclusivity were not reached. Breastfeeding was again added as part of the Healthy People 2020 goals, but without changes to the current healthcare system we might not achieve those targets, either.

That’s why organizations such as the Baby-Friendly Hospital Initiative and NICHQ offer programs designed not just to reach individual mothers, but to make health systems more supportive of breastfeeding. 

What does this have to do with childhood obesity and policy advocacy? Some research indicates that breastfeeding reduces the risk of childhood (and adult) obesity. In 2007, the US Agency for Healthcare Research and Quality (AHRQ) did a meta-analysis of studies on the health benefits of breastfeeding—including studies on breastfeeding and obesity.3 AHRQ’s analysis demonstrated that breastfed infants showed reduced risks of obesity and type 2 diabetes later in their lives, and that duration of breastfeeding is inversely related to the risk of developing obesity. The array of health benefits for mom and baby both is what makes supporting breastfeeding policies  a worthwhile focus for healthcare professional advocates.

Breastfeeding policy advocacy can happen on many levels, as outlined in the AAP’s Obesity Policy Opportunities Matrix:

  • In the maternity, delivery, and post-partum areas, healthcare providers can encourage and support new mothers as they learn to breastfeed. 
  • If implemented at the institutional level, Hospital Breastfeeding Policies can help ensure that all healthcare providers and staff follow the same breastfeeding protocols and distribute consistent, accurate information about breastfeeding.
  • Systems-level change can include supporting and implementing the10 Steps to Successful Breastfeeding across a hospital. For instance, NICHQ’s Best Fed Beginnings initiative will facilitate hospital participation in a learning collaborative to make institutional changes with the ultimate goal of becoming a designated Baby-Friendly hospital through Baby-Friendly USA.
  • In OB and pediatric offices, healthcare providers seeing pregnant mothers and newborns can provide individual encouragement as well as more tangible support like lactation areas for nursing mothers. And instead of handing out formula samples and coupons to expecting or new mothers, healthcare providers could distribute information about breastfeeding support groups and resources in the community.
  • Outside of healthcare settings, healthcare professional advocates can use tools like The Business Case for Breastfeeding to educate employers on the economic benefits of supporting lactating mothers in workplaces to increase employee retention after childbirth.
  • State-level advocacy provides opportunities to focus on state laws and policies related to breastfeeding, i.e. lactation areas in public places. 
  • At the federal level, the Affordable Care Act requires employers to provide space and reasonable break time for working women to express breast milk, which may open new doors for successful breastfeeding policy advocacy.  

Healthcare professional advocates working on childhood obesity have a plethora of possible focus areas. Breastfeeding is a crucial one because it offers so many health benefits to mothers and babies alike, and it is something that most mothers—regardless of race or socioeconomic status—can do for their infant with support. Healthcare professionals are positioned to provide that support as well as advocate that it be provided in workplaces and in the community. They can be credible and effective breastfeeding advocates because they work with mothers and infants from birth onwards; they have the relationships with patients and families to provide individual support; and they possess the knowledge and the resources to advocate for broader policies to support breastfeeding.

>> For more information about NICHQ's breastfeeding projects, go here.

>> For more information about NICHQ's Best Fed Beginnings initiative, go here.

1. CDC Vital Signs. “Hospital Support for Breastfeeding.” August 2011.
2. AAP Policy Statement. “Breastfeeding and the Use of Human Milk.” Pediatrics Vol. 129 No. 3 March 1, 2012 pp. e827 -e841.
3. Lau, Joseph et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville (MD): Agency for Healthcare Research and Quality (US); April 2007.

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Monday, March 12th, 2012

Raising Our Voices Together: Faith Communities and Healthcare Professionals as Allies Against Childhood Obesity

Posted by: Kristi Fossum Jones, MPH

Churches. Synagogues. Mosques. These and other houses of worship are present just about everywhere in the US. More than just sacred places, they are often powerful forces for change in their communities, and the role these religious congregations play in local communities can make them ideal allies for healthcare professionals working to reverse the  trend of childhood obesity .

Faith communities have long been a part of movements  for social change, and their leaders are often well-respected members of the community. Most religions are founded on doctrines that emphasize not only caring for the spirit, but also caring for the body. Faith communities serve whole families with programs for both adults and children. And, perhaps most importantly for those working to combat childhood obesity, these houses of worship are often located in the heart of the neighborhoods where their members live and work.

