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Impact‌ ‌of‌ ‌the‌ ‌COVID-19 Pandemic‌ ‌on‌ ‌Childhood‌ ‌Obesity‌ ‌

A dad helps his son to put on a protective face mask so that it fits properly to help prevent the spread of COVID-19 / Coronavirus. Whether it’s going back to school or to the store, they are prepared.

The American Academy of Pediatrics has reported that nearly 2.3 million children in the United States have tested positive for coronavirus since the start of the pandemic. In addition to the health impacts of COVID-19 itself, there is evidence that COVID can be connected to other diseases as well, including obesity. The Centers for Disease Control and Prevention lists obesity as one underlying risk factor for severe consequences from COVID-19.

Early evidence is also beginning to show that COVID-19, and the economic consequences of the pandemic, may be increasing the risk for obesity. Factors such as limited access to affordable, healthy food, fewer places or chances to be physically active, or uncertain access to healthy school meals, can increase a child’s risk for obesity.

To get a better understanding of how COVID-19 might ultimately impact childhood obesity rates in the future, we spoke with Dr. Punam Ohri-Vachaspati of Arizona State University and Dr. Lindsey Turner of Boise State University.

Prior to the pandemic, what impact does school attendance have on a child’s risk for obesity?

Dr. Lindsey Turner: There’s a fair amount of evidence accumulating that school can reduce the risk for obesity.  That’s most likely because of the structure and predictability of school days, as well as access to healthy school meals, physical education, and other supports for students. There’s also some good evidence to suggest that for lower-income students who eat meals at school, those meals are associated with a lower risk of obesity. So ensuring that students continue to be able to access healthy meals at school is important.

Dr. Punam Ohri-Vachaspati: Prior to this very unusual school year, the vast majority of school-going children in the U.S. have had access to healthy school breakfast and lunch, and maybe a healthy snack. Nutritional standards were updated for these meals nearly a decade ago, and there is evidence that those changes may have contributed to healthier weight among school-age children, especially those from families with low incomes. School attendance also provides opportunities for physical activity—either through activities in school or through active commuting to school such as biking or walking—which are associated with healthier weight outcomes in children. There is emerging evidence that elementary school-age children gain weight at a rapid rate when the school is out during summer. So, as Lindsey noted too, schools can reduce the risk for obesity among children.  

“Especially early in the pandemic, it was difficult for families to find healthy, affordable foods regularly, making them more likely to purchase processed and packaged foods. The absence of school meals in a child’s day or the change in composition (because of much needed waivers) of meals offered during the pandemic are areas that need examination.”

Dr. Punam Ohri-Vachaspati, Professor of Nutrition at the College of Health Solutions at Arizona State University
With so many kids out of school much more than normal in 2020-21, what do we know about how some of the policy responses (e.g., school meal waivers, Pandemic EBT, etc.) may have impacted risk for obesity? 

LT: Pandemic EBT (P-EBT) was put into place to allow the families of students who most relied on access to free or reduced-priced meals at school to be able to replace those meals with items purchased locally from supermarkets or other locations. The quick availability of this program from USDA was necessary to address skyrocketing rates of food insecurity early in the pandemic. In addition, USDA allowed all schools waivers for flexibility in how and where meals are served, and allowed schools to offer free meals. That rapid response was crucial to meet the needs of children and families nationwide.

POV: Some of our early assessments have shown that parents find the P-EBT benefits very useful. These benefits need to continue until children are back in schools on a regular basis and have the ability to access school meals. The school meal waivers have allowed schools and communities to offer much needed school meals to children during COVID-19 school closures. Parents find the access to these free meals critical, but there have still been challenges related to limited hours and location of meal distribution sites, lack of feasible delivery options, as well as families running out of meals before the next pickup day. We need innovations in program delivery to meet the needs of parents (re)-entering the workforce while their children are still not attending school on a regular basis. With growing food insecurity rates, these benefits are extremely helpful for families in need.

What kind of questions do we need to study to better understand the connection between COVID-19 and childhood obesity? 

LT: There are a lot of important questions on this topic. While pre-existing obesity can lead to more severe consequences of COVID-19, it’s likely that the circumstances caused by the pandemic will also increase the prevalence of obesity. I say this because for many students there are fewer options for them to be physically active if they are not in school regularly during the week, and there are probably also dietary consequences from changes in where students eat and what they are eating. It will be important to study the behaviors that combine to increase risk for overweight– that is, physical activity, sedentary time, and dietary intake. Changes in any one of these are likely to increase the risk of childhood obesity, and the pandemic has impacted all three types of behavior.

POV: There is growing evidence that food and physical activity environments where children live can impact their health. For example, in our recent work we showed that over time, having additional convenience stores in a child’s neighborhood had a negative impact on their weight status. During extended school closures, children are much more likely to go to these kinds of stores in their neighborhoods, so we need to investigate if the negative impacts of these features get exacerbated when schools are closed for extended periods. Another concern is shifts in household purchasing behaviors during this time. Especially early in the pandemic, it was difficult for families to find healthy, affordable foods regularly, making them more likely to purchase processed and packaged foods. The absence of school meals in a child’s day or the change in composition (because of much needed waivers) of meals offered during the pandemic are areas that need examination.

Similarly, on the physical activity front, when children are not in school they are not participating in the structured physical education or walking / biking to school.  Absence of these options, especially among children living in communities that are not safe from traffic or crime and/or do not have access to safe public parks, sidewalks, or other features that can promote physical activity, has the potential to result in unhealthy outcomes. Are children living in walkable communities or close to safe public parks protected from some of the negative impacts of pandemic school closures on physical activity and weight? 

“With so many families dealing with financial challenges due to the pandemic, the connection between food insecurity, unhealthy eating habits, and obesity, have become even more evident. Finding ways to support the health of children year-round—whether during a pandemic or not—must be a priority for our nation.”

—Dr. Lindsey Turner, Director of Initiative for Healthy Schools at Boise State University
Are there policy changes that have been put in place because of the pandemic that you think ought to be maintained even without the pandemic? Are there things that are working well now that we should keep doing? 

LT: I think it’s going to be very important to learn more about school meal delivery during the pandemic, because this is an area where so many changes were made rapidly by incredibly committed and creative school nutrition professionals. With the changes in school nutrition programs, it’s possible that some changes—such as making all meals free—might be worth keeping after the pandemic is over.

POV: At the outset of the pandemic the school food systems were challenged to deliver free meals to all children and they did a remarkable job organizing and delivering these meals. These programs were implemented on a very short time scale. The lessons learned from this experience can be instrumental in exploring universal free meals for children or expanding eligibility criteria—we know school meal participation rates are higher among those who receive free and reduced-price meals. On the flip side, waivers relaxed some of the nutritional requirements for school meals—these waivers were critical to ensure children were fed during the uncertain times. However, when we return to the post-pandemic era, it is important to ensure that the advances made on the nutritional quality of school meals are reinstated and further improved. 

At the end of the day, what does the research tell you about the impact COVID-19 is likely to have on childhood obesity rates? 

LT: The pandemic has definitely shone a bright light on the crucial role that schools play in supporting healthy behaviors among children and adolescents. The pandemic has also reduced opportunities for physical activity even outside of school times, in terms of sports and play time outdoors. With so many families dealing with financial challenges due to the pandemic, the connection between food insecurity, unhealthy eating habits, and obesity, have become even more evident. Finding ways to support the health of children year-round—whether during a pandemic or not—must be a priority for our nation.

POV: COVID-19 is likely to affect obesity rates in children in a significant way. Absence of regular school attendance over extended periods is a major concern. Schools play a critical role in keeping our children healthy by providing a structure that includes provision of healthy meals and opportunities of physical activity as well as limits to sedentary time. In addition to school closures, the pandemic created environments, whether because of lockdowns or public health measures, that may be more conducive to unhealthy behaviors in children. Social distancing prevented children from being physically active and increased sedentary time. Parents’ shopping patterns changed—less frequent trips and increased reliance on non-perishable foods. Disruptions in the food supply chain meant changes in what was available in stores. Loss of jobs and disruptions in income increased food insecurity rates—all impacting households with children disproportionately. Children and their families most certainly need support now and will continue to do so over time—this is necessary to protect children from long-term negative impacts of the pandemic.  

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State of Childhood Obesity: Prioritizing Children’s Health During the Pandemic

october 2020

This report, released in October 2020, presents the latest childhood obesity rates and trends, expert insights, relevant research, and policy developments, including emergency relief efforts to support major federal nutrition programs. It highlights promising strategies for prioritizing children’s health and improving equity in response to the pandemic and throughout recovery.

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PRIORITY POLICY

School Meals and Snacks

Many children consume up to half their daily calories at school. Nationwide more than 29 million children participate in the National School Lunch Program and nearly 15 million participate in the School Breakfast Program. 

See the Policy
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Six school nutrition professionals from the Midwest to the East Coast share their inspirational stories about helping to ensure that kids and families have healthy foods during the COVID-19 pandemic.

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Infant and Toddler Milk Companies Spend Millions Targeting Caregivers With Dubious Nutritional Claims—and it’s Working

With new dietary guidelines on the horizon for the youngest children, new research examines harmful marketing practices aimed at getting babies and toddlers hooked on sugary drinks

Earlier this month, an advisory committee released an assessment of nutrition science that will inform the upcoming 2020 Dietary Guidelines for Americans. Updated every five years by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS), the guidelines provide advice to everyone in America, and act as the foundation for several key federal nutrition programs.

For the first time, those guidelines will include nutrition advice for children from birth to two years of age. One of the conclusions of the advisory committee is that infants and toddlers under age 2 should avoid drinking sugar-sweetened beverages, a recommendation supported by leading health organizations.

Health experts currently recommend breastfeeding until a child is at least one year old, and from about 6 months, teaching children to eat a healthy family diet, including a variety of fruits and vegetables and plain water and milk to drink.

