Search Results

Working in nutrition advocacy, it is often tempting to focus on all the problems with our food system that have yet to be solved. As with any kind of advocacy work, it seems there is always so much work left to do. But as we wrap up 2018 and begin setting goals for the upcoming year, I wanted to take a moment to reflect on 3 things I’ve learned over the past year of my work as Advocacy Coordinator at Balanced. Progress is not linear Just recently, Balanced celebrated a victory related to the D.C. Council’s approval of the Healthy Students Amendment Act - a huge win for students in D.C. Public Schools. Very soon after, the USDA announced its decision to loosen school nutrition standards to allow higher amounts of sodium, flavored milks, and refined grains on school lunch menus. Those two events occurred in the same week. Sometimes it feels like we’re taking two steps forward and one step back, but we have to remember that progress is progress. The D.C Public Schools victory will affect nearly 50,000 students’ lunch menus every day, and being that no other state has (yet) adopted this type of mandate, we are confident it is only the beginning, and it paves the way for other school districts to follow suit. While the USDA changes are incredibly frustrating and disheartening, it only makes our work more urgent. It is crucial to remember that almost every social justice movement in history has taken decades, if not longer, to realize substantial change. In the scheme of things, this movement of nutrition advocacy is just getting started. Progress is a series of little challenges, resulting in small and big victories. The setbacks that happen along the way are merely part of the process. Advocacy campaigns are uncomfortable, but so worth it. As someone whose natural inclination has always been to stay quiet and avoid causing a disruption, learning to push past the inevitable discomfort of advocacy campaigning has been a major challenge for me over the last year. I’ve had to remind myself that asking food-serving institutions to simply feed our loved ones fewer disease-causing foods is not an outrageous ask. In fact, it's outrageous we even have to ask for that to begin with! While it may never be easy, it will be worth it every time. Decision makers need to hear from YOU. In Balanced’s first few months as an organization, after focusing the majority of our efforts on corporate campaigning, we learned that no one knows your community as well as you do. Real change comes when everyday people -- people with loved ones’ whose health is directly affected by the foods served by institutions -- step up and demand change. That’s why we can’t do this work without advocates like you. If you’re a parent, a student, or a community member, you have everything it takes to bring about massive change in your community. If you’d like to get started working towards healthier menus in your local institutions - with the complete support of the Balanced Advocacy Team - sign up to get started. Sarah is the Advocacy Coordinator at Balanced. Driven by her belief that health depends on a food system that cares about people, she is passionate about helping community advocates lead effective healthy-menu campaigns in schools, hospitals, and other critical institutions. You can reach her here: sarahl@balanced.org

When people ask me, “What made you want to work in nutrition advocacy?” I rarely have a satisfying answer to give them, partly because I don’t know what type of response they’re really fishing for. Some people expect a vague but idealistic vision—the eradication of world hunger, for example. Others want to know what, if anything, inspired me, as if working in nutrition advocacy were some kind of predestined calling. And while sometimes I feel like I simply fell into it, the real answer is rooted in my personal history with food and health. I know all too well the negative consequences of poor diet on health, not just from my extensive study of nutrition science, but also from lived experience. Like many Americans, I was raised eating a highly processed diet consisting primarily of convenience foods, refined grains, and meat, dairy, and eggs. Worse yet, I scarcely ate a fruit or vegetable unless it came from a can. I’ll spare you the details, but I know, quite literally in a visceral way, that this “Standard American Diet” has contributed significantly to various ailments, avoidable suffering, and subsequent medical treatments that I’d rather not have experienced. It was only through education that I began to connect the biochemical and physiological dots, so to speak. This new appreciation for the profound, intimate connections between diet and health led to a personal dietary shift, which, for me, was a slow transition. And while I’ve mostly managed to regain my health, I still worry what irreversible damage has been done at the genetic level that could manifest as something much more serious later in life. That the typical American diet is a “standard” at all is the problem; my story is hardly unique. This industry-controlled definition of what is healthy and appetizing is ultimately a product of the machinations Big Food and Ag employed to protect their interests. Their bottom line is to turn profits—not to nourish people in a responsible, health-promoting manner. Thanks to an emboldening USDA, the superiority of these corporate interests over our health has been codified into policy. As a result, our palates have been groomed en masse to prefer that which is killing and sickening us. Connecting this political dot with the biochemical and physiological dots was critical in realizing that individual change can never be a panacea for a pervasive, structural problem. Given that institutions, like schools and hospitals, are the interface between industry and ordinary people, they hold a tremendous amount of leverage in the fight against endemic diet-related disease—much more so than a handful of individual actors who opt to give up meat on Mondays. When one has suffered ill