School Salad Bars: Placement Matters

Do you have picky eaters at home? Fruit and vegetable consumption is low among children and tends to decrease by one serving by the time kids reach their teen years. Thankfully, the National School Lunch Program (NSLP) has been focused on encouraging young students to buy and eat more produce. Since 2010, the Let's Move Salad Bars to Schools campaign has raised over ten million dollars to assist school cafeterias in obtaining salad bar equipment. One recent study examined whether the location of the salad bar in the school cafeteria impacted fruit and vegetable consumption.

During the study, which involved 533 middle school students from six schools in Arizona, salad bars were either placed as part of the cafeteria serving line or outside of the line. Researchers then compared the amount of fresh fruits and vegetables that were served, consumed and wasted.

In the cafeterias featuring a salad bar as part of the lunch line, 98.6 percent of students served themselves fruits and/or vegetables from the salad bar and 90.6 percent of those students actually consumed the fruits and vegetables. On the other hand, at the schools with salad bars outside of the lunch line, only 22.6 percent of students served themselves fruits and/or vegetables and only 20.7 percent of those students actually consumed the fruits and vegetables.

Bottom Line: In this study, there was about a fivefold difference in the amount of salad bar items sold and consumed depending on the placement of the salad bar. The results suggest that allowing students to serve themselves prior to paying for their meal requires less effort, thus increasing the chance they will choose fruits and vegetables. Salad bars should be encouraged in school cafeterias and placed in a convenient location. If you are trying to get your child to eat more fruits and vegetables at home, try allowing your child to serve his/her own fruits and vegetables along with the rest of their meal and always have fruits and vegetables easily accessible as snacks. 

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Can a Cluttered Kitchen Lead to Stress Eating?

Can you recall a time when you found yourself stress eating? Stress can lead to consuming too much food by impacting behavior and impairing one’s ability to execute self-control. A recent study examined whether a cluttered kitchen contributes to stress and leads to overeating.

Researchers assigned 98 college-aged women to either an organized kitchen or a messy one in which furniture and cookware were out of place. The women were then asked to complete one of three writing tasks about the following topics: a time when they felt out of control, a time when they felt in control or the last lecture they attended (a neutral condition).

After being exposed to either the standard or cluttered kitchen and completing the writing task, each woman was given three bowls that had been previously weighed and filled with one of three snacks: cookies, crackers or carrots. The women were asked to taste and rate each type of food and were told they could eat as much as they wanted. Each bowl was then reweighed to determine their intake.

Across the board, more participants consumed cookies and crackers than they did carrots. The analysis showed that the participants who ate the most cookies were those participants exposed to a messy environment and also those who wrote about a time when they felt out of control. These findings are consistent with the idea that people often turn to sweet foods for comfort during times of stress.

Bottom Line: The combination of a chaotic environment along with a stressed mindset may increase your chances of over indulging. Take a few minutes each day to put things away in your kitchen and unclutter your environment. Remember to think about your desk at work as well; a cluttered desk may contribute to stress and lead to overindulgence in sweets around the office. After a stressful day, practice mindfulness by recalling a time when you felt in control. 

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Keeping It Legal -- EEOC Insight on Wellness Programs

When developing and implementing a wellness program, employers need to comply with the Equal Employment Opportunity Commission (EEOC) regulations, portions of which are being finalized this year. Until then, the results of a recent court ruling in EEOC v. Flambeau, Inc. may be of assistance to employers in determining whether employee health information can be gathered to create a program that offers valuable incentives to participating employees.

In this case, Flambeau established a wellness program for its employees in 2011 – initially offering a $600 credit to any worker who participated. By 2012, the company required any employee who wanted to obtain health insurance to complete two of the requirements set out in the wellness program. The first requirement was a health risk assessment, which required employees to complete a questionnaire about medical history, diet, mental health, social well-being and job satisfaction. The second requirement was a biometric screening that included a routine physical exam – height, weight, blood pressure and a blood test. This information was aggregated and used to identify health risks and medical conditions among the workforce to estimate corporate insurance costs and set premium levels. 

One employee refused to complete both requirements and was dropped from Flambeau’s insurance coverage. The EEOC brought an action on behalf of the employee on the grounds of an Americans with Disabilities Act (ADA) violation that bans employer-mandated medical examinations. The judge upheld the employer’s wellness program and ruled that the program fell squarely into the ADA’s “safe harbor” for insurance benefit plans because it met the following conditions:

• The wellness program requirement was a “term” of the employer’s insurance benefit; it was not mandated outside the realm of its insurance benefits offerings. It was also deemed critical by the court that the employer provided adequate advance notice of the wellness program requirements to workers through educational handouts, and that the assessment and testing coincided with the open enrollment period.
• The wellness program requirements were clearly intended to assist the employer with underwriting, classifying or administering risks associated with the insurance plan. The information was collected in aggregate and then directly used to classify health risks to calculate projected insurance costs for the benefit year. 
• The wellness program was not a condition of employment and employees could refuse to participate and remain employed – even though they would have to obtain health insurance elsewhere.
• There was no evidence of discrimination or disability-based distinctions against any specific workers or groups of employees, and the information collected was not used to treat any single employee differently.

