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Andrea N. Giancoli, MPH, RDFeeding the Kids and You
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Newsbites June 30th: Good News Bad News

Andrea Giancoli, MPH, RD
Chronic diseases in children are on the rise. According to the Journal of the American Medical Association obesity, asthma, diabetes and attention deficit disorder have soared in the last four decades. In 1960 1.6% of US children suffered an activity limiting chronic ailment, compared to 7% in 2004. Researchers blame increased screen time i.e. television, video games and other electronic media, more time spent indoors, decreased physical activity, increased consumption of fast foods and sugary beverages, and changes in parenting (ouch). Go to The Increase of Childhood Chronic Conditions in the United States to read the full article.

The good news is when it's a family affair children fare better than when the focus is on the child alone. So says researchers who tested the unique family based weight management program "Bright Bodies" (this study was also published in the Journal of the American Medical Association. The Journal's latest issue is dedicated to chronic disease in kids). The children who participated with their families received an intensive family-based program that included exercise, nutrition education and behavior modification. The children who were not part of the family group just received weight management counseling in a clinic every six months.

The results were significant. After one year the kids in the family based program showed decreased body mass index (a measure of weight for height), decreased body fat and improved blood cholesterol levels while the other kids fared worse in all of the same categories. That gets a big wow! More ammunition that as adults we must be models of behavior!

Have a great rest of your weekend with lots of fruits and veggies!

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Recipe of the Week: Green Treasure Salad

Andrea Giancoli, MPH, RD


I saw grapes on sale this weekend at the grocery and thought it was time for this easy dessert recipe. This one comes from The Network for a Healthy California Orange County Coalition (formerly The California Nutrition Network Orange County Coalition)

Green Treasure Salad
Ingredients
1 cup grapes (green, seedless)
1 green apple, chopped
½ cup miniature marshmallows
½ cup nonat lemon-flavored yogurt
2 T slivered almonds

Makes about 2 servings.. double or triple the recipe for more of course.

Instructions:
Mix together the grapes, apple pieces, marshmallows, yogurt, and almonds.
Serve in small bowl
Enjoy!

This yummy dessert is a good source of fiber, calcium vitamin C and adds a nice dose of needed potassium. I suppose you could also make this an afternoon snack. If you don’t plan to serve it right away, add the almonds in just before serving. Otherwise they get a little soggy.

Nutrient Facts per serving
Calories 230
Fat 4.5 grams
Protein 5 grams
Fiber 3.5 grams
Calcium 133 mg
Potassium 400mg
Vitamin C 13 mg

Have a fruit and veggie filled day!

(photo courtesy of Dano)

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Boning up on D

Andrea Giancoli, MPH, RD

History has taught us to load up on calcium for bone health, but take note vitamin D is quickly emerging as the superstar bone nutrient. Vitamin D is in fact necessary for the absorption of calcium. So if we don’t get enough of the D, it won’t matter if we are getting enough calcium. At its worst vitamin D deficiency can result in rickets and stunted growth in children, osteomalacia -weakened muscles and bones - and osteoporosis in adults.

Traditionally vitamin D is known as the sunshine vitamin because the body can synthesize it when the sun hits our skin. So theoretically we should be able to get all we need from the sun, as there aren’t a lot of food sources of vitamin D.

Unfortunately, sunscreen has been getting in the way of that source. History has also taught us to wear sunscreen to protect us from skin cancer. That practice, however, blocks out the suns’ ultraviolet rays that are needed to trigger vitamin D production in the body. There is a current debate amongst dermatologists and vitamin D experts over safe sun exposure. The dermatologists say sunscreen sunscreen sunscreen to protect protect protect our delicate skin from the suns’ harmful rays. While the vitamin D experts claim the risk from lack of vitamin D is much higher than the risk for getting skin cancer, so spend a little time in the sun

Ironically chronic vitamin D deficiency has been linked to a reduced risk of some cancers. And it doesn’t stop there; the big D appears to be protective against diabetes, high blood pressure, and heart disease, perhaps even multiple sclerosis. The current recommendation for vitamin D ranges from 200 to 400 International Units (IU). But the consensus is that isn’t enough. To obtain the vitamins’ protective effects researchers advise 1,000 to 2,000 IUs a day. That’s a big jump.

