Dietitian says even 10% weight loss has health benefits; weight-loss drugs, diets and pediatric guidelines are in the news

American Heart Association photo

By Melissa Patrick
Kentucky Health News

As the end of January approaches and that New Year's resolution to lose weight may have already been forgotten, it's important to remember that if you are overweight, it's worth the effort to hang onto that resolution. Even losing up to 10 percent of your body weight can provide health benefits. 

Karen Klefot, registered dietitian and diabetes consultant at the Barnstable Brown Diabetes Center at the University of Kentucky, told Kentucky Health News that it's important for a person to set short-term goals when they are trying to lose weight and that even a 10% weight loss can improve blood pressure, sleep, diabetes, cholesterol and energy levels.  

"There is value in losing up to 10 percent of an individual's weight," Klefot said. "Oftentimes, we feel like we have to lose 50 pounds, but . . . that's a lot of weight, when really, honestly, you know, we can have those health benefits with it only being 10 percent."

Klefot offered several suggestions for getting started with a weight-loss plan, including keeping track of your daily exercise and daily food intake as a way to evaluate where some lifestyle changes can be made. 

"I think it's important to focus on things that are realistic and attainable, especially when it comes to weight loss," she said, later adding, "And I would say to focus on one to two pounds per week." 

For example, she said one easy lifestyle change is to trade sugar-sweetened beverages for water or to add more fiber-rich foods, fruits, vegetables and whole grains to the diet. And, she said, eat less fast food, which takes some planning ahead.    

Asked about the popular low-carbohydrate diets, Klefot stressed that it's important to not cut out carbohydrates completely because they are the main fuel source for our bodies. 

"We're not supposed to be depriving our body of carbs," she said. Also, "We need healthy fat and we need protein."

Further, she said it's important to limit sweet treats to "every now and then, but maybe not every single day." And if you have a strong sweet tooth, try adding more fruit to your diet. 

Klefot also noted that increasing your physical activity is important for weight loss, noting that the general recommendation is for a person to get 150 minutes of moderate-intensity aerobic activity a week. The Centers for Disease Control and Prevention adds two or more days of muscle-strengthening activities a week to that recommendaton. 

MyPlate.gov is the federal government's guide to healthy eating.

Recognizing that insurance does not always cover weight-loss efforts, Klefot encouraged people to look at reliable sources when it comes to seeking solutions, such as MyPlate.gov, the U.S. Department of Agriculture's guide to healthy eating. In addition, she encouraged yearly physicals and said local health departments often offers diabetes programs. 

"I wish more insurances would cover more appointments with a registered dietitian because I think more patients would be able to come," which would likely reduce both obesity and diabetes in Kentucky, Klefot said. 

Best diets in 2023

Each year U.S. News & World Report reviews a list of science-backed diets and ranks them. The diets are reviewed by a panel of leading medical and nutrition specialists in diabetes, heart health and weight loss. 

Of the 24 diets that were reviewed, the Mediterranean diet ranked first. This diet focuses on plant-based foods, like fruits and vegetables, while incorporating whole grains, beans, nuts, seafood, lean poultry and unsaturated fat from extra-virgin olive oil.

The DASH diet, which stands for dietary approaches to stop hypertension, or high blood pressure, tied for second place. It also emphasizes fruits, vegetables, whole grains, lean protein and low-fat dairy, which are high in blood pressure-lowering nutrients, like potassium, calcium, magnesium and fiber.

Also tied for second was the flexitarian diet, a semi-vegetarian diet that allows a person to be a vegetarian most of the time, but to still be able to enjoy meat on a special occasion. 

New weight-loss guidelines for children

For the first time in 15 years, the American Academy of Pediatrics has released new evidence-based recommendations for treating childhood obesity, with an emphasis on early and intensive treatment. 

The new guidelines stress that obesity is a chronic disease and should be treated as such. And while the guidelines continue to say that intensive behavioral therapy and lifestyle changes should be a first-line approach, for the first time AAP now recommends children 12 and older be considered for anti-obesity medications and those 13 and older with severe obesity be considered for weight-loss surgery. 

“There is no evidence that ‘watchful waiting’ or delayed treatment is appropriate for children with obesity,” Dr. Sandra Hassink, an author of the guideline and vice chair of the Clinical Practice Guideline Subcommittee on Obesity, said in an AAP news release.

NBC News reports that there are now four drugs approved for obesity treatment in teens starting at age 12: "Orlistat, Saxenda, Qsymia and Wegovy — and one, phentermine, for teens age 16 and older. Another drug, called setmelanotide (brand name Imcivree), has been approved for kids age 6 and older who have Barde-Biedl syndrome, a genetic disease that causes obesity."

In Kentucky, 39% of children were either overweight or obese in 2019-20, up from 37% in 2016-2017, according to the 2022 Kids Count Data Book. The State of Childhood Obesity report says that in 2020-2021, 25.5% of Kentucky's children were obese. 

New anti-obesity drugs are expensive

The Trust for America's Health latest annual report says four of every 10 Kentucky adults are obese and 72.3% are either obese or overweight, ranking the state third in the nation.

New drug treatments for obesity are working, but they are expensive and are not always covered by health insurance, Lesley Stahl reported Jan. 1 on CBS's "60 Minutes." 

One of those drugs is semaglutide, marketed under the brand Ozempic for Type 2 diabetes and Wegovy, in higher doses, for weight loss. CBS reports Ozempic was first approved by the Food and Drug Administration as a type 2 diabetes medication in 2017. Wegovy was approved by the FDA as a chronic weight management treatment in 2021.

In support of these medications, Dr. Fatima Cody Stanford, an obesity doctor at Massachusetts General Hospital and associate professor at Harvard Medical School, told Stahl that the common beliefs about obesity are all wrong. It's not willpower, she said, "It's a brain disease. And the brain tells us how much to eat and how much to store." Further, she said, "The number one cause of obesity is genetics." 

Doctors are frustrated that there are drugs that works for obesity, but insurance companies won't cover them. 

"We are frustrated every single day when we see patients who desperately need to lose weight to reduce diabetes, reduce the hypertension, stroke, heart disease, and we can't give them this fabulous, robust medication that is very effective and safe. And we can't give it to them because insurance won't cover it," Dr. Caroline Apovian, co-director of the Weight Management and Wellness Center at Brigham and Women's Hospital in Boston, told Stahl. 