Employers looking to establish a wellness program can gain insight from this case; however, the specific law on the ADA’s safe harbor and the administration of health insurance plans could vary based on jurisdiction.  It is advisable, therefore, to check with your counsel to ensure any wellness plan you develop is compliant.

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5 Strategies to Improve Wellness Engagement

Are you struggling with keeping employees excited and engaged in your wellness program? Falling into ruts, getting bored and becoming disinterested in routines is common, but with a little work, innovation and planning, you can breathe new life into your program and increase participation. Try incorporating these five strategies to keep employees engaged in your program while building excitement about health and wellness initiatives.

1. Be innovative and create new events.  Based on employee feedback from previous wellness programs, try integrating new programs into the ones that received the most attendance, were the most successful and attracted the most interest. It can become too easy to repeat the same events over and over, which can result in overuse and eventual boredom.

2. Seek success stories.  Seek out employees who have become champions in the wellness program and achieved positive results. Use their stories as a road map for others and to exemplify the benefits of the wellness program. Invite these employees to speak and spread the word or feature them on your Intranet or in your company newsletter.

3. Highlight the benefits.  Promote and communicate the employee wellness activities that are offered and explain why the activities are beneficial. Identify different ways to become healthy and involved. When employees understand the choices available to them, they will be more inclined to participate.

4. Introduce all aspects of health.  Physical health is just one aspect of overall well-being. For most employees, this means more exercise, increased physical activity, better diets and improved eating habits. Employers have the opportunity to introduce other ways to achieve wellness by integrating new holistic health information into the program, focusing on mental health and reducing stress levels, and helping employees improve financial health.

5. Celebrate achievements.  Even though employers want to see the end results and bottom line, these measures should not cloud the success of participants. Along the way, reward milestones reached by employees. Small progress often leads to long term success. Celebrate these mini-achievements while keeping a focus on what still needs to be done. Employees will feel the excitement of meeting these benchmarks. 

When C-level executives and management are excited about the wellness program, often employees will catch the enthusiasm and participate. Evaluate what is working within the plan and discard what is not. Don’t be afraid to try something new and fresh.

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Reduce Chronic Disease with Omega-3 Fatty Acids

Diet and lifestyle play a huge role in the development of chronic diseases. Risk factors including inflammation, high cholesterol and insulin resistance can lead to diabetes, heart disease and obesity. With the prevalence of these diseases in the United States slowly increasing, it is important to focus on minor nutrition upgrades in your diet to help lower your risk of chronic disease.  A recent study looked at the benefits of omega-3 fatty acids, which have been shown to reduce systemic inflammation and provide a multitude of other benefits.

A randomized, controlled study assessed the impact omega-3 fatty acids would have on biomarkers of fatty acids, triglycerides, HDL/LDL and total cholesterol levels, markers of inflammation including C-reactive protein and glucose/hemoglobin A1C. Fifty-nine adults with pre-diabetes or metabolic syndrome were included in this 8-week study. Each participant was provided supplements containing polyunsaturated fatty acids. The participants received corn oil, botanical oil or fish oil supplements. The botanical oil was rich in alpha-linolenic (ALA) fatty acids and the fish oil supplement in eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids.

The results indicate that supplementation with botanical oil and fish oil has the ability to improve disease biomarkers in adults with type 2-diabetes and metabolic syndrome. Specifically, fish oil supplementation increased blood levels of omega 3 fatty acids, decreased triglycerides, increased HDL (good) cholesterol, and reduced hemoglobin A1C and C-reactive protein levels. Botanical oil decreased total cholesterol and LDL (bad) cholesterol. The patients that received supplementation with corn oil did not show any significant changes in disease markers from baseline to post-supplementation treatment.

Bottom Line: Omega-3 is an essential fatty acid, which means the body cannot make it -- we must get it from our food. Walnuts, flax seeds and leafy vegetables are sources rich in ALA omega-3 fatty acids. Oily fish is rich in EPA and DHA omega-3 fatty acids. It is recommended to consume two servings of oily fish per week for healthy adults, equating to approximately 500 mg of EPA and DHA. If you do take a fish oil supplement, check that it contains EPA and DHA fatty acids.