health, even if just briefly, one comes to truly value how liberating good health can be. Sadly, many people don’t realize just how sick they are until their circumstances become dire, or they have little to no capacity to improve their health due to a lack of knowledge, skills, or resources. Recognizing my privilege in possessing those necessary tools is what turned my hobbyhorse into a career in nutrition advocacy. (It certainly wasn’t because I particularly enjoy getting hung up on during outreach phone calls.) Most people would agree that there is a certain moral obligation to use one’s unique knowledge and skill set for the benefit of others, especially when millions of people’s lives are at stake. There are few things more poignant to me than when a young child unwittingly consumes—and becomes habituated to consuming—a known carcinogen. And it is heart-wrenching to watch loved ones in older age suffer worsening disability that most likely could have been prevented or greatly attenuated with a more balanced diet. And seeing my peers, in the prime of their lives, begin to reckon with early signs and ramifications of diet-related chronic illness gives me great cause for concern. Everyone is touched by this issue, either directly or by proxy. I am furious that conniving food companies have been given a free pass to wreak havoc on the bodies and minds of my family, friends, and neighbors. I’m in this battle because somebody else hasn’t won it for us yet, and if I can utilize my education against those profiting from human suffering, then I will. I remain hopeful that public health can improve dramatically when my knowledge and skills become everyone else’s. Institutions may be complicit now, but it won’t always be so. Industries are formidable, but not invincible, and their supremacy can and must be challenged. Madeline is the Institutional Outreach and Support Manager at Balanced. She holds a B.S. and M.S. in Nutrition from the Univ. of Texas and Tufts, respectively. As a nutrition expert, she advocates for more plant-based dining options in critical institutions with the aim of building healthier food environments and fostering better public health outcomes. You can reach her here: madelineb@balanced.org ___________________ Balanced is a nonprofit organization providing the tools, resources, and supports for everyday people to advocate for healthier menus in their community institutions. Please support Balanced's mission with a donation of any size today.

With the announcement that loosened school nutrition standards are going to allow for increased servings of refined grains, flavored-milk, and higher sodium limits, the USDA has once again shown us that lobby money and politics are more important to them than our children's health. There is not a single (credible) health or nutrition professional who would argue that serving kids more refined grains, sugar (hello chocolate milk), and sodium is a good idea. Unequivocally, public health data from the past thirty years has told us the exact opposite. So, what possible incentive would the Department of Agriculture have to push more junk onto our children's lunch trays? For one, the USDA is both responsible for creating nutritional guidelines and promoting commodities and products like corn, sugar, meat, and dairy - the very products dominating our unhealthy food system. This extreme conflict of interest rarely benefits public health and the nutrition "advice" propagated by the USDA is almost always influenced by food manufacturers. Take one look at a school lunch menu and you'll see that the politicians responsible for setting the nutrition standards aren't shy about taking money from companies that benefit from the so-called "common-sense flexibilities" of loosened nutrition regulations. There is nothing common-sense about feeding children increased amounts of foods linked to disease. Common-sense would be more heavily regulating the food industry and it's dangerous practices and products - not giving them a green light to sell more junk food to children. If, as Sonny Perdue claims (without data, by the way), kids aren't eating the healthier foods on their plates, we have to ask ourselves, "Is adding more unhealthy food to the menu the logical answer to that problem?" It just doesn't make logical sense. It doesn't make common-sense. It doesn't make moral sense. It only makes corporate and political dollars and cents. Here at Balanced, we're committed to holding corporations and political bodies accountable until they make our health a priority. We've started a petition to tell the USDA it's time they put our children's health first. Sign and share it here. While we work on putting together a more formal campaign addressing these dangerous new standards, we encourage you to reach out directly to Sonny Perdue and his team at the USDA. Let them know you don't agree with these new standards and neither does basic nutrition science. You're welcome to use the text below or write your own message. Email the USDA here: https://www.usda.gov/tellsonny Mr. Perdue and the USDA team, I've recently learned of your intention to loosen the nutritional guidelines on school lunches. Allowing for increased amounts of refined grains, sugar, and sodium on school menus is dangerous to the health of our children and public health more broadly. With diet-related disease at an all time high - costing the US government upwards of 200 billion dollars a year - the need for improved nutrition standards is more urgent now than ever before. Instead, your team has decided to move in the exact opposite direction. A move I can only assume is the result of conflicting interests between the heavy promotion and propping-up of commodity goods and the health of our families. It seems in this case, business interests were more important to you than the lives of the Americans your department serves. Signed, _________________________ Balanced is a nonprofit organization that depends on the support of people like you. Please consider a donation of $10 today.