In Kentucky, Ozempic and Wegovy are not covered by Medicaid for weight loss. Stahl reported that  Rhode Island officials have decided that health insurance for their state employees will cover the entire class of anti-obesity drugs.

NBC News reports that experts are confident that the FDA will likely approve Eli Lilly & Co.'s drug tirzepatide for weight loss in 2023, but it also will be expensive and there is little indication that insurers will widely cover it. 

Lilly declined to comment on the new drug's cost, but NBC reports, "Outside experts said it is possible the drugmaker could price it similarly to Wegovy, which carries a list price of around $1,500 for a month’s supply, and Saxenda, which costs about $1,350 for a month’s supply."

Kentucky still ranks 37th in well-being of children in latest Kids Count Data Book, but isn't progressing as much as other states

By Melissa Patrick

Kentucky Health News

The annual Kids Count Data Book on children's well-being, released June 21 by the Annie E. Casey Foundation and Kentucky Youth Advocates, again ranks Kentucky 37th in the nation for the overall well-being of its children. 

The latest data are for 2019, and are largely compared with data from 2010. The report rates children's overall well-being through 16 indicators in four major domains: health, economic security, education and family and community. 

Overall, Kentucky saw improvement in 11 of the 16 indicators, did worse in three of them and stayed the same on one. One measure did not show a comparison. 

“Though the commonwealth made progress on a number of indicators of child well-being between 2010 and 2019, rankings show we are not making progress as quickly as other states – and that progress is in jeopardy unless federal and state policymakers act boldly to sustain the beginnings of pandemic recovery efforts,” Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release. 

Nearly one in four Kentuckians are children. Here's a look at each domain.

Charts from Kids Count Data Book; to enlarge any one of them, click on it.

Health: Kentucky's health ranking improved this year, to 35th. Last year's report ranked Kentucky 42nd after changing one of the domain's indicators to measure childhood obesity instead of youth alcohol and drug abuse. The last report to use the original indicator was in 2019, when the state ranked 25th for health. 

The report says 37 percent of Kentucky's children were either overweight or obese in 2018-19, the same as in 2016-17. The national rate is 31%. Kentucky has the highest childhood obesity rate in the nation. 

Kentucky continues to have a low rate of children without health insurance, 4%. The national average is 6%. The news release reports that about  45,000 Kentucky children remain uninsured.

Another indicator of children's health is the rate of babies born weighing less than 5.5 pounds. That is 8.7% in Kentucky, where it has hovered for years. 

Education: Kentucky ranked 30th in the report's Education domain, down from 27th last year. 

The best news in this category is that 91% of Kentucky high-school students graduate on time. 

The bad news is that the share of preschool-age children not in preschool increased to 60% in 2017-19, from 57% in 2009-11. And the share of fourth-graders not proficient in reading inched up to 65% in 2019, from 64% in 2009. 

And though the share of eighth graders who are not proficient in mathematics improved to 71% in 2019, from 73% in 2009, that still means only 29% of the state's eighth graders are proficient in math. 

Economic well-being: Kentucky ranks 40th in economic well-being, with all four indicators showing improvement since 2010. 

The percentage of Kentucky children in poverty dropped to 22% in 2019, from 26% in 2010; children whose parents lack secure employment dropped to 31% from 37%; and teens who are not in school and not working dropped to 8% from 11%. 

Also, the percentage of children living in households with a high housing cost burden dropped to 23% in 2019 from 32% in 2010.  A high housing-cost household is defined as one where more than 30% of monthly household pre-tax income is spent on housing-related expenses, including rent, mortgage payments, taxes and insurance.

Family and Community: Kentucky ranked 43rd in the family and community domain, down from 41st in last year's report. 

Kentucky improved in three family-and-community indicators, including children living in high-poverty areas (15%), children living in families where the household head lacks a high school diploma (11%) and teen births.

The number of teen births in Kentucky continues to drop. In 2019, there were 25 births per 1,000 females aged 15-19. In 2010, that number was 46 per 1,000. The national average is 17 per 1,000. 

The percentage of children living in single-parent homes increased to 36% in 2019, from 35% in 2010. 

Impacts of the pandemic

"We cannot talk about child well-being in any meaningful way in this moment — or address the considerable challenges America’s children and families now face — without discussing the effects of the coronavirus," Lisa M. Hamilton, president and CEO of The Annie E. Casey Foundation, writes in the foreword to the report. 

To capture the impact of the last year, the Data Book takes a look at information collected in the Household Pulse Survey, which the report says was conducted in multiple waves since the onset of the pandemic by the Census Bureau and is the only source of robust national and state data related to the pandemic. 

“The supplemental pandemic-era survey data highlighted in the Data Book gives us a clearer picture of how families are faring today, including the disproportionate impact the pandemic has had on families of color," said Brooks. 

Key findings about Kentucky children in the supplemental report include: 

• In 2020, one in five (20%) Kentucky adults with children in their household had little or no confidence in their ability to make their next rent or mortgage payment, with the highest rates experienced by Black families (40%) and Latinx families (30%). By March 2021, the statewide rate was at 15%, suggesting the beginnings of a recovery. 
• 15% of Kentucky households with children reported sometimes or often not having enough food to eat throughout 2020 – a family stressor that hit Black households (26%) and a combination of smaller racial groups (American Indian, Alaska Native, Pacific Islander, Native Hawaiian and those of more than one race) the hardest (29%). This statistic only slightly improved overall in March 2021 to 13%.
• More than one in four (26%) Kentucky adults living in households with children felt down, depressed, or hopeless in 2020, with only slight improvement (22%) by March 2021.

Brooks, of Kentucky Youth Advocates, said, “The commonwealth can and will bounce back from the ripple effects of the pandemic, and a key component of that is ensuring kids and families have the resources to meet basic needs and overcome daily challenges.”

Brooks praised the state's leaders for supporting children during the pandemic, by supporting child care, using federal funds to address the pervasive "digital divide," and ensuring schoolchildren have access to food while learning at home through the pandemic EBT program. 