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Control Glucose with Probiotics

What’s the deal with live and active cultures? Probiotics are good bacteria that can impact the regulation of intestinal function and digestion. Emerging research has found that probiotics have the ability to improve brain function, decrease LDL cholesterol, lower blood pressure, manage irritable bowel syndrome and other gastrointestinal diseases, lower blood glucose and improve immune function. Recent research has demonstrated that alterations in gut microbiota are involved in diabetes and metabolic disorders. Probiotics may be used to alter gut microbiota and lower glucose; a review and meta-analysis of the research was performed to assess the effects of probiotics on glucose and insulin.

Seventeen randomized controlled trials were analyzed in a meta-analysis and explored the effects of probiotics on glycemic control. These studies included a total of 1,105 participants that were broken into two groups: 551 participants in the probiotic group and 554 in the control group. These studies ranged from three to 24 weeks with varying probiotic species and doses among each study.

The results from four of the trials indicated a significant reduction in fasting blood glucose levels after probiotic consumption. Eleven studies found a reduction in insulin after probiotic supplementation. Results indicated that a combination of probiotic species is more beneficial than one single strand. Overall, probiotics had a greater effect on fasting blood glucose in participants with diabetes.

The mechanism by which probiotics lowers blood glucose is unclear. Researchers propose strains of lactic acids that have antioxidant properties may decrease oxidative stress, which is shown to be present in hyperglycemia. Also, low grade inflammation is observed in obese individuals and those with diabetes; probiotics may help regulate inflammation by reducing pro-inflammatory cytokines.

Bottom Line: Consumption of foods containing probiotics may help to improve blood glucose control. Probiotics are found naturally in yogurt, aged cheese, kefir and tempeh. They are also added to certain grains. Include these food sources in your diet for additional health benefits and reduced risk of chronic disease.

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Strategic Snacking

Many people turn to popular diet trends to lose weight, but these fad diets do not work in the long run and often leave frustration in their wake. Strategic snacking throughout the day can support weight loss and weight maintenance. Unfortunately, typical snacks consist of simple sugars and saturated fat. When choosing your afternoon snack, make sure to grab one that is less energy dense and contains a multitude of nutrients, including protein.   

A recent randomized crossover study comparing yogurt, crackers and chocolate assessed if consuming a high protein yogurt snack would improve appetite control, satiety and reduce food intake at dinner in twenty healthy females ages 25 to 29. The study compared three 160-calorie afternoon snacks: high protein yogurt, high-fat crackers and high-fat chocolate. The participants consumed each snack in the afternoon for three consecutive days. On the fourth day of each pattern, the participants consumed a standardized breakfast and lunch, and the respective snack was consumed three hours post lunch.

The results indicated that consumption of each snack led to immediate reductions in hunger and increased fullness followed by gradual increases in hunger until dinner was requested. Consumption of the high protein yogurt snack led to greater reductions in afternoon hunger compared to the other snacks. Additionally, after eating the yogurt snack participants requested dinner at a later time and consumed fewer calories at dinner time compared to the other snacks. This study indicates that eating a high protein snack in the afternoon is one way to control appetite and control portions at dinner. 

Bottom Line: Eating more often can aid in weight loss if you snack strategically. Aim for an eating pattern that includes three nutritionally balanced meals with one to two healthy snacks daily. Focus on the quality of the foods you are choosing and incorporate nutrient dense foods including vegetables, fruits, whole grains and lean proteins.

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Love Your Heart with Cocoa Flavanols

Chocolate is rarely thought of as a nutritious food, yet it contains plant-based chemicals that provide positive health benefits. Chocolate is derived from cocoa beans found within the pod-like fruits of the cacao tree. Cocoa beans are fermented, roasted and ground into a rich-tasting powder that contains flavanols. Previous studies have shown that a higher intake of flavanol-containing foods can improve arterial function in individuals at risk for cardiovascular disease. A new study sought to evaluate whether consumption of cocoa flavanols can also help to maintain cardiovascular health in healthy individuals.

Included in this study were 100 middle-aged adults (ages 35 to 60 years of age). Individuals were healthy men and women without history, signs or symptoms of cardiovascular disease, myocardial infarction, stroke, peripheral arterial disease or medications. Excluded from this study were those with cardiovascular disease, diabetes, kidney failure, acute inflammation, heart rhythms, alcoholism and vitamin supplement use.

Participants were divided into two groups: an intervention group and a control group. The intervention group consumed a drink containing 450mg of cocoa flavanol twice daily for one month. The control group consumed a drink that contained no cocoa flavanol. Compliance was measured by the return of empty packets at the end of the trial. The primary end point measured was flow mediated vasodilation (a measure of endothelial function used to evaluate cardiovascular risk) and secondary endpoints measured were specific plasma lipids and blood pressure.

