Energy Balance at a Crossroads: Translating the Science into ... - Core

FROM THE ACADEMY

Energy Balance at a Crossroads: Translating the Science into Action Melinda M. Manore, PhD, RD, CSSD, FACSM; Katie Brown, EdD, RD; Linda Houtkooper, PhD, RD, FACSM; John M. Jakicic, PhD; John C. Peters, PhD; Marianne Smith Edge, MS, RD, LD, FADA; Alison Steiber, PhD, RD, LD; Scott Going, PhD; Lisa Guillermin Gable, MA; Ann Marie Krautheim, MS, RD

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NE OF THE MAJOR CHALlenges facing the United States is the high number of overweight and obese adults, along with the growing number of overweight and unfit children and youths. To improve the nation’s health, young people must move into adulthood without the burden of obesity and its associated chronic diseases. To address these issues, the American College of Sports Medicine, the Academy of Nutrition and Dietetics (the Academy), and the US Department of Agriculture’s (USDA) Agriculture Research Service convened an Expert Panel meeting in October 2012, entitled “Energy Balance at a Crossroads: Translating the Science into Action.” Experts in the fields of nutrition and exercise science came together in Washington, DC, to identify the biological, lifestyle, and environmental changes that will most successfully help children and families understand the dynamic nature of energy balance and tip the scale toward healthier weights. The desired outcome of this expert panel meeting was to translate the science of energy balance into practical and appropriate recommendations for training current and future professionals in nutrition,

This article is simultaneously published in the July 2014 issues of the Journal of the Academy of Nutrition and Dietetics and Medicine & Science in Sports & Exercise. Copyright ª 2014 by the Academy of Nutrition and Dietetics and the American College of Sports Medicine. This is an open access article under the CC BY-NCND license (http://creativecommons.org/ licenses/by-nc-nd/3.0/). 2212-2672/$0.00 http://dx.doi.org/10.1016/j.jand.2014.03.012

exercise/physical activity (PA), health education, and prekindergarten through grade 12 teacher education. This included discussing the associated components necessary to achieve and maintain a healthy body weight. The specific goals are as follows: 1.

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Professional Training: Develop a comprehensive strategy to facilitate the integration of nutrition and PA education— emphasizing the dynamic nature of energy balance in the regulation of weight—into the training of undergraduate and graduate students in dietetics/ nutrition science, exercise science/PA, and prekindergarten through grade 12 teacher preparation programs, as well as into the training of existing Cooperative Extension faculty. Consumer and Community Education: Develop best practices for integrating education on the dynamic nature of energy balance into new and currently-funded state and federal nutrition and PA programs for preventing and/or reducing obesity.

The Expert Panel meeting was divided into three sections. The first section addressed the biological and lifestyle factors that impact energy balance, the second section addressed undergraduate and graduate educational and training issues, and the final section addressed best practices associated with educating the public, including consumers and communities, about the dynamic nature of energy balance. Key points addressed by each speaker are summarized here and followed by the group consensus recommendations for each goal.

EXAMINING BIOLOGICAL AND LIFESTYLE FACTORS INFLUENCING THE DYNAMIC NATURE OF ENERGY BALANCE The concept of energy balance for regulating body weight is simple in principle. When energy expenditure exceeds energy intake, weight is lost. When energy intake exceeds energy expenditure, weight is gained. Because of the high prevalence of obesity in the United States, interventions for prevention and treatment of obesity have typically focused on reducing energy intake, increasing energy expenditure, or a combination of these strategies. Although these interventions have shown success, weight change might be less than expected, and not all individuals respond to these interventions in a similar manner.1,2 A potential factor contributing to individual variability in weight regulation, with different patterns of diet and PA, can be the type of intervention used. Dietary interventions to reduce energy intake or efforts to increase energy expenditure through PA are often treated as separate and independent approaches. For example, suggesting that a 500 kcal/day deficit from energy intake will consistently yield 1-lb weight loss per week (eg, 3,500 kcal¼1 lb) for everyone.1-3 This static approach to energy balance does not take into account the impact that changing energy intake has on total energy expenditure.4 By definition, energy balance is a dynamic, not static, process in which altering one component of the energy-balance paradigm can affect the physiological and biological components of the other in an unpredictable or unintended way4-6 (see Figure 1). We know that body weight is regulated by a number of factors, including genetic, metabolic, environmental, social, and behavioral components, which

