News Tips from American Public Health Association Meeting in New Orleans

Study Suggests Home Cooking is a Main Ingredient in a Healthier Diet

--People who frequently cook meals at home eat healthier, consume fewer calories regardless of where they ate dinner

People who frequently cook meals at home eat healthier and consume fewer calories than those who cook less, according to new Johns Hopkins Bloomberg School of Public Health research.

“When people cook most of their meals at home, they consume fewer carbohydrates, less sugar and less fat than those who cook less or not at all – even if they are not trying to lose weight,” says Julia A. Wolfson, MPP, a CLF-Lerner Fellow at the Johns Hopkins Center for a Livable Future and lead author of the study.

The findings also suggest that those who frequently cooked at home – six-to-seven nights a week – also consumed fewer calories on the occasions when they ate out.

Wolfson is scheduled to present the research at the American Public Health Association’s Annual Meeting in New Orleans, Louisiana, on November 17. The study will be published online in the journal Public Health Nutrition.

Wolfson and co-author Sara N. Bleich, PhD, an associate professor in the Department of Health Policy and Management at the Bloomberg School, analyzed data from the 2007-2010 National Health and Nutrition Examination Survey from more than 9,000 participants aged 20 and older. The survey asked detailed questions about what participants ate during a 24-hour period as well as other eating behaviors such as fast food in the past 30 days. The researchers found that 8 percent of adults cooked dinner once or less a week and this group consumed, on an average day, 2,301 total calories, 84 grams of fat and 135 grams of sugar. Forty-eight percent of participants cooked dinner six to seven times a week and they consumed 2,164 calories, 81 grams of fat and 119 grams of sugar on an average day. The researchers also found that those who cook at home more often rely less frequently on frozen foods and are less likely to choose fast foods on the occasions when they eat out.

The research found blacks are more likely to live in households where cooking occurs less frequently than whites; and individuals who work more than 35 hours a week outside the home also cook less often.   

“Obesity is an escalating public health problem that contributes to other serious health issues, including diabetes, high blood pressure and heart disease,” says Wolfson. “The evidence shows people who cook at home eat a more healthy diet. Moving forward, it’s important to educate the public about the benefits of cooking at home, identify strategies that encourage and enable more cooking at home, and help everyone, regardless of how much they cook, make healthier choices when eating out.”

Wolfson says there may not be a one-size-fits-all solution to getting people to cook more. “Time and financial constraints are important barriers to healthy cooking and frequent cooking may not be feasible for everyone. But people who cook infrequently may benefit from cooking classes, menu preparation, coaching or even lessons in how to navigate the grocery store or read calorie counts on menus in restaurants.”

“Is cooking at home associated with better diet quality or weight-loss intention?” was written by Julia A. Wolfson and Sara N. Bleich. The study was supported by the National Heart, Lung, and Blood Institute (grant number 1K01HL096409).

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Healthy Cafeteria Food Options Often Not Eaten By Young Children

--Nearly six in 10 put a vegetable on their tray, but only a quarter actually take even a single bite

You can offer young children healthier food choices in the elementary school cafeteria, but will they actually put it on their trays and eat it?

Probably not, suggests a new Johns Hopkins Bloomberg School of Public Health study.

Researchers observed 274 children in kindergarten through second grade in 10 New York City public schools as they selected from the offerings during one lunch period when a chicken-and-vegetable entrée was on the menu. They watched to see whether each of the 6-through-8-year-olds chose a fruit, vegetable, whole grain, low-fat milk and/or a lean protein, taking before and after photos of the trays. They found that while 75 percent of the kids chose the lean protein (the entrée), only 58 percent chose a fruit and 59 percent chose a vegetable. And among those who put the various types of food on their trays, only 75 percent took even a single bite of the protein, while only 24 percent ate a bite of their vegetables.

“We have been thinking that if young children choose healthy food, they will eat it,” says Susan M. Gross, PhD, MPH, a research associate in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. “But our research shows that is not necessarily so.”

Gross is scheduled to present the research at the American Public Health Association’s Annual Meeting in New Orleans, Louisiana, on Nov. 17.

She says the environment in the cafeteria had a major impact on whether the children ate their lunches. Along with recording how much food the children selected and ate, the researchers also examined the noise level, supervision level, how full the cafeteria was, the length of the lunch period and the packaging of foods.

They found that children were much more likely to finish their food if a teacher ate in the cafeteria with them. They found that more children ate their vegetables and whole grains when it was quieter in the cafeteria, though noise had little effect on consumption in the other food groups. The children were more likely to eat when their food was cut up into smaller pieces and when lunch periods were longer.

