Health and Fitness Blog

SUNDAY, March 14 (HealthDay News) -- Hopes that two available drugs could help prevent diabetes and the problems it causes in overweight people with poor sugar metabolism have been dashed by a major international study.

The trial involved two drugs prescribed for other reasons -- Diovan (valsartan), a blood pressure medication; and Starlix (nateglinide), which is given to control existing type 2 diabetes.

The study was financed by Novartis, the drug company that markets both products.

The Starlix portion of the five-year trial, involving more than 9,300 overweight adults, found the drug had no benefit in reducing the incidence of newly diagnosed diabetes, cardiovascular death or events such as heart attack, stroke and heart failure.

The Diovan portion did find a modest effect -- 14 percent -- in preventing new diabetes cases. However, as was the case in the Starlix part of the trial, using Diovan led to no reduction in the cardiovascular conditions for which diabetes is a major risk factor.

Results of the trial were reported in two papers released early on March 13 by the New England Journal of Medicine, and slated for presentation Sunday at the American College of Cardiology's annual meeting, in Atlanta.

"It would be great if we had something that would prevent diabetes and cardiovascular disease at the same time," said Dr. Robert M. Califf, vice chancellor for clinical research at Duke University, and one of the leaders of the trial. "We didn't get that."

And despite the faintly positive results of the Diovan portion of the trial, "in neither case would we recommend such prophylactive [preventive] treatment in people who don't have diabetes but have abnormal glucose tolerance," Califf said.

So, lifestyle remains the key factor in preventing obesity and poor blood sugar control from turning into full-blown type 2 diabetes, he said.

"It looks like diet and exercise are the mainstays of prevention," he said. "If people could lose a few pounds more and exercise more, there would be a lot less diabetes."

It's an old message, but one that is difficult to get across, said Califf, who noted that more than 35 percent of the people in the trial did go on to develop diabetes in just five years. "We need to keep looking for better treatments, but lifestyle modification is the best thing we have going," he said.

The people in the trial, which was done at 806 centers across 40 countries, had diagnosed cardiovascular disease, known risk factors such as obesity and impaired ability to metabolize sugar.

They were divided into groups -- some receiving Diovan, some getting Starlix, and some taking a placebo. All entered a lifestyle modification program aimed at reducing weight and dietary fat intake and increasing physical activity.

Over five years, 36 percent of those taking Starlix developed diabetes, compared to 34 percent of those taking a placebo. Diabetes developed in about a third of those taking Diovan, compared to about 37 percent of those taking a placebo. The rates of cardiovascular problems and deaths were similar in all groups.

"We must continue to develop new therapies while encouraging people to exercise and pay attention to what they eat," Dr. John McMurray, professor of cardiology at the University of Glasgow in Scotland and a member of the trial's executive board, said in a Duke University news release. "Losing at little as 5 percent of body weight has been shown to make a dramatic difference in other studies."

Diabetes is a growing world-wide medical problem, McMurray and Califf noted. Some 150 million people now have the disease -- 90 percent have type 2 diabetes -- and the incidence is predicted to increase 50 percent by 2025.

There is an inexpensive drug available that has been shown to help prevent diabetes, added Dr. David M. Nathan, a professor of medicine at Harvard University and director of the Diabetes Research Center at Massachusetts General Hospital, who wrote an accompanying editorial in the New England Journal of Medicine. It is metformin, a leading drug for diabetes treatment that has been used for decades.

A study he led reported in 2002 that metformin reduced new diagnoses of diabetes by 58 percent over three years and by 34 percent over 10 years, Nathan wrote. But lifestyle changes, such as eating less and exercising more, are equally effective preventive measures, he said.

More information

Find out how you can help prevent diabetes at the American Diabetes Association.

Source

SUNDAY, March 14 (HealthDay News) -- Hopes that two available drugs could help prevent diabetes and the problems it causes in overweight people with poor sugar metabolism have been dashed by a major international study.