Bottom-line: don’t be quite so afraid of the sun. The recommendation is to make sure you get adequate sunlight but of course avoid burning. So what does that mean? How much sun? It is longer for some than it is for others. The darker your skin the more time in the sun you will need, 2-4 times more than that of a pale skinned person. The general rule of thumb from Vitamin D enthusiasts is to get just enough sun before your skin changes color i.e. before you get pink if you are light skinned, about 10 to 20 minutes. If you live in the Northern United States the sun’s rays aren’t strong enough year round to trigger vitamin D production in the skin so make sure you get a little sun in this summer to carry you through the winter months. But do put your sunscreen on after you’ve been in the sun for a few minutes, and before you start to change color.

And of course there are a few food sources you can rely on; milk is a good source because it is fortified with vitamin D (most soy and rice milks are now too, but you have to read labels to make sure). Yogurt may or may not be fortified so again check labels. Fatty fish like salmon, mackerel, sardines, shrimp and tuna are excellent sources. Egg yolks and mushrooms have a little. Look for fortified cereals and orange juice to boost your intake.

You can also take a supplement. The American Academy of Pediatrics recommends 200 IU supplements for at-risk children and adolescents. There hasn't been an official updated recommendation for adults yet, but keeping it under 2,000 IUs a day is considered safe.

Go out and get your D!


(photo courtesy of keone)

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Newsbites June 23: Shaq, Kid Marketing, TGIF's smaller

Andrea Giancoli, MPH, RD
Are y'all gonna check out Shaquille O'Neal's childhood obesity themed reality series this week, "Shaq's Big Challenge"? I certainly am. In the six part series Shaq challenges 6 overweight tweens to adopt healthier lifestyles and increase their activity level. I'm very curious to see how his tough love and scare tactics panned out with these kids. Research and most experts don't really support that kind of approach.. but who knows, maybe a big celeb like Shaq can exert a positive influence. The show starts Tuesday April 26 on ABC. Apparently, as an appointee of the Florida Governor's Council on Physical Fitness, Shaq hopes to take his crusade into the States' schools advocating more PE and nutritious lunches.


That I really am curious to see as we all know it is quite a challenge to dramatically change the inner workings of our school system given the pressures on them by such legislation as "No Child Left Behind" and lack of funding for higher quality meals. If he comes up with a solution I am all ears!


More on the marketing front: Food firms are being asked to take the lead of Kellogg's by further restricting advertising to children. The Chairman of the House Subcommittee on Telecommunications and the Internet, Senator Edward Markey, is calling on Coca-Cola, General Mills, Kraft, PepsiCo and McDonald's to step up and play larger role in "solving the childhood obesity problem through socially responsible advertising practices". The Democratic Representative held a hearing this week with the Subcommittee to determine if legislative or regulatory action should be taken to "safeguard kids from junk food ads" said Markey. The Federal Trade Commission and Department of Health and Human Services will also hold a forum, Weighing In: A Check-Up on Marketing, Self-Regulation, and Childhood Obesity July 18th to further examine the food industries practices and if any progress has been made.


What do you think? I think this is the last chance for these food and beverage companies to finally make a real commitment to get on the responsible bandwagon and drastically cut back on clever marketing to our kids. If not, I'm all for policy change.

One last thing... T.G.I. Friday's smaller portions menu is working! Four months ago the restaurant chain introduced “Right Portion, Right Price” and so far it's been a success actually bringing in more customers! This is a good sign that consumers are becoming more committed to change and the food industry's response is getting a response. The responsible bandwagon may turn into profits.. imagine that.

The world is changing...

Have a fruit and veggie filled day!

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Recipe of the Week:Easy Strawberry Dessert

Andrea Giancoli, MPH, RD






Another easy yummy recipe from Dona Richwine, RD, MS. It's perfect for summer nights.