KYA wants Congress to make the expansion of the child tax credit permanent, and wants Kentucky to enact its own refundable earned-income tax credit; to focus on increasing access to high-quality child care; to use federal funds to improve school-based mental-health supports for students; to expand school-based nutrition programs; to allow state employees 12 weeks of paid family leave after the birth or adoption of a child; and to double down on efforts to support families involved in the child welfare system. 

The Kids Count Data Center provides current and trend data for child well-being indicators related to each of the four domains in the report, at both a state and county level. It also offers a feature to create customized tables, maps, bar charts and graphs.

Researchers find mental health of parents matters when it comes to child obesity; study also examined role of income and rurality

As more of the nation's children become overweight or obese, especially in rural areas, researchers are beginning to look beyond some of the known causes, like inactivity and a poor diet, to other contributors, like the mental health of their parents.

One such study, using data from 14,733 children between the ages of 10 and 17 in the 2016 National Survey of Children's Health, found that both the mother and father's mental health were associated with their child's weight, but only the mother's association remained significant after the data were adjusted for children's food security, physical activity and screen time.

More than one in five Kentucky children between 10 and 17 are obese, ranking the state third in the nation, according to a new report from the Robert Wood Johnson Foundation.

The study, published in The Journal of Rural Health, also found that children were more likely to be overweight or obese in homes with household incomes that were double the federal poverty level or less, and less likely in other households. This comparison found little rural and urban differences.

Among rural families, 44.1% of children in low-income families were either overweight or obese, compared to 32.9% of those in high-income families. Among urban families, 40.4% of children in low-income families were either overweight or obese, compared to 28.3% in high-income families.

The study also found that among higher-income families, positive mental health of either parent was associated with lower odds that the child would be overweight or obese, but those odds persisted only in regard to the mother's mental health after adjusting for other possible causes such as food insecurity, physical activity and screen time.

The mental health status of the parent was determined by this question: "In general, how is your mental or emotional health?" Those who answered "excellent" or "very good" were placed in the "positive mental health" category and those who answered "good," "fair" or "poor" were not.

"Our findings highlight the need to address maternal mental health in rural settings in order to address the physical health of the child," the researchers wrote. "We show that mothers’ mental health (in rural settings) remains associated with child weight among high‐income rural families despite adjustment for known individual, child‐level risk factors for obesity."

The report also points to the "novel association" between a father's mental health and a child's weight, noting that the lack of association after the data were adjusted could reflect a more "transactional relationship" that often exists between fathers and children, compared to mothers' supportive.

"This might explain why the variables of family food security, child physical activity, and child screen time moderated the association between paternal mental health and child weight," the researchers write.

The report notes that the study only looked at data at one point in time, which leads to the potential for "reverse causality." For example, overweight and obese children may experience more stress at school, which could have an affect on their parent's mental health instead of the parent's mental health instead of vice-versa. The report acknowledges that the mental-health data is self-reported.

"Despite these limitations, we found associations between mental health and child overweight/obesity," the researchers write. "In addition, these national‐level data provide evidence that the rural–urban differences in obesity prevalence among children may be secondary to distributions of income, as we observed no difference in the rural prevalence of overweight/obesity after stratifying by income."

Foundation says its 6-year, 7-county effort to help communities tackle health issues can be a model for the rest of the state

Foundation for a Healthy Kentucky map of recently finished "Investing in Kentucky's Future" program

If more Kentucky communities tackled their health issues as communities, the overall health of the state could be improved. That's one lesson of a six-year program that the Foundation for a Healthy Kentucky recently completed in seven counties.

The "Investing in Kentucky's Future" initiative focused on children. It "improved student eating habits, increased youth physical activity, trained teachers to support students experiencing trauma, and increased youth resilience," the foundation said in a report on the program, which reached nearly 13,000 students in 28 participating schools.

It said the initiative "strengthened cross-sector coalitions" in the seven counties and "led to the adoption of 38 local ordinances and policies to help sustain the improvements and promote health equity long-term." Looking ahead, it "has prompted the foundation to expand its work in obesity prevention and childhood trauma interventions."

For example, in May, the foundation announced a $200,000 grant in Russell and surrounding counties to address childhood trauma in a rural setting, building on lessons from a Jefferson County program that was part of the initiative.

The overall goal of the $2.4 million initiative was to reduce school-aged children's risk of developing chronic diseases later in life. The communities contributed $1.7 million in matching funds, as well as countless volunteer hours by local citizens.

"Health is something that people don't typically recognize as a community undertaking, and this initiative aimed to transform that thinking and set in motion a series of changes that will lead to healthier, more productive adults throughout each participating Kentucky county," foundation president and CEO Ben Chandler said. "We're sharing what's been learned so other Kentucky communities can replicate these achievements."

An event of the Clinton County Healthy Hometown Coalition

Six of the participating communities (Breathitt, Clinton, Grant, McLean, McCracken and Perry counties) chose childhood obesity prevention as their issue. Jefferson County focused on adverse childhood experiences (ACEs) and building resilience in children who have faced trauma.

Both issues are complex, and influenced by a variety of factors, so they require involvement by various sectors of the community, working in a coalition, the foundation said. With its report, the foundation released videos on obesity prevention and ACEs to help other Kentucky communities.

"Participants told us that identifying a local champion and engaging the school system were critical to success in each of the counties," Chandler said. "But by far the most decisive factor was ensuring that the local health coalition includes multiple members from a broad range of community organizations: schools, hospitals, elected officials, youth groups, and businesses. It takes more time to get everyone aligned but the resulting collaboration makes all the difference in creating long-term change to improve health."

The grant "gave us an opportunity to do something big and to really make an impact and we've done that," Marsha Bach, a member of the Grant County coalition, Fitness for Life Around Grant County (FFLAG) and a health promotion manager with the Northern Kentucky Health Department, says in the obesity video.

Each grant included a one-year planning phase in which the foundation provided training and technical assistance for development of a business plan. This made the program more accessible to small communities with fewer resources, said Amalia Mendoza, senior program officer at the foundation, who developed and oversaw the program.