The trial involved two drugs prescribed for other reasons -- Diovan (valsartan), a blood pressure medication; and Starlix (nateglinide), which is given to control existing type 2 diabetes.

The study was financed by Novartis, the drug company that markets both products.

The Starlix portion of the five-year trial, involving more than 9,300 overweight adults, found the drug had no benefit in reducing the incidence of newly diagnosed diabetes, cardiovascular death or events such as heart attack, stroke and heart failure.

The Diovan portion did find a modest effect -- 14 percent -- in preventing new diabetes cases. However, as was the case in the Starlix part of the trial, using Diovan led to no reduction in the cardiovascular conditions for which diabetes is a major risk factor.

Results of the trial were reported in two papers released early on March 13 by the New England Journal of Medicine, and slated for presentation Sunday at the American College of Cardiology's annual meeting, in Atlanta.

"It would be great if we had something that would prevent diabetes and cardiovascular disease at the same time," said Dr. Robert M. Califf, vice chancellor for clinical research at Duke University, and one of the leaders of the trial. "We didn't get that."

And despite the faintly positive results of the Diovan portion of the trial, "in neither case would we recommend such prophylactive [preventive] treatment in people who don't have diabetes but have abnormal glucose tolerance," Califf said.

So, lifestyle remains the key factor in preventing obesity and poor blood sugar control from turning into full-blown type 2 diabetes, he said.

"It looks like diet and exercise are the mainstays of prevention," he said. "If people could lose a few pounds more and exercise more, there would be a lot less diabetes."

It's an old message, but one that is difficult to get across, said Califf, who noted that more than 35 percent of the people in the trial did go on to develop diabetes in just five years. "We need to keep looking for better treatments, but lifestyle modification is the best thing we have going," he said.

The people in the trial, which was done at 806 centers across 40 countries, had diagnosed cardiovascular disease, known risk factors such as obesity and impaired ability to metabolize sugar.

They were divided into groups -- some receiving Diovan, some getting Starlix, and some taking a placebo. All entered a lifestyle modification program aimed at reducing weight and dietary fat intake and increasing physical activity.

Over five years, 36 percent of those taking Starlix developed diabetes, compared to 34 percent of those taking a placebo. Diabetes developed in about a third of those taking Diovan, compared to about 37 percent of those taking a placebo. The rates of cardiovascular problems and deaths were similar in all groups.

"We must continue to develop new therapies while encouraging people to exercise and pay attention to what they eat," Dr. John McMurray, professor of cardiology at the University of Glasgow in Scotland and a member of the trial's executive board, said in a Duke University news release. "Losing at little as 5 percent of body weight has been shown to make a dramatic difference in other studies."

Diabetes is a growing world-wide medical problem, McMurray and Califf noted. Some 150 million people now have the disease -- 90 percent have type 2 diabetes -- and the incidence is predicted to increase 50 percent by 2025.

There is an inexpensive drug available that has been shown to help prevent diabetes, added Dr. David M. Nathan, a professor of medicine at Harvard University and director of the Diabetes Research Center at Massachusetts General Hospital, who wrote an accompanying editorial in the New England Journal of Medicine. It is metformin, a leading drug for diabetes treatment that has been used for decades.

A study he led reported in 2002 that metformin reduced new diagnoses of diabetes by 58 percent over three years and by 34 percent over 10 years, Nathan wrote. But lifestyle changes, such as eating less and exercising more, are equally effective preventive measures, he said.

More information

Find out how you can help prevent diabetes at the American Diabetes Association.

Source

THURSDAY, March 11 (HealthDay News) -- Obesity plus daily drinking boosts the risk of liver disease in men and women, researchers report in two new studies.

In one study, scientists at the University of Oxford examined the medical records of 1.2 million middle-aged British women. They followed them for an average of about six years and found that overweight or obese women faced a higher risk of cirrhosis of the liver, and the risk increased if they also reported drinking an average of a third to half a drink a day.

Still the overall numbers were small: Of those who drank that much, only 0.8 or 1 in 1,000 was admitted to the hospital with cirrhosis of the liver or died of the disease over five years.