Easy Strawberry Dessert
Ingredients:
1 nine inch angel food cake
3 pints strawberries



Instructions:
1. Cut angel food cake into 12 same size pieces.
2. Wash strawberries in running water and remove stems.
3. Mash strawberries until juicy.
4. Pour over individual pieces of cake.
Serves 12

Nutrition Facts for 1 slice:
Calories 85
Fat 0 gm
Saturated fat 0 gm,
Cholesterol 0 mg
Vitamin C 25 mg

For a bit more pizzazz put a dollop of nonfat vanilla or strawberry yogurt on top. Or squirt on a little lowfat whipped topping.

Have a fruit and veggie filled day :)

(photo courtesy of Jeff Kubina)

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Is alli Your Ally?

Andrea Giancoli, MPH, RD
What's my opinion on alli? I would have to say mixed. alli is the weight loss drug approved to be sold over-the-counter by the Food and Drug Administration (FDA). It went on the market this week and has been selling like hotcakes. But make sure those hotcakes don't come with too much fat!

Briefly, alli is the same as prescription Xenical but in a smaller dose. Both contain the drug Orlistat that blocks some fat digestion in the intestinal tract by inhibiting fat digesting enzymes. (Xenical contains 120 milligrams per dose while alli is 60 milligrams). Sounds great.. but what happens to the fat that's not digested? Something potentially unpleasant. That fat is excreted along with the feces and can result in "leaky" or "loose" stools, flatulence, foul smelling stools and any other number of symptoms related to gastrointestinal distress.

The makers of alli, Glaxo/Smith/Kline (GSK) claim if taken as directed such "changes in bowel habits" are minimized and the dieter appropriately adjusts. According to GSK, when alli is taken with a meal it blocks 25% of the dietary fat consumed in that meal. GSK further instructs alli should only be used as part of a low fat, reduced calorie diet. Only one 60 milligram pill should be taken with each meal and no more than 15 grams of fat should be consumed at that meal. If more than 15 grams of fat are consumed, or more than one alli pill is taken, then the dieter will surely experience the "unpleasant" side effects (and probably not pleasant to be around either). Thus, keep your meals low fat if you're popping alli.

GSK says the side-effects make the drug self-limiting. If not taken as directed, the dieter will surely suffer the disagreeable consequences, which in turn ought to prevent such practice in the future. Apparently, that theory has been played out with dieters who took the prescription dose Xenical. Nobody enjoys gastrointestinal distress!

So what do I think? I think alli can be one tool in a comprehensive weight loss effort. It is by no means the magic pill or answer to one's weight loss fantasies. If you take alli, you still need to follow a low fat, reduced calorie diet. So it can reinforce some good habits. alli won't have dramatic results (something we all hope for but can never find), but rather acts as a "supplement" to weight loss efforts. I repeat it's not a magic pill!

Is there potential for abuse? Of course there is (it has been flying off pharmacy shelves, so I am sure we will hear plenty of stories about its after effects).. but once alli is abused, it is unlikely the dieter would want to go through that experience again.

My advice, if you want to try it, do your due diligence. Learn as much as you can about it, how it works, what you can reasonably expect and then make your own informed decision.

GSK has a website for consumers at myalli.com, but I also suggest you visit the FDA's website for unbiased information at http://www.fda.gov/cder/drug/infopage/orlistat_otc/index.htm. If any of you decide to use it, I am anxious to hear feedback!

Easy on the avocado if you're on alli.

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No More Tony: No, not Tony Soprano, Tony the Tiger!

Andrea Giancoli, MPH, RD
Did ya hear? Did ya hear? Tony the Tiger may not be so Greeeeeaaaaat anymore. The Kellogg Company made history today agreeing to adopt nutrition standards for their foods marketed to kids. But wait there's more! They're also promising to back off pushing their products in the media using kiddie characters like Tony the Tiger, Sponge Bob, Shrek etc. They have pledged not to use such licensed characters in mass media advertising to kids under 12 unless a product meets the new nutrition standards.

Wow! This is big news. Why now you ask? Well, otherwise Kellogg's would face a lawsuit from advocacy groups Center for Science in the Public Interest (CSPI) and the Campaign for Commercial Free Childhood (CCFC) as well as two independent parents who wanted them to stop marketing junk food to young kids. Rather than face litigation Kellogg's did the right thing and settled, promising to make significant changes in the way they make and advertise their products. Good of them.