The above characteristics make faith communities excellent partners, and venues, for obesity outreach efforts. Many are already involved as individual institutions or as groups:

  • Solid Rock United Methodist Church in Philadelphia provides people in the neighborhood with a safe place for indoor exercise, line dancing, basketball, and an obesity program for children.
  • The Seventh Day Adventist denomination as a whole focuses on healthy living and offers a comprehensive website of health resources.
  • Jewish Community Centers (JCC’s) are involved in JCC Grows, a healthy food and hunger-relief program with an emphasis on community gardens.
  • On the south side of Chicago, a Muslim community is leading the Campaign for Health, Wellness, and Healing, which focuses on food justice, health education, and an alternative business model for corner stores. 
  • Ecumenical Ministries of Oregon offers food policy resources for faith communities, and helps to link them with local farms.

Healthcare professionals interested in advocating for childhood obesity policy changes can engage with faith communities in many ways. While creativity is vital to meet local needs, useful resources are already available. Below are sample resources for use and adaptation: 

Healthcare professionals and faith communities can make excellent partners and collaborate on education, advocacy, outreach, and policy to improve child health and reduce the prevalence of childhood obesity.

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Wednesday, April 13th, 2011

Hunger and Obesity: Related Problems on the Rise

Posted by: Hillary Anderson, Project Manager (NICHQ)

Purchasing healthy foods on a budget can be a challenge. And fresh fruits and vegetables may not be available in all neighborhoods. When food competes with covering other basic household expenses like rent or mortgage, medical bills, or transportation to work, families have to make tough choices. And that sometimes means sacrificing quality and nutrition for what is convenient and least expensive.  

Feeding America, the nation’s leading domestic hunger-relief charity, reports that hunger is increasing: their organization is now annually providing food to 37 million Americans, including 14 million children. And although it may seem contradictory at first glance, hunger and obesity can both occur in the same child, family, or community.

A recent Huffington Post article, “Hunger Obesity and Innovation in the Emergency Food System” points out that “following a 30-40 percent rise in people visiting food pantries since the recession, food banks have become a strategic point of opportunity to improve the health of poor families.” But it can be difficult for food banks, which rely almost entirely on food donations, to provide healthy options like fresh produce and whole grains. So how do we overcome the economic and logistical barriers to getting healthier foods into food banks?

One answer is collaboration. The Huffington Post author highlights the California partnership between MAZON and Kaiser Permanente called Healthy Options, Healthy Meals. In this partnership, collaboration is key. MAZON brings healthy eating and nutritional education specific to the state’s emergency food programs to Kaiser Permanente’s eight patient regions; Kaiser then utilizes its network of healthcare professionals to support food bank program and policy changes.

Another example of this kind of successful partnership can be found in the Let’s Move! Detroit community‘s Green Ribbon Collaborative. Featured on the Let’s Move! Blog, the Green Ribbon Collaborative coordinates efforts among the Gleaners Community Food Bank, the Green of Detroit’s Urban Agriculture program, the Detroit Economic Growth Corporation (DEGC) and the Fair Food Network. The agricultural partners provide 20 pounds of fresh produce to residents at a minimal price, and, in turn, Gleaners Community Food Bank arranges for distribution to Detroit’s east side.

Collaborative, community-based solutions like these are critical in addressing both the rising hunger and obesity rates across the county. Emergency food systems and food banks demonstrate a critical point of opportunity for healthcare professionals to improve child and family nutrition. By partnering with local businesses and existing organizations, healthcare professionals can have a lasting impact on the health of their communities.

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Tuesday, February 8th, 2011

BOV Site Makes The News in MS

Posted by: Erin Ellingwood

The Be Our Voice project site in Mississippi was mentioned in a 12/10/10 article in The Clarion-Ledger (MS). Dr. Gerri Cannon-Smith, the BOV project lead, was interviewed about her thoughts on having Patrick House, the most recent winner of NBC’s The Biggest Loser, volunteer as a spokesperson for childhood obesity awareness in Mississippi.