Yet, many caregivers find it difficult to implement this advice—from the many challenges of breastfeeding to picky toddlers whose favorite word is “no.” Often conflicting advice from family, friends, pediatricians, social media and others confuses things even more.

But formula manufacturers claim to offer the solution: Infant formula that is “closest to breastmilk” and milk-based drinks for toddlers (known as toddler milk or toddler formula) that claim to promote young children’s nutrition, development and growth. These claims, however, directly contradict expert recommendations and are not backed by scientific evidence.  

Furthermore, companies spend a lot of money in marketing to convince parents that they have young children’s best interests in mind. And according to recent research from the Rudd Center for Food Policy and Obesity at the University of Connecticut, these marketing claims work. Sixty percent of toddler caregivers surveyed agreed with unsupported claims that toddler milk provides nutrition toddlers don’t get in other foods.

Researchers recently took a closer look at infant formula and toddler milk marketing claims and how they influence caregivers. Their study, which was funded by the Robert Wood Johnson Foundation, surveyed 1,645 U.S. parents and other primary caregivers of infants and toddlers to measure their agreement with common marketing claims on these toddler drinks, identify products they served their child, and assess the relationship between agreement with claims and whether they served the products to their child.

We talked to Jennifer Harris, PhD, MBA, one of the study’s authors and a senior research advisor, marketing initiatives, at the UConn Rudd Center, to find out more about their findings—and what the implications are for young children’s health. Harris is also an author of a research brief published by Healthy Eating Research that examines opportunities to address some of the harmful marketing practices behind these drinks.

1. What’s so important about infant and toddler nutrition?

The infant and toddler years are a critical period for developing healthy eating habits. What a child eats at ages 1 to 3 can have an enormous effect on their preferences for healthy foods and beverages for the rest of their lives. Unfortunately, the diets of most American toddlers aren’t as healthy as they should be. They often include added sugar, including sugary drinks like fruit drinks. And we know that sugary drinks can lead to many long-term health risks, including obesity, diabetes and other chronic diseases.

Teaching young children to enjoy eating a variety of healthy foods takes time and perseverance, and many parents worry that their young child isn’t eating enough. That’s an opportunity that companies have seized upon with toddler drinks – they seem to promise parents a simple solution to getting their child to eat more and get better nutrition. In focus groups, parents have told us that they provide toddler milks to fill a gap in their child’s nutrition when they don’t eat enough healthy fruits and vegetables.

2. What are toddler drinks and why don’t experts recommend giving them to young children?

Everyone has probably heard of infant formula, but the idea of toddler drinks is a fairly new one. With increasing breastfeeding rates (and associated declines in infant formula sales), formula companies needed to find new ways to grow their business, so they invented a new product –a “formula” for young children who are too old for infant formula. In 2015, manufacturers in the United States spent $17 million to advertise toddler milks, a four-fold increase from 2006.

There are two kinds of toddler drinks – both are marketed as the “next step” after infant formula. “Toddler milks” are labeled as a nutritional drink for 1 to 3-year-olds. Another type – “transition formulas” – are marketed for infants and toddlers from 9 to 18 or 24 months.

Both raise substantial concerns among health and nutrition experts. Toddler milks consist of non-fat powdered milk, vegetable oil and added sugar (like corn syrup solids). Since they are a sweet milk drink, serving them can actually backfire and make it more difficult to teach young children to like the taste of healthy drinks, such as plain unsweetened milk or water. Plus they can cost four times as much as plain milk, which experts recommend for children this age.

Transition formulas are actually the same ingredient composition as infant formula, which is not appropriate for children over 12 months — but companies market them for the “transition” from infant formula to the family diet for children up to 18 or 24 months old.

The marketing of toddler drinks is extremely effective, though. Toddler milks are the fastest growing “formula” category. Here in the United States, the volume of sales of toddler milks increased by 133% from 2006 to 2015. And worldwide, their sales increased by more than 50% from 2008 to 2013.

3. What are some of the main marketing claims about infant formula and why are they a problem?

Infant formula is an important option for many families, particularly those who cannot or choose not to breastfeed. But infant formula marketing implies that these products provide health and nutritional benefits for infants above and beyond breastmilk. Packages claim that product formulations reduce gas or fussiness, provide DHA for brain development, or prebiotics for baby’s immune system—but none of these so-called benefits are backed by scientific evidence.

Despite this lack of scientific support, 52% of infant caregivers agreed that infant formula is better for babies’ digestion and brain development and 61% agreed that it can provide nutrition not present in breastmilk. Furthermore, 71% indicated that infant formula claims mean that infant formula is as good as breastmilk for babies. And that directly contradicts child nutrition experts and substantial research demonstrating that breastmilk is superior for infants up to a year.

We’ve also seen research that shows continued widespread marketing of infant formula directly to American consumers. In addition to traditional advertising on TV and in magazines, companies provide free infant formula to new parents in the hospital and pediatrician offices, provide free formula to mommy bloggers to write about the formula they give their own child, and offer feeding advice for each stage of babies’ development on company websites. These are just a few examples of a marketing strategy to position formula companies as “experts” on the nutrition and health of babies. 

4. What about for toddler milks?

Similarly, toddler milk marketing claims many benefits for young children’s nutrition, cognitive development and growth that are not supported by scientific evidence—such as “DHA and iron to support brain development”, “Lutein like that found in spinach for eyes,” or “prebiotics to help support digestive health.” And caregivers believe these claims. In our research, 60% of those surveyed agreed that toddler milks provide nutrition not available in plain milk or other foods. These marketing claims even imply that toddler milks are necessary for toddlers to have correct nutrition—which approximately a third of parents believed.

Another issue with toddler milk marketing is that parents find it difficult to tell the difference between infant formula and toddler drinks. The packages look very similar, with the same or similar brand names, colors and package shapes, and they are often stocked side-by-side on store shelves. Toddler milks are also less expensive than infant formula. But what’s in them is very different, and in fact it can be dangerous to serve toddler milk to infants because the ingredients don’t meet their nutritional requirements. We found that 11% of infant caregivers mistakenly served a toddler milk most often to their child.

5. Are there any notable differences either in who is exposed to this kind of marketing, or how people respond to it?

We think our research demonstrates how incredibly powerful marketing can be. For example, we found that even though 80% of our study participants agreed with expert recommendations to serve breastmilk to infants and plain whole milk to toddlers, the majority of them still agreed with common marketing claims that compare infant formula favorably to breastmilk and toddler milk to healthy foods. And when caregivers believed these claims, they were significantly more likely to serve infant formula or toddler milk to their children.

Furthermore, our research indicated that higher levels of education didn’t lead to a decreased likelihood to believe marketing claims. In fact, it was the opposite—caregivers with a college degree were more likely to agree with such claims and serve toddler milks to their children.

Some brands of toddler milks are also advertised extensively in Spanish-language media. However, we found that Hispanic and non-Hispanic parents were equally likely to provide toddler milks to their children.

6. What can be done from a policy perspective about the marketing of transition formula and toddler milk, both in the United States and abroad?

In the U.S, infant formula is highly regulated by the FDA, but there are still some loopholes. For example, most claims on infant formula qualify as “nutrition” or “structure function claims”, meaning that they link a product ingredient with a bodily function (e.g., “lutein for eyes”). Unlike health claims, these types of claims do not require significant scientific agreement and preapproval by the FDA. Furthermore, there are no specific requirements for toddler drink labels, product names or formulations. That needs to change. There should be regulation of the marketing of infant formula and toddler drinks and improved product labelling. There should also be stricter FDA requirements for all claims on foods intended for children under the age of 3.

In fact, a group of 30 public health experts, including the UConn Rudd Center, recently petitioned the FDA to establish regulations for labeling products sold as toddler milks. The petition asks FDA to develop regulations so that caregivers are not misled

Globally, the World Health Organization’s International Code of Marketing Breastmilk Substitutes directly prohibits all marketing of infant formula and toddler drinks directly to consumers, as well as other forms of marketing. The United States is one of only six countries that has not enacted any regulations to limit infant formula or toddler drink marketing in any way.

That would be an important step toward ensuring that caregivers are able to make the best decisions about feeding their child – without influence from the millions that companies spend in marketing to directly contradict child health expert recommendations. Our research shows that this marketing misleads parents and benefits only companies’ bottom-line.


What comes next: USDA and HHS will hold a public meeting on their assessment on August 11 and take public comments until August 13. Members of the public can submit comments.

Supporting a Healthy Early Childhood During the COVID-19 Pandemic

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the nation’s largest federal nutrition programs, serving approximately 6.3 million people, including about half of all infants born in the United States. WIC helps low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 achieve and maintain a healthy weight by providing healthy foods and nutrition education; promoting breastfeeding and supporting nursing mothers; and providing healthcare and social-service referrals. 

The COVID-19 pandemic has made it more difficult for WIC participants to access their standard benefits, and for new participants to enroll. To get a better picture of WIC during this time, we spoke with Georgia Machell, PhD, senior director of research and program operations for the National WIC Association (NWA), and Geri Henchy, director of nutrition policy and early childhood programs at the Food Research Action Center (FRAC). Below is a transcript of the conversation. 

How has WIC been a support to families during the COVID-19 pandemic?

Georgia: WIC has continued to operate, which has been extremely helpful to families who rely on it for access to healthy food, breastfeeding support, nutrition education, and referrals. In response to social distancing protocols, WIC agencies across the country have been working tirelessly to shift what has been primarily an in-person program for over 40 years, to remote service provision. The flexibilities in the Families First Coronavirus Response Act have enabled WIC services to be provided in new ways. For example, the physical presence requirement has been waived in WIC certification. Traditionally participants would go into a clinic to have height and weight measures taken as part of a certification appointment. Obviously, those things are not safe to do in the current environment, and so WIC is doing remote certifications in a number of innovative ways. Our understanding is that most certifications are happening by phone, however we’ve heard from some of our members about drive-thru WIC clinics that are being set up in various places. Participants pull up to the WIC clinic in their car, call the number, and clinic staff come out and do a certification.  

