1. Challenges in Navigating
Today’s Abundant Food Supply
Bonnie Y. Modugno, MS, RD
www.muchmorethanfood.com
1

2.  “There is no one recommendation
for a healthful diet”
2010 Dietary Guidelines
Advisory Committee Report,
2

3. What are families eating?
America
Menzel and DiAluisio. Hungry Planet: What the World Eats. © 2005
3

4. Guatemala
Menzel and DiAluisio. Hungry Planet: What the World Eats. C 2005.
4

5. 5

6. 6

7. Percent of foods with 1-3 stars
100
90
80
70
60
50
40
30
20
10
0
total produce cereals seafood meat dairy soups deli
items
27,000 foods surveyed
Hannaford Markets, 2006
http://www.hannaford.com/Contents/Healthy_Living/Guiding_Stars/gs_faq.shtml 7

8. 70
60
Establishments per 1000 residents
50
40
LA County
30 West LA
20 South LA
10
0
Convenience Small food Medium Sized Large
Store Store Market Supermarket
Sturm and Cohen. Zoning for Health, Health Affairs 28(6) 1088-1097. c 2009 8

9.  2010 Adam > 30 BMI
Drewnowsky (UW) study 45
40
35
30
 Funded by NIH grant 25
20
15
 2001 Seattle shoppers 10 > 30 BMI
in low cost vs. high priced 5
0
grocery stores
http://www.msnbc.msn.com/id/37280972/ns/health-diet_and_nutrition/t/pricey-
grocery-stores-attract-skinniest-shoppers/#.T4ioY9m8S5J 9

10. Cost of food 1985-2000
Soft Drinks
Fats/Oils
Eggs
Sugar/Sweets
Poultry
% Increase Red Meat
Dairy
Cereal/Bakery
Fish
Fr and Veg
Fr. Fruit and Veg
0 50 100 150
USDA Data 2002 10

11. 90
Soda
80
70 Bread
 Cost in cents
60 Potato
 September/2011 food costs chips
50
Cookies
40
 This is how the USDA farm Licorice
30
bill subsidizes our food supply
Orange
20
10 Apple
0 Carrots
100 Calories
11

12.  It’s not a matter of availability. All of the stores in his
study stocked a wide range of nutritious
food, including plenty of fruits and vegetables.
 Healthy, low-calorie foods cost more money and
take more effort to prepare than processed, high-
calorie foods.
 “We can’t assume that access is sufficient.”
http://www.msnbc.msn.com/id/37280972/ns/health-diet_and_nutrition/t/pricey-grocery-
stores-attract-skinniest-shoppers/#.T4ioY9m8S5J
12

13. 13

14. 30% of all calories consumed as snacks
Map for convenience stores in LA
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15. 15

16. Crispy Calimari w/ vegetables
Pork Milanese
Personal Meat Lover's Pizza
Chicken Strips w/ fries and gravy 2/10
“fast food”
Large Tuna Melt
Sunrise Quesadilla… Fat Kcal
Calories
Smokin' Q 3 Pack Burger w/…
Granny's Country Omelet
Jalapeno Smokehouse Bacon…
Ribs and More Ribs
0 500 1000 1500 2000 2500
http://www.nowpublic.com/health/forbes-top-10-most-fattening-chain-restaurant-meals-calorie-
menu 16

17. Calories Added Sugar (tsp)
16
14
12
10
Home
8
Restaurant
6 Added
Fast Food 4 Sugar
School 2
Other 0
USDA: Table 1—Daily intake of food at home and away from home NHANES 2003-4
17

18. Calories Added Fats (gm)
45
40
35
30
Home 25
Restaurant 20
15 Added
Fast Food
10 Fats
School 5
Other 0
USDA: Table 1—Daily intake of food at home and away from home NHANES 2003-4
18

19. 19

20.  Movie Theaters
5 oz. boxes of candy
500-750 Calories
32 oz. beverages
406 Calories
8 cups of buttered popcorn
440 Calories
20

21. Theme Parks
4 oz. cookies
 493 Calories
8.5 oz. cinnamon roll
 872 Calories
8 oz pecan roll
 716 Calories
21

22. 80
70
60 T. Candy -Cons
50 T. Candy- NC
40 Choc-Cons.
30 Choc-NC
20 Sugar-Cons
10 Sugar-NC
0
Weight (kg) BMI Waist Circ. (cm)
http://www.eurekalert.org/pub_releases/2011-06/fl-nss062811.php
22
http://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675

23. 2400
2300
T. Candy -Cons
2200
T. Candy- NC
2100 Choc-Cons.
2000 Choc-NC
Sugar-Cons
1900 Sugar-NC
1800
Calories
http://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675
23

24.  Food marketing  Maternal age
practices  Assortative mating
 Physical activity  Sleep debt
 Infections  Endocrine disruptors
 Perinatal epigenetic  Pharmaceutical
factors iatrogenesis
 maternal obesity  Ambient temperature
 over/undernutrition
 hyperinsulinemia
24
Critical Reviews in Food Science and Nutrition 49(10) 868-913 (2009)

25. Proposed model of fetal programming of offspring of women with
abnormal metabolic environment (increased insulin resistance).
Catalano P M Reproduction 2010;140:365-371
25
© 2010 Society for Reproduction and Fertility

26. Changes over
time for study
outcomes
Ebbeling, C. B. et al. Arch Pediatr Adolesc Med 2003;157:773-779.
26
Copyright restrictions may apply.

27. NW
Obese
Lomenick J P et al. JCEM 2009;94:4463-4471
27
©2009 by Endocrine Society

28. NW
Obese
NW Pre-adol.
Obese Pre-adol.
Lomenick J P et al. JCEM 2009;94:4463-4471
28
©2009 by Endocrine Society

29. 29

30. SUMMARY
 We live with an abundant and adulterated food
supply
 There is no one right way to eat
 Body size should not be the litmus test for what one
gets to eat
 Conventional dietary recommendations may actually
increase risk of obesity for vulnerable children
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31. FEEDING CHILDREN, FEEDING OURSELVES
It is not where you eat.
It is what you eat when you get there.
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32. Q&A
Bonnie Y. Modugno, MS, RD
www.muchmorethanfood.com
32

33.  BMI is an important indicator of overweight and obesity in
childhood and adolescence.
 When measurements are taken carefully and compared
with appropriate growth charts and recommended
cutoffs, BMI provides an excellent indicator of overweight and
obesity sufficient for most clinical, screening, and surveillance
purposes.
Himes. Pediatrics Vol. 124 No. Supplement 1 September 1, 2009 pp. S3 -S22
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34.  BMI is a poor surrogate measure of adiposity
 Compared w/ dual energy x-ray
absorptiometry, excessive body fat was found in
 77% of children w/ BMI > 95th %
 20% of children w/ BMI between 85-94th %
 50% of children have “moderate” adiposity
 30% of children have “normal” body fat stores
Freedman, et al. Classification of Body Fatness by Body Mass Index–for-Age
Categories Among Children Arch Pediatr Adolesc Med. 2009;163(9):805-811.
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