California's Children

Maternal "food control" from "food insecurity" = child obesity

May 1, 2012: Low-income mothers with infants under 6 months who lack food security may be using unhealthy feeding practices with their babies, suggests the findings of a study presented at the Pediatric Academies Societies annual meeting in Boston last weekend, and reported in AAP News.

Feeding habits that promote obesity have been found to begin in infancy. In addition, living in a low-income neighborhood has also been found to be associated with higher obesity risks.

Study lead author Rachel Gross, M.D., pediatrics professor at Albert Einstein College of Medicine, New York, and colleagues interviewed 201 low-income mothers (primarily Hispanic) from the Women, Infants and Children (WIC) program about feeding styles (whether they tried to control how much the child ate), feeding practices (e.g., breastfeeding, adding cereal to bottles) and concerns about obesity.

Results showed that about one-third of the mothers reported food insecurity.

“We found that food insecurity is related to controlling feeding practices, which have been shown to increase child obesity,” Dr. Gross said. “These controlling feeding practices involved both restriction, in which parents limit the infant’s intake even if the infant is hungry, and pressuring, in which the parent encourages the infant to eat more even if the infant is full.”

It is believed that when mothers control what an infant eats, it may disrupt the child’s ability to regulate his or her own hunger and fullness, leading to overeating and inappropriate weight gain, Dr. Gross explained.

Some facts from the Food Research and Action Center:

Obesity rates increased by 23% for all low-income children 10- to 17-years old between 2003 and 2007, (compared to 10% for the national average), according to a national study of more than 40,000 children. The study also found that in 2007, children from lower income households had more than two times higher odds of being obese than children from higher income households. (Singh et al., 2010a).

Rates of severe obesity were approximately 1.7 times higher among poor children and adolescents in a nationally representative sample of more than 12,000 children aged 2 to 19 years (Skelton et al., 2009).

In addition, a 2011 longitudinal study of 1,788 women who were offered housing vouchers (in 2001) under a U.S. Department of Housing and Urban Development (HUD) program to move to more affluent neighborhoods, a decade later had 20% lower rates of obesity and diabetes than the control group who remained in the low-income neighborhoods.

Written for California's Children by Elizabeth J Carlyle.

Sick kids can't learn: Rothstein says RTTT $ should require SBCH participation

UPDATE, March 10, 2012: National Public Radio interviews Los Angeles families who take advantage of the district's School-Based Health Centers in this clip: 

 

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March 1,  2012: Richard Rothstein, at left, a former education columnist for the New York Times who is now a research associate at the Economic Policy Institute and senior fellow  at the Warren Institute on Law and Social Policy at the University of California (Berkeley) School of Law, writes in his commentary for the Economic Policy Institute that "keeping children in good health" is a critical part of the formula for success in public education.

Citing that School-Based Health Centers (SBHCs) in "disadvantaged neighborhoods" may be the "only practical way to keep children in good health," Rothstein laments that "adequate promotion of such centers has been distressingly absent from the Obama administration's education policy."--  

(SBHCs offer a safety net for children who lack health insurance, including checkups, physicals, immunizations, mental health treatment, dental care and drug counseling. The clinics also monitor students' chronic diseases, such as asthma, and treat their illnesses so they don't miss school.)

Although, in a February 7, 2012 speech at Harvard Graduate School of Education, Secretary of Education Arne Duncan insisted he is “a huge fan of out-of-school anti-poverty programs,” Rothstein clearly sees a disconnect between the policies and the rhetoric.

An excerpt from Rothstein:

... Such clinics are essential props for student achievement, not only because children who are absent because of illness can’t benefit from good teaching, or because children with untreated dental cavities are distracted by oral discomfort, or because untreated asthma (an epidemic in polluted urban neighborhoods) keeps children awake at night and drowsy in school, or because children can’t read well if they have uncorrected vision difficulties, but because there are few primary care physicians located in low-income neighborhoods. And where primary care is available, parents working low-wage hourly jobs cannot get time off to take children for routine and preventive visits. Often, such visits can happen only if they occur on school campuses and within the school day.

The Grub Box pilot: Combating child obesity with access to veggies

February 23, 2012: In a unique pilot project on pediatric obesity, Alameda County Medical Center's Highland General Hospital and People's Grocery of Oakland, a non-profit that promotes healthy and economically viable communities through local food systems, have teamed up to provide a free "Grub Box" to 15 families who agreed to participate in the 6-month healthy eating study. 

A Grub Box contains about 12 items of fruits and vegetables (12 - 16 pounds worth of produce) depending on what is being grown at local farms. Each week there are about 4 types of fruit, herbs and/or onions, at least one bunch of greens (kale, collards, chard, or mustards), and the remaining 6 items are seasonal vegetables.

Robert Savio, M.D., chief of pediatrics, above middle, and Michele Bunker-Alberts, above left, a family nurse practitioner and lactation consultant, designed the healthy-eating project with a $10,000 grant from the American Academy of Nurse Practitioners.

"We see a disproportionate number of families that are struggling with pediatric obesity," said  Bunker-Alberts. "They typically live in neighborhoods where they have less access to the type of foods we're asking them to eat."