WIC clinics are rapidly innovating, which is important in these times. It is important to be able to provide services remotely, extend the certification periods, and extend batch issuance for EBT benefits so that folks don’t have to come back to clinics to get certified or call back to continue those processes. 

Geri: I think that WIC has been a tremendous support to families during the COVID-19 pandemic. Even before the pandemic, WIC has been important to 6 million families and children. We know that WIC is a program that supports eating healthier and being healthier and can help reduce a child’s risk for obesity.  

As important as it was before, it’s even more important now because we know most people are stuck at home. We’ve already seen several studies showing a significant increase in food insecurity since the start of the COVID 19 pandemic, and reports of decreased dietary quality. WIC’s role in helping to improve food security and dietary quality, and to support overall health, is even more important now because of the circumstances surrounding this public health crisis. This is true for families already on WIC and for the many people who are newly eligible due to having recently lost their jobs and being thrust into dire circumstances.  

And that’s why the things that Georgia is talking about — where WIC is trying to adapt quickly to being able to serve in this new environment — are really important. For WIC, as with many other things, it’s been a race against time. When states first started social distancing and shutting things down, some states didn’t deem WIC as essential, so they shut WIC down. This meant that people couldn’t get services.  

Imagine, a mother brings her new baby to WIC for a scheduled appointment to enroll in the program, but the doors are locked due to a state having shut down the clinic. What is this mom supposed to do? While these obstacles did surface during the start of the pandemic, now we are seeing that because of the waivers and other progress that’s been made that it’s possible to enroll participants over the phone.  I’m not sure that they can serve everyone by phone yet, but I think there is a lot of innovation that’s going on and I am really happy about it. 

And a theme that’s really come forward for me is partnerships. I really think all of these partnerships — that the National WIC Association has with its members, that we have with our anti-hunger members — are proof of how everyone has worked together and employed their expertise to make sure that WIC can keep serving people during this pandemic. And I’ve really thought that’s one good thing that I see coming out of this. We all care about continuing to support the health of low-income communities and newly eligible communities. And we’ve really been able to work together with a big massive effort to make sure people can still get on the program. 

Data

Obesity Rates Drop Among Young WIC Participants

Between 2010 and 2016, the obesity rate among children ages 2 to 4 who participate in WIC declined significantly nationwide and in 41 states and territories, according to data from the Centers for Disease Control and Prevention (CDC). The Robert Wood Johnson Foundation produced a special report examining how WIC can help give children a healthy start in life.

Read the Full Report

How have the relief packages that Congress has passed so far impacted WIC?

Geri: Georgia referenced the crucial waivers that have recently been passed, including the waiver allowing WIC to serve people without their being physically present in the clinic. There are also technical waivers that USDA has issued that have helped WIC move forward.   

Two of the other things we really care about in terms of the waivers are, making it easier for enrollees to get their benefits electronically and allowing states to offer clients flexibility in WIC food package choices to accommodate supply chain disruptions.  

Since WIC benefits are on EBT cards now for most states, WIC benefits can simply be downloaded remotely allowing participants to have their benefits even if the WIC office is closed due to COVID-19. It’s important for states to keep moving forward on that, and it shows the value of having upgraded the technology for benefit issuance to EBT because it’s a lot harder in places where they haven’t done that.  

Regarding food availability, in some places, not all of the foods that are normally part of the WIC food package are available, so states can make some changes to help connect participants to healthy food during these urgent circumstances. In some ways, it seems like the states should be given even more leeway on this front. For example, there’s a WIC requirement that you can buy bread if it’s whole-grain and weighs one pound, but some WIC participants can’t find this exact product because of the supply chain disruption. It’s my impression that USDA is saying, “Well if you can find some whole grain pasta or some of the other things on the list, then you can’t substitute out a larger size bread.” And I think it would be better and easier for people if the state WIC people were allowed to have more flexibility in their waivers around the WIC food package than it appears to me that they have.  

Georgia: I think that we share similar concerns and we obviously want to make sure that, first and foremost, people can access the foods that they’re eligible to purchase with their WIC benefits, and if those foods are not available, that there are appropriate alternative options. Sometimes those foods are not available because of supply chain issues or because of stockpiling, so we definitely want to encourage the use of waivers to increase the range of foods that are available to WIC participants at this time.  

Going back to the issue around what’s happening in the retail setting, we’ve also been doing a bit of myth-busting over the past few weeks. For example, we’ve seen some messaging on social media in the past few weeks that’s tried to discourage people from shopping at the beginning of the month because that’s when WIC benefits are issued. The National WIC Association has been clear with our messaging that we don’t want to discourage people from shopping at any specific time of the month and that benefits are issued at different times in different places. And so that people should be respectful neighbors and be mindful that when you are shopping during whatever time of the month, if there are foods that are WIC-eligible (with a shelf tag that says WIC), be mindful that there could be someone who really needs them in the coming days and weeks. 

story

How WIC Gives Children a Healthy Start, Preventing Obesity in Early Childhood

In summer 2019, to better understand the decline in obesity among young WIC participants, we spoke with Georgia Machell and Jim Weill, president of FRAC.

Read the Interview

The WIC shelf tags have garnered a lot of attention in the past few weeks. There have even been celebrities like Michelle Obama and Kerry Washington reminding their twitter followers too, “Please look out for the WIC shelf tags and be mindful about these things.” So yeah, it’s certainly been interesting, but again, we’re just really trying to promote respectfulness and mindfulness when you are shopping. 

How have shortages of staples at grocery stores impacted families who use WIC? 

Georgia: It’s difficult to say exactly how widespread that is. I will say that we are having weekly conversations with state WIC directors and others to try and keep an ear to the ground on what different folks are experiencing in different places, and like many things in WIC, the experiences are different across the country.  

With regards to infant formula, unlike other foods, there are no alternatives to formula. Whenever there are formula access issues, there is concern that families may try to make their own formula or overly dilute formula to make it go further. These are dangerous and potentially life-threatening practices. The National WIC Association is providing messaging around this issue for WIC agencies to share with participants.  

Geri: Yes, it does vary a lot, and we get the same thing when we’re checking in with our network of anti-hunger advocates. For example, in Wisconsin, they have plenty of milk with various fat percentages, but in many other places, certain milk varieties are not available.  Participants can’t get nonfat milk, so they’ve got to shift to low-fat or full-fat milk. That is one of the most common things that people have waivers for. And then in some places, the shelves are cleared out. But in other places, they’re not.  

One place overall that seems to have more problems than others is rural areas.  To the extent that the supply chain is disrupted, it can really be an issue in rural areas.  People in rural areas are having to go a long way to get to the store and then their local stores are having supply chain issues. And I see Georgia nodding because that is something we’re really hearing about. Looks like you’re hearing about it too. 

Georgia: Yeah, definitely. And I will say that we’ve been particularly mindful of rural communities, both in thinking about the immediate response and the implications of COVID, but then also in thinking about some of the innovations that we know are going to be implemented over the coming weeks and months to increase access to WIC services remotely. There’s a positive long-term implication there for rural communities for whom we know transportation and physical access has always been a barrier to accessing WIC services. So as awful as this situation is, if we think about the kind of long-term implications of innovation, there’s certainly something there that suggests that there could be positive for access to rural communities to services like WIC. We just need to make sure the impact of these changes to service provision is measured and current waivers are extended.  

Geri: I think that a lot of the issues around client-facing technology are coming to the fore here. So states or local agencies that have been thinking about that and trying to work toward that are in a better position than those who haven’t and who may be smaller and have fewer resources to start with. We’re definitely seeing that people are able to use telehealth and FaceTime to talk to WIC offices. And the other part of that really is whether people are going to be able to move forward with online ordering.  

Yes, we have positive progress being made, it’s a race against time, and everybody’s trying to do the best they can to make sure to serve everyone. But these things will have longer-term implications. And I will say also that, going back to your original question, one of the things that we’re seeing now is there are remarkable differences in impacts related to race and ethnicity.  

We know that certain populations are being hit much harder than others in terms of mortality with the COVID-19 virus. We also know what that means for all of the food programs, including WIC, and we want to make sure that vulnerable populations are served. I think that all of these waivers that we have from USDA, all of these partnerships, and all this hard work will help us reach all of the communities that need to be reached, ensure that individuals understand how to get the critical WIC services that they need, now, starting from that first contact, by phone or internet, to the shopping experience being successful. 

As we move forward, the traditional role of WIC in supporting health and wellness in all of these different communities grows in importance. That’s why I think it’s good that everyone’s working together to move forward, including using all of their different resources and partnering with each other, to reach everyone who needs to be helped. You normally don’t see the kind of rapid change in a program that we’re seeing right now within WIC. 

Policy Recommendations

Women, Infants, and Children (WIC) Program

The Family First Coronavirus Response Act provides $500 million in additional funding for WIC to improve access to nutritious foods among pregnant women with low incomes or mothers with young children who lose their jobs or are laid off due to the COVID-19 pandemic. 

Learn More and See Policy Recommendations

Are there other changes that you think would be needed either in the short term to help respond to the pandemic or longer-term shifts in WIC that you are working on, will continue to work on, despite the coronavirus?

Geri: I feel like this is a good time to put some more fruits and vegetables in the WIC food package. That would help meet a need right now during the pandemic, but it would also put us in a good position for the permanent revisions to the food package down the line, which are Congressionally-mandated and should be happening soon.  

Georgia:  I’m glad that you brought up the food package because that’s definitely something that’s top-of-mind, especially as we’re thinking about how folks are struggling to access aspects of it right now.  