At the end of the one-month trial, consumption of cocoa flavanol resulted in an increase in flow mediated vasodilation over the control group by 1.2 percent. Secondary end point measurements showed a significant decrease in systolic blood pressure by a 4.4mmHg and a significant decrease in diastolic blood pressure by 3.9mmHg. This decrease in blood pressure was noted to have effects similar in size to that of blood pressure lowering medications.

By applying the Framingham Risk Score (a risk assessment tool used for estimating the risk of a heart attack over the next ten years) to the individuals in this study post-intervention, cocoa flavanol consumption was found to predict significant lowering of the ten-year risk by thirty percent overall for coronary heart disease, cardiovascular disease, myocardial infarction, and death from coronary heart disease or cardiovascular disease. Stroke risk was not significantly decreased.

Bottom Line: The results from this study support the hypothesis that cocoa flavanol intake has the potential to support the maintenance of cardiovascular health via improvements in endothelial function. Before reaching for that chocolate bar, remember that not all chocolate is created equal. Levels of cocoa flavanols vary widely from brand to brand. Pure cocoa powder has the most antioxidants, followed by dark chocolate. 

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Parental Body Weight and Childhood Obesity

New data from the American National Health and Nutrition Examination Survey showed that 8.1 percent of infants (0-2 years) had high birth weight for length. Even more alarming, in 2012 more than one third of children were overweight or obese. The prevalence of overweight and obesity in children has become a significant public health concern. A recent review looked at the effectiveness of parent involvement and application of behavior change techniques in weight control interventions.

A cross-sectional study was conducted in five primary schools in Gao Hand Town, Shanghai. In the study, students were broken up into four classes depending on criteria:

I.Both father and mother had normal BMI

II. Father overweight, mother normal weight

III. Father normal weight, mother overweight

IV. Both father and mother overweight

Results showed that the total prevalence of overweight children in one school was 27.2 percent,16 percent higher in boys than girls, and also 30.8 percent higher in fathers than mothers. Both parental body weight statuses were closely related to whether children were overweight or healthy. When both parents were overweight, the prevalence of overweight children was even higher than when compared with children with one overweight parent. 

There are a number of potential explanations relating parental body weight and overweight children. One factor may be low familial socioeconomic status and reduced levels of parental education. Parental obesity-related behaviors (physical inactivity, screen time, sugar-sweetened beverages, sleep duration and fast food) may also play a role by affecting confidence to support behavioral changes in their children. Finally, altered family structure can impact prevalence: children without siblings are at an increased risk of being overweight than those with siblings.

Bottom Line: Children are likely to adopt both healthy and unhealthy behaviors from their parents. Parents can serve as role models for their children by eating healthy foods and being physically active. Encouraging kids to join sports or active hobbies, limiting screen time and offering nutritious foods are a few of the ways parents can promote healthy habits at home. 

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Sedentary Behavior Related to Cancer Risk

Sedentary behavior has been emerging as an independent risk factor for chronic disease and mortality. Time spent sedentary displaces potential physical activity, causing decreased energy expenditure and resulting in weight gain and obesity. Researchers looked at the relationship between time spent sedentary and cancer risk in a new study.

Researchers conducted a comprehensive, systematic literature review and meta-analysis of prospective published studies on TV viewing time, recreational sitting time and occupational sitting time in relation to site-specific cancers. The meta-analysis ultimately included 43 observational studies where 68,936 cancer cases were analyzed, including colon, endometrial, lung, breast, rectum, ovarian, prostate, stomach, esophagus, testicular, renal cell and non-Hodgkin lymphoma.  

Each two-hour per day increase in sedentary time was related to a statistically significant eight percent increase in colon cancer risk and a ten percent increase in endometrial cancer risk. There was also positive correlation between sedentary behavior and lung cancer, though this was considered a borderline statistically significant increase of risk. By comparison, associations of sedentary behavior with cancer risk were null for cancers of the breast, ovaries, prostate, stomach, esophagus, testes, renal cell and non-Hodgkin lymphoma. Interestingly, colon, endometrial, breast and renal cell cancers are all positively associated with obesity; however, from this meta-analysis obesity is considered a risk factor for only colon and endometrial cancers. This suggests that sedentary behavior and obesity have an effect on risk factors of certain cancers whereas obesity is an independent risk factor of other cancers.

Bottom Line:  Try to get the recommended amount of physical activity as often as possible—for the sake of your health. Strive for 150 minutes of moderate aerobic physical activity (30 minutes, 5 days a week) or 75 minutes of intense aerobic physical activity (25 minutes, 3 days a week). It is best to also include 2 to 3 days of muscular strength training each week to maintain fitness and muscle mass.

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