Download the entire article here: documents/121910ClarionLedger.pdf

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Friday, January 28th, 2011

Eat 'Em Like Junk Food? New Approaches to Marketing Healthy Snacks

Posted by: Erin Ellingwood

It’s no secret that Americans struggle to get their two or more fruit servings and three or more vegetables servings per day. In fact, the latest CDC statistics from the Behavioral Risk Factor Surveillance System show that only 32.5% of adults are eating the recommended daily servings of fruit and only 26.3% are eating the daily recommended servings of vegetables. But what are concerned individuals to do? In the end, unhealthy snacks are just more readily available and cheaper for adults and kids than are healthy snacks.

Some private companies are out to change that imbalance. The Wall Street Journal Health Blog reported last Halloween that A Bunch of Carrot Farmers™ (led by Bolthouse Farms) launched an ambitious campaign to rebrand baby carrots. The “Eat 'Em Like Junk Food” campaign was taken nationwide with the release of Scarrots, “a new kind of Halloween treat.” Carrots came in mini-packages and included glow-in-the-dark tattoos. But did kids go for it? "We've been blown away by the response to this campaign," said Jeff Dunn, chief executive officer, Bolthouse Farms. The company is following up the success of Scarrots with Super Bowl-themed packaging. More pictures and information can be found on their website, And if this packaging is not available in your area, the website offers a place where you can write Bolthouse Farms and “tell [them] why [they] should bring ‘em to your city.”


But carrots aren’t the only thing getting a makeover in the snack world. As the Wall Street Journal reported last October, “Fresh Del Monte Produce and a vending-machine maker, the Wittern Group, collaborated on a machine specially engineered to dispense fresh-cut fruits and veggies — even easily bruised bananas.” The machine—which went on the market in 2010—has two temperature zones. The top is loaded with bananas kept at about 57 degrees. The bottom zone—kept at about 34 degrees—holds packages of fresh-cut fruit and vegetables. The vending machine is already in some schools and sells for more than $5,000 compared to about $3,000 for a typical machine.

And even though adults seem more reluctant to pick fruits and veggies over chips and soda, recent research shows that children may be more likely to choose healthy snacks as long as the packaging features familiar cartoon characters. Using characters to market healthy foods was perhaps more prevalent in the pop culture of years past (remember Popeye and his spinach?), but it’s seeing a comeback today in characters like those from Veggie Tales. Of course, the implications of character marketing to kids make some parents and experts uncomfortable, which is why fun packaging like the kind used for these baby carrots—that doesn’t feature popular cartoon characters—is being met with such applause.

In the end, every child may not be getting the recommended daily servings of fruit and veggies yet, but innovations like these may help combat the stereotype that snacks have to be unhealthy to be fun and tasty.


Pushing Fruits and Veggies With Junk Food Tactics

The Great Banana Challenge—How to Dispense Healthy Snacks From A Vending Machine

State-Specific Trends in Fruit and Vegetable Consumption Among Adults --- United States, 2000-2009

Influence of Licensed Characters on Children's Taste and Snack Preferences

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Friday, January 21st, 2011

Wal-Mart Announces New Pricing Strategies for Fruits & Veggies

Posted by: Erin Ellingwood


According to the New York Times, on Thursday, January 20, Wal-Mart announced a five year plan to drop prices on fruits and vegetables and to make thousands of its packaged foods lower in unhealthy salts, fats and sugars. The move represents a big step forward in addressing the affordability of healthy food in America.

While other national companies—like ConAgra—have promised similar reductions in unhealthy ingredients, Wal-Mart has much more influence over the market as a whole since it is the largest retailer in the United States. Wal-Mart “sells more groceries than any other company in the country” and is one of the largest purchasers of foods produced by national suppliers. Michael Jacobson, Executive Director of Center for Science in the Public Interest, describes Wal-Mart as being “in a position almost like the Food and Drug Administration” in terms of influence on the American food industry. The company’s five year plan is not only a great starting point for testing pricing strategies, it’s also a move that will likely push the major food suppliers it does business with—like Kraft—to follow a similar approach.

However, Wal-Mart’s plan is not without its caveats. According to Mr. Jacobson, “The company’s proposed sugar reductions are ‘much less aggressive’ than they could be” and “[Wal-Mart] is not proposing to tackle the problem of added sugars in soft drinks, which experts regard as a major contributor to childhood obesity.” The five year timeline is also much less aggressive than most experts would like.