NWA recognizes the good work being done by FNS career staff and WIC staff on the ground.  We are really hoping that the waivers that currently in-place and being approved will be extended beyond May.  

We’re in the midst of this focusing event right now and a number of the things that WIC leaders are working tirelessly to implement in a very short timeframe are things that have been in the pipeline for a while and they’re just having to do it in an expedited timeline and with the pressure of knowing that we’re about to have an influx of new WIC participants as well. 

I think that in the short term, one of the things that we’re encouraging our members to really engage with is having some unified messaging. I think there has been some confusion about whether WIC is open and the National WIC Association has put together a really good toolkit for WIC agencies to use. Some of our core messages say that WIC is here for you in the COVID-19 crisis. Your EBT benefits will not be canceled. Infant formula companies are not giving out free formula, because that was something that was one of those myths that were kind of floating around online that we felt like we needed to address quickly. And then also to just be respectful and not stockpile WIC foods.  

We’re keeping in really good communication with one another, which our members are good at doing, and the National WIC association plays a really important role in terms of convening people. As this pandemic unfolds in different time frames in different places, it’s really important that we’re listening to each other and making sure we’re all working together to continue to support access to WIC.  

The Impact of Changing SNAP and School Meals During COVID-19

Emergency relief would shore up programs, but longer-term proposals would still reduce access to food stamps, make school meals less healthy.

By Jennie Day-Burget

The coronavirus pandemic has resulted in thousands of deaths in the United States and has upended daily life for millions of people across the country. Part of the emergency response at all levels of government has been to ensure that children and families continue to have access to healthy affordable foods.

The largest nutrition assistance program in the United States is the Supplemental Nutrition Assistance Program (SNAP)—sometimes known as food stamps—with the National School Lunch and School Breakfast Programs also among the largest. These programs have become even more critical during the current pandemic but pending changes to those programs would fundamentally change how they are run and who has access to them.

I spoke with Giridhar Mallya, senior policy officer of the Robert Wood Johnson Foundation, to better understand how recent coronavirus relief legislation impacts SNAP and school meals, as well as some of the longer-term proposals in both areas.  

Why is SNAP important? Why has the Robert Wood Johnson Foundation invested in the success of the program?

SNAP is the Supplemental Nutrition Assistance Program. It’s the program that was previously referred to as food stamps. As a foundation, we care a great deal about promoting health equity, which means giving everybody a fair shot at living out their full health potential. A program like SNAP is just essential to that mission. It provides individuals and families financial support to put food on the table. It serves about 40 million people in this country, in any one particular year. About half those people are kids, and two-thirds are kids, older adults, or people with disabilities. So, it really serves as a lifeline for those people.

Supplemental Nutrition Assistance Program

Learn more about the Supplemental Nutrition Assistance Program, previously referred to as food stamps, and see policy recommendations from the Robert Wood Johnson Foundation

Visit the SNAP Policy Page

What I really love about the program is that it not only meets its primary goal of reducing hunger—and it does that effectively, as has been shown by a whole body of research studies—it also reduces poverty among families. When you look at people who were served by SNAP as kids, if you then follow them over the course of their life, as adults, they have lower rates of things like diabetes and high blood pressure. And some people served by the program have better economic outcomes as adults. So, this program is really a home run in terms of people’s physical, financial and social health.

What does it mean for a family to have access to SNAP, particularly during challenging times in their lives?

Most of the families with kids that are served by this program live in poverty. For a family of four, that means they’re living on $26,200 or less per year, which really helps put this in perspective. The SNAP benefits—which could be a couple hundred dollars a month—really could mean the difference between a child having three meals per day versus maybe only two or one. Particularly for young kids, food is fuel for their development—their developing bodies, but also their developing minds. There are a number of studies that show that kids who don’t go hungry— who are food secure—are both able to be more physically present at school, but also mentally present. So, it has both short and long-term impacts on their educational trajectory.

Congress has recently passed several pieces of legislation to address the coronavirus pandemic. Have any of those impacted SNAP?

Yes, those laws include a few broad changes to SNAP. For one, the work requirements and time limits on benefits that are normally in place have been effectively suspended. Secondly, it lets states request special waivers from the Secretary to provide temporary, emergency benefits to existing SNAP households up to the maximum monthly allotment. Finally, households with children who would normally be receiving school meals will receive emergency SNAP assistance to help cover the meals those children would have had at school. All of those are good changes that aim to make benefits more secure for more people during this emergency.

However, the legislation has not included an increase to the baseline SNAP benefit, which some advocates were calling for as the debates were happening. There was an increase in SNAP benefits during the Great Recession, for instance, that reduced hunger and financial distress.

Apart from that emergency response, what are the potential longer-term changes to SNAP currently on the table?

There’s a lot going on in terms of US Department of Agriculture actions as it relates to SNAP. In the aggregate, the longer-term changes USDA has proposed will make it harder for a number of people and families to qualify for the program. And for those that continue to qualify, many will see a reduction in benefits. So, I think that is kind of the big-picture impact of these proposals.

In terms of the particular proposals: First there is a proposal from USDA that basically would make it harder for states to waive the work requirements that are written into SNAP. The second is a rule change that would make it harder, again, for states to be more flexible in terms of their eligibility requirements as it relates to income thresholds and asset thresholds. And then the third rule change relates to how utility costs are accounted for in determining whether a person or family is eligible or not. And it basically, again, sets a federal standard, instead of having the state-by-state standards, even though the latter may better reflect what utility costs look like in that place.

What would these proposals mean to those families who are affected by these rules?

The big picture impact is that it would adversely affect eligibility and the amount of benefit that millions of families get. If you look at the impact of all three of these proposals together, 3.7 million people would lose eligibility for SNAP and around 4 ½ million people or more would see a decrease in benefits.

We were talking specifically about children before: About a half-million households with children would see a loss of eligibility and over a million would see a decrease in the amount of benefit that they get. So, it’s really just a substantial and significant adverse impact if all three of these rule changes went into place together.

How would these changes to SNAP impact kids’ access to healthy meals at school?

There are going to be changes to broad-based categorical eligibility that don’t just affect SNAP, but also school meals. What happens under broad-based categorical eligibility is that if a child or a family is receiving a certain type of cash benefit from the state, they can automatically qualify for SNAP, and then in turn they can automatically qualify for free or reduced-cost school meals. 

With the proposed changes from USDA to broad-based categorical eligibility, almost a million kids would lose their direct eligibility for school meals. Some of them, with additional documentation, would be able to continue to get free or reduced-cost school meals, but some wouldn’t. So, this proposed change would also affect kids’ access to healthy and nutritious meals in school. It’s a double whammy in that way: It impacts food security in the home and also in school.

What impact do healthy school meals have on kids, in terms of their health and their learning?

I think what we’ve seen, particularly since the Healthy and Hunger-Free Kids Act, is that the nutritional quality of school meals, kids’ participation in school meals, and their satisfaction with the school meals have improved. So those are all great things.

What’s even more important, I think, from a public health perspective, is that we’re finding that through improved nutritional quality of school meals, plus a number of other changes that are happening in school environments, that this can have a positive impact on a kids’ health. Additionally, we know that when kids are well-fed, they are much more prepared to learn in school, to meet the developmental and educational milestones they should be meeting, and that they perform better in school. So there are positive impacts on nutrition, health and educational outcomes that are put at risk if this rule goes through.

In January, the U.S. Department of Agriculture proposed changes to the school meals programs that would make those meals less healthy. Can you talk about what impact that proposal would have?

The proposal from USDA would mean that schools would be allowed to serve less fruit, fewer whole grains, fewer varieties of vegetables, and more starchy vegetables. Foods like pizza and cheeseburgers could be served more often without being required to meet nutrition standards. This would have a real impact on the roughly 30 million students who rely on school meals.

healthy lunch tray and pizza

Proposal to Weaken School Meal Nutrition Standards

A proposal from the U.S. Department of Agriculture would make school meals permanently less healthy. The proposal would allow schools to serve less fruit, fewer whole grains, fewer varieties of vegetables, and more starchy vegetables. Foods like pizza and cheeseburgers could be served more often without being required to meet nutrition standards.

Urge USDA to Reconsider

An analysis from Healthy Eating Research examined the projected impact of the proposal and found that it would have negative impacts on kids’ health and academic achievement. The students who would be most impacted by these changes are those from low-income families attending majority black and Hispanic schools and in rural communities—kids who are often already at highest risk for obesity and related health conditions.

USDA has taken some positive steps to give schools flexibility in how they serve meals during the pandemic, as more than 54 million kids across the country face school closures. That flexibility is commendable, because we know how important healthy meals are to these kids. That’s exactly why these potential changes to school meal nutrition standards would be the wrong approach.

Has the coronavirus legislation impacted school meals too?

Yes. As I mentioned before, households with children who participate in the school meals programs should now receive a SNAP benefit instead, so that’s one way the legislation impacts these programs. Secondly, USDA has allowed states more flexibility in how they serve meals so that they can serve them outside of school settings.

In the bigger picture, what policy preferences does RWJF have when it comes to SNAP and school meals?

These programs, both SNAP and school meals, have health, educational and economic benefits. So, I think the big question is: Do we want to make it easier or harder for people to access these effective programs? Our position is that any proposed policy changes to these programs should make it easier for people to qualify and reap the benefits. And when we look at the proposed changes, whether it’s the three proposed changes to the SNAP program or this most recent proposed rollback to school meal standards, we don’t think those changes meet that principle.

Very specifically, in terms of SNAP, any proposed changes should be carefully considered in terms of what impact it will have on eligibility and utilization, and therefore on the health, educational and economic outcomes we described. Second, SNAP should continue to invest in strategies that enable people to purchase healthier foods. And there are a few different models that SNAP has tested, which have proven effective. We know that it can be more expensive to eat more healthfully, so we need to enable families to do that. Third, we believe these three proposed changes to SNAP should not move forward and that the program should be maintained in its current form.