Last night, thanks to the tireless efforts of a coalition of people and organizations including numerous Balanced parent advocates, the D.C. Council voted to approve the Healthy Students Amendment Act, which guarantees vegetarian options on every menu and vegan/plant-based options upon request. No other state in the country mandates school menus adopt this kind of balance. As has been shown over and over again, the greatest determiner of food choice is food environment, and the DC Council's commitment to more balanced menus is progress on the path to more balanced food environments - for all our children. By demonstrating such bold leadership, DC Public Schools is no doubt setting the stage for a healthy-menu revolution in districts and communities across the country. Trust us when we say this is just the beginning! Together, we can (we are!) create a healthier future for every family.

Pop quiz: what food product that can’t be labeled nutritious, healthy, relatively low calorie, relatively low fat, or a rich source of protein is now being served to children in an industry-sponsored study that aims to prove serving more of this product will help children learn better? Did you guess eggs? If so, you’re correct. That’s right, the Egg Nutrition Center has already begun conducting research using middle school children in Missouri. As part of their study to determine if a “protein-rich breakfast” helps students learn better, they’re not only feeding children an excess of eggs, they’re increasing the servings of processed meat, too! Serving eggs and processed meat to children everyday is obviously, demonstrably putting their health at risk. Even one of the people involved in this study compared the new breakfasts to Egg McMuffins, so it's hardly a stretch to say kids shouldn't be eating it. My child is not school-aged yet, but I’ll tell you what, if one of the largest food industry interest groups in the country used her to conduct “studies” at the expense of her health, there would be hell to pay. In fact, whether or not my child goes to a certain school is irrelevant. There should already be more accountability for companies that sacrifice our children's health in order to profit. Clearly industry self-regulation hasn't worked, because this study and its misleading claims will certainly be used to market more egg products to children under the guise of "nutrition education" in schools. The consequences of a practice like using "research" to circumvent marketing regulations cannot be overstated. The industry doesn't need children to buy their products - sure, they need kids to want them - but what they really need are the institutions that serve those children to buy their products. The purchasing power of one child is small, but the purchasing power of one food director serving 500 kids (usually more) is huge. These companies should not, under any circumstance, use children to conduct a study that will inevitably lead - through misrepresentation of the data or outright lying - to the exact outcome the Egg Nutrition Center wanted before they even began the study. More schools serving more egg products. I can already see the headlines, “New study shows children should eat more eggs and processed meats for breakfast at school.” These kinds of studies are happening all over the country to unwitting parents and children who are lied to and manipulated by the food industry. Unfortunately, there is no uplifting end to this story, no heroic David vs. Goliath outcome...yet. But knowing what we’re up against is the first step in making the major changes our families desperately need and deserve. And I'm in this fight for the long haul. Oh, did I forget to mention they incentivized participation by giving children $25 gift cards (page 157)? ______________________ Take action to hold these companies and interest groups accountable by leading or supporting a campaign today: balanced.org/lead Contact the Egg Nutrition Center directly to share your concerns about industry-funded research in schools. As a nonprofit, Balanced depends on the generous donations of our supporters. If you value the work Balanced is doing to make healthier eating easier for all, please consider a small donation today.

