News from California Project LEAN

Leaders Encouraging Activity and Nutrition

Greetings!

Find out what's happening in California to address the obesity epidemic, a year after the Communities Putting Prevention to Work (CPPW) initiatives were funded. California Project LEAN's enews will keep you updated on the work that is being done by the California Department of Public Health (CDPH) and San Diego, and Los Angeles counties to address nutrition, physical activity, and obesity. Read on to learn more about county implementation plans and available resources.

Developing Regional Food Systems in San Diego County

Farmers market San Diego County Health & Human Services Agency's CPPW project is making progress on its nutrition goal to develop a regional food systems policy and support other food systems strategies that benefit local agriculture systems and the health of the community.

The Farm to School Taskforce began as a series of meetings between Ray Kau, Marketing Representative for Whole Foods Market, and San Diego Unified School District food service staff. The meetings began after Chef Ann Cooper's visit to San Diego inspired a wish to improve the nutritional value of food offered to students at more than 200 district schools. Whole Foods Market leveraged its contacts with local growers to engage them in conversations with school food service staff to see how more locally grown fruits and vegetables could be purchased by schools.

The Taskforce now numbers nearly 70 members: local growers, distributors, chefs, restaurants, community organizations, and food service directors from six school districts. The Taskforce has expanded its leadership beyond Whole Foods Market to help give the group countywide reach and to better integrate activities into existing wellness initiatives.

To date, 13 districts have sourced produce locally, a major step when considering that nearly all the produce would otherwise have been shipped to Los Angeles. Changing the food system involves much conversation and education among all parties involved as they develop capacity to provide the produce needed and adapt or create new systems for purchasing, transporting, processing, and preparing this produce.

"By creating a structure for open communication among farmers, food service directors, public health professionals, and local chefs, we have been able to build on each others' expertise and accelerate farm to school activities at an unprecedented rate," explained JuliAnna Arnett, Food Policy Manager for the San Diego Childhood Obesity Initiative. "Working together, we are engaging in new conversations and learning how we can all support healthy food in the school environment."

The largest single local produce purchase was made from Stehly Farms Organics by San Diego Unified Food Service in October 2010: 1,866 cases (75,640 pounds) of organic Valencia oranges. Following their lead, 11 other districts sourced the same product, bringing the total purchase to 2000 cases (80,000 pounds) of local oranges - fresh from the farm and onto students' lunch trays. San Diego Unified School District, the second largest district in California, now has a goal of purchasing 25% of its fresh produce from local growers and has defined what "local" means to aid their vendors and for use in contracting. Read more about the district guidelines here.

Next steps for the Taskforce include continuing monthly procurement negotiations between farmers and food service directors, expanding healthy and local food marketing efforts, and working with schools to better align farm to school activities with district wellness policies and public health resources.

Developing Healthy Food and Beverage Policy in Los Angeles County

Strong Vending Policy

One goal of Los Angeles County Department of Public Health's (DPH) grant, Project RENEW (Renew Environments for Nutrition, Exercise and Wellness), is to promote healthy food and beverage policies in city and county programs serving youth and other vulnerable populations.

As a foundation of this work, the County of Los Angeles Vending Machine Nutrition Policy was adopted in 2006 to encourage healthier diets by increasing access to healthy foods and beverages and reducing access to unhealthy food and beverage options for county employees and the public at county facilities.

"There was incredible potential to affect many people," said Paul Simon, Director of Chronic Disease and Injury Prevention at DPH. "The county government is the largest single employer in the region with about 40 departments and roughly 100,000 employees, plus many thousands of members of the public who come into county facilities."

"The area where we can have the quickest wins relate to the county's purchasing of foods and beverages, then later in the concessions environment, such as cafeterias, snack shops, and in the many programs and services where we provide food and beverages," explained Simon. "When you think about it, there is an incredible amount that governments purchase."

Improving Food in Cafeterias

With a strong vending policy in place, DPH next looked at the cafeterias in the five health care facilities operated by the county's Department of Health Services (DHS). The idea that DHS should offer recommendations for its Dietary and Concessions contract was first suggested by County Supervisor Mark Ridley-Thomas in a September 7, 2010, motion.