There is also the question of accountability and holding hold Wal-Mart to its promises. According to the New York Times, The Partnership for a Healthier America  “will monitor the company’s progress” as it implements its plan. Still, the changes will not go into effect immediately and, while Wal-Mart has been specific about its goals for reducing unhealthy ingredients by 2015, it has been vague about a timeline for rolling out the pricing reductions on fruits and vegetables.

The company is receiving attention for its plan from high places—First Lady Michelle Obama has publicly thrown her support behind their initiative. Mrs. Obama’s support of Wal-Mart is seen as “a prominent effort by the administration to spur further moves toward healthier food.”

The Robert Wood Johnson Foundation has made using pricing strategies to promote healthy food one of its 6 policy priorities for reversing childhood obesity by 2015. And although Wal-Mart’s five year plan is in imperfect in its details, it has already successfully accomplished one goal of childhood obesity advocates: help push the national discussion about pricing disparities and strategies to the forefront of public attention.   

We’re eager to hear from healthcare professional advocates about how they think this might affect the children and families in their community. If you’d like to share, please leave a comment!

Read More:

Wal-Mart Shifts Strategy to Promote Healthy Foods

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Tuesday, January 18th, 2011

BOV Community Partner Listed In Top 10 Healthcare Innovations in NC

Posted by: Erin Ellingwood

Congratulations to Advocates for Health in Action (AHA) for being listed at #8 on the Institute for Emerging Issues (IEI) top 10 list of Healthcare Innovations in North Carolina!

IEI received more than 70 nominations of promising healthcare innovations already at work in North Carolina. In February, they will begin to develop an action plan for how the 10 most promising innovations can be scaled and/or replicated to deliver better care at lower costs and create new, high-paying jobs across the state.

Laura Aiken, MHA, is the Director of AHA and the site lead for the Be Our Voice project site in WakeMed, NC. Way to go, AHA!

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Wednesday, December 22nd, 2010

Childhood Nutrition Reauthorization Signed Into Law

Posted by: Erin Ellingwood


On December 13th, 2010, President Obama signed into law the Healthy, Hunger-Free Kids Act, also known as the Child Nutrition Reauthorization (CNR). NICHQ joins with our friends and partners at the RWJF Center to Prevent Childhood Obesity in celebrating the passage of this landmark legislation.

Dr. Dwayne Proctor, Director of the Childhood Obesity Program Management Team at RWJF   summarized the magnitude of this legislation: “This is a huge victory for the 31 million students who participate in federal school meal programs and for all kids in schools.  This law is a game-changer in our efforts to reverse childhood obesity - it improves school nutrition, increases program access, and puts an additional $4.5B towards child nutrition programs over 10 years – that’s the largest increase to the authorization since it was started.” 

What exactly does the Healthy, Hunger-Free Kids Act do?

Improves School Nutrition1

  • The law allows the U.S. Department of Agriculture to update school nutrition standards for all food in schools, including offerings through vending machines, stores and à la carte lines. It provides the largest increase in school lunch reimbursements in 30 years (6 cents per lunch, which would be tied to schools meeting stronger school lunch standards).
  • School meal quality also would be enhanced through stronger technical assistance to schools, improved meal financing and increased accountability regarding the foods schools serve and sell, and how they operate their programs.
  • TheThe law strengthens local school wellness policies by updating existing requirements, increasing transparency, providing opportunities for community involvement and creating compliance measurements.

Increases Program Access1

  • It makes it easier for children receiving Medicaid benefits to participate in school meal programs by using Medicaid data to directly certify eligible children, instead of requiring individual applications. About 115,000 more low-income children will receive free school meals each year as a result of the bill.
  • An additional 21 million after-school suppers will be served to at-risk children by 2015, and after-school sites would receive roughly $14,000 in additional revenue per site, on average, per fiscal year. The law also establishes nutrition requirements for these after-school programs.
  • Schools will receive $40 million for farm-to -school and school-garden programs to bring more healthy foods into schools and support local agriculture.


  • The legislation will spend $4.5 billion on child nutrition programs over 10 years. That is 10 times as large as the last reauthorization.
  • The law is partially paid for by eliminating a $2.2 billion temporary increase to Supplemental Nutrition Assistance Program (SNAP) benefits that was part of the stimulus package. This offset was the source of some opposition by House Democrats.
  • The reduction in SNAP benefits would not go into effect until 2013. The White House has committed to working with Congress to restore the SNAP funding.