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FROM THE ACADEMY

Figure 1. Key factors that regulate and influence energy balance, which can ultimately influence weight, body composition, and overall health.

can influence both sides of the energy balance equation differently, depending on the individual and the circumstances.4,2,7 This concept is important as we ascertain the contribution of dietary factors, including macronutrient composition, and PA factors, including varying modes, intensities, and quantities, on energy balance. With this new information we can refine recommendations to improve the regulation of body weight and composition. We now have strong scientific evidence supporting the benefits of consuming a healthy diet and being physically active for improved health and longevity, achieving or maintaining a healthy body weight, and reducing risks of chronic disease.8-11 Although the amount of daily PA required to significantly improve the health of most sedentary Americans is within reach,11 there has been little success in motivating the vast majority of people to add even this modest level of PA into their lifestyle.12 The biggest question for the new millennium might not be “what” or “how much,” 1114

but simply “how” to make sustainable lifestyle changes that foster healthy body weight. The “small changes” approach has had some success.13 This approach emphasizes small consistent changes in lifestyle to eliminate the energy gap that leads to weight gain. However, even this method requires individuals to find a compelling reason to sustain this behavior change in the face of competing life priorities.14 One promising approach might be to shift the focus away from the emphasis on health (eg, appropriate diet and PA) to discussing other benefits, such as improved learning, cognition, and productivity in the workplace. Rather than aiming at self-actualization as the motivator, more basic motivators of human behaviors could be used to help individuals thrive in the modern world, such as education and employment, which provide the means for acquiring the basic elements for survival. If the reason for building recommended guidelines for diet and PA into schools was to improve classroom learning and


test scores, the discussion might change. The outcome would be bettereducated children who are able to more successfully compete in the marketplace. Likewise, the workplace could be transformed if healthy living, derived using science and evidencebased PA and healthy eating practices, were an expectation of employers because it improves productivity. More research is needed on the effectiveness of using an “alignment of purpose and incentives” approach in different settings throughout society. Finally, consumers also need to embrace and understand the role of diet and PA in managing body weight. The high prevalence of overweight and obesity in the United States has increased the importance of balancing energy (calories) consumed and energy expended to achieve and maintain a healthy weight and body composition. Numerous policy and educational efforts aim to help consumers achieve energy balance. Still, the International Food Information Council Foundation’s 2012 Food & Health Survey consistently July 2014 Volume 114 Number 7

FROM THE ACADEMY finds that consumers remain largely unaware of their estimated daily energy needs and how these energy needs can be altered—and weight management improved—by changing daily PA.15,16 In the 2010 Dietary Guidelines Alliance Consumer Research (research specifically on parents), the outcomes revealed a lack of basic understanding of the term calories and the impact that calories (eg, energy intake) have on weight. There was also a belief among some parents that calories might be the latest food and nutrition fad.17 The need to individualize communications about the numerous factors that impact energy balance is essential, as each person has a unique weight-management profile that is affected by many factors, including genetics, age, PA, health issues, and desired weight outcome. Although some Americans would like to maintain weight and prevent additional weight gain, others would benefit from achieving successful weight loss. However, in order to effectively communicate energy or caloric balance, it will be imperative to examine consumer response to energy balance communications. Some messages or terminology, although widely accepted by health professionals, are not understood by consumers. A key first step in addressing consumers’ calorie confusion might be to familiarize them with their daily calorie needs. Consumers need to understand the amount of energy needed to maintain weight and how that daily calorie need is affected by type and amount of PA as well as food and beverage choices.

ENERGY-BALANCE EDUCATION: PREPARING THE NEXT GENERATION OF EDUCATORS IN NUTRITION AND DIETETICS AND EXERCISE SCIENCE Dietetics education is a process of accruing knowledge and skills that are subsequently implemented within the field. As registered dietitian nutritionists (RDNs) grow professionally, they layer new knowledge, skills, and experience onto existing foundations. The layering effect allows dietetics students to move from the novice level in undergraduate programs to competency in the coordinated or internship programs, and ultimately to become proficient dietetics practitioners. Education July 2014 Volume 114 Number 7

