Before starting a new medication, patients and their providers must weigh their options: how do the benefits of treatment compare to the drug’s potential side effects? For chronic medications, patients will receive treatment for the foreseeable future, so the potential risk of medication-induced weight gain can play an important factor in treatment decision making. When evaluating the side effects of chronic medications, how well can we tease apart a real risk from a perceived risk?
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As COVID-19 continues to wreak havoc on our health and economy, it should come as no surprise that food security is another casualty of this pandemic for many U.S. residents. More than 20% of U.S. households reported being food insecure in April 2020, which is defined as not having sufficient access to food due to a lack of resources. By comparison, in 2018 11% of U.S. households were food insecure at some point, suggesting that the COVID-19 pandemic has had a massive impact on the ability of U.S. residents to feed themselves and their families. The numbers are even more dire for households with children aged 12 and under, 40% of which report some level of food insecurity in the wake of COVID-19. This is especially troubling because food insecurity has lasting long-term health implications for children, including higher prevalence of obesity and emotional, behavioral, and academic problems.
Fitness and health influencers around the globe have promoted coconut oil as a superfood, and a quick internet search reveals numerous lists of alleged benefits, ranging from seizure prevention to weight loss. One of the claims that seems to top almost every list of purported benefits is that coconut oil has a positive effect on heart health. But is an oil higher in saturated fat than butter really heart healthy? Should we all be replacing olive oil, butter, or other vegetable oils with coconut oil for to help our hearts?
If you visit a New York City or Philadelphia restaurant (when you’re able to go out to eat again), you may be surprised to see a label on the menu that you’re unfamiliar with. Both of these cities require chain restaurants with 15 or more locations nationwide to post sodium warning labels next to menu items and combination meals containing more sodium than the recommended daily limit of 2,300 mg. A single menu item with over a day’s worth of sodium may sound like a rarity, but at Applebee’s, for instance, every single sandwich and pasta dish has more than 2,300 mg of sodium. Sodium warning labels are a relatively new policy tool that cities can use to help educate consumers about the sodium content of their foods, and prompt restaurants to reduce sodium content to avoid labels.
Children across the nation have transitioned to virtual learning for the foreseeable future—dramatically altering their educational experience— it’s prompted me to reflect on my own days of grade school. As an adult, I miss playing at recess, making papier-mâché in art class, and singing in the choir. One thing I don’t miss: the school lunch. Square pizzas, mushy chicken-fried steak, and highlighter orange mac-and-cheese frequented school lunch menus in the 1990s and early 2000s. Everything was too sweet, too processed, or too bland. With changes under the current administration, now I fear that when children return to school, they may also be returning to these less healthy meals.  In 2010, the Healthy, Hunger-Free Kids Act (HHFKA), championed by First Lady Michelle Obama, passed with bipartisan support. This bill overhauled the School Breakfast Program (SBP) and National School Lunch Program (NSLP). The HHFKA increased funding for school-provided meals; expanded the eligibility for free and reduced school meals; and created more stringent requirements for nutrition in schools, including increasing the amount of fruits and vegetables in meals, shifting to whole-grains, setting sodium restrictions, and switching to fat-free or low-fat milks. Since 2017, the Trump administration has been rolling back regulations on the SBP and NSLP, citing convoluted regulations that make it difficult for schools to comply, decreased participation from students, and increased food waste. This year, the US Department of Agriculture (USDA) has proposed relaxing nutrition requirements and delaying compliance dates for schools, all of which it says will “simplify operational requirements, increase efficiency, and make it easier for State and local Program operators to feed children.”1 The claims by the Trump administration are wholly inaccurate. In a 2019 review of the SBP and NSLP, the USDA found that over 80% of school meals complied with dietary requirements.2 They also found a positive correlation between nutritional quality and student participation: schools offering healthier foods saw a higher proportion of students choose school-provided meals.2 While a few small studies of individual schools have shown increased food waste with these program changes, a similar number of studies have found either no change or reduced food waste. 3 Furthermore, the USDA historically has not tracked this data, making comparisons of food waste before and after the HHFKA difficult.2 The most important finding of the program review was that the changes in dietary requirements improved the nutritional quality of school-provided meals. Meals in the SBP and NSLP had over 20% improvement in nutritional quality after implementation of the HHFKA, and 15% better nutrition over the meals of students who did not participate in these programs.2 Several studies report students’ decreased consumption of empty calories and increased choice of fruits and non-starchy vegetables after the implementation of the HHFKA.3 All of these changes have positively impacted the overall diet of students nationwide. Some lawmakers, public health officials, and advocates have speculated that relaxing these regulations has more to do with cost than nutrition. It is true the SBP and NSLP have increased costs by about 25 cents per meal for breakfast and 78 cents per meal for lunch .2 Despite these increases, state and local funds only contribute 3% of the total cost of the SBP and NSLP, with the remainder funded by USDA reimbursements and school meal revenues.2 Childhood nutrition is a key determinant of health over the lifespan. Childhood obesity increases the risks of cardiovascular disease, metabolic syndrome, Type 2 diabetes, and cancer in adulthood.4 Children with worse nutritional intake also demonstrate lower academic achievement.5 Given these wide-reaching effects, addressing childhood nutrition may be the closest thing we have to a silver bullet to improve the overall health and well-being of entire populations. The SBP and NSLP feed nearly 30 million children each day.6 Many children in the US get the majority of their meals from school, and this is particularly true of students from low-income backgrounds. Twenty-one percent of US households with children are food insecure, and the SBP and NSLP are crucial safety nets for these households.7 The changes to the SBP and NSLP made under the Obama administration took a step in the right direction to addressing childhood obesity, malnutrition, and food security. These improvements must not be undone in the name of politics. Although the period for public comments for the proposed rollbacks has ended, President Trump’s changes will not be implemented until the next school year starts in the fall. There is still time to voice opposition to the proposed rules, by joining healthcare and public health workers in signing this petition or writing to elected officials directly. All of us must act to help ensure healthier school meals for students and improve the health and well-being of future generations. Author's Bio:Jade Connor is a MD candidate at Harvard Medical School. She received a BS in Biology at Baylor University, and a master’s degree in European Public Health from Maastricht University in the Netherlands. Her research interests include healthcare disparities and aging, as well as the implementation and evaluation of community health programs targeting these issues. Jade enjoys traveling and makes it a point to collect postcards from each place she visits.
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