Among the successes the foundation listed were:

• New policies expand physical education in middle school, require future streets to be usable by walkers and cyclers, allow school fitness equipment to be used by the community after school, and make healthier foods available in schools and park concession stands.
• New facilities include parks, fitness equipment, sidewalks and walking paths, playgrounds, filtered drinking water fountains, community trails and standing desks in schools.
• Many communities leveraged the Foundation grant to secure additional funding. For example, the Purchase Area Health Connections-Paducah Chapter secured another $400,000 Rotary Club grant to build a playground at the health park developed with foundation funding, and then another $500,000 donation to build a second phase of the park; sidewalks to school in Grant County will be part of trail system funded by a follow-up grant from another foundation.
• More than 90 percent of students had increased physical activity and improved nutrition, from such measures as classroom movement activities and standing desks; events such as fun runs, walking and biking programs, and the Annual Nutrition Fair created by the Partnership for a Healthy McLean County; a "Fitness Buddies" program of the Clinton County Healthy Hometown Coalition, in which high-school students helped third and fourth graders with intense physical activity; elimination of deep fryers in school cafeterias; installation of filtered drinking water fountains; and work with farmers to get more fresh produce to students.
• All six coalitions began or expanded student food programs over the weekends or the summers. Most students reported that school was the only place they got fruits and vegetables. Offering fresh produce at snack time "appears to be a successful strategy" to increase consumption, the report found.

In close vote, Louisville sets content rules for children's menus, citing child obesity; critics say law invades parental responsibility

A food-service business in Louisville will be allowed to offer a children's menu only if it includes certain types of healthy items, under an ordinance passed by 13 Democrats on the Metro Council over "vocal bipartisan objections" from 11 other members, Phillip M. Bailey reports for the Courier Journal. "The proposal touched a nerve with many residents and council members who said such choices should be left up to parents."

Supporters said the ordinance is needed to fight an epidemic of child obesity and is the first in the United States to set food and drink standards for children's menus. The American Heart Association, which spearheaded the proposal, said about 12 cities, mostly in California, have adopted similar rules, Bailey reports. Mayor Greg Fischer said he plans to sign the measure into law.

The ordinance will require food service businesses "to provide a non-fried fruit or vegetables, a whole grain product or a lean protein or one 2-ounce serving of nuts, seeds, dry beans, peas or one egg," Bailey reports. "The restaurant must make available either a water, sparkling water, flavored water with no added natural or artificial sweeteners or milk product." Violation carries a fine of up to $100.

"Many of the council members who voted against the idea said they support the goals but that it shouldn't be the city's job to tell people how to eat," Bailey writes.

"Here we go again, this is a government overreach. We continue to tell parents what they need to do with their children," said Councilwoman Mary Woolridge, D-3rd District, one of three Democrats who joined eight Republicans in voting against it.

"Several Democrats who voted for the measure also expressed doubts that it would achieve its goals," Bailey reports. Councilwoman Vicki Aubrey Welch, Blackwell's co-sponsor, said it would address the local childhood obesity epidemic.

"Nearly 25 percent of Louisville sixth-graders and 18 percent of kindergartners are obese, according to the Louisville health department," Bailey writes. "Health advocates point out that one out of three children in the United States eat fast food and thus have a higher caloric intake that can result in a poor diet, obesity and diabetes."

Vast majority of Ky. adults see child obesity as serious problem; one-third of Ky. children aged 10 to 17 are obese or overweight

By Melissa Patrick
Kentucky Health News

This should come as no surprise: More than 90 percent of the state's adults say it's a problem that one in three Kentucky children aged 10 to 17 are overweight or obese.

Results were nearly identical to the last time the question was asked, in 2009.

The Kentucky Health Issues Poll, taken Oct. 24 to Dec. 2, found 56 percent of Kentucky adults saw childhood obesity as a serious problem for the state, and another 35 percent said it was a problem, but not serious. Only 6 percent saw it as no problem at all.

About 34 percent of Kentucky's children between 10 and 17 are overweight or obese, according to the 2016 National Survey of Children's Health. Nationally, that number is about 31 percent. Overall, the rate has remained stable over the past decade. The poll did not give its respondents any information about the problem, said Bonnie Hackbarth of the Foundation for a Healthy Kentucky, which co-sponsors the survey.

Obesity is calculated through Body Mass Index, essentially a ratio of height to weight. Children are given a "BMI for age," comparing them to other children of the same age and gender. The federal Centers for Disease Control and Prevention defines a child as obese if their BMI for age is equal to or greater than 95 percent of their age-and-gender group. They are classified as overweight if they are at or above the 85th percentile.

"We have to find more ways to help Kentucky's children learn healthy eating and exercise habits early on in life," Ben Chandler, president and CEO of the health foundation, said in a news release. "The older we get, the more difficult retraining our dietary and lifestyle habits and losing excess weight become. And even in the early stages of life, obesity has a damaging effect on physical, social and emotional health."

The CDC says obese children are more likely to be obese adults. Adult obesity comes with a higher risk of developing heart disease, type-2 diabetes and many types of cancers – all conditions that plague our state. About 34 percent of Kentucky adults are considered obese.

Concern about child obesity is greater in area-development districts around Louisville and Lexington, where more than 60 percent see it as a serious issue. In the rest of the state, it ranged from 49 to 53 percent.

The poll's margin of error is plus or minus 2.4 percentage points. Co-sponsored with the Cincinnati foundation Interact for Health, it surveyed a random sample of 1,692 adults throughout Kentucky via landlines and cell phones.

American Academy of Pediatrics says children under the age of 1 should not be given fruit juice

Children who are less than a year old should not drink fruit juice because it offers them no nutritional benefit, according to new guidelines from the American Academy of Pediatrics.

“Parents may perceive fruit juice as healthy, but it is not a good substitute for fresh fruit and just packs in more sugar and calories,” said Dr. Melvin B. Heyman, co-author of the statement. “Small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1.”

The statement, published in the journal Pediatrics, says the change was prompted by the rising rates of childhood obesity and concerns about dental health. The previous recommendation was no fruit juice under the age of 6 months.