standards, established by the Accreditation Council on Education for Nutrition and Dietetics, are in place to ensure that the proficient practitioner is ready for an entry-level position in the workforce. In February 2012, new education standards were released for Didactic Programs in Nutrition and Dietetics, Internships for Nutrition and Dietetics, and Coordinated Nutrition and Dietetics Programs. Current standards do not address knowledge or skills in the areas of exercise science or PA (2012 Standards for Dietitian Education Programs, available at: http://www.eatright.org/ACEND/). In general, dietetics students are trained to work with individuals in applying the Nutrition Care Process and prescribing diet recommendations for prevention and treatment of acute and chronic disease. To lead effective interventions that help Americans achieve and maintain healthy body weights, RDNs must understand the dynamic nature of energy balance. The lack of education requirements related to the role of PA in energy balance and chronic disease prevention might limit nutrition and dietetics practitioners to only one side of the equation when working with today’s overweight and obese pediatric and adult populations. Within the exercise science area, formal education on the energy expenditure side of the equation has focused on exercise prescription. Exercise science students are typically trained to work with people to prescribe exercise for fitness and/or sports performance, and others are trained in bench and laboratory sciences. Although this training has its place, much of the research and public health recommendations have shifted from exercise for fitness to PA and exercise for health and prevention of chronic disease.11,18 Exercise science educators need additional training in nutrition and in the field of PA and health at the population level. How do we prepare exercise science students to help reduce the obesity epidemic and its associated chronic diseases? This goal cannot be accomplished by having exercise science students simply take one nutrition course, or vice versa. Students need to be trained using a multidisciplinary model that includes a curriculum in exercise/PA and an understanding of nutrition and behavior sciences. This approach would enable students to better understand the

factors that can prevent or reduce overweight and obesity. These educational approaches will help the RDN and the exercise science professional work together. They will better understand the scope of practice and language used within each profession and the role each can play in helping clients. Finally, it will help them work together within schools and communities to achieve healthier lifestyles.

TRANSLATING THE DYNAMIC NATURE OF ENERGY BALANCE INTO PUBLIC AND CONSUMER EDUCATIONAL PROGRAMS FOR HEALTHY LIFESTYLES AND OBESITY PREVENTION Cooperative Extension System Positioned for a Role in Training The Cooperative Extension System is a nationwide, noncredit educational network in the United States. Federal, state, and local governments provide core funding for the Cooperative Extension System. Every state and territory has a Cooperative Extension state office located at its Land-Grant University as well as a network of regional or local offices. The Cooperative Extension System is an active partner with other organizations addressing state and local community interests. The Cooperative Extension System faculty, staff, and volunteers provide practical, researchbased education on food, nutrition, and health to children, youth, and adults. Cooperative Extension is uniquely positioned to lead training for community educators. Such education could include the dynamic nature of energy balance and translation of this science into practical approaches to prevent and decrease obesity and its associated diseases. The USDA National Institute for Food and Agriculture (NIFA) is the federal partner in the Cooperative Extension System. USDA-NIFA contributes funding to the Cooperative Extension System and helps it to identify and address current issues. Obesity prevention is a priority issue for NIFA. Traditionally, food and nutrition have been the primary foci of Cooperative Extension System programs addressing obesity prevention. NIFA and its LandGrant University partners have infrastructure and networks that are uniquely situated to use their three-part mission of research, education, and the


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FROM THE ACADEMY Cooperative Extension System to integrate food, nutrition, and PA education into effective programs to help solve the multifaceted obesity problem.19,20 USDA is in a unique position to spearhead program leadership and partner with other government agencies to facilitate dissemination of accurate energybalance messages in public education programs, including the Supplemental Nutrition Assistance ProgrameEducation (SNAP-Ed) and the Expanded Food and Nutrition Education Program (EFNEP; www.nifa.usda.gov).

Integrating Dynamic Energy Balance into Public School Programs Most (>90%) US children and youth spend about 7 hours/day in school much of the year. In 2011, schools served 35 million school lunches to students each school day.21 Schools also offer opportunities for students to be active through physical education, recess, and in-class activity breaks for PA. Unfortunately, schools have repeatedly sacrificed PA to increase academic time, despite evidence of the benefits of PA in learning readiness and academic performance.18 Because of the vast reach and potential for sustained intervention, schools are central venues for translation of energybalance science into action.18,22 This potential was recognized when the Institute of Medicine identified schools as a national focal point for obesity prevention.22 School-based controlled studies offer insights into best practices, but have had limited success in reducing obesity, in part, because the intervention programs have not been sustained.23 Adoption and maintenance of lifelong healthy behaviors require ongoing opportunities in a supportive environment. Schools should provide a consistent environment that is conducive to healthful eating and regular PA, inside and outside of the classroom. Coordinated changes in curricula, school environment, school food and health services, and after-school programs are needed to reinforce the numerous factors that impact energy balance and advance obesity prevention.24 In this era of dwindling resources and high-stakes testing, stakeholders must be convinced of the benefits and partnerships must be formed to sustain programs. Programs must move forward 1116