We at NICHQ would like to thank everyone who’s worked so hard to get this vital legislation through Congress. What a victory for child health!

1 Summary points authored by Dr. Dwayne C. Proctor.

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Wednesday, November 17th, 2010

Fast Food Marketing and Children

Posted by: Erin Ellingwood


Last week, the Rudd Center for Food Policy & Obesity at Yale University released a new report entitled Fast Food F.A.C.T.S. (Food Advertising to Children and Teens Score). The Center found that children as young as 2 are seeing more fast-food ads than ever before, and that restaurants provide largely unhealthy side dishes and drinks as the default options that come with kids’ meals. The new report is the most comprehensive study of fast food nutrition and marketing ever undertaken.

Researchers examined the marketing efforts of 12 of the nation’s largest fast-food chains. Additional data included the calories, fat, sugar and sodium in more than 3,000 kids’ meal combinations and 2,781 menu items. Perhaps the most disturbing finding, indicative of the disheartening nature of the overall report, is that “out of 3,039 possible kids’ meal combinations, only 12 meet the researchers’ nutrition criteria for preschoolers” and “only 15 meet nutrition criteria for older children.” That breaks down to only 0.39% and 0.49% of kids’ meal combinations for each respective age group. 

Any healthcare professional could tell that the fast food climate being pushed in today’s market was unhealthy for our children. But the Rudd Center’s report shows just how detrimental fast food and marketing is—and it’s far beyond anything people expected.

However, hope is not lost. In the words of RWJ President and CEO Risa Lavizzo-Mourey, “Parents should demand the healthy items in kids’ meals—like apple slices and low-fat milk—and they should let fast-food companies know they don’t want them using games, toys and popular characters to lure their children toward unhealthy habits. In the words of one fast-food slogan, let the fast food companies know that you want to ‘have it your way.’”  The report authors also offer practical recommendations for transforming the restaurant and marketing landscapes. The Rudd Center’s findings may be alarming, but hopefully this report will serve as a call to action for both the healthcare and fast food industries alike.

Fast Food FACTS (full report):

Fast Food FACTS (summary):

A Statement by Risa Lavizzo-Mourey on Fast Food FACTS:

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Monday, September 27th, 2010

10 Sites Among Recipients of $31 Million HHS Award

Posted by: Erin Ellingwood

On September 14, the U.S. Department of Health and Human Services (HHS) announced $31 million for awards to ten communities in eight states and one award to a state health department to support public health efforts to reduce obesity and smoking, increase physical activity and improve nutrition.

The awards were funded by the Prevention and Public Health Fund included in the Affordable Care Act. They are also part of the HHS Communities Putting Prevention to Work (CPPW) program, which is a comprehensive prevention and wellness initiative administered by the Centers for Disease Control and Prevention. Of the 9 awards given, 7 were designated for obesity prevention efforts.

The announcement of the award is a powerful event in celebration of National Childhood Obesity Awareness Month. The CPPW program is an example of a national initiative with a local focus, much like Be Our Voice. Such programs are vital to the fight against the obesity epidemic. National policies and programs must be complemented by change and implementation at the local level if we are to reverse the trend of childhood obesity within a generation.

To view a detailed listing of grant awardees, visit:

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Friday, September 24th, 2010

NICHQ Tapped To Create and Manage National Prevention Center for Healthy Weight

Posted by: Jonathan Small

NICHQ Awarded $5 Million by HRSA to Lead Nationwide Quality Improvement Program to Help Address Obesity in Children and Families


Part of Nearly $100 Million Granted by HHS for Key Public Health and Prevention Priorities through the Affordable Care Act



Boston, MA, September 24, 2010 — The National Initiative for Children’s Healthcare Quality (NICHQ) announced today it has been awarded a $5 million grant from the US Department of Health and Human Services to help address the obesity epidemic. NICHQ will lead a consortium of organizations to establish a national Prevention Center for Healthy Weight for the Health Services and Resources Administration.  This Center will guide and support the activities of teams from at least 50 communities across the nation to better prevent and treat obesity.