DHS was instructed to work with DPH to insert nutrition requirements into the $20 million food services contract, with five focus areas for contract recommendations: 1) access to at least one healthy meal option, 2) a plan to reduce sodium, 3) favorable water pricing, 4) calorie counts on menu boards and 5) portion size limits, for example providing cups no larger than 12 ounces at soda fountains.

While the contract is still pending, Project RENEW staff is optimistic the recommendations will be included."We thought we would get resistance," said Paul, "but DHS was completely receptive. When they showed the recommendations to the food service vendor they said 'No problem, we'll do it'. They're already moving in this direction."

Reducing Sodium Consumption in Los Angeles County

Sodium label In September 2010, the Los Angeles County Department of Public Health's Division of Chronic Disease and Injury Prevention released a brief titled, "The Potential Health Impact of Reducing Excess Sodium Consumption in Los Angeles County." This brief makes the case for limiting sodium consumption in order to reduce incidence of high blood pressure, heart disease, stroke, and kidney complications and decrease risk of stomach cancer, osteoporosis, and an enlarged heart. The brief also provides a one-pager for individuals: "How Can I Reduce Sodium in My Diet?"

According to the brief, direct and indirect costs of cardiovascular diseases alone are estimated to be approximately $400 billion per year in the United States. In Los Angeles County, hypertension-related health conditions account for more than 100,000 hospital admissions each year, while more than 17,000 deaths and nearly 77,000 years of potential life are lost annually as a result of heart disease and stroke.

Recent estimates from the health impact analysis conducted by DPH suggest that reducing population sodium consumption, even by a modest amount, has the potential to greatly reduce the number of cases of hypertension in Los Angeles County and save millions of dollars in annual treatment costs.

The brief outlines strategies at the national, state, and local level to reduce sodium consumption. One strategy calls for implementing venue-based food policies that set nutrition standards, including sodium limits, on all foods purchased, served or sold by an institution or employer. In a first, major step toward achieving the goal of lowering sodium consumption, the County of Los Angeles Vending Machine Nutrition Policy was recently amended to limit sodium in snack foods to no more than 360 milligrams per package or container.

CDPH Supports Efforts to Decrease Consumption of

Sugar-Sweetened Beverages in the Central Valley

coke fountain California Project LEAN funded four organizations in California's Central Valley to work toward adoption of local policy that will increase access to healthier beverages while decreasing access to sugar-sweetened beverages (SSBs) in their communities. These grantees are being funded through CDPH's Communities Putting Prevention to Work obesity prevention grant.

A recent analysis of data from the 2005 California Health Interview Survey indicates that some of the heaviest SSB adult consumption rates by county were in Kings, Madera, and Kern counties - all Central Valley counties. Some of the highest SSB consumption rates by children aged 2-11 also are in Central Valley counties. In Kings County, for example, 57.2% of 2-to-11-year-old children drink one or more sodas per day while in Kern County, 55% do, and in Fresno County, 53.1% do. The grantees are working on the following efforts:

Dolores Huerta Foundation (Foundation) is conducting a community public education campaign and promoting worksite policies that would decrease and/or eliminate SSBs and increase access to healthier beverages. The Foundation is also looking at ways to reduce and/or eliminate SSBs from schools.
Kaweah Delta Hospital Foundation (Kaweah) is working to increase the number of healthy beverages in vending machines at the hospital and in employee break rooms. Kaweah also is working with the City of Visalia's Parks and Recreation Department to develop a wellness policy that would decrease access to SSBs in vending machines, concession stands and at special events. Youth will also be involved in developing a social marketing campaign. Additionally, partner Family Health Care Network is working to establish a policy that would eliminate SSBs from being served at meetings.
Central California Regional Obesity Prevention Program is laying the groundwork for policy changes and program development at reducing SSBs in several Central Valley counties, including San Joaquin, Stanislaus, Merced, Fresno, Madera, Kings, and Tulare.
The Tulare County Health and Human Services Agency, Department of Health Services is working to reduce access to SSBs in a number of settings.

CPL has developed a fact sheet on limiting SSBs for parents in English and Spanish. For more information about CPL's SSB efforts, contact Cyndi Walter.

February 2011