based on best available evidence rather than waiting for best possible evidence. As an example, the University of Arizona is currently conducting a successful schoolecommunity partnership. Their College of Agriculture and Life Sciences, Nutritional Sciences Department, and Cooperative Extension have partnered with the Pima County Health Department, YMCA, Food Bank, and local schools to deliver reinforcing “model” programs supporting PA, access to healthy food, and increased nutrition and PA knowledge.25 Feasible contributions by each partner add up to consistent opportunities for translating the science of dynamic energy balance into action in communities.

DISCUSSION Educational efforts to prevent obesity and manage weight have focused primarily on reducing energy intake and, more recently, on combining reduced energy intake with increasing energy expenditure. The impact of PA alone on weight change is more limited.8 Despite these approaches, overweight and obesity are still major public health issues. Frequently, weight-loss approaches advocate changes in diet without discussing appropriate PA or how the integration of these two factors will impact weight change.8,11,26 Emphasizing only one side of the energy-balance equation ignores the dynamic nature of energy balance, which requires the integration of PA and nutrition. Through understanding that PA and nutrition have complementary and integrated roles in weight management, educators can help people understand how each side of the equation influences the other. A review of curricula for future health care practitioners reveals that current training does not provide the groundwork for an integrated approach that includes both nutrition and PA and the understanding of the dynamic nature of energy balance (http://www.csress.usda.gov/nea/food/ pdfs/health_infocus_background_el.pdf). Exercise science training does not integrate nutrition, and nutrition and dietetics training typically lacks exercise science and PA education in its training competencies. In addition, further inclusion of behavioral theory in these disciplines would be beneficial. These disconnected sets of


disciplines are less effective in isolation when confronting the obesity epidemic.

Call to Action/Opportunity RDNs and exercise science professionals need to effectively communicate the importance of both sides of the energybalance equation and its dynamic nature, placing emphasis on both energy intake and expenditure and the effect one has on the other.4,9,20,27,28 This message should be consistent, yet tailored to the specific interests of each audience. The messages need to be science- and evidence-based, and easily understood. Incorporating behavioral psychology principles can help to engage and motivate people to effect sustainable change in energy intake and expenditure. For example, school administrators might be motivated by opportunities to improve the learning and test-taking skills of their students, health care providers might respond to potential improvements in cognition and other health benefits, and business professionals might respond to the potential for improved productivity of workers. Consensus recommendations have been developed for the twin goals of training future educators and health professionals in both nutrition and PA and developing consumer and community education programs that emphasize the dynamic nature of energy balance and its importance in achieving and maintaining a healthy weight.

Training Future Educators and Health Professionals Higher education needs to integrate nutrition and PA using an understanding of the dynamic nature of energy balance for undergraduate and graduate students in dietetics/nutrition, exercise science, health and wellness, and prekindergarten through grade 12 preparation programs.

Recommendations 1.

Integrate a multidisciplinary approach to the training of exercise science/PA professionals and RDNs in the dynamic nature of energy balance. This approach integrates PA competencies into July 2014 Volume 114 Number 7