Obesity constitutes a grave threat to the health and well-being of our nation.  Obesity rates have risen dramatically over the past decades with particularly strong impact on diverse and disadvantaged communities. According to the Organization for Economic Cooperation and Development (OECD), the United States has the highest rate of obesity among all developed nations. Three in four Americans will become overweight or obese by 2020, unless industry, the public and the government work together to address the issue.


NICHQ’s program will establish the collaborations recommended by the OECD – partnerships between health care, public health and community-based organizations. These partnerships should lead to changes in the community environment and individual health behaviors to promote healthy weight and health equity. The program will focus on children and families from across the nation, with an emphasis on communities at higher risk.


NICHQ will lead the program in collaboration with the following expert partners: the Association of State and Territorial Health Officials, the Association of Maternal and Child Health Programs , CSI Solutions, the Institute for Healthcare Improvement , Let’s Go!: Maine Medical Center , National Association of County and City Health Officials, National Association of Community Health Centers and Nemours.


“NICHQ has been working for nearly a decade to address the growing threat of obesity, and we have helped thousands of health care professionals – doctors, nurses, dieticians, and others – be more effective in counseling families and in working to make their communities healthier places to live,” said Charles Homer, MD, NICHQ’s President and CEO.  “We are honored to have this opportunity to extend the work with our many partners under HRSA’s leadership to contribute to solving this critical issue.”


“The Prevention Center for Healthy Weight will play a key role in identifying collaborative strategies for addressing and reducing obesity – an alarming and growing public health problem,” said HRSA Administrator Mary K. Wakefield, PhD, RN. 


United States Senator John Kerry congratulated NICHQ for this award in his remarks at the Boston Medical Center on Friday, September 24. Senator Kerry was on hand to highlight how national health care reform will benefit Massachusetts hospitals. “We know we need to focus not just on sickness, but on wellness,” said Kerry. “The unique work being done by organizations like the National Initiative for Children’s Healthcare Quality (NICHQ) is ensuring Massachusetts continues to lead the way in quality, affordable healthcare.”


Founded in 1999, the National Initiative for Children’s Healthcare Quality (NICHQ) is an independent, not-for-profit, action-oriented organization dedicated to achieving a world in which all children receive the high quality healthcare they need.  Led by experienced pediatric healthcare professionals, NICHQ’s mission is to improve children’s health by improving the systems responsible for the delivery of children’s healthcare.


For the press release from HRSA, please click here:

For the press release from Senator Kerry's office, please click here:

Senator Kerry with NICHQ CEO Charlie Homer and COO Rachel Steele

Senator John Kerry congratulates NICHQ’s President and CEO,

Charles Homer, MD, and Chief Operating Officer, Rachel Sachs Steele, MEd, after the announcement of the grant award.


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Friday, September 17th, 2010

Congress Declares September "National Childhood Obesity Awareness Month"

Posted by: Rachelle Mirkin

This past March the U.S. House of Representatives passed a resolution designating September 2010 as the first ever National Childhood Obesity Awareness Month. Then, on September 1st, President Obama released a memo officially proclaiming  the designation (read the presidential proclamation here). To commemorate this event, Be Our Voice is creating new resources to give healthcare professionals, as well as the general population, more information about the causes of childhood obesity and the efforts being made to address them.

BOV is in a unique position to celebrate National Childhood Obesity Awareness Month. Be Our Voice aims to get healthcare professionals out of their offices and into their communities as voices and implementers of change. Because the project does not focus on one clinical or policy recommendation, BOV is highly compatible with many existing initiatives and individual passions. Clinicians and other HCPs who are engaged in childhood obesity prevention and reduction programs can make sustainable, community-based level changes.  We are very proud of the over two hundred BOV advocates currently out there and ask you to join with them for change. 

The official website for National Childhood Obesity Awareness Month, Healthier Kids, Brighter Futures, has a list of events happening around the country during the month of September. I encourage you to find and participate in the events happening in your area.

And, of course, spend some time on the Be Our Voice website to learn how you, as a healthcare professional, can raise your voice for kids this September.

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Thursday, August 5th, 2010

Massachusetts Tackles School Nutrition

Posted by: Erin Ellingwood

You may not think of Massachusetts as a state that has an obesity problem, but according to the recent report, F as in Fat: How Obesity Threatens America’s Future, Massachusetts only ranks 18th on a list of the states with the lowest rates of childhood obesity. But the state legislator is taking action to change that with the help of Massachusetts’ school officials, farmers, and public school districts.