The new recommendations for each age group are:

• Children ages 1 to 3 should be limited to four ounces, or 1/2 cup, per day
• Children 4 to 6 can have four to six ounces daily
• Children and teens 7 to 18 should have no more than eight ounces, or 1 cup, per day

The statement also suggests:

• Toddlers should not be given juice at bedtime.
• Toddlers should not be given juice from bottles or sippy cups that allow them to sip on juice throughout the day. This constant exposure can cause tooth decay.
• Children should eat whole fruits.
• Unpasteurized juice is not recommended for children of any age.
• If your child takes any medication, make sure grapefruit juice will not interfere with it. 
• Fruit juice is not recommended to treat dehydration or diarrhea.

Dr. Nikki Stone, associate professor of dentistry at the University of Kentucky College of Dentistry, created a "Drink Pyramid" graphic to educate children about healthy drinking habits that reminds parents and children that juice should only be consumed once a day.

“We know that excessive fruit juice can lead to excessive weight gain and tooth decay,” said co-author Dr. Steven A. Abrams. “Pediatricians have a lot of information to share with families on how to provide the proper balance of fresh fruit within their child’s diet.”

Foundation's $3 million program is helping seven counties become healthier in several ways, independent evaluation says

A initiative focused on children's health is helping the Foundation for a Healthy Kentucky change community policies and environments, improve physical activity and nutrition, and strengthen health coalitions in seven Kentucky communities, according to an independent evaluation released by the foundation today.

The grants in the five-year, $3 million "Investing in Kentucky's Future" initiative are also providing useful lessons for place-based grantmakers, said the evaluation by the Center for Community Health and Evaluation, a research center of the Kaiser Permanente Washington Health Research Institute.

The initiative is aimed at reducing the risk that today's school-aged children will develop chronic disease later in life. It has made matching grants for community health coalitions in Breathitt, Clinton, Grant, Jefferson, McCracken, McLean, and Perry counties. All are focused on preventing and reducing childhood obesity except the Louisville coalition, which is working to foster resiliency in children facing traumatic events and other experiences that can lead to toxic stress in childhood and chronic health conditions in adulthood.

"The real value of the Investing in Kentucky's Future initiative is that it's fostering the ability of these seven Kentucky communities to keep improving their residents' health long after the grant period ends," Charlie Ross, chair of the foundation's board of directors, said in a news release. "Yes, the grants have helped build some beautiful walking trails and playgrounds and ensure healthier foods at park concessions, but they've also created lasting partnerships, changed school and community policies, and developed the skills of a cross-sector coalition of people committed to making a healthier future for their children."

The evaluation listed five lessons from the initiative:

1. Community-Driven Grant Approach: Allowing community health coalitions to study and determine their own health priorities and the solutions they would employ is leading to greater grantee engagement, but also to more diverse strategies.
    
2. Coalition Approach: Requiring grantees to use or create a coalition of partners from a variety of sectors is helping build community support for the work. School engagement has been particularly important for the initiative, which focuses on school-aged children.
    
3. Planning Phase to Promote Equity: Recognizing that communities have various levels of ability to compete for and implement grant programs, the foundation included funding for a required a planning phase during which grantees would develop a structured business plan to address their selected issue. The planning phase made the grant more accessible to communities with fewer resources.
    
4. Sustainability Elements: Grant requirements that were focused on sustainability ─ the planning phase, a 50 percent cash match, a focus on changing policies in the community, and an evaluation ─ have given coalition members skills and experience to them continue to improve the health of their communities.
    
5. Shorter-Term Evaluation Measures: The foundation recognized that significant changes in complex health issues take more than five years to see, so it focused its evaluation on shorter-term changes that have been proven to lead to longer-term health improvements.

Investing in Kentucky's Future is entering its fourth year, but some communities' grants will extend into 2019 because they started later than others. The grantees are: Partnership for a Healthy McLean County, Purchase Area Connections for Health (McCracken County), Fitness for Life Around Grant County, Breathitt County Health Planning Council for Children, Perry County Wellness Coalition, Clinton County Healthy Hometown Coalition, and the Bounce Coalition (Jefferson County).

A copy of the evaluation, "Toward a Healthier Kentucky: Lesson Learned from Evaluating Place-Based Community Health Improvement," is available here. 

Study finds childhood obesity quadruples the risk of developing type 2 diabetes; 20 percent of Kentucky's children are obese

Children who are obese may be four times more likely to develop type 2 diabetes than those considered to have a healthy weight,  according to a British study.

“A child with obesity faces a four-fold greater risk of being diagnosed with diabetes by age 25 than a counterpart who is normal weight," Dr. Ali Abbasi, of King’s College London, one of the study’s authors, said in the Endocrine Society news release.

Obesity and diabetes are epidemic health problems in Kentucky. More than a third of the state's children (36 percent) are either overweight or obese, and one in five between 10 and 17 are obese. More than 3,000 Kentucky's children and teenagers are estimated to have diabetes, according to the 2016 Kentucky Diabetes Fact Sheet.

The study, published online in the Journal of the Endocrine Society, examined body-mass indexes, diabetes-diagnosis records and other data from 369,362 children in the United Kingdom between the ages of 2 and 15.

Obesity was defined as having a body mass index in the top 5 percent of the population in the child's age group. BMI is a ratio of height to weight, and is used as a screening tool to indicate whether a person is underweight, a healthy weight, overweight or obese.

Researchers found that nearly half the children and teens diagnosed with type 2 diabetes between 1994 and 2013 were obese.

They also found that the rate of children in the U.K. who developed type 2 diabetes increased, from 6.4 per 100,000 in 1994-98 to 33.2 per 100,000 in 2009-2013.

“Diabetes imposes a heavy burden on society because the condition is common and costly to treat,” Abbasi said. "Given that diabetes and obesity are preventable from early life, our findings and other research will hopefully motivate the public and policymakers to invest and engage in diabetes prevention efforts.”

Obese children 9 to 11 should be tested for fatty liver disease; almost 20 percent of Kentucky's children are obese

Obese children from 9 to 11 should be screened for non-alcoholic fatty liver disease, according to new guidelines endorsed by the American Academy of Pediatrics.

Fatty liver disease is not a single disease process, but a range of conditions. It affects up to 38 percent of obese children and adolescents, and is commonly associated with other obesity-related conditions such as diabetes and sleep apnea, says a news release from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

“It has rapidly evolved into the most common liver disease seen in the pediatric population and is a management challenge for general pediatric practitioners, subspecialists and for health systems,” experts said in a articlein the Journal of Pediatric Gastroenterology and Nutrition.