Forty-one years ago, a major broadcast marketing publication printed this: “If you’re selling, Charlie’s Mom is buying. But you’ve got to sell Charlie first. His allowance is only fifty cents a week, but his buying power is an American phenomenon. When Charlie sees something he likes, he usually gets it. Just ask General Mills or McDonald’s.” When brought to the attention of the public, many people were rightfully outraged. An FTC investigation followed, and to the shock of no one, the industry rebuffed calls for accountability and regulation. Learnings from the early playbook of Big Tobacco set the food industry up with the tools it needed to flip the conversation from one of industry accountability to that of consumer choice and parental responsibility. One executive went so far as to say, "Children, like everyone else, must learn the marketplace. You learn by making judgments. Even if a child is deceived by an ad at age 4, what harm is done? He will grow out of it. He is in the process of learning to make his own decisions." Right, because four-year olds are notorious for good decision making. As the mother of a four-year old, obviously I think the industry statements are outrageous. Even more outrageous to me though, is the fact that the Washington Post article that reported on these early efforts to curtail marketing to children is from 1979. Forty years later and we’re still having this conversation. The food industry is still using the same tactics to avoid culpability - blaming consumers and parents primarily - while scheming behind the scenes, looking for ways to make our children “customers for life.” The thing is, the food industry knows exactly which marketing tactics are most effective and they’re experts at using them. Customer for life strategies - aka hook them young - all but guarantee revenue well into our children’s adulthood. They also all but guarantee some form of diet-related disease later on, but the food industry by and large does not care. Each of us (and probably every person you know) has likely been influenced by one or more of their customer for life marketing strategies. Ever buy a box of sugary cereal because it reminds you of your childhood? Purchase some food product because of the retro “limited edition packaging” that is eerily reminiscent of that summer you were six? Or swing through the drive-through lane and order a crispy chicken sandwich (the adult equivalent of a chicken nugget happy meal) and have the taste of those french fries take you back a few decades? None of this is by accident. The core of the industry’s playbook is simple: create doubt. And you know who doesn’t have the critical thinking abilities to know what's true and what's not? 4 year olds. Children. It's easier to earn the loyalty of a customer young than it is to create doubt when they're older. Turns out, hooking people young, creating doubt that the product - the beloved product from your childhood - is responsible for negative outcomes, blaming consumers, and outright denying responsibility is wildly effective. It was effective in 1979 and it’s effective now. Take for example this more recent quote from Steve Anderson, the former president of the National Restaurant Association, who said this when asked about fast food's role in diet-related disease, "Whatever happened to old-fashioned discipline? Just because we have electricity doesn't mean you have to electrocute yourself.” (Brownell, 2009) Which is, I suppose, a fair point. Until you realize the food industry is leaving live wires disguised as jump ropes everywhere and is indifferent to our electrocution.

Instead of focusing exclusively on the state of our food system, I’ve been spending some time trying to figure out how we got to this point. To that end, I’ve been reading a ton of books, peer-reviewed research, and long-form essays about the history of our food system, how industry shaped our food environment, and the resulting public health crisis associated with diet-related noncommunicable diseases. As a former educator, I understand how important context and history are in the discussion about change and policy. So, I’ve compiled a list of books/resources, and one of my favorite quotes from each book, that folks interested in food policy and industry accountability may find useful. A quick caveat: none of these resources is perfect in its analysis of and recommendations for an improved food system. That being said, they’re exceptional places to start and they prompt great conversation! And while they’re all available online, I was able to easily find each of the recommended books at my local library. Salt, Sugar, Fat: How the Food Giants Hooked Us by Michael Moss “Inevitably, the manufacturers of processed food argue that they have allowed us to become the people we want to be, fast and busy, no longer slaves to the stove. But in their hands, the salt, sugar, and fat they have used to propel this social transformation are not nutrients as much as weapons—weapons they deploy, certainly, to defeat their competitors but also to keep us coming back for more.” Pandora’s Lunchbox: How Processed Food Took Over the American Meal “The avalanche of prefabbed, precooked, often portable food into every corner of American society represents the most dramatic nutritional shift in human history.” The Dorito Effect: The Surprising New Truth About Food and Flavor by Mark Schatzker “Flavor factories churn out chemical desire. We spray, squirt, and inject hundreds of millions of pounds of those chemicals on food every year, and then we find ourselves surprised and alarmed that people keep eating. We have become so talented at soaking our food in fakeness that the leading cause of preventable death - smoking - bears a troubling resemblance to the second leading cause of preventable death - obesity.” Food Politics by Marion Nestle “This book exposes the ways in which food companies use political processes—entirely conventional and nearly always legal—to obtain government and professional support for the sale of their products. Its twofold purpose is to illuminate the extent to which the food industry determines what people eat and to generate much wider discussion of the food industry’s marketing methods and use of the political system.” Fool Me Twice (PDF) an NDC Advocacy Report This report offers evidence that the same unacceptable practices used by the tobacco industry are being employed by the food and alcohol mega-industries and argues that governments should consider policies to curtail such influence on public health policy. Decades of tobacco control show the alternative is millions of preventable deaths. Next on my reading list… Unsavory Truth: How Food Companies Skew the Science of What We Eat by Marion Nestle The End of Overeating: Taking Control of the Insatiable American Appetite What are you reading? Any suggestions for the team at Balanced? _______________________________________________________________________________ Balanced is able to provide advocacy and education resources to communities across the country because of generous supporters like you. Please help us expand our services by donating before the end of the year.