So here's the rundown - Any food advertised on TV, radio, print, or websites with an audience of 50 percent or more children under age 12 will have to meet the following nutrient standards per serving of that food:

• No more than 200 calories;
• No trans fat and no more than 2 grams of saturated fat;
• No more than 230 milligrams of sodium (except for Eggo frozen waffles);
• No more than 12 grams of sugar (excluding sugar from fruit, dairy, and vegetables).

The sugar still seems a little high, but Kellogg's rebuff's that stating "we view this level as a starting point and are committed to innovate and/or provide alternative choices at lower sugar levels over time". Seems reasonable, if that happens of course. Otherwise, I think these are pretty good standards to follow so far.

They've made additional commitments such as not advertising in schools to kids under 12. That's pretty big too. To get more details check out CSPI's press release click here. And as always let me know your thoughts, pro or anti Kellogg's new nutrition commitments.

Have a Tony the Tiger free day!

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Recipe of the Week: Green Chili Chicken Salad

Andrea Giancoli, MPH, RD

This recipe is adapted from one we used in the community when I worked for the Los Angeles County Nutrition Program. We took traditional recipes submitted by the Latino community we were working with, and revised them somewhat to reduce fat, calories and sodium without compromising flavor (as much as possible). This one was originally submitted by one of our promotoras, Idalia del Prado. A promotora is a community member who is trained to teach healthy habits within that community.

Green Chili Chicken Salad

Ingredients:

1 lb cooked chicken breast, shredded (or chunks)
2 - 7oz cans of green salsa (tomatillo)
1 bag prewashed and cut romaine lettuce, (5-10 oz bag depending on how lettucy you want the salad to be)
2 large tomatoes, chopped
1 cup reduced fat cheddar cheese, grated
1 - 14 ½ oz can black or pinto beans, rinsed
½ cup low fat (light) sour cream
12 tortilla chips

Instructions:
1. Place chicken and green salsa in a pot or sauté pan and cook for about 5 minutes (you can simply mix the chicken with the salsa and skip the cooking part. Simmering it with the salsa helps lock in the flavors but if you're time constrained don't worry about it).
2. If you did warm up the chicken and salsa set aside to cool for a few minutes.
3. In a large salad bowl gently toss the lettuce, tomatoes, cheese and beans.
2. Add the chicken and toss.
3. Garnish each serving with 1 tablespoon sour cream and a couple of chips.
4. Serve immediately

Serves 6


You can find precooked chicken usually in the meat section of your grocery store. If you've got time on your hands and want to save money, buy raw chicken breast. To cook it, bring the chicken to a boil in a large pot. Simmer until cooked through, remove from the pot and allow it to cool for a few minutes (keeping food safety in mind - 2 hours is the limit for meat to be out of the refrigerator so don't forget about it). Once the chicken is cool enough to handle, shred it or chop it up into chunks. Return it to same pot, add the green salsa and cook for about 5 minutes. Remove chicken from heat allowing it to cool while you prepare the rest of the salad).


The salsa in this recipe acts as the dressing helping keep fat and calories down, plus adding to your vegetable intake. Brilliant!

Nutrients per serving:
Calories: 339
Protein: 31 g
Fat: 12 g
Cholesterol: 56 mg
Sodium: 570 mg (that's if you cook the chicken yourself; precooked chicken may or may not have added sodium, check the nutrition facts label and ingredients)
Fiber: 7 g (wow!)
Carbohydrate: 29 g
Iron: 4 mg (nice)
Vitamin A: 325 RE
Calcium: 182 mg

Enjoy and have a fruit and veggie filled day!
(photo courtest of fonticulus)

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New Slightly Revamped Recs to Fight Child and Youth Obesity

Andrea Giancoli, MPH, RD
More official recommendations to treat and prevent childhood obesity that are pretty much similar to all other official governing bodies' recs. That's not a bad thing. It continues to reinforce the messages to parents, pediatricians and communities in general.