As for the proposal on school meals, we think it’s misguided. As our CEO Richard Besser put it, “Weakening school nutrition standards does not solve problems; it creates them.”

The bottom line is that, while the coronavirus response legislation seems likely to help in the near term, the long-term changes still on the table would make SNAP harder to access for many people and would make school meals less healthy.

For more on how the coronavirus relief legislation impacted SNAP and other food programs, see resources from the Food Research & Action Center and Urban Institute.

A Closer Look at Food Insecurity

Two kids picking produce at the grocery store

Last fall the Urban Institute released a new interactive tool mapping food insecurity across the country. The dashboard provides county-level data about a range of different factors that impact food insecurity, and groups counties by risk factors.

We spoke with Elaine Waxman, senior fellow at the Urban Institute about the new tool. A transcript of our conversation follows.

Can you define food insecurity? 

Food insecurity, at least as we conceptualize it in the United States, means lacking access to enough food for an active, healthy life. Another way that we sometimes describe it is that you have limited or uncertain availability of nutritionally adequate foods for your household. 

That might mean that you’re running out of money and you’re not sure you’ll have enough to buy more food or even that you’re skipping meals for an entire day. 

And are there other questions or standards that are different between kids and adults? 

The food security module that’s used in surveys asks questions about both the adults in the household, and children. Having children with food insecurity is less common though because adults tend to shield kids, not surprisingly. But we also know that children living in food-insecure households—even if they perhaps have more adequate resources than their parents—is still related to poor outcomes. So, we’re very concerned if children are identified as directly food insecure, but we also understand that larger universe of kids living in a food insecure household is a risk we should be worried about. 

The new dashboard has a lot of data in it, like housing costs, income, credit scores—information that people might think of as unrelated to food security. How is this connected to food insecurity? 

The interactive map breaks down level of food insecurity and related risk factors in each county.
Source

Fundamentally, food insecurity is an economic and social condition of not having enough resources. And one of the things that we know is that expenses for food compete with other expenses for basic needs. So, for example, families are often in the position of trading off between housing costs and buying food. Or transportation and buying food. Or childcare costs. And food is one of the first things to go in a budget because it’s something that’s more easily changeable than, for example, your rent payment. And in order to really understand the conditions that are contributing to food insecurity and the trade-offs that people are making, it’s important to look at the other pressures that families are facing. So that’s sort of the first part of our thinking about creating the dashboard. 

The second part is that we increasingly understand that food insecurity is connected to important outcomes. So, we know that food insecure individuals are at higher risk for chronic diseases such as diabetes. And when they actually develop it, they’re less well-positioned to manage it in terms of being able to eat well and eat regularly. We’re also are just beginning to have some emerging understanding that food insecure individuals are at greater risk for premature death, which is a topic that’s gotten a lot of attention in the last few years. 

“The goal of the dashboard is to help communities and organizations that are thinking hard about how to disrupt food insecurity. To see these connections in one place and think about the fact that, while federal nutrition programs and food banks are important short-term strategies and longer-term strategies, to really tackle the problem we have to include these other sectors.”

Are there geographic differences that the dashboard tracks over time? 

The dashboard is a cross-sectional snapshot, so it doesn’t collect data over time. But, let’s step back for a minute and talk about trends. Most of us know that food insecurity hit an all-time high during a short period after the Great Recession. But perhaps what people have not realized is that it’s continued to persist at fairly high levels even as it has begun to slowly inch downward. So, we still have nearly 40 million people in the United States who identify as food insecure. And given that we know that food insecurity is associated with a lot of poor outcomes, that’s very worrisome. So, one of the reasons we wanted to highlight this issue at this time is that, perhaps we’re in a stronger economy, but that’s not consistently true for many people. And, yet this perhaps is a window of time where we can begin to tackle some of these vulnerabilities. 

And I think in terms of geography, we present a map that helps people visually see the patterns of food insecurity in the country. But also, they can see that we’ve identified peer groups of counties. And they’re facing multiple challenges that are similar. So, for example, there are some counties that classify as “very high, with multidimensional risks.” These are often rural counties with persistent, long-term poverty. Their issues run the gamut from high unemployment to really poor health outcomes. Thinking about what you might do in that community, it’s probably different than, for example, a more prosperous area that still is challenged by food insecurity, alongside high housing costs. 

“Our goal was to help people begin to unpack the challenges and think about what their entry points could be. And also, to be able to visually see on a map, well, even though I’m, say, in the southeast, or I’m in Appalachia, I can see that there are counties with similar challenges to me that are in, say Indian country.”

 In fact, when we did some site visits to sort of test out the dashboard approach, we visited one Appalachian county and several of the participants in the focus group remarked that they were really intrigued by the fact that there were communities in very different parts of the country that were facing some of the same challenges and that they would find it more helpful to talk to those communities than, say some that were more nearby but weren’t really facing the same kinds of circumstances. So those are exactly the kinds of conversations that I think we hope to promote. 

How can the dashboard affect strategies that local city, county or state leaders might take for approaching some of those challenges? 

One of the things we wanted to use the dashboard to do was to open up the conversation about strategies for different kinds of problems. Obviously we can’t be anywhere near exhaustive in that, but we provide a list of strategies by major topic areas, including physical health, housing and transportation costs, and financial health of the community. And we list promising practices and resources in all of those areas. So it’s a way to get started. It’s not going to provide any sort of ready-made toolbox but we hope that it puts multiple resources in one place and makes those conversations easier to have. 

Another thing we emphasized in a companion report that we released in December is how to engage communities directly in using the data in a meaningful way. And by communities we mean residents, but also community leaders and other stakeholders. And so one of the things that that we did in the past year in a half-dozen communities, and that we outlined as something communities can do as well, is to organize data walks. That means bringing key data points about a community, maybe with comparison data from other peer groups, to a group of residents or leaders and asking them to engage and react directly. 

“Data is only one starting point and it’s a great way to allow people to react and say, ‘Wow, I didn’t know that about my community,’ or, ‘Yeah, that really resonates, and let me tell you why I think that’s happening here,’ or, ‘I don’t think the data fully capture the problem. I think the data probably understates the problem.’ ”

For example we did one in Fort Smith, Arkansas, where a lot of the community leaders and elected officials there started up some really robust conversations about transportation barriers, which is not usually the first conversation that comes up when you ask people to talk about food insecurity. 

But they could see that households in their area were spending a large part of their incomes on transportation costs. And that led to a conversation about how transportation may be a direct barrier in terms of getting to a grocery or a food pantry, but also how transportation costs eat into peoples’ incomes for affording basic needs. 

How many of those have you done? 

In the past year, we did six—in Austin, Texas; Fort Smith, Arkansas; Perry County, Kentucky; Indiana County, Pennsylvania; Fresno, California; and Hattiesburg, Mississippi. And, in each case, I think community residents often either feel ignored or sometimes they just feel talked about—that their opinions and their living experiences aren’t valued at the same level as survey data. 

We hope that the dashboard actually provides a mechanism to bring those two things together. Because obviously, engaging directly in conversation about what works in your community is the next step. It’s not enough to just have dots on a map. You need to be able to say, “Well, what would really make a difference here?” or, “Why is it that we think we have the solutions here but people aren’t taking them up?” Those are the kinds of conversations that people know they need to have, but they’re challenging. We hope that this provides some tools to makes those conversations easier to organize. 

And we can’t provide national data on all the topics that we know are relevant. So when we do data walks, we also encourage communities to identify other trends and issues in their community that they think should literally be up on the wall. We put big posters up on the wall. And so, in some of the communities we visited, for example, people wanted to have statistics about incarceration. Or they wanted to show the really stark disparities between different racial and ethnic groups with respect to income. Or they wanted to show high foster care placements because they felt that showed a trigger for food insecurity that people needed to talk about. 

So, the dashboard gets you started, but then the community can add the issues that they think are most compelling. 

Urban Institute’s interactive food insecurity map allows the user to pick a county to see the level of food insecurity in its child population and total population. It also compares the county data to the state, national, and peer group food insecurity averages.
Source

What kind of response have you had to the dashboard?  

The initial response was more positive than we had anticipated. And I think the positions people have depend on how they’re using it. So for example, I think foundations or service providers who cover multiple areas find it super useful because they have to think about, what kinds of challenges are communities facing, who has the most significant challenges, what are the characteristics of that community? Then I might prioritize. And it allows them to sort of do that targeting and resource planning through this tool. 

On the other hand, a local county might say, “Wow, I didn’t realize this about our county. I didn’t realize we’re considered a high-housing-cost-county even though we’re in the middle of Arkansas.” 

“And that’s something we really need to, to talk about. So I think it has different uses depending on the point of view, but we felt heartened that there was enthusiasm for all those different levels.”

Is there anything else that you want to share? 

One of the things that I think is a particular contribution about the dashboard is that it also includes financial health data from credit bureau information for every county in the United States, which is really unusual. We’re lucky in that we have a relationship with a credit bureau—we’re able to access that data that’s not usually available to communities. 

So that’s something that we want to draw attention to because if you think about it, a credit score is an indicator of the extent to which people have resources and buffers to fall back on. And if you have a large number of sub-prime credit scores in your area, everybody who is affected by that is probably paying more for a lot of basic expenses than would otherwise be the case. So if you have a sub-prime credit score, you’re paying a lot more for an auto loan. And you may really need a car in order to get to a job. 

Or you aren’t able to get a credit card with a decent rate to have in emergencies. And these are the things that a lot of Americans I think take for granted, but they’re really basic financial management strategies. And so I think communities are beginning to talk about what we can do to help improve the financial health of community members. And, how that intersects with peoples’ ability to meet their basic needs. And so, it’s a unique source of information that I think we’re able to bring. 