Accountability is really important to us here at Balanced. So important, in fact, that we made it one of our core values. We value accountability both internally and externally, and appreciate when we're held to a high standard. Fundamentally, it's about demanding the best of ourselves and those around us. So when it came to holding institutions accountable for change, we knew we needed a tool that would measure progress toward their best. In partnership with an expert nutritionist, lifestyle medicine practitioners, and numerous institutional food service professionals, we built the Balanced Menu Scorecard. In the week since we announced the inaugural scores for the largest 25 school districts in the country, we've gotten a whole host of inquiries. To help clarify and provide transparency about the process, we've provided a few quick answers to the questions we get most often. First of all, what is the Balanced Menu Scorecard and what is the purpose? The scorecard lists the healthfulness scores of menus at various institutions. These scores were generated using a survey assessment tool that holistically evaluates the dietary quality of meal offerings on a given menu. We created the scorecard to raise awareness about the epidemic of disease-promoting food environments that are produced and reproduced by the institutions that communities rely on for food. Such institutions include schools, worksites, hospitals, prisons, and so on. Too many of these institutions of authority are shaping local food environments in ways that ultimately promote or facilitate unhealthy eating habits, and these same institutions, in large part, have the power to flip the script. I noticed most of the scores are pretty low, how would an institution score higher? To achieve a high score, the institutions would have to: consistently offer as many plant-based proteins as animal-based proteins emphasize 100% whole grains, legumes, vegetables, and fresh fruits daily; include a diversity of fruits and vegetables from all classes; demonstrate a food environment that is at least 50% fruits and vegetables, with protein and refined grains limited to less than 20% of the foods served deemphasize high-cholesterol, high-saturated fat, high-sodium foods including meat, egg, and junk food products include no processed meats (chicken nuggets, pepperoni, sausage, deli meat like turkey and ham, hot dogs, bacon, etc...) heavily restrict red meats; advertise non-dairy fortified milks; restrict dairy to no-sugar-added and lowest-fat options; be transparent in all options offered and in portion sizes of meat offerings. Whoa, that's a lot of things for folks to do and it seems like you're pushing a vegan agenda. We look to see the diversity of proteins offered, and if the majority of proteins are meat, that does impact the score. The instrument is designed to consider what proportion of the menu's entrees are centered around plant-proteins, and what proportion are animal proteins. Optimally, we're looking to see a balance between meat and non-meat proteins. Traditionally, institutional menus have been dominated by unhealthy meat-centered entrees, with little room for balance. These are the foods that evidence-based nutrition science has shown time and again to negatively impact health when over-consumed. We want to make sure there is balance in the meals served, so that unhealthy foods aren't over-consumed. The scorecard also considers the amount of processed meats on the menus. As a result of the American Academy of Pediatrics  call for the reduction or elimination of processed meats from children's diets, we take into consideration the ratio of processed to unprocessed meats served each week. In addition to analyzing how much of the menu's proteins come from sources that don't contain cholesterol or saturated fats. Why are most of the scores the same? Because most of the menus are the same or astonishingly similar. Heavy hitters include: chicken nuggets, pizza, cheeseburgers, cheesy beef nachos, and maybe a cold peanut butter and jelly. Few menus have an adequately diverse offering of vegetables, and few provide alternatives to dairy. For context, the baseline minimum standard for a healthy dietary pattern is 50% fruits and vegetables. 25% is supposed to be whole grains. Protein (meat or plant) is capped at 20% and dairy should never be more than 10%. We only found a few menus that met those criteria. Why are you calling out schools? Aren't they usually just following the national guidelines? We are calling on schools, not calling them out. We believe schools have the responsibility and opportunity to positively impact entire generations of children. Each one of their annual 360+ meals is an opportunity to cultivate and develop healthy eating habits. Given this great opportunity, and the professionalism of the food service teams at most schools, we trust they're capable of making the changes necessary to improve the healthfulness of their menus. And frankly, the Federal Nutrition Standards are anemic at best. Industry influenced and profit-centric at worst. Evidence-based nutrition science is providing the clear and robust evidence for more balanced menus at a pace that moves quicker than the FNS revisions. Following FNS is not a guarantee that children are being served truly nutritionally sound meals that consider both their short- and long-term health outcomes. Why should we