Children with fatty liver disease often have no symptoms. The article's authors write that early screening is important because it can detect the condition before "the onset of irreversible, end-stage liver disease."

Almost 20 percent of Kentucky's children 10 to 17 are considered obese, the eighth highest rate in the nation, according to the State of Obesity report. The state ranks third for obese high-school-aged children, also at nearly 20 percent.

Screening requires a blood test; if it comes back positive, the child will need to undergo additional tests to determine if fat deposits are present in the liver and to rule out other conditions.

Treatment of fatty liver disease improves the child's diet, avoiding sugar-sweetened beverages and increasing physical activity. No medicines are available to treat the disease.

Kentucky is one of only 2 states where adult obesity rose last year; now we're fifth in the nation; state diabetes rate highest ever

By Melissa Patrick
Kentucky Health News

We're fat, and getting fatter. And that's making us sicker.

More than one-third of Kentucky adults are obese, placing the state fifth in the country in obesity, a big jump from 12th the year before. Kentucky was one of only two states where obesity rates increased from 2014 to 2015, according to the latest State of Obesity report.

Graphics are from the State of Obesity report

Kentucky's adult obesity rate increased to 34.6 percent in 2015, up from 31.6 percent in 2014. In 1990, only 12.7 percent of Kentucky adults were obese. Get the adult obesity rate in your county at KentuckyHealthFacts.org.

“Obesity remains one of the most significant epidemics our country has faced, contributing to millions of preventable illnesses and billions of dollars in avoidable health care costs,” Richard Hamburg, interim president and CEO for Trust for America's Health, said in a news release.


"Obesity continued to put millions of Americans at increased risk for a range of chronic diseases, such as diabetes and heart disease, and costs the country between $147 billion and $210 billion each year," says the release.

The report, "The State of Obesity: Better Policies for a Healthier America," is conducted by Trust for America's Health and the Robert Wood Johnson Foundation and is based on data from the federal Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, a continuous national poll.

Most obese Kentuckians fall between the ages of 26 and 64, with 36.8 percent of those aged 26-44 obese and 40.5 percent of those aged 45 to 64 obese, says the report.

The report found that black Kentucky adults were the most likely to be obese, at almost 43 percent, followed by whites (32.9 percent) and Latinos (24.3 percent). There was little difference between men and women.

The report also measured obesity-related health issues, such as diabetes and high blood pressure.

Kentucky's reported diabetes rate is at its highest ever, 13.4 percent, which places it fourth in the nation. This is up from 12.5 percent in 2014 and 10.6 percent in 2013. The report projects that almost 600,000 Kentuckians will have diabetes in 2030.

"Diabetes is the seventh leading cause of death in the United States, accounting for around $245 billion in medical costs and lost productivity each year," says the report.

The state's high-blood-pressure rate, at 39 percent, is about the same as the year before. The state ranks sixth in this measure. The report projects that 1,175,750 Kentuckians will have high blood pressure in 2030.

"Approximately 30 percent of hypertension cases may be attributable to obesity, and the figure may be as high as 60 percent in men under age 45," the report says. "People who are overweight are more likely to have high blood pressure, high levels of blood fats and high LDL (bad cholesterol), which are all risk factors for heart disease and stroke."

The report also updated high-school obesity rates and found that Kentucky's 18.5 percent was about the same as the last time such data were gathered in 2013. But because some other states' rates went up, Kentucky no longer ranks first in the nation. We're third.

The report notes that Kentucky adults fall into the top 10 states for the highest rates of physical inactivity (32.5 percent); states with the highest rates of obese 10- to 17-year olds (19.7 percent); and states with the highest rates of obesity among 2- to 4-year-olds (15.5 percent).

Kansas and Kentucky were the only two states to see obesity increases in 2015. Most remained steady, and four states saw a drop: Minnesota, Montana, New York and Ohio.

Nine of the 11 most obese states are in the South, and 22 of the top 25 are in the South and Midwest. Louisiana has the highest obesity rate, 36.2 percent.

More than half the states have obesity rates at or above 30 percent, with four above 35 percent. Obesity rates are above 20 percent in every state; in 1991, no state had a rate above 20 percent.

The authors outline a set of policy recommendations to combat obesity, including: investment in obesity prevention; focusing on early-childhood and school-based policies and programs that support healthier meals, physical activity and less screen time; prioritizing active transportation planning and access to healthy foods in communities; and covering a full range of obesity prevention, treatment and management services under all public and private health plans.

“These new data suggest that we are making some progress but there’s more yet to do. Across the country, we need to fully adopt the high-impact strategies recommended by numerous experts," Hamburg said. "Improving nutrition and increasing activity in early childhood, making healthy choices easier in people’s daily lives and targeting the startling inequities are all key approaches we need to ramp up."

New guidelines recommend no more than 6 teaspoons of sugar a day and one sugared drink a week for children and teens

By Melissa Patrick
Kentucky Health News

Children and teens should consume no more than six teaspoons of added sugars a day and drink no more than one 8-ounce sugar-sweetened beverage per week, according to new advice from the American Heart Association.

"The typical American child consumes about triple the recommended amount of added sugars,” Dr. Miriam Vos, lead author, nutrition scientist and associate professor of pediatrics at Emory University School of Medicine in Atlanta, said in a news release. "[And] are currently drinking their age in sugary drink servings each and every week."

The average American child takes in about 80 grams of added sugar daily — half from food and half from beverages, according to the AHA's analysis of the most recent data from the National Health and Nutrition Examination Survey.

The 2015 KentuckyYouth Risk Behavior Survey found that almost one-third of Kentucky's high school students drank a sugared soda one or more times per day during the seven days before the survey; 23 percent had sugared soda two or more times a day; and 13 percent three or more times a day. Nearly 36 percent of Kentucky's children are either overweight or obese, acccording to the Alliance for a Healthier Generation.

The AHA statement, based on a comprehensive review of scientific research on the effects of added sugar on children's health, is published in its journal Circulation.

The statement also says children younger than 2 should have NO added sugar. They have lower calorie needs than older children, so there is little room for foods and drinks with added sugars that don't provide "good nutrition," AHA says.