FROM THE ACADEMY Energy Balance 4 Kids with Play With schools nationwide facing substantial budgetary constraints and mounting pressure to improve students’ academic performance, schools will face a major challenge in becoming the national focal point for obesity prevention, as recommended by the Institute of Medicine in its 2012 report, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. In particular, low-income schools with large proportions of racial and ethnic minorities tend to have the fewest resources available to align with these efforts.22 Since 2007, the Academy of Nutrition and Dietetics Foundation has been implementing and evaluating an innovative school-based nutrition and energy-balance program called “Energy Balance 4 Kids” in low-income school districts in the Midwest. In this program, specially trained registered dietitian nutritionists deliver the direct-to-student curriculum, lead efforts to improve the school wellness environment, and develop community partnerships to bring additional opportunities for increased access to healthy foods and activity to the students, school, and families. In 2011, the Academy Foundation, in partnership with the Healthy Weight Commitment Foundation, began implementing a 2-year intervention called “Energy Balance 4 Kids with Play” in four high-need schools in Richmond, CA, pairing the registered dietitian nutritionist nutrition coaches with trained recess coaches. During the intervention, students received 12 weeks of nutrition education, and the schools received the prestigious US Department of Agriculture Healthier US Schools Challenge award for reaching benchmarks in school meals and policies addressing topics such as competitive foods, minutes of physical activity, and nutrition education. Successful schoolecommunity partnerships were also established, including partnerships with the local food pantry, Cooperative Extension, and the Girls on the Run program. Together Counts The Healthy Weight Commitment Foundation is recognized as a leader in energy-balance education because of its partnership with Discovery Education in a “one-stop energy-balance shop” (www.togethercounts.com) for parents, teachers, and school health professionals. The “Together Counts” website offers comprehensive resources for schools and families and an opensource curriculum that is available worldwide, free of charge. To date, it has engaged nearly 3 million teachers, students, and parents with its content. The Healthy Weight Commitment Foundation has discovered that partnerships and incentives drive effectiveness, and has awarded more than $275,000 in prizes, including incentives for schools that have achieved US Department of Agriculture Healthier US Schools Challenge certification. Its “Find Your Balance Challenge” rewards student teams in kindergarten through grade 5 for documenting their steps toward achieving energy balance in their schools. A Student Participatory Wellness Program—Fuel Up to Play 60 “Fuel Up to Play 60” is a student-centric program developed by the National Dairy Council and the National Football League to improve schools’ nutrition and physical activity (PA) environment and students’ behaviors. More than 73,000 schools are enrolled in Fuel Up to Play 60, and 11 million students are actively involved. Working with adult champions, Fuel Up to Play 60 engages and empowers students to make healthy changes that contribute to energy balance and influencing students’ healthy choices. This flexible program fits schools’ capacities for implementing wellness practices and can be customized based on schools’ needs and students’ interests. Currently, 60% of enrolled schools have implemented at least one new strategy to improve the school nutrition and PA environment. Most (56% to 70%) enrolled educators report that Fuel Up to Play 60 is improving the nutrition and PA environment and student eating and PA behaviors. A Fuel Up to Play 60 pilot study showed small but statistically significant pre/post findings for a student population (N>30,000) meeting 2010 Dietary Guidelines for American recommendations for consumption of fruits, vegetables, whole grains, and low-fat/nonfat dairy, as well as breakfast and 60 minutes per day of PA.29 Key variables linked to positive change included student involvement, presence of one or more adult champions, rewards and mini-grants, and the belief that the program positively affects the school and supports overall wellness goals. Figure 2. Successful integrated nutrition and physical activity programs for families and children within the school setting. the training of RDNs and nutrition knowledge and skills into the training of exercise science/PA professionals. Both groups need training in the behavioral sciences. As a first step, the Academy of Nutrition and Dietetics and American College of Sports Medicine are currently considering the development of a joint certificate July 2014 Volume 114 Number 7

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program addressing these three areas. Develop competencies for prekindergarten through grade 12 school teachers and physical education teachers using the dynamic energybalance approach. This outcome would allow teachers to be champions for integration of nutrition, PA, and behavioral

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education focused on reducing obesity. Teachers would have the knowledge and skills to help their students make healthy choices. Develop comprehensive nutrition education core standards, both in nutrition and PA, for kindergarten through grade 12 schools that includes a clear integration of


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the dynamic energy-balance approach. The USDA Food and Nutrition Service and the Institute of Medicine are considering the benefits of national nutrition education curriculum standards for elementary and secondary school children.18 This is an opportunity to widen the scope of such standards to include dynamic energy balance. Integrating similar standards into the physical education curriculum would provide children with the knowledge and skills to facilitate lifetime PA and also be advantageous to ensure cross-curriculum promotion of the importance of both healthy eating and PA. Encourage the development of comprehensive curricula emphasizing the dynamic nature of energy balance, and that provides experiential learning opportunities for students and current health professionals. This could be done through the USDA Higher Education Challenge Grant program, US Department of Education grants, University programs, or through professional organizations producing educational materials that can be used in training future health professionals.

Consumer and Community Education Programs Developing a strategy to incorporate more realistic energy-balance messages into education programs for consumers and communities is vital for achieving and maintaining healthy weight and body composition among the population. It is also critical that we better understand how this energy balance concept can be shared with the public. See Figure 2 for descriptions of three school-based nutrition and PA programs that are already successfully working toward this goal.