The American Medical Association (AMA) convened a group of experts under the banner Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity (The committee is also co-funded by Department of Health and Human Services and the Centers for Disease Control and Prevention). It's a long report and breaks down the recommendations into stages, Stage 1 aimed to prevent weight gain and Stage 4 for aggressive weight management. The gist of the recommendations for kids (and parents to encourage) are as follows:

1. Eat five or more servings of fruits and vegetables per day (personally I don't think this is enough... but perhaps a more realistic goal for kids)
2. Consume no sugar-sweetened beverages (nada!)
3. Eat a daily breakfast
4. Limit meals outside of the home (i.e. more meals at home and fewer restaurant/fast food meals)
5. Family meals should happen at least 5-6 times per week
6. Limit portion sizes
7. Parents - Allow the child to self-regulate his or her meals and avoiding overly restrictive behaviors (i.e. refrain from telling your child to "clean her plate")
8. Limit screen time to two or fewer hours per day
9. NO television in the room where the child sleeps
10. Engage in one hour or more of daily physical activity


Of course the report gets into more detail and more specifics. But again these are all great recommendations and we need to continue to encourage parents and children to try to stick to them so they become the norm. And of course as adults we must be models of behavior. To read more go to http://www.ama-assn.org/ama/pub/category/11759.html.

Have a fruit and veggie filled day!

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School Meals from Scratch?

Andrea Giancoli, MPH, RD
Not a lot of interesting news this week so I thought I'd tell you about a very unique charter school I took a tour of on Friday. I suppose "unique" charter school is somewhat redundant, but this one really is. The school is a middle school called LA Leadership Academy.

What makes the LA Leadership Academy so unique is that the school lunches are all cooked from scratch. That is almost unheard of in this age of pre-prepared school meals. In fact many many schools don't even have kitchens anymore.

This particular school occupies an old old building in Koreatown that was once part of church offices and I believe housing units as well. It has a large kitchen that can accommodate production of a few hundred meals a day.

Something else that is unique about this school is they have instituted what is referred to as "universal lunch". Meaning that everyone eats for free, staff included (although usually "universal lunch" refers to students only). They are able to do this because 91% of the kids in attendance are eligible for a free or reduced priced meal. The school is reimbursed around 2 dollars a meal by the Federal and State (very little from the State but every penny counts) governments for every free or reduced priced meal that is served. The school also kicks in some money from the general fund to make up any differences. The Food Service Director also takes advantages of commodities to supplement the program. Commodities are foods that schools receive from government surpluses that are either free as part of the schools allotment.

I toured the school with several of my colleagues and had the pleasure of sitting down with the kids and eating the school lunch. The school serves only one meal with a vegetarian alternative. They keep it simple. That day the meal was pasta with marinara and baked chicken. I had sautéed tofu for the vegetarian alternative. It was delicious!!! (I'm going to try and figure out to make it). As each student goes through the lunch line they are given a bowl of cut up fruit, then the entree and then they have the option of also helping themselves to a salad bar. It's a complete, healthy and balanced meal. The Food Service Director serves mostly whole grain products and cooks with very little extra fat and no added sugars.

Of course as a small school they are able to make this happen and Food Services does have to get the school to pickup some of the cost. But no one is being paid to collect tickets or scan cards so it sort of comes out even.

Universal lunch is a fantastic idea and something we should push for especially in our lower income schools. Each child gets to eat and it does away with all the complicated paperwork. Universal lunch has the potential to improve the health of our kids by providing all of them with a healthy balanced meal.

If any of you are aware of any universal lunch (or breakfast) programs in your areas please do share. I'd like to learn more about how this can be done.

Have a fruit and veggie filled week!

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Recipe of the Week: Stone Salsa

Andrea Giancoli, MPH, RD

I just love summer fruit. I went to Costco yesterday and bought a flat of apricots and pounds of cherries. I am in fruit heaven. The nectarines made me think of making Stone Salsa with my dear friend Dona Richwine when we worked at the "Ask the Dietitian Program at Farmers' Markets doing food demos and giving out samples. People loved it!
Stone fruits are those that have a pit, such as peaches nectarines and apricots. This recipe makes great use of these summer delights and is a great twist on your traditional salsa. It's a hit with kids and fabulous for summer barbeques. From the kitchen of Dona Richwine I give you...