But among those who reported drinking an average of 2.5 drinks a day, the rate was 2.7 in 1,000 among those with healthy weight and five in 1,000 among those who were obese.

In another study, teams at the universities of Glasgow and Bristol tracked more than 9,000 men in Scotland for an average of 29 years. They found that a combination of higher alcohol consumption and obesity boosted the levels of liver disease beyond what would be expected.

Both reports appear online March 12 in the BMJ.

More information

The American Liver Foundation has more about alcohol-induced liver disease.

Source

THURSDAY, March 11 (HealthDay News) -- Obesity plus daily drinking boosts the risk of liver disease in men and women, researchers report in two new studies.

In one study, scientists at the University of Oxford examined the medical records of 1.2 million middle-aged British women. They followed them for an average of about six years and found that overweight or obese women faced a higher risk of cirrhosis of the liver, and the risk increased if they also reported drinking an average of a third to half a drink a day.

Still the overall numbers were small: Of those who drank that much, only 0.8 or 1 in 1,000 was admitted to the hospital with cirrhosis of the liver or died of the disease over five years.

But among those who reported drinking an average of 2.5 drinks a day, the rate was 2.7 in 1,000 among those with healthy weight and five in 1,000 among those who were obese.

In another study, teams at the universities of Glasgow and Bristol tracked more than 9,000 men in Scotland for an average of 29 years. They found that a combination of higher alcohol consumption and obesity boosted the levels of liver disease beyond what would be expected.

Both reports appear online March 12 in the BMJ.

More information

The American Liver Foundation has more about alcohol-induced liver disease.

Source

(HealthDay News) -- Obesity is a major problem in the United States, and children are no exception. Today's kids are spending more hours watching TV, sitting at the computer or playing video games, and less time being active.

The Cleveland Clinic says the following factors make childhood obesity more likely:

• A genetic predisposition or family history of obesity.
• Not getting enough exercise.
• Eating unhealthy foods.
• Rarely, a health condition such as an endocrine disorder.

Source

(HealthDay News) -- Obesity is a major problem in the United States, and children are no exception. Today's kids are spending more hours watching TV, sitting at the computer or playing video games, and less time being active.

The Cleveland Clinic says the following factors make childhood obesity more likely:

• A genetic predisposition or family history of obesity.
• Not getting enough exercise.
• Eating unhealthy foods.
• Rarely, a health condition such as an endocrine disorder.

Source

TUESDAY, March 9 (HealthDay News) -- Colon cancer survivors who are moderately or severely obese face tougher survival odds following treatment compared with their normal-weight peers, a new study reveals.

The finding builds on prior research that established that being obese raises the risk for developing colon cancer in the first place.

"Previous studies have shown that obesity does influence the risk of developing colon cancer, but this study takes it one step further," said study author Dr. Frank A. Sinicrope, a professor of medicine and oncology at the Mayo Clinic in Rochester, Minn. "Because now we know that if you're obese, you have a higher risk of cancer recurrence or death for patients who have established colon cancer."

Sinicrope and his colleagues, whose work was funded in part by the U.S. National Cancer Institute, report their findings in the March 15 issue of Clinical Cancer Research.

The American Cancer Society estimates that last year more than 106,000 Americans were newly diagnosed with colon cancer, while nearly 50,000 men and women died from the disease.

To explore a potential connection between obesity and colon cancer survival, the authors analyzed data concerning 4,381 men and women who had been diagnosed with either stage II or stage III colon cancer. All of the patients had undergone both surgical removal of their cancer and subsequent chemotherapy.

Based on body mass index (BMI), which is a measurement that takes into account weight and height, the researchers determined that approximately 20 percent of the patients were obese (above 30 on the BMI chart). Among that group, about seven in 10 patients were classified as "moderately obese" (BMI between 30 and 34.9), while slightly more than one-quarter were "very obese" (BMI of 35 and up).