Resources

Healthy Food Financing Initiative Policy Page

The Healthy Food Financing Intiative is a public-private partnership that provides grants and loans to finance the construction and development of grocery stores and other healthy food retailers in underserved areas.

Learn More

Healthy Food Financing Initiative Map

Check out the map to see which states have have their own initiatives to increase access to healthy foods in communities across America.

See The Map

The Urban Institute Dashboard

Explore Urban Institute’s dashboard to see the food insecurity levels within a county, related risk factors, and opportunities for intervention.

Explore the Dashboard

Unhealthy Drinks Dominate Children’s Drink Sales

Learn the FACTS about Children’s drinks

With so many children’s drinks available in the marketplace, parents are often left wondering which are healthy and which are not. A recent Rudd Center FACTS report found that the majority of children’s drinks sold in 2018 were sweetened fruit drinks and flavored waters with added sugars and/or low-calorie sweeteners. Looking at the front of the packages, many sugary children’s drinks appear to be healthy choices, with images of fruit and nutrition-related claims, but none meet expert recommendations for drinks that should be served to children under age 14.

We recently spoke to food marketing researchers, Dr. Jennifer Harris and Dr. Fran Fleming-Milici of the Rudd Center for Food Policy and Obesity at the University of Connecticut, to learn more about this report.

Q: The Rudd Center released its Children’s Drink FACTS report last fall. Could you give us a short overview of this report? What are some key findings?

A: This report assessed the sales, nutrition and marketing of children’s drinks, drinks that were marketed directly to children or to parents as drinks to serve to children. We found that fruit drinks and flavored waters that contain added sugars and/or low-calorie sweeteners accounted for 62% of the total sales of children’s drinks in 2018. Only 38% of children’s drink sales were for healthier, unsweetened drinks, such as 100% juice or juice/water blends.

Marketing plays a big part in what kids want to drink. In 2018, companies spent $20.7 million advertising children’s drinks with added sugars. When you see numbers like that, it’s no surprise that children continue to consume sugary drinks.  This is a problem. Consumption of these drinks leads to long-term health risks, including cardiovascular disease, type 2 diabetes, hypertension, and dental decay.

Companies do offer healthier options for children, such as juice/water blends with no added sugars or low-calorie sweeteners, and companies do advertise some of these products to parents and children. However, companies continue to spend more on TV advertising of sweetened drinks than they spend on TV advertising of healthier drinks that meet expert recommendations. Given this difference in ad spending, it isn’t surprising that in 2018 children saw twice as many TV ads for sweetened children’s drinks as they did for drinks without added sweeteners.

We also found similar brand names, pictures of fruit, and nutrition claims, such as “good source of Vitamin C” or “no high fructose corn syrup,” on both sweetened fruit drinks and flavored waters and on healthier drinks. For example, images of fruit appeared on almost all of children’s sweetened drink packages (regardless of whether the product contained any fruit juice). This makes it really challenging for parents to know which drinks are healthy options for their children.

Also, about three-quarters of children’s sweetened drinks included low-calorie sweeteners such as sucralose and acesulfame potassium, the same sweeteners found in diet soda, but the front of the packages did not mention this. Instead, these drinks were often promoted as “low sugar” or “less sugar.” These claims appeal to parents who care about reducing sugar in their child’s diet, but the American Academy of Pediatrics recommends that parents do not provide products with nonnutritive sweeteners to children.

Overall, the lack of transparency about ingredients in children’s drinks, coupled with confusing claims and extensive marketing of sweetened drinks, is a problem. Parents should be able to easily find and identify a healthy drink for their child.

Q: This report came on the heels of some of the foremost experts on children’s health releasing a consensus statement with recommendations for what young children should and should not drink. How does this report build on those recommendations?

A: It’s fitting that our report came out just weeks after the consensus statement, which was a real game-changer for the field. The consensus statement recommends that water and plain milk are the go-to drinks for young kids; drinks with added sugars or low-calorie sweeteners are not recommended for children under the age of 5. Our report shows that not one of the 34 top-selling sweetened children’s drinks met expert recommendations for healthier drinks. The consensus statement should be a call to action for companies to reconsider the nutrition content of their products and their marketing strategies. When it comes to children’s drinks, companies should prioritize children’s health over profits.

Healthy Drinks Matter for Healthy Kids

In 2019, four of the nation’s leading health organizations released guidelines on appropriate beverage consumption for children. Read our interview with Megan Lott of Healthy Eating Research to learn more about the guidelines and how sugary beverages impact children’s health.

Read more

Q: How about brands advertising directly to children, or targeted marketing to Hispanic and African-American children? What does the report say about that?

A: Some companies continue to advertise sweetened drinks directly to children. For example, Kraft Heinz advertised two sweetened drinks—Kool-Aid Jammers and Capri Sun Roarin’ Waters—on children’s TV programming.  Two companies, Kraft Heinz and Coca-Cola, were responsible for 80% of TV ads for sweetened drinks that children under 12 years old viewed in 2018.

In previous Rudd Center Targeted Marketing reports, we found that food companies target Black and Hispanic youth with advertising for their least healthy products, including sugary drinks, candy, fast food, and snacks. This marketing contributes to health disparities affecting youth in communities of color. In this report, a few children’s drink brands targeted their advertising to Hispanic and African-American youth and parents.  For example, Black children saw more than twice as many TV ads for Minute Maid Lemonade as White children saw. Sunny D and Capri Sun also advertised on Spanish-language TV, where they devoted a significant amount (25%) of their TV advertising spending.

Q: What are some recommendations in your report?

A: Our report includes recommendations for not only food and beverage companies, but also for policymakers, regulatory agencies, and media companies to help parents easily identify healthier children’s drinks. A few of our top recommendations include:

  • Beverage manufacturers should clearly indicate that products contain added sugars and/or low-calorie sweeteners and the percent juice content on the front of children’s drink packages.
  • The Children’s Food and Beverage Advertising Initiative (CFBAI)—the voluntary, industry self-regulatory program—should establish nutrition standards that conform with health expert recommendations. Specifically, drinks with added sugars and/or low-calorie sweeteners should not be advertised directly to children.
  • The U.S. Food and Drug Administration could require that products with nutrition-related claims on packages meet minimum nutrition standards and prohibit the use of fruit and vegetable images on drink product packages that contain little or no juice.
  • State and local taxes on sugary drinks should include children’s fruit drinks and flavored waters to raise the price and discourage purchases.

Related Content

FULL REPORT

Children’s Drink FACTS

The UConn Rudd Center for Food Policy and Obesity released the report discussed above in October 2019. Check out their website to read the report and learn tips on healthy beverage consumption for children.

Read the Report
Additional Research

Sugary Drink F.A.C.T.S.

The Rudd Center also has produced additional research examining the nutrition of and marketing behind other sugary drinks. Children’s drinks alone were a $2.2 billion market in 2018.

Learn More
POLICY

Food Marketing to Children

Children in the United States are inundated with food and beverage ads, and companies target communities of color with their advertising. Learn more about food marketing and see recommendations from RWJF.

Visit Policy Page

Healthy Drinks Matter for Healthy Kids

We know that what kids drink can have a big impact on their health. Earlier this fall, four of the nation’s leading health organizations released recommendations on what kids ages 0 to 5 should and should not drink.

And this week the Centers for Disease Control and Prevention released state-by-state obesity data among children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The nutrition guidelines for WIC includes beverage guidelines for young children. We talked to Megan Lott, deputy director of Healthy Eating Research and lead author of the Healthy Beverage Consumption in Early Childhood report, to get her perspective on these latest reports and what the data show. She gave us a breakdown on the findings, why they matter, and the impact they will have on our youngest kids. 

To start, can you give us a quick overview of the Healthy Beverage Consumption in Early Childhood report that was released in September?  Why is the report important? 

These new guidelines outline what kids 0 to 5 should and should not drink. It’s important because beverages are a significant source of calories and nutrients in a young child’s diet. What children drink can have a big impact on their health in the long run, and many are not drinking healthy beverages. For example, many infants consume 100% juice before their first birthdays, which can increase their risk for nutrient deficiencies. Even more concerning is the consumption of sugar-sweetened beverages, with close to half of 2-to-5-year-olds consuming one every day, can increase a child’s risk for obesity, diabetes, and other health problems.

To ensure kids grow up healthy we must establish healthy patterns early on. The drink guidelines in this report can help parents and caregivers do that. 

Don’t these recommendations already exist? What’s new about this particular report? 

You’re right, there are many different drink guidelines out there, but there are gaps in either the age ranges covered or the types of beverages discussed. With so many kids’ drinks on the market and no consistent guidelines about which ones are healthy and which are not, it’s easy for parents and caregivers to be left scratching their heads.This new report clears up the confusion by providing clear, consistent, science-based recommendations on what kids ages 0 to 5 should and should not drink. It’s the first time that leading health organizations (the Academy of Nutrition and Dietetics, the American Academy of Pediatric Dentistry, the American Academy of Pediatrics and the American Heart Association) have made consistent recommendations for beverage consumption for this age group. 

What do these organizations recommend? 

The four organizations agree that:

  • Babies from 0-6 months should only drink breast milk or infant formula.
  • In addition to breast milk or infant formula, from 6-12 months a small amount of drinking water should be offered once solid foods are introduced to help babies get familiar with the taste – just a few sips at meal times is all it takes. It’s best for children under 1 to not drink juice. Even 100% fruit juice offers no nutritional benefits over whole fruit.
  • Once a baby turns 1-year-old, it’s time to add whole milk, which has many essential nutrients, along with some plain drinking water for better hydration. A small amount of juice is ok now, but make sure it’s 100% fruit juice to avoid added sugar. Better yet, serve small pieces of real fruit, which is even healthier.
  • From ages 2-5 milk and water are the go-to beverages. Look for milk with less fat than whole milk, like “skim” or “low-fat.” If you choose to serve 100% juice, stick to a small amount, and remember adding water can make a little go a long way!
  • All kids 5 and under should avoid drinking flavored milks, toddler formulas, plant-based/non-dairy milks, caffeinated beverages and sugar- and low-calorie sweetened beverages, as these beverages can be big sources of added sugars in young-children’s diets and provide no unique nutritional value.   