Stone Salsa
Ingredients:
· 3 yellow peaches, ripe but firm
· 2 nectarines, ripe but firm
· 2 white peaches, ripe but firm
· 3-4 large apricots, ripe but firm
· 1/2 red onion
· 1 bunch cilantro
· Juice of 2 limes

Instructions:
1. Wash all fruit. Remove stones/pits and dice
2. Dice onion
3. Finely chop cilantro, leaves only
4. Mix everything together well with lime juice
Serve with tortilla chips, over fish, chicken or a side salad.

The yellow orangish color of these fruits packs this recipe with beta-carotene and valuable phytonutrients. Plus you also get a nice dose of fiber.

Enjoy!

Have a fruit and veggie filled day!
(Photos courtesy of Vic Lic and Saynine)

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The Food Label Can be Your Friend

Andrea Giancoli, MPH, RD
I had a meeting today with a local superintendent for Los Angeles Unified and he shared with me that he and his family have recently started trying to eat more healthfully. But like many people he is often swayed by clever marketing when grocery shopping. He shared a story with me about grocery shopping with his kids. They wanted him to buy a certain cereal and he felt an alternate type would be much healthier. The kids quickly pointed out the Nutrition Facts label of both packages and demonstrated that their choice was actually a healthier one. (Of course I was thrilled to hear kids were reading food labels. Warmed my little heart). What smart kids! They went deeper and turned the package over to see the back.

I always tell people to ignore the front panel of packaged food and go straight to the Nutrition Facts label and the ingredients list on the back. These are the two places where you will really get useful information that can help you make better choices. Do not be taken in by those beautiful pictures or flashy descriptive terms on the front. Those are put there just to sell you the product. Be a smart and alert consumer!

Here are just a couple of tips when food sleuthing:
When reading the Nutrition Facts panel, pay careful attention to how large a serving size is of the food and how many servings per package. Often when we think we are buying a single serving package of food, the Nutrition Facts label tells us otherwise. Serving sizes are usually much smaller than what we think is reasonable. If there is more than one serving per package make sure you calculate how many total calories are in that food if you were to eat the whole thing.

If the food is something like cereal, the serving sizes can be wide and varied. Some cereals list as much as 2 cups per serving (some of the "puffy" type cereals) while others are only a 1/2 cup (like granola which is very calorie dense) per serving. So you've got to be careful.

Something to look out for in the ingredients list when buying breads, rices and pastas is "whole" grains. Avoid as much as possible any products that list "enriched" flour or rice as the first ingredient. Enriched flours have been stripped of many of their nutrients via processing and by law must add back in iron, thiamin, riboflavin, niacin and folic acid. But that's it.. fiber, zinc and a whole slew of other nutrients are not added back in.

Ok that's it for now. Ciao for now. Have a fruit and veggie filled day!

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Newsbites: June 3rd

Andrea Giancoli, MPH, RD
First the good:

Kudos to Green Giant and Nickelodeon for joining forces to encourage kids to eat more fruits and vegetables. Soon Sponge Bob Square Pants, Dora the Explorer Diego from "Go Diego Go" will grace the labels of Green Giant green beans, corn, broccoli and fresh grapes. And in their brilliance, packages will also come complete with stickers for the kiddies to stick all over themselves. Progress in advertising is being made.

Now the not so great:

Turns out summer time may be detrimental to your teen's waistline. In a new study just released in the June issue of the Archives of Pediatrics & Adolescent Medicine, fitness gains by overweight teens participating in school-based lifestyle oriented PE programs were undone after the 3 month summer break. Our kids' home and surrounding environments seem to encourage sedentary behavior with ample opportunity to consume calories. School really can be part of the answer, is year round school part of the answer too?

More evidence that sugary beverages are linked to weight gain, and this time in preschoolers. Researchers in Canada studied the diets of over 2000 preschoolers and report in the Journal of the American Dietetic Association that drinking sugar sweetened beverages between meals puts some children at risk for being overweight. My questions is: What are preschoolers doing drinking any sugar sweetened beverages at all? Between meals or otherwise? This sets a bad precedent, especially during such formative years. I don't need to read research to know this is not a good thing!

Have a fruit and veggie filled week that's sugary beverage free!

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