About 37 percent of the patients were normal weight (BMI of 20 to 24.9), while a similar number were deemed overweight (BMI of 25 to 29.9). Six percent were classified as underweight (BMI under 20).

Tracking all the cancer survivors for an average of eight years, Sinicrope and his associates observed that 36 percent went on to experience cancer recurrence, while 42 percent ultimately died.

Furthermore, the researchers found that, taken as a group, being either moderately or very obese was associated on average with a 19 percent increase in the risk for death, when compared with normal-weight cancer patients.

Although the pool of underweight patients was considerably smaller, the researchers found that the underweight group also had a much poorer survival rate than normal-weight patients. And while overweight patients actually seemed to fare slightly better (by 6 percent) than normal-weight survivors, Sinicrope indicated that more sophisticated obesity measurements that take into account muscle-mass ratios (not revealed by BMI) could yield slightly different results.

Gender differences were also apparent.

With a patient pool that was more or less evenly divided between men and women, the authors found that taken on their own, the most severely obese men faced the highest risk for cancer recurrence and death -- tagged as a 35 percent increase, relative to normal-weight patients.

However, women on the lowest end of the obesity scale were linked to a 24 percent increased risk for death -- a risk that actually dropped down to 11 percent as obesity rose.

"For now, we don't really have a clear explanation for why the moderately obese women did worse than the very obese women," said Sinicrope. "Menopausal status and hormone replacement therapy -- which could be protective against colon cancer -- could both be factors. But we don't know which women were pre- or postmenopausal and which were taking this medication."

As for what general underlying cause accounts for the obesity-survival risk connection, Sinicrope said the question remains unanswered. But he speculated that the association might result from the presence of higher insulin and insulin-like growth-factor-1 hormone levels in obese patients.

"We know the obese patients have higher levels of both these hormones, which have been associated with both obesity and colon cancer risk in the past," he noted. "So we think that could be playing a role in this risk."

A number of variables could explain the findings, said Dr. Joseph Martz, chief of the division of colorectal surgery at Beth Israel Medical Center in New York City.

"Obesity is often associated with a higher likelihood for diabetes and other diseases, and overall secondary immune dysfunction. And since colon cancer is somewhat of an immune disease, that is going to be a driving factor," he noted.

"There is also a good deal of data already regarding the supportive benefit of exercise and activity after colon cancer treatment in terms of prognosis," Martz added. "So I think that goes along with the concept that obese individuals are less likely to be in shape. Also, there may be some inherent surgical limitations that could compromise the technical ability to achieve complete removal of the cancer and the potentially affected lymph node tissues when operating on an obese person. All of this may play a role."

On a related front, a separate study published this week in the Journal of the National Cancer Institute provides fresh evidence that being obese does appear to be linked to a higher risk for colon cancer.

However, the research team -- led by Peter T. Campbell of the epidemiology research program at the American Cancer Society -- also found that the obesity-survival link does not seem to hold for all tumors, but only for those that are so-called "microsatellite stable." Obese patients who had this common type of tumor had lower five-year survival rates than obese patients with "microsatellite-high" tumors, suggesting that obesity has a varying impact on prognosis, depending on the kind of colon cancer at hand.

More information

For more information on colorectal cancer, visit the American Cancer Society.

Source

TUESDAY, March 9 (HealthDay News) -- Colon cancer survivors who are moderately or severely obese face tougher survival odds following treatment compared with their normal-weight peers, a new study reveals.

The finding builds on prior research that established that being obese raises the risk for developing colon cancer in the first place.

"Previous studies have shown that obesity does influence the risk of developing colon cancer, but this study takes it one step further," said study author Dr. Frank A. Sinicrope, a professor of medicine and oncology at the Mayo Clinic in Rochester, Minn. "Because now we know that if you're obese, you have a higher risk of cancer recurrence or death for patients who have established colon cancer."

Sinicrope and his colleagues, whose work was funded in part by the U.S. National Cancer Institute, report their findings in the March 15 issue of Clinical Cancer Research.