Recommendations 1.

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Determine what energybalance messages work most effectively with consumers. Research is needed to help the professional better communicate

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clear and realistic energy-balance messages to consumers. These messages need to help consumers better understand the impact of nutrition and PA on their health and weight. Communicating the message of dynamic energy balance to a wider audience. Once messages are identified, collaborative efforts will facilitate the reach of the messages to a wider audience. Government and public health agencies and schools; community agencies; businesses; and medical, health, and fitness facilities can distribute these educational messages to diverse sectors within communities. The USDA is in a unique position to spearhead program leadership and partnership with other government agencies and land-grant universities to facilitate dissemination of integrated energy-balance messages in public education programs, including SNAP-Ed and EFNEP. Promoting collaboration among key professional networks would help promote accurate and realistic messages about energy balance to the public. Facilitate partnerships with schools and local public health professionals, organizations, and programs. Prekindergarten through grade 12 schools provide an excellent vehicle for the delivery and practice of energy balance. From the meals, snacks, and vending machines to the physical education, recess, and sports programs, there are opportunities to promote integrated nutrition and PA. Enhancing these efforts through community partnership programs, such as school and community gardens, walking school buses, community walking programs, and before/ afterschool programs, expands opportunities to access healthy food and PA. Programs like “Fuel Up to Play 60” and “Energy Balance 4 Kids with Play” are excellent examples of the integration of daily PA and movement in schools and improved access to healthy food.29


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Map integrated nutrition and PA programs currently being provided. A mapping resource would allow individuals to quickly find and select integrated nutrition and PA programs in which to participate or to bring to their schools, organizations, churches, or communities. Many government, corporate, and foundation nutrition and PA programs are now available, but not widely marketed. Mapping would reduce duplication of programs and allow providers to identify “nutrition and PA educational program deserts.” This mapping could be done similar to the way the USDA Economic Research Service currently maps food deserts.

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AUTHOR INFORMATION M. M. Manore is a professor, Oregon State University, Corvallis. K. Brown is national education director and A. Steiber is chief science officer, Academy of Nutrition and Dietetics Foundation, Chicago, IL. L. Houtkooper is a professor and associate director of cooperative extension, College of Agriculture and Life Sciences, and S. Going is a professor and head of the Department of Nutritional Sciences, both at the University of Arizona, Tucson. J. M. Jakicic is a professor and chair of the Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA. J. C. Peters is chief strategy officer, Colorado Center for Health & Wellness, and a professor, Center of Human Nutrition, University of Colorado School of Medicine, Denver. M. Smith Edge is vice president of nutrition and food safety, International Food Information Council Foundation, Washington, DC. L. Guillermin Gable is president, Healthy Weight Commitment Foundation, Washington, DC. A. M. Krautheim is senior vice president, Nutrition Affairs, National Dairy Council, Rosemont, IL. Address correspondence to: Melinda M. Manore, PhD, RD, CSSD, FACSM, Oregon State University, School of Biological and Population Sciences/ Nutrition, Milam 103, Corvallis, OR 97331. E-mail: [email protected]

STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.

FUNDING/SUPPORT There is no funding to disclose.

ACKNOWLEDGEMENTS The authors thank Margaret Bouvier, PhD, of Meg Bouvier, Medical Writing for help in writing this manuscript. Conveners, Sponsors, and Speakers: American College of Sports Medicine (ACSM) (Convener/Sponsor); Academy of Nutrition and Dietetics (AND) (Convener/Sponsor); United States Department of Agriculture/Agriculture Research Service (USDA/ARS); (Convener/Sponsor) and National Institute of Food and Agriculture (NIFA); International Food & Nutrition Council (IFIC) (Speaker); International Life Sciences Institute (ILSI) North America (Sponsor); National Dairy Council/Dairy Research Institute (Sponsor/Speaker); Quaker/Pepsi (Sponsor); National Cattlemen’s Beef Association (Sponsor); American Council on Exercise (Sponsor); Centers for Disease Control (CDC) (Speaker); Healthy Weight Commitment Foundation (Speaker); Sports, Cardiovascular, and Wellness Nutrition (SCAN) Dietetic Practice Group (Sponsor).

July 2014 Volume 114 Number 7


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