Yesterday, August 4th, Governor Deval Patrick signed into law the School Nutrition Bill, which takes an aim at establishing standards for all foods sold outside of regular school  meal programs. Most schools and communities in Massachusetts currently have no standards for the kinds of food available to nearly one million public school students in vending machines, a la carte, or in school stores.  And while we’d hope that kids are choosing salads or fruits for snacks, studies show that most students are buying donuts, candy, soda, and potato chips when given the opportunity.

The new School Nutrition Law will increase the selection of healthy foods available while banning the sale of deep fried foods, salty or sugary snacks, and high-calorie sodas in public schools. Schools are now required to make fresh drinking water available along with fruits and vegetables anywhere food is sold. This law also makes it easier for schools to purchase directly from Massachusetts farms—a boon to both farmers and students as, according to available data, kids eat more fruits and vegetables and try new options when they know the food is local.

In addition, the Massachusetts Department of Public Health is now responsible for developing nutritional standards for food or beverages sold in public schools by the start of the 2012-2013 academic school year. Many lawmakers and experts in Massachusetts hope that this law, as well as the standards resulting from its passage, will become a model to the rest of the country in ways to effectively fight childhood obesity.

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Tuesday, June 29th, 2010

RWJF and Trust for America's Health Release "F as in Fat 2010"

Posted by: Rachelle Mirkin

RWJF and Trust for America’s Health Release F as in Fat 2010

Adult obesity rates climbed in 28 states during the past year and now exceed 25 percent in more than two-thirds of the states, according to F as in Fat: How Obesity Threatens America’s Future 2010.

The report, by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), includes obesity rates among youths ages 10-17, and the results of a new poll on childhood obesity conducted by Greenberg Quinlan Rosner Research and American Viewpoint. The poll shows that 80 percent of Americans recognize that childhood obesity is a significant and growing challenge for the country, and a strong majority supports a comprehensive national effort to prevent childhood obesity.

In addition, the report highlights troubling racial and ethnic disparities in adult obesity rates. For example, adult obesity rates for Blacks and Latinos were higher than for Whites in at least 40 states and the District of Columbia. 

The report identifies actions that the federal government and many states are taking to address the epidemic and recommends specific strategies to accelerate momentum. Recommendations include: ensuring that disease-prevention measures in the new health reform law are implemented strategically, expanding the commitment to community-based prevention programs, and sustaining investments in research and evaluation.

The Be Our Voice sites are actively engaged in working to change these trends.


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Tuesday, June 29th, 2010

Polly Arango

Posted by: Rachelle Mirkin

Polly Arango, an NICHQ founding Board member and co-founder of Family Voices, passed away on Sunday.  Polly was a tireless advocate committed to her causes and focused on ensuring families were central to the voice and commitment to children with special health needs.  I appreciated her warmth, strong spirit, commitment and dedication.  She was an inspiration and guiding light. 


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Monday, May 17th, 2010

A Picture Is Worth a Thousand Words

Posted by: Rachelle Mirkin

This picture was just sent my way. I smiled and then my heart sank. For me it sums up our struggles as public health professionals, parents, advocates and Americans in one clear picture. 

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Wednesday, May 12th, 2010

White House Task Force on Childhood Obesity Releases Action Plan

Posted by: Rachelle Mirkin

You may remember I closely follow the Let’s Move campaign. When the campaign launched in February, it included a presidential memorandum that called for a comprehensive plan to be created to end childhood obesity. Well, you can envision my excitement on Tuesday when the Interagency Task Force on Childhood Obesity revealed their strategic action plan to end childhood obesity within a generation.

The task force included a set of recommendations in the report focused on the four priority areas established in the February memo: empowering parents and caregivers; providing healthy food in schools; improving access to healthy, affordable foods; and increasing physical activity. While not perfect, they are a good start.

All of us at the Be Our Voice campaign are thrilled to see this report because it aligns with our own efforts to advocate for children’s health. We cannot reverse the trend of childhood obesity alone—we need collaboration among parents, physicians, government leaders, community leaders and more. I am pleased that our administration at the highest level recognizes we need this partnership and has launched a coordinated effort with key benchmarks to measure success.

Take a look at the plan.

What do you think? Do you believe that with cooperation from all sides we will in fact end childhood obesity within a generation?

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