The American Cancer Society estimates that last year more than 106,000 Americans were newly diagnosed with colon cancer, while nearly 50,000 men and women died from the disease.

To explore a potential connection between obesity and colon cancer survival, the authors analyzed data concerning 4,381 men and women who had been diagnosed with either stage II or stage III colon cancer. All of the patients had undergone both surgical removal of their cancer and subsequent chemotherapy.

Based on body mass index (BMI), which is a measurement that takes into account weight and height, the researchers determined that approximately 20 percent of the patients were obese (above 30 on the BMI chart). Among that group, about seven in 10 patients were classified as "moderately obese" (BMI between 30 and 34.9), while slightly more than one-quarter were "very obese" (BMI of 35 and up).

About 37 percent of the patients were normal weight (BMI of 20 to 24.9), while a similar number were deemed overweight (BMI of 25 to 29.9). Six percent were classified as underweight (BMI under 20).

Tracking all the cancer survivors for an average of eight years, Sinicrope and his associates observed that 36 percent went on to experience cancer recurrence, while 42 percent ultimately died.

Furthermore, the researchers found that, taken as a group, being either moderately or very obese was associated on average with a 19 percent increase in the risk for death, when compared with normal-weight cancer patients.

Although the pool of underweight patients was considerably smaller, the researchers found that the underweight group also had a much poorer survival rate than normal-weight patients. And while overweight patients actually seemed to fare slightly better (by 6 percent) than normal-weight survivors, Sinicrope indicated that more sophisticated obesity measurements that take into account muscle-mass ratios (not revealed by BMI) could yield slightly different results.

Gender differences were also apparent.

With a patient pool that was more or less evenly divided between men and women, the authors found that taken on their own, the most severely obese men faced the highest risk for cancer recurrence and death -- tagged as a 35 percent increase, relative to normal-weight patients.

However, women on the lowest end of the obesity scale were linked to a 24 percent increased risk for death -- a risk that actually dropped down to 11 percent as obesity rose.

"For now, we don't really have a clear explanation for why the moderately obese women did worse than the very obese women," said Sinicrope. "Menopausal status and hormone replacement therapy -- which could be protective against colon cancer -- could both be factors. But we don't know which women were pre- or postmenopausal and which were taking this medication."

As for what general underlying cause accounts for the obesity-survival risk connection, Sinicrope said the question remains unanswered. But he speculated that the association might result from the presence of higher insulin and insulin-like growth-factor-1 hormone levels in obese patients.

"We know the obese patients have higher levels of both these hormones, which have been associated with both obesity and colon cancer risk in the past," he noted. "So we think that could be playing a role in this risk."

A number of variables could explain the findings, said Dr. Joseph Martz, chief of the division of colorectal surgery at Beth Israel Medical Center in New York City.

"Obesity is often associated with a higher likelihood for diabetes and other diseases, and overall secondary immune dysfunction. And since colon cancer is somewhat of an immune disease, that is going to be a driving factor," he noted.

"There is also a good deal of data already regarding the supportive benefit of exercise and activity after colon cancer treatment in terms of prognosis," Martz added. "So I think that goes along with the concept that obese individuals are less likely to be in shape. Also, there may be some inherent surgical limitations that could compromise the technical ability to achieve complete removal of the cancer and the potentially affected lymph node tissues when operating on an obese person. All of this may play a role."

On a related front, a separate study published this week in the Journal of the National Cancer Institute provides fresh evidence that being obese does appear to be linked to a higher risk for colon cancer.

However, the research team -- led by Peter T. Campbell of the epidemiology research program at the American Cancer Society -- also found that the obesity-survival link does not seem to hold for all tumors, but only for those that are so-called "microsatellite stable." Obese patients who had this common type of tumor had lower five-year survival rates than obese patients with "microsatellite-high" tumors, suggesting that obesity has a varying impact on prognosis, depending on the kind of colon cancer at hand.

More information

For more information on colorectal cancer, visit the American Cancer Society.