trust the Balanced Menu Scorecard? Consumers and institutions can place full trust in the scorecard because it is based on a rigorous analysis of the nutrition science literature and current federal dietary guidelines, and it thus holds institutions to a high standard of healthfulness. The scorecard essentially reflects whether or not an institutional menu has successfully maximized healthy foods and minimized any unhealthy foods. Additionally, as an independent non-profit, Balanced's analysis and recommendations have not been watered down by industry influence or junk science. Have more questions? Send them our way: AudreyS@balanced.org Like the work we do? Support our mission? Please consider donating to help us keep our advocacy and outreach tools free and available to all. As a 501(c)3 we depend on the generosity of mission-aligned people like you.

Recently, I’ve had the privilege of meeting with the food service directors — and often their contracted food service company — of numerous major school districts. I mean it when I say, "privilege" because I do not envy their jobs and I'm grateful for the commitment most have to our children. Recognizing the enormous responsibility inherent in their jobs is something I do not take lightly, and something they rarely hear. I mean, when's the last time you heard glowing reviews of a traditional school lunch? The work is hard and the accolades are few. Even after the most tense conversations, I’ve left each meeting proud of the work we’re doing, and excited to move the needle toward healthier menus. Most conversations have been relatively pleasant and I’ve learned a lot from the professionals around the table. But, to be honest, I’ve also left each meeting with a lingering frustration. Fundamentally, I believe every person is doing the best they can with the knowledge and skills they have. I also believe — as a former educator — that learning new information and acquiring new skills is almost always a positive thing. Having coached teachers for over 5 years, I know what it’s like to grapple with difficult ideas, be pushed to the limit, and put the good of others ahead of our own defensiveness when confronted with the challenge of change. I believe this is why it’s so frustrating to spend time persuading food service professionals and dedicated school staff that investing in children’s health, even when it's hard and new, is worthwhile. Worth reevaluating current practices. Worth trying new things. Worth throwing out preconceived notions or excuses. Worth learning from each other. Worth keeping an open mind. At Balanced, I believe our ask of school districts and other institutions is pretty reasonable: improve the healthfulness of lunch menus by replacing a portion or two of foods high in cholesterol, saturated fat, and sodium with plants. In short, more fruits, vegetables, and plant-proteins. Fewer chicken nuggets, meatball subs, and corn dogs. For most school districts it would be as simple as swapping one animal-based entree each week with a plant-based alternative. Bean burrito instead of beef. Tofu teriyaki instead of chicken. Vegetable quesadilla, lentil marinara, or a veggie burger once in awhile (you get the idea). Still, despite being armed with science, stories, community support and even a toolkit designed expressly to help the food service team every step of the way, our team is usually met with a list of excuses and more often than not, hostility. The thing is: I get it, I really do. It is not easy or pleasant to have an unknown someone — or organization — asking you to do your job differently and change something that’s ostensibly working just fine. I understand how that could make some adults feel angry, hostile, or defensive. And I could say “but that’s my job” to justify why I continue to advocate so doggedly despite the resistance, but that wouldn’t be true. Although it *is* my job, more than that, it’s the right thing to do. My loyalty is — and will always be — to the children impacted by unhealthy food. To be clear, my loyalty to our children is not a blind attack on adults. It does mean, however, that I’m prepared to hold the institutions that serve our families accountable until meaningful change occurs, even if/when it’s uncomfortable. As much as I want to acquiesce and have a more uneventful professional life, I can’t. The future health and wellbeing of our children is more important to me than the temporary discomfort of a difficult conversation. My goal has never been to antagonize adults or call into question the abilities of food service professionals. It is because of my deep belief in their professionalism and potential that I hold them to such high standards. And it is because the stakes are so high I refuse to demand less. The way I see it, we are in partnership with one another, not opposition. The amazing thing about partnerships though, is that their primary role in our lives should be to make us better. True partnerships require us to be our best selves, and when we’re not, they help us improve. So as I enter even more conversations with major decision makers over the next few weeks, I enter them with an open mind, high expectations, and a sense of hopefulness. Yes, change is hard, uncomfortable and annoying even — but the very real health of children depends on us not backing down. And what we can achieve by embracing the challenge together is worth it.