The findings come as Congress prepares in 2015 to reauthorize the Child Nutrition Act, which funds the National School Lunch Program and National School Breakfast Program. Several years ago, new dietary guidelines were adopted by the U.S. Department of Agriculture for school feeding programs requiring schools to provide healthier lunches including whole grains, lean protein and low-fat milk. There was pushback in many circles because mass production of those foods can be more difficult and more costly.

“As much as we are focused on menus in the school lunch program, we need to look more at our cafeteria environments, especially with our youngest children,” Gross says. “We can give kids the healthiest food possible, but if they don’t have time to eat it or they are distracted by how noisy the cafeteria is, they’re not going to eat it. They’re on their own and we need to do as much as possible to help them through that lunch period.”

“Does selection of foods in the school cafeteria by 6-8 year olds translate into consumption? Results of a cafeteria observation study” was written by Susan M. Gross, Allison Zucker, Erin Biehl, Sahnah Lim, Beth Marshall, Marycatherine Augustyn, David M. Paige and Kristin N. Mmari.

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New School Meal Requirements: More Harm than Good?

--Restrictions for Saturated Fat and Calories, but No Limits for Added Sugars, Can Mean More Carbs for School Meals

New federal regulations requiring school meals to contain more whole grains, less saturated fat and more fruits and vegetables, while perhaps improving some aspects of the food being served at schools across the United States, may also be perpetuating eating habits linked to obesity, diabetes and other diet-related diseases, an analysis by Johns Hopkins Bloomberg School of Public Health researchers has found.

The reasons: Based on analysis of school meals and the new requirements, the whole grains served are mostly processed, which means they are converted into sugar when digested, and many of the required foods, like fruit and milk, contain added sugar because many schools opt to serve canned fruit, fruit juice, and flavored milk. The new requirements do not limit the amount of added sugar in school meals. The researchers are recommending that the requirements be expanded to limit added sugars and processed foods and to ensure carbohydrate quality.

The findings will be presented in a poster on Nov. 18 at the American Public Health Association’s Annual Meeting.

School meals can account for more than 50 percent of a student’s daily caloric intake, and more than 30 million children participate in school breakfast and lunch programs. Childhood and adolescent obesity rates have more than tripled since 1970.

“The low-fat craze in the last two decades has caused Americans to transition to a high-carb, low-fat diet,” notes Sadie Barr, a student in a joint MPH-MBA program at Johns Hopkins University’s Bloomberg School of Public Health and Carey Business School. “This has been strongly linked to obesity, diabetes and other diet-related diseases, in large part because the majority of the carbs we have been eating are processed. School lunches, even with these new regulations, still largely reflect this diet.”

Congress passed the Healthy, Hungry-Free Kids Act (HHFKA) in 2010. It requires school meals (breakfast and lunch) to consist of 51 percent whole grains, increases the amount of fruits and vegetables offered to students, restricts saturated fats to less than 10 percent of meal calories, imposes calorie restrictions and only allows skim or 1 percent milk to be served (only skim milk is allowed to be flavored). (HHFKA also restricts salt, but this was not addressed in this paper.) The goal was to provide nutritious food that promoted healthful eating.

In 2004, the U.S Department of Agriculture instituted a voluntary program, the Healthier U.S. School Challenge, for elementary school lunches, which used many of the same menu guidelines outlined in the HHFKA. Breakfast was added in 2012. HHFKA is based in large part on the Healthier U.S. School Challenge, but extends to all grade levels.

For their study, “Challenging School Food Policy: Why New Nutrition Standards for School Meals are at Odds with Nutritional Science,” researchers did two things: Analyzed the new regulations in the context of nutrition science, and compared the new regulations to what was being served in the 2009-10 school year. They also looked at the smaller group of schools that had already implemented the healthier food guidelines.

Lunches at schools where the Healthier U.S. School Challenge had already been implemented contained more than 54 percent carbohydrates, which was actually slightly higher than schools that were not participating in the initiative. The majority of carbohydrates were processed. Researchers say the Healthier U.S. School Challenge menus should look very similar to what schools are now serving under the new regulations.

“The one thing I found shocking,” notes Barr, “is that the HHFKA regulation requirements make no mention of carbohydrates. The word `fat’ is mentioned perhaps hundreds of times. But the word `carbohydrate’ is not mentioned once. They didn’t recognize that primary macronutrient. Requiring grains served to be at least 51 percent whole is a step in the right direction, but isn’t enough to ensure that the meals served will be more whole and less processed, which would be more advantageous to health.”

The researchers, in addition to recommending that HHFKA be expanded to limit added sugars, curtail the amount of processed carbohydrates and increase whole grain and whole food products, are recommending that an independent panel of experts be convened to reevaluate the saturated fat and calorie restriction. This would help insure that processed carbohydrates are not replacing saturated fats, Barr says.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Stephanie Desmon at 410-955-7619 or sdesmon1@jhu.edu and Barbara Benham at 410-614-6029 or bbenham1@jhu.edu.