Why is the heart association interested in this problem? Children who eat diets high in added sugar have increased risk factors for heart disease, including obesity, high blood pressure, diabetes, fatty liver disease and unhealthy cholesterol levels, says the report.

Added sugars are any sugars or syrups that are added to foods during processing or preparation. The sugars in fruits, vegetables and other whole foods are natural sugars. One teaspoon of sugar equals 4 grams of added sugar.

The best way to avoid added sugars is to "serve mostly foods that are high in nutrition, such as fruits, vegetables, whole grains, low-fat dairy products, lean meat, poultry and fish, and to limit foods with little nutritional value," Vos says.

"A plain whole grain bagel with cream cheese can have no added sugar, while a frosted doughnut has 23 grams of added sugar," she told Jacqueline Howard of CNN. "A bowl of cereal can range from 1 gram to 12 or more grams, depending on the brand. One soda typically has 33 grams. A healthy breakfast of a low added-sugar, whole-grain cereal with a piece of fruit and a glass of low-fat milk would have about 1 gram of added sugar [but] varies by the cereal."

Starting in July 2018, food manufacturers will be required to list the amount of added sugars on nutrition labels.

The latest national U.S. Food and Drug Administration guidelines recommend limiting added-sugar intake to less than 10 percent of your daily calories. For someone older than 3, that means eating no more than 12.5 teaspoons, or 50 grams, of added sugar a day and 25 grams for children 1 through 3 years. The AHA guidelines cuts this amount in half for children.

That amount is "closely aligned with the new recommendations," Vos told CNN. "The AHA statement provides a fixed amount, 25 grams, that is less than 10 percent of calories for most children and is easier for parents to understand."

“I hope our recommendations help parents feel more confident limiting sugar. This statement helps answer the question how much is OK so parents can choose the right combination of foods and drinks so their children are healthier,” Voss told AHA News. “If parents know how much they are looking for, it will help the food industry satisfy that goal.”

Clinton County coalition works to change the health lifestyle of its children, in an effort to change the local health culture

By Melissa Patrick

Kentucky Health News

Public officials and local leaders in a small, rural county in Southern Kentucky that ranks near the bottom of in the County Health Rankings for the state have formed a coalition to improve the health of its community, with a focus on its children.

Clinton County (Wikipedia map)

Clinton County ranked 102nd out of 120 Kentucky counties in the 2016 County Health Rankings. “We recognize that. We saw that in our kids,” Lora Brewington, chief compliance officer of Cumberland Family Medical Center Inc., told Kentucky Educational Television in a report to be aired soon about the coalition.“And if we don’t change something now, we’re going to be going to the funeral home for kids a lot younger.”

So, with the help of the Foundation for a Healthy Kentucky, they formed the Clinton County Healthy Hometown Coalition to implement a multi-faceted public health program for the community's citizens, that focuses on its children.

“The coalition came together [according to] Aristotle’s thinking, that the whole is greater than the sum of its parts,” Brewington told KET. “We have a lot of great groups, that do a lot of great things, but if everyone is going for the same goal, and the resources are not combined, you’re not going to accomplish anything. And once we get everybody together and on the same page, by combining resources, we’ve been able to do some great things.”

Paula Little, assistant superintendent and supervisor of instruction for Clinton County schools, told KET that the coalition recognized most of the county's health issues stemmed from obesity, and decided to focus their efforts on the children in the community to change their culture.

"So we feel like if we can start young and start with our children and teach them healthy habits and healthy lifestyles that when they grow up they won't be faced with obesity and all of those chronic diseases that go with it," Little said.

Many of the coalition’s activities are school-based. Teachers have incorporated physical activity into the school day as well as during their morning routines and after-school day-care programs.

The coalition has worked with the schools to improve nutrition. Fruits and vegetables are now served every day with every meal. The schools also began offering supper to students during the school year and has since served over 6,400 meals. The program began last October.

Recognizing that an estimated 38 percent of Clinton County's children live in low-income families, the coalition launched a summer food program that delivers breakfast and lunch in a retrofitted school bus called the Bus Stop Café to areas in the county with high student populations.

The Healthy Hometown Coalition has also implemented school-based health clinics, which provides for the healthcare needs of students through a public-private partnership while they are at school. The clinics are run by the Cumberland Family Medical Center. In addition to providing clinical care, the clinics provide body mass index assessments and provide nutrition and obesity counseling.

“It’s about accessibility,” Brewington said. “It’s about the kid who has a cough and needs to see a doctor, but the parent can’t take off from work. ...It's about having healthcare right there where the child is the majority of the time."

Not mentioned in the KET report is that Clinton County schools implemented a comprehensive smoke-free policy last year that will go into effect in July. The policy will ban smoking on school property both during school hours and during school sponsored events, and also includes electronic cigarettes and all vapor products.

The coalition is working to change the culture of its community so that a healthy lifestyle becomes the norm, and not the exception.

“When you’re attempting to change a culture, and change the way people live, that’s a very long process,” Little said. “And it has to be something that’s consistent, that’s ongoing, and it has to be a message that children hear everywhere they go in the community.”

A full-time coordinator, April Speck, manages the various coalition programs and writes a weekly health column in the Clinton County News that often celebrates individual success stories. The coalition also sponsors community events, and has built a new playground.

“What makes me feel good about it is that I know there’s a real need here,” Speck told KET. “There’s a lot of kids who have childhood obesity... And just seeing them start to make changes in what they are doing, how much they are eating, their water intake, I know that we’re making an improvement.”

McDonald's stops sending to schools man who says he lost much weight eating only at McDonald's, including Big Macs and fries

Photo via flickriver.com

McDonald’s has stopped "giving nutrition advice to students in schools, pulling back on a program that critics said was a subtle form of fast-food marketing that could imperil kids’ health and understanding of nutrition," Roberto Ferdman reports for The Washington Post.

The company had been sending to schools "a middle-aged teacher from Iowa who came to fame after claiming to have lost almost 60 pounds eating only McDonald’s," including Big Macs and french fries, Ferdman writes.

"McDonald’s said in a statement this week that Cisna stopped those visits last fall, after a Washington Post article highlighted how McDonald’s used its relationship with local schools and teachers’ associations to get its message in front of students. . . . McDonald’s had long defended the practice, saying that Cisna’s presentation was about choice, not about eating McDonald’s. But critics argued it amounted to little more than a veiled attempt to woo customers at a young and impressionable age."