Each time we ask for suggestions about ways we could improve our work, who we need to know, or where we need to go, our supporters step up and let us know what they want and where they need us to be. In large part because of our supporters, Balanced traveled to Rochester, NY this past week. Hundreds of physicians, educators and students have reached out to us from this city asking us to help them improve their school and hospital menus, and we just had to see the great work they're doing firsthand! In an effort to better understand how to support and empower the people asking for change in Rochester, I boarded a plane headed east! The first among many stops with was to meet a physician currently working at a hospital in the city. Her goal: healthier menus for patients and guests. Something we can definitely get behind! Like many doctors, she is passionate about ensuring that  hospital systems optimize health, to decrease diet-related illnesses and increase life expectancies-- which is one of our greatest challenges to tackle in medicine today. With enormous humility and admiration, I learned how she has gone above and beyond her call of duty, worked directly with the hospital’s food service director and offered everything from sample menus, in-house food tastings and evidence-based support for the changes. When I asked what inspires her and keeps her motivated, she notes, [we] “haven’t set up the systems that allow people to be healthy.” We couldn’t agree more. Additional meetings with other thought leaders in the community increasingly highlighted the miraculous shift happening in Rochester towards creating healthy food systems. Not only are both hospitals systems having open conversations about changing menus, but the school districts are also empowering local teachers to pilot programs for personnel. Next up: the food on the trays in the cafeteria. Rochester appears to be unique in that there is a huge network of influential people coming together on a regular basis to celebrate the benefits of eating more plants. There is even an entire Lifestyle Medicine Clinic dedicated to educating and leading people through a healthy and safe transition to a plant-based diets. People of all ages and in all stages of discovering healthy eating are stepping up in Rochester to ask for change. This is exactly where Balanced can help! In the coming months, we will continue to work with these community leaders and institutions to ask for healthy menu changes. This means removing known disease-causing foods and replacing them with health-promoting fruits, vegetables, whole grains and legumes. We can’t wait to see Rochester optimize their menus in schools and hospitals so that their children and families alike can also optimize their health. Want Balanced to hear about your city? Drop me a line: Lornac@balanced.org

Here at Balanced we talk to a lot of doctors who are working to treat disease before major disaster strikes. This week, we have the enormous privilege of learning from Jennifer Nemeth, a cardiac rehabilitation nurse who helps patients recover and thrive after one of those major disasters - a cardiac event. We can't imagine a person better positioned to share their thoughts on what we need to do differently in order to prevent and treat the number one leading cause of death in the United States - heart disease. And if you're thinking Jennifer looks familiar, that's because you might recognize her from one of our earliest videos. Tell us about yourself! I'm a cardiac Registered Nurse who desires nothing more than to guide others to better health. I earned a double degree in Dietetics (nutrition) and nursing, a certificate in plant based nutrition from Cornell University, and I'm a certified Food for Life instructor through the Physicians Committee for Responsible Medicine. After spending several years in our disease-care system, I came to realize Americans are becoming sicker and sicker while trying to be “healed” through medications and surgical procedures. These cover ups only address the symptoms and not the root cause of chronic disease. I now work at UCSD in the prestigious Dr. Dean Ornish's Prevent and Reverse Heart Disease Cardiac Rehabilitation Program, enabling patients who've experienced cardiac events to thrive through a plant-based diet, exercise, meditation and group support. Can you tell us a little bit about your journey in healthcare and how the food system has shaped the way you practice medicine today? I’ve always had the desire to help others and I knew I wanted my profession to follow suit. My first job out of nursing school was on a step-down unit taking care of post-op coronary artery bypass graft (CABG) patients. In its basic sense, the surgeon acts as a plumber and takes vessels, usually out of the leg, and makes new connections on the heart, bypassing clogged vessels. I remember being appalled at what they served these patients directly after surgery. It usually consisted of mashed potatoes, gravy and an