These are general guidelines. Of course, unsweetened and fortified non-dairy milks may be a good choice if a child is allergic to dairy milk, lactose intolerant, or if their family has made specific dietary choices such as abstaining from animal products. We encourage caregivers to consult with their healthcare provider to choose the right milk substitute to ensure that your child is still getting adequate amounts of the key nutrients found in milk, such as protein, calcium, and vitamin D, which are essential for healthy growth and development.

How do these guidelines compare to what is in the WIC food package? For example, doesn’t WIC allow juice?

Great question. Let’s start off by defining WIC. WIC is a federally funded program for low-income pregnant women, new mothers, infants and children age 5 and under. It provides families healthy food and nutrition education, among other things that are important to a child’s growth and development. 

The recommendations in our report align with the beverages allowable in the WIC food package. Juice is WIC-eligible, but only pasteurized, unsweetened 100% fruit juice and only for children 1-4 years of age (100% juices are not included in WIC food packages for children under 1 year old). Fruit drinks, fruit-flavored drinks, sports drinks and ades, and other beverages that are not 100% juice are not WIC-eligible. 

Our guidelines do not recommend flavored milk. The WIC program allows the states to choose whether or not to allow flavored milk, however, most do not. In fact, only 6 states allow flavored milk. 

What does the WIC data that was released this month say? What implications does the data have on these recommendations? 

New data from the Centers for Disease Control and Prevention shows that, between 2010 and 2016, obesity rates among children participating in WIC declined in 41 states and territories. This is encouraging and suggests that changes made to WIC in the last decade may be having a real impact on kids’ health, including nearly half of all infants born in the United States who are covered by WIC. 

We know that the choices people make are based on the choices people have. By making healthy foods and drinks WIC-eligible, we can help millions of parents make healthier choices for their kids. 

What impact do you hope these recommendations have? 

I hope policymakers will look at these guidelines as they consider changes to food packages for WIC and kids meals served in restaurants, such as substituting flavored milk with whole milk or water. 

I would also like for manufacturers to consider these guidelines as they think about how they package things like juice for children (labeling of 100% juice and sizes of juice boxes), which are available to children enrolled in the WIC program.

And of course, I hope these guidelines help parents and caretakers, in early care and education centers, at home, and in doctors’ offices, provide the right beverages to help children grow up at a healthy weight.

Where can I get more information? 

The full guidelines and accompanying technical report can be found at www.healthydrinkshealthykids.org. This site also contains handouts, infographics, and a set of parent-focused one-minute videos, in English and Spanish, covering all the different topics mentioned in the guidelines, such as tips for swapping out sugary drinks and understanding different types of milk. 

The state-by-state WIC data from the CDC can be found elsewhere on this site.


Published on November 21, 2019


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Increasing Healthy Food Options in Vending Machines

Nearly four million vending machines in schools, hospitals, apartment buildings, and other places where kids spend time dispense snacks and drinks every day. Starting Jan. 1, 2020, more of those food and beverage choices will be healthy, under a new public health commitment adopted by the National Automated Merchandising Association (NAMA), with support from the Alliance for a Healthier Generation (Healthier Generation) and the Partnership for a Healthier America (PHA), two national nonprofits dedicated to improving children’s health, including reducing obesity.

Over the next three years, the share of “better for you” options available in the nation’s vending machines will increase from 24 percent to 33 percent—a gain of nearly 40 percent over current levels. NAMA defines “better for you” as a food or beverage that meets at least two established healthy food standards.

Victoria Brown, senior program officer at RWJF, recently spoke with NAMA CEO Carla Balakgie, Healthier Generation Chief Strategy and Partnership Officer Anne Ferree, and PHA COO Stacy Molander to learn more about this unique partnership.

Victoria: I’m very excited about this initiative. It’s so encouraging to see public health and industry collaborating to make healthy foods more available. We know how important it is for kids and families, no matter where they are, to be able to make healthy choices. We also know that reformulating products to be healthier and changing practices to promote healthier foods and drinks is good for businesses’ bottom line.

I think this is a great example of how, working with public health, industry can do a lot to improve the accessibility of healthy, affordable food choices. In your view, why are collaborations between public health and industry important?

 AnneThrough our work at Healthier Generation, we understand that there’s no single solution for addressing complex public health problems. The data is clear that incremental change by major food and beverage industry leaders can produce dramatic shifts in the purchase and consumption of “better for you” products.

Stacy: Industry can—and should—be a major contributor to building a Culture of Health. The benefit of a partnership like this is that the reach is industrywide. This is a model we’ve employed elsewhere with proven success.

Carla: Working with the public health community was critical to helping NAMA make this public health commitment. Healthier Generation, PHA, and other highly respected public health groups provided insights, ideas, and recommendations that we used to strengthen the commitment throughout the two-year development process. All three of us are dedicated to making it a success for everyone—public health, industry, and consumers.  

Victoria: From a public health perspective, why focus on vending machines? 

Stacy: With nearly four million vending machines nationwide, the industry’s reach is substantial and crosses many socioeconomic levels, including lower income communities, where people are disproportionately affected by obesity and diet-related conditions.

Anne: Vending machines are inextricably woven into many families’ daily lives. Shifting the mix of products offered in vending machines not only meets consumers where they are but ensures that they are making the best choices they can for themselves and their families.

Carla: Individually, NAMA members have been making progress over the years in providing more “better for you” offerings. Acting together in a formalized fashion will accelerate this progress. We simply felt that there was more for our industry to do, given the epidemic of childhood obesity and changing consumer eating patterns. And although NAMA operators provide a range of services, this commitment focuses on vending machines for two reasons: They represent the majority of consumers we serve, and they are where we feel we can make the biggest impact on public health. 

Victoria: What did it take to create this commitment to “better for you” options and get it adopted?

Carla: It helped that we know PHA and Healthier Generation well, having worked with them since 2005 on our nutrition labeling program, FitPick.

We worked on this particular public health commitment for nearly two years. First, we studied previous models between PHA and Healthier Generation and other industries, and then we worked with our Board of Directors and industry leaders to craft a model that met our goal of offering increased “better for you” options to consumers.

We formed a nutrition working group; hired expert advisors at Convergency, Inc.; and secured a credible data aggregator and analytics company, Keybridge. Multiple meetings with the Board of Directors, as well as many discussions with operators, food and beverage manufacturers, distributors, and brokers, were held.

We created an extensive database to understand which products meet public health guidelines and to establish the percentage of “better for you” products we offer today—an essential step in determining our three-year goal. Finally, our participating companies conducted field tests across the country to learn more about how to successfully implement this commitment.  

It was an intensive effort, frankly far more so than we anticipated. Every step was crucial to building confidence in the data, the baseline, and in setting the ambitious goal we eventually decided upon. Key to our success was the ongoing collaboration with the public health community and our nearly 15-year relationship with PHA and Healthier Generation.

Stacy: Most importantly, it took leadership, and for that, we thank Carla for her vision and dedication, along with the NAMA Board for its unanimous decision to move in this direction. It’s not easy to motivate an individual company to embrace change like this, let alone an entire sector!

Victoria: At RWJF, we believe in the power of cross-sector partnerships to create opportunities for health where people live, learn, work and play. What are your organizations accomplishing together that you could not have done separately?

Carla: Partnering with Healthier Generation and PHA played a critical role in encouraging our vending machine operator companies to participate by adding significant credibility to this work. That would not have been possible by industry alone.

Anne: This collaboration demonstrates so clearly how influential organizations can leverage their respective relationships, assets, and strengths to build impact that’s broader than what a single organization could achieve.

For example, NAMA brings a massive distribution system, customer base, business innovation, marketing prowess, and highly engaged and committed leaders. Healthier Generation contributes a deep understanding of and relationships with the players across the convenience services landscape, coupled with a robust and trusted community engagement approach. And PHA has a credible and efficient validation model, plus a national event platform to spotlight commitments and communications for motivating others.

Victoria: What kinds of products changes do you anticipate consumers will see when they go to the vending machine?

 Stacy: We expect they will see an increase in the availability of “better for you” products like nuts, snacks made with whole grains, and bottled water—and, of course, fewer full calorie soft drinks and packaged foods high in sodium and added sugar.

Carla: Vending machines will carry a broader selection of “better for you” snacks and beverages. This could include favorite snacks that are reformulated and some that are brand new. 

Anne: To comply with NAMA’s definition of “better for you,” snacks and beverages must meet at least two sets of recognized public health standards. We know suppliers have a wide variety of options and Healthier Generation is looking forward to working closely with them and NAMA to fulfill that goal.

Victoria: What kind of impact do you hope to make? 

Carla: We hope to see the commitment drive improvement in public health and increase the opportunity for choice around “better for you” options in vending machines.  We want more kids and families to enjoy their snacks and beverages of choice from vending machines while diversifying the offerings with increased numbers of “better for you” selections. This is one reason we are also calling on food and beverage manufacturers to work with us to ensure that we have the right mix of products to meet ever-changing consumer demand.

Anne: We want to maximize the impact of initiatives like this one, and we hope that other food and beverage manufacturers and suppliers will join us in building the demand for healthier products. 

Stacy: It’s simple, really. That more people across the country have the opportunity to select a “better for you” product, more often. That increased pressure to stock “better for you” items will drive food and beverage manufacturers to create new products that meet the established criteria. And that we will collectively see this impact much faster and at a much larger scale by working with a sector-wide group like NAMA.