Study: health warnings on sugary drinks make a difference; 3 states seek legislation to add them; beverage lobby pushes back

By Melissa Patrick
Kentucky Health News

Health warning labels on sugary beverages, like those found on tobacco products, could make parents less likely to buy them for their children, according to a study from the Perelman School of Medicine at the University of Pennsylvania.

“Regardless of the specific wording, results show that adding health warning labels to sugary-sweetened beverages may be an important and impactful way to educate parents about the potential health risks associated with regular consumption of these beverages, and encourage them to make fewer of these purchases,” Christina Roberto, lead author of the study, said in the news release. “The findings are in line with similar studies conducted on the effects of warning labels on tobacco products, which have been shown to increase consumer knowledge of health risks related to tobacco use, and encourage smoking cessation."

Warning labels used in the study

The online study, published Jan. 14 in the journal Pediatrics, included about 2,400 demographically and educationally diverse parents of six to 11 year olds. The online survey tested the effects of five different warning labels about the potential health effects of sugary beverage intake, including labels about calories, weight gain, obesity, diabetes and tooth decay.

The study found that 40 percent of participating parents said they would choose a sugar-sweetened beverage for their child after viewing a warning label, compared to 60 percent of participants who saw no labels on the beverages, and 53 percent of parents who only saw the calorie label. There was no significant buying difference between the groups seeing the calorie-only label and no label, says the report.

The research found that the specific words on the warning label didn't make a difference in the parent's purchasing choice, but the presence of the label did, says the report.

Soft drinks and juices marketed for children have as many as seven teaspoons of sugar per 6.5 ounces, which is nearly twice the recommended daily serving for that age group, says the report. Lead author Roberto noted that more than half of children (66 percent) under the age of 11 drink sugary-sweetened beverages on a daily basis.

Graph: USDA Dietary Guidelines 2015-20

The Harvard T.H. Chan School of Public Health documents that sugary beverages "are a major contributor" to childhood obesity, a real problem in Kentucky which is first in high school obesity rates (18 percent); eighth for 10- to-17- year olds (19.7 percent) and sixth for children ages 2 to 4 from low-income families (15.5 percent), according to the "State of Obesity" report. The Kaiser Family Foundation reports that 35.7 percent of children ages 10-17 in Kentucky are either overweight or obese.

The U.S. Department of Agriculture recently decreased its recommended daily amount of added sugar by 5 percentage points, now recommending added sugar be limited to 10 percent or less of calories per day, Kimberly Leonard reports for U.S. News & World Report. The USDA Dietary Guideline report notes that almost half (47 percent) of all added sugars consumed in the U.S. is from sugar-sweetened beverages.

BJC HealthCare in St. Louis offers specific guidelines about the amount of sugar children should consume.

• Preschoolers averaging 1,200 to 1,400 calories per day should limit added sugar to about 4 teaspoons (16 grams) per day.
• Children ages 4 to 8 who average 1,600 calories per day should limit added sugar to about 3 teaspoons (12 grams) a day. To fit in all the nutritional requirements for this age group, there are fewer calories available for added sugar.
• Pre-teen and teens averaging 1,800 to 2,000 calories per day should not have more than 5 to 8 teaspoons (20 to 32 grams) of added sugar per day.

The study found that 75 percent of the participating parents support warning labels being added to the containers, but support for such legislation hasn't gained much traction and is getting push-back from the beverage lobby.

NPR reports that while no city or state has been able to pass a law to add health warnings to sugary beverages, "California, New York and Baltimore all have legislation in the works requiring these labels on sugary drinks."

Leana Wen, Baltimore's health commissioner, told NPR that the beverage industry is pushing back hard in Baltimore, lobbying legislators to reject the warning label policy and using fear tactics with the small businesses, telling them they will be hurt by this law.

In addition, ,"Legislation in Congress to tax sugar and high-fructose corn syrup failed to advance last year, and a few years ago a court overturned a ban on jumbo-sized sodas in New York City. Last summer the beverage industry sued San Francisco over a law that required health warning labels on sugary drinks and that prohibited ads of them on city property, saying the law violated the First Amendment," Leonard writes for the U.S. News & World Report.

HealthDay reports that the American Beverage Association reviewed the study and issued this statement: "Consumers want factual information to help make informed choices that are right for them, and America's beverage companies already provide clear calorie labels on the front of our products. A warning label that suggests beverages are a unique driver of complex conditions such as diabetes and obesity is inaccurate and misleading. Even the researchers acknowledge that people could simply buy other foods with sugar that are unlabeled." The organization added: "With our Balance Calories Initiative, we are working toward a common goal of reducing beverage calories in the American diet."

Washington state study finds new school lunch standards have made students' food healthier; other studies say they are eating it

School lunches are healthier since the federal government created sweeping changes to the program five years ago and almost the same number of students eat a school lunch as before the changes were implemented three years ago, according to a study in Washington state, published in the journal JAMA Pediatrics.

The 2010 Healthy, Hunger-Free Kids Act requires schools to make their menus healthier with more whole grains, fruits and vegetables, less fat and sodium and smaller portion sizes. In 2014, the law added similar nutritional guidelines to all snacks and beverages served during the school day.

Researchers looked at the nutritional value of school lunches and the food choices of about 7,200 students in three middle schools and three high schools in an urban school district in Washington. Data was collected 16 months before and 15 months after the new nutrition standards were implemented for the 2012-13 school year.

The study found that the new rules did not significantly change how many students participated in the meal program. It did not look at whether the students actually ate their healthier lunch, but the researchers cited previous research that found the amount of plate waste has not changed since meal changes were introduced.

The rules have come with some growing pains and complaints from students and dietary staff about food waste, smaller portion sizes, changes in food preparations that make the food unappetizing, fewer students buying lunch and the added cost incurred to pay for the healthier foods.

These complaints prompted the School Nutrition Association and the School Superintendents Association to write a letter to Congress asking for some changes including increased reimbursement to cover the costs of the new meal standards and a request to decrease the whole grain requirements back to half, Carina Storrs reports for CNN.