artery-clogging hunk of meat. Weren’t we just trying to undo this process? Even though I wasn’t completely plant-based at that time, It made me wonder why weren't healing foods promoted? What is one thing you would change about the food ecosystem in your community that would make a profound impact on your patients' quality of life? One huge start would be to stop serving foods in the hospital cafeteria and to the patients that are scientifically proven to promote diabetes, heart disease and cancer. It breaks my heart to see items such as meat lovers pizza and bacon, which have ingredients that the renown World Health Organization (WHO) states are Group I carcinogenic to humans, in the same class as cigarette smoking and asbestos. We need to have integrity and set the standard by being health care, not sick care. We can do that by serving healing foods. When did you first realize your patients struggle unnecessarily hard to lead healthy lives? Human behavior change is not easy. We are so culturally conditioned to believe that eating animal products is normal, necessary and natural. Two wonderful books I read about this is “Why We Love Dogs, Eat Pigs, and Wear Cows: An introduction to Carnism” by Melanie Joy, PhD and “The Pleasure Trap: Mastering the Hidden Force that Undermines Health & Happiness” by Douglas J. Lisle and Alan Goldhamer. I think the most difficult part about diet change for my patients is they initially think they’ll never enjoy food again and they can not enjoy social events. Both are far from the truth and once they are educated more about it, those fears often vanish and they realize they can live an even more fulfilling life.  What has you most concerned about your local food system? My top concerns are currently related to the growth of our food, primarily: water and bees. Animal agriculture takes so many precious resources, especially water. I learned a lot about this in the Netflix documentary “Cowspiracy.” I didn’t realize a typical cow drinks 30-40 gallons/water per day. Instead of using that water to hydrate cattle, it would be great to use that to hydrate food for people to eat. According to these calculations, It takes about 4,200 gallons of water per day for a meat-eater’s diet vs about 300 gallons per day for a plant-based eaters diet.  Due to more and more pesticide use, the bee population is starting to diminish, causing a major crisis. According to Dennis vanEngelsdorp of Penn State University's College of Agricultural Sciences, "One in every three bites of food you eat comes from a plant, or depends on a plant, that was pollinated by an insect, most likely a bee”. If we don’t have pollinated plants, we don’t have food to consume. How do you choose to impact your local food system? (either in your work through Balanced or other projects you are working on locally) I am going to try and work on getting a farmers market started on our hospital campus so our patients and staff can enjoy fresh, local produce. I am a full supporter of the work Balanced does and hope to promote it through my health system. I’d love to see more and more plant-based options offered at the cafeteria. On a small scale, my husband and I just started a small garden and are even more appreciative of the hard work our farmers do!  If you could design the ideal meal for your patients, what would it be? I like to educate my patients that they don’t have to create these complex, time-consuming recipes. Think about the plethora of whole foods out there and combine them into a meal. My mantra is create a bowl with “a bean, a green and a grain” and throw a sauce on top. For example, black beans, kale and brown rice with salsa on top. Or chickpeas, broccoli and quinoa with BBQ sauce. Use fruit as a snack. It doesn’t need to be complicated. How can our supporters get in touch with you if they would like to know more about your practice? Please feel free to reach out to me at jenn@reinventingnutrition.com, follow me on instagram at @reinventingnutriton or Google “UCSD cardiac rehab” for more information on the Ornish Lifestyle Medicine™  Program for Intensive Cardiac Rehabilitation. Some great San Diego community resources for classes and events are www.veg-appeal.com and www.plantdiego.com

Two of Balanced's advisory board members, Dr. Robert Ostfeld and Dr. Andrew Freeman, recently authored a paper published in the American Journal of Medicine. Titled, "The Deficit of Nutrition Education of Physicians" the paper's abstract reads: In this paper, we will examine the trends occurring globally in the realm of nutrition and cardiovascular disease prevention and also present new data that international nutrition knowledge amongst cardiovascular disease providers is limited. In turn, this lack of knowledge has resulted in less patient education and counseling, which is having profound effects on cardiovascular disease prevention efforts worldwide. We encourage everyone to check it out here: https://www.amjmed.com/article/S0002-9343(17)31229-9/fulltext