Published on November 20, 2019


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How Childhood Obesity Rates Have Changed Over Time

Young kids exercising in PE class

National childhood obesity rates rose from the 1970s into the early 2000s and have grown much more slowly since then. We recently spoke with Diane Schazenbach, director of the Institute for Policy Research at Northwestern University, about new research she and colleagues published using various federal data sets to examine some of the long-term trends in obesity rates. Below is a brief interview about the research.

In the big picture, what does your research show about how obesity rates have changed over the last few decades?

Overall, the rate of childhood obesity has more than tripled over the last four decades—rising from 5 percent in 1978 to 18.5 percent in 2016. Of course, that is an alarming trend! In response, resources have poured into addressing childhood obesity, through public health efforts, reforms to school policies and nutrition assistance programs, and more. What we find is that there is a sharp break in trend—a leveling off—starting in 2003. These days, the prevalence of childhood obesity is still rising, but at a much slower rate than it used to.

To put this in concrete terms, from 1978 to 2003, the childhood obesity rate grew by about 1 percentage point every 2 and a half years. Since 2003, it’s closer to 1 percentage point per decade. More work to bring down childhood obesity rates is needed, for sure, but there is some good news here!

From 1978 to 2003, the childhood obesity rate grew by about 1 percentage point every 2 and a half years. Since 2003, it’s closer to 1 percentage point per decade.

For many years, Black and Hispanic youth have had higher obesity rates than White or Asian youth. How have those differences been changing over time?

That’s right. In 2016, 26 percent of Hispanic children had obesity, compared to 22 percent of Black children and 14 percent of White children. We find that obesity rates among white children have remained steady since 2002 and are no longer increasing. Black and Hispanic children, on the other hand, have not seen the same progress and their obesity rates are continuing to increase. As a result, the gaps in obesity rates have been increasing between groups. For what it’s worth, unfortunately our national data, the National Health and Nutrition Examination Survey, do not include a large enough sample for us to reliably analyze obesity among Asian children.

One pattern we noticed that was surprising was that a lot of this increasing gap between Black and Hispanic children on the one hand and White children on the other hand happens by the time children are age 5. After that point, all groups experience increases in obesity at about the same rate. This suggests that we need to be aiming more of our efforts to address obesity at younger children, and think about the food and activity environments they face in preschools, child care, and in their homes.

young children being active

Childhood Obesity Data

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You also examined how rates differ between males and females. What did you see there?

The overall trends show that boys and girls have similar rates of obesity, and have experienced the same patterns of gains over time. In fact, we had to argue to keep the results by gender in the research, because reviewers did not think the results were interesting! We pushed back, saying that the lack of difference is itself an interesting finding!

How about how obesity rates change as children get older?

We found some pretty striking patterns as children get older. In particular, we find that a birth cohort’s obesity rate increases steadily from age 2 through about age 10, but that it levels out after that, so that obesity rates stay steady from ages 10 through 18. Of course, this pattern may differ for individual children—that is, in their teenage years some kids hit a growth spurt and see their BMI fall while others see theirs increase. But overall, as a group, we find that kids who were born in a certain year have about the same obesity rates at ages 11, 14 and 17.

There are many people and organizations – nonprofits, foundations, policymakers, businesses, schools, and others – working to help children grow up at a healthy weight. How should they use your new research to inform their strategies?

First, I’d want to point out that the slowing down of the rate of increase in obesity that started around 2003 is real progress, and is likely due to the efforts that these groups have put into helping children grow up at a healthy weight. It’s always difficult to prove this statistically beyond a doubt, but I’d say it is more likely than not that these efforts helped out. If the upward trend in obesity had not been slowed, today childhood obesity rates would be 10 percentage points higher than they actually are.

We probably want to direct additional resources at promoting healthy weights in younger children, especially in preschool years and extending through elementary school years.

But there is more work to be done, and I think we uncover a few important facts that should help inform this work going forward. We probably want to direct additional resources at promoting healthy weights in younger children, especially in preschool years and extending through elementary school years. I’d be quick to caution that we should not slow down our efforts at other ages, but instead we should think about new investments in younger children. Second, we need to keep working at finding successful strategies especially for Black and Hispanic children, where we have seen less progress.

See the full article: Understanding recent trends in childhood obesity in the United States

Published on September 8, 2019


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Boosting Physical Activity in Rural Communities with Play Streets

Kids in Texas playing on a water slide.
Photo courtesy of Baylor University and Johns Hopkins Bloomberg School of Public Health.

We know how important physical activity is for our health—especially for children. It builds strong bones and muscles, reduces the risk of obesity and even improves academic performance. But in rural communities—where there may be fewer resources, sidewalks, playgrounds, and parks—there often are fewer opportunities for kids to engage in the kind of physical activity that keeps them healthy and happy.  

That’s why, in many rural communities across America, streets, parking lots, school grounds, and open fields are being temporarily taken over by bounce houses, hula hoops, and other active games. When communities come together to host Play Streets in these spaces, they provide a way for children and their families to engage in safe physical activity—something that’s especially important for under-resourced communities that lack safe parks and playgrounds, or that have spaces that are not being utilized for play.  

We chatted with Keshia M. Pollack Porter and M. Renée Umstattd Meyer, the authors of a new guide to implementing Play Streets in rural communities, about why Play Streets are so important and how advocates and decision-makers can support them across the country.

What are Play Streets and why are they important—particularly for children living in rural communities?  

In general, Play Streets refer to the temporary closure of streets, parking lots, school grounds, or open fields, basically any public space, for a specified time period—say three to five hours—to create a safe, publicly accessible space for kids and their families to have fun and be active. You might find yard games, sports equipment, or bounce houses with water slides there—anything that can be set up temporarily, and that allows kids to engage in active play in a safe, supervised environment. 

The name “Play Streets” suggests that these play areas need to be on streets, but in a small rural community, it is not always feasible to close what may be the only street! Thus, for some communities, activating public spaces for play is one way to create Play Streets. 

Hosting Play Streets can be a cost-effective way to help kids be active, especially during the summer months when they’re not in school and don’t have regular recess. That’s particularly true in rural communities that lack resources and where residents lack access to transportation, parks, playgrounds, and other safe places to engage in physical activity. People living in rural communities are disproportionately at risk for chronic diseases and conditions that are associated with insufficient physical activity, such as diabetes and obesity. Rural children also have a higher risk for obesity than kids living in cities, and children of color who live in rural communities are at the highest risk.

So, Play Streets can be a great strategy—not just for providing opportunities for kids to play and be active, but for fostering community relationships and connections, which can be challenging in rural areas. Even just the planning process for Play Streets can spark new partnerships, by providing community members with the chance to work together to put on the Play Street.

Why did you create this guide and who is it for?

We created this guide to help rural and small community groups plan and implement Play Streets. We hope that it will help those groups through every step of the process—from planning the day, including selecting a location and getting the word out; to implementing the Play Street, including set-up and clean-up; to what happens after it’s over, including debriefing and getting feedback from participants. 

It also includes plenty of tips and recommendations for community partners and local organizations, such as faith-based institutions, neighborhood associations, community-based organizations, health departments, libraries, schools, and hospitals, as well as residents, advocates, policymakers, and others seeking to promote health and foster relationships within their communities. Community organizations and businesses will find practical strategies for selecting a location, engaging partners, managing risks, staffing, and promoting Play Streets. And advocates and residents can use it to educate decision-makers about the benefits of Play Streets and specific steps they can take to help implement them in their community.

What are three things Play Streets organizers need to know?  

First, while it might seem like Play Streets are a big undertaking, they’re very doable, even for organizations with limited resources. And while having lots of volunteers can help the day run smoothly and encourage people to participate, you can absolutely have a successful event without a large staff.

Second, you might consider coupling Play Streets with another activity going on in your community, like a summer reading event at a local library, a church picnic, or a back-to-school bash or open house. This is a great way to introduce your Play Street to a built-in audience. You might even be able to share resources, staff, and planning.Finally, it’s really important to partner with your community when putting on Play Streets. Doing so will create new relationships, partnerships, and connections with other local organizations, and may even help you boost attendance and secure more resources.

How can local policy- and decision-makers support Play Streets?

There are several ways policy- and decision-makers can support Play Streets in your community, including making sure permits are assigned promptly (particularly for Play Streets occurring on streets); enabling shared use policies for Play Streets that occur in places like school grounds and churches; and supporting policies that support safe active transportation to help people travel to and from Play Streets.

Recruiting policy- and decision-makers to attend and help promote Play Streets can also help build support within the community and attract more partners to lend time, staff, and resources. Consider asking your local elected officials to take part and offering them a role during Play Streets, such as thanking local businesses or community service groups for donating resources or leading a family-friendly activity. 

What’s your most memorable Play Streets experience and why?

I think it’s important to remember that Play Streets aren’t just for kids—they’re for entire families, and part of what makes them great is the way they can help support intergenerational connections. We really saw how this played out at a Play Street sponsored by the Coley Springs Missionary Baptist Church in the small town of Warrenton, North Carolina. At first, they noticed that parents and guardians who attended were mostly sitting on the sidelines, while kids played basketball and volleyball, jumped rope, and participated in other physical activities. 

So, the Play Streets team came up with a great plan: they added line dancing for their next Play Streets, complete with a sound system and a local church member to lead the activity. And it paid off: not only did the adults participate, but the kids joined in too. Then that led to adults and children interacting together for other activities and games, such as musical chairs. 

This is such a great example of bringing together kids, adults, and families for fun, safe physical activity and creating lasting bonds within rural communities.

Kids running covered in paint.
Photo courtesy of Baylor University and Johns Hopkins Bloomberg School of Public Health.

For more information on implementing or supporting Play Streets, check out the guide, which was made possible with funding from the Physical Activity Research Center (PARC).

Published on August 29, 2019


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Hear from experts about the impact of policies and programs in their communities, read interviews with researchers about data releases, and learn how some communities are taking action to help more children grow up healthy, including from places that have measured a decline in childhood obesity rates. 

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