To qualify for the project, at least one child in the family had to meet the definition of obesity (a Body Mass Index in the 95th percentile or higher: e.g., a child who is 4 feet tall and weighs 100 pounds is considered obese).

To begin, Savio measured the children's weight and other indicators of their health, such as cholesterol and glucose levels. Savio and Bunker-Alberts stressed that with children, the goal is typically not to reduce weight but to focus on maintaining it so that when the child grows, his or her BMI will drop.

The project also included workshops by nutrition educators:

The families learned how to prepare vegetables like chard and kale and often shared information with each other. The workshops also focused on such issues as portion control and how to read food labels, said Raheemah Nitoto, a holistic health and nutrition educator who ran workshops with a hospital nutritionist. Some of the participants weren't able to recognize leafy green vegetables such a chard or kale. "So handing them that and telling them to go off and eat that wouldn't be helpful," she said.

Savio and Bunkers-Albert are still collecting data from the project (which ended in November). But they hope to expand it to more patients and their families.

Ultimately their goal is to track patients for years to see if jump-starting new eating habits by providing them with healthy foods made a long-term difference in their lives.

Written for California's Children by Elizabeth J Carlyle.

 

Language development linked to prenatal vitamin D

Reuters news service has picked up a research report from Australian scientists (published on-line in Pediatrics) linking pre-natal exposure to mother's vitamin D intake to fetal brain development that affects language. The research indicates that mothers who had low vitamin D intake during pregnancy were more likely to give birth to a child with language impairments.

 Over 20 years ago, Andrew Whitehouse, lead author, and hiscolleagues began measuring vitamin D levels of more than 700 women who were about halfway through their pregnancy. Five and 10 years later, they tested the children of these moms to measure their behavioral and emotional development and language skills. The researchers split the moms into four groups – from lowest to highest vitamin D levels – and they found that the risk of having a kid with emotional or behavioural issues was the same for each group. The low-vitamin D group had between 15 and 46 nanomoles per litre (nmol/L) in their blood, while the high-vitamin D group had 72 to 154 nmol/L. Levels below 30 nmol/L are considered deficient.

When the researchers looked at language skills, the team found that mothers in the lowest category were more likely to have a child with a language impairment than mothers in the highest vitamin D category.

The language impairments were determined from scores on a vocabulary test. For instance, about 18 per cent of moms in the lowest group had a child with a language issue at age 10, compared to roughly eight per cent of the moms in the highest group.

“The logical thought is that maternal Vitamin D insufficiency during pregnancy is affecting the normal course of brain development,” Dr. Whitehouse wrote in a e-mail.

Dr. Lisa Bodnar, assistant professor of epidemiology at the University of Pittsburgh (who was not a researcher in the study), commented to Reuters that one factor that will be important to tease out is whether obesity might be involved.

“We know that obesity before pregnancy is associated with poor vitamin D status in pregnancy, and we know that obese moms are more likely to have children with developmental delays and cognitive impairments,” she said.

 

2 CA nonprofits get Aetna grants to reduce infant mortality in at-risk populations

February 14, 2012:  Seven nonprofits in the U.S. have been awarded a total of $363,650 from the Aetna Foundation to help expectant women from minority populations have healthier pregnancies and healthier babies.

The Aetna Foundation is focusing on racial and ethnic health care equity in hopes of reducing the high rate of infant mortality in the U.S. among vulnerable communities, particularly in the African-American population where preterm birth and mortality in the first year of life are double the rates of the white population and where breastfeeding rates are lower. The grants will address such issues as breastfeeding, obesity and pregnancy, perinatal stress, access to prenatal care and the effectiveness of doulas, and will focus on at-risk women and their babies in California, Florida, New Jersey, Pennsylvania and Texas.

The California grants:

-- $25,000 to the Institute of Noetic Sciences in Petaluma: to translate into Spanish and make culturally appropriate enhancements to the Mindful Motherhood Training, an educational program for pregnant women that teaches mindfulness-based skills to reduce chronic stress, which often afflicts minority populations at higher rates and can lead to premature births, childbirth complications, low-birth weight and impaired cognitive development. The program is currently being modified in a project funded by the National Institutes of Health to include a greater emphasis on healthy eating and living behaviors to address the needs of the growing population of obese low- and middle-income pregnant women whose weight puts them at higher risk of complications in pregnancy and childbirth. The Spanish-language version of the Mindful Motherhood Training will be piloted, tested and refined to ensure its effectiveness and cultural literacy among Hispanic populations.

-- $30,000 to La Clinica de La Raza, Inc., Oakland: to expand the capability of its San Antonio Neighborhood Health Center, and to provide high-quality and culturally appropriate perinatal support services in languages other than Spanish to accommodate the growing diversity of the once primarily Hispanic, low-income neighborhood. Designed to reduce the number of low birth-weight babies born in the community, the Health Center's perinatal program helps eligible women enroll in California's Medicaid program and provides individual and group health education classes, birth control method counseling, psychosocial case management, nutrition education and counseling, and breastfeeding instruction.