Source

NEW YORK (AFP) – New York leaders are pressing for a so-called fat tax on the soft drinks industry, saying that sweet beverages are responsible for an upsurge of obesity across the United States.

State Health Commissioner Richard Daines took up the issue Monday, speaking of a "golden opportunity" to create the tax.

"The dramatic underpricing of sugar-sweetened beverages, their widespread availability, and the ceaseless marketing of these products constitute a stumbling block to good health and are a clear and present danger to the future of our children," Daines said.

He called obesity "the biggest public health challenge of this and the next few decades."

Public officials in New York and other states are echoing that call, eyeing the tax as a chance both to influence diets and to replenish tax coffers depleted by the recession.

New York Mayor Michael Bloomberg, well known for his anti-smoking crusade in the city, also touted the idea in his weekly radio address Sunday.

"In these tough economic times, easy fixes to our problems are hard to come by," he said. "But the soda tax is a fix that just makes sense. It would save lives, it would cut rising health costs."

Nearly 20 percent of US children between the ages of six and 19 are estimated to suffer from obesity, which can encourage diabetes, heart disease and other grave problems.

Health experts blame insufficient exercise, but also the habit, particularly among the poor, of washing down fast food with extra-sugary soda.

The crisis has fed ballooning public costs -- 7.6 billion dollars in annual obesity-related medical bills in New York state alone -- much of which are covered by taxpayers.

Tax proponents say that soft drinks should be treated like tobacco so that the government can effectively price people away from their bad habits.

The soda industry dismisses the cigarettes parallel and has lobbied hard -- successfully so far -- against the levy.

J. Justin Wilson, senior research analyst at the soft drinks industry-connected Center for Consumer Freedom accused the government of using spurious health arguments to sneak in a new tax on businesses.

"If the city or state is out of money, then they should own up to it, rather than trying to hide taxes in a whole slew of new fees," he told AFP.

"They should own up to their financial mismanagement and raise income taxes."

The industry scored a rare piece of positive publicity Monday when it announced huge voluntary reductions in the amount of high-sugar drinks sold to schools across the country.

Leading companies, including Coca-cola and PepsiCo, joined former president Bill Clinton in announcing the initiative, saying that 88 percent less calories were now sold in drinks compared to 2004.

"It's a brand new day in America's schools when it comes to beverages," the head of the American Beverage Association, Susan Neely.

"Our beverage companies have slashed calories in schools as full-calorie soft drinks have been removed. The beverages available to students are now lower-calorie, nutritious, smaller-portion choices."

Wilson, at the Center for Consumer Freedom, accused the government of denying people their guilty pleasures, or, as he put it, deciding their own "balance of enjoying life and life extension."

"They're punishing people for enjoying a little life once in a while," he said.

Source

NEW YORK (Reuters) – A deal to sell healthier drinks in U.S. schools has slashed the amount of fattening beverages offered to students, former President Bill Clinton said on Monday as New York leaders pushed for a soda tax to tackle obesity and budget shortfalls.

Many health experts say non-diet soft drinks are a key source of excess calories in the U.S. diet and likely helping to fuel the obesity epidemic. Two-thirds of Americans, including one in three children, are overweight or obese.

An initiative by The American Beverage Association --including The Coca-Cola Co, Dr Pepper Snapple Group and PepsiCo -- the Clinton Foundation and the American Heart Association has helped cut shipments of full-sugar soft drinks to schools by 95 percent compared with 2004, Clinton said.

"There's been a dramatic shift toward lower calorie and more nutritious beverages in schools," Clinton told a news conference. "It could lay the foundation for broader changes in our society."

Although the American Beverage Association said school drink sales make up less than one percent of the total market, Clinton said companies were not asked to forgo revenue, instead "we asked them to make money in a different way."

The guidelines allow 100 percent juice drinks, low-fat milk and bottled water in elementary and middle schools, and diet beverages and calorie-capped sports drinks, flavored waters and teas in high schools.

A report prepared by Keybridge Research LLC said that while the agreement had only been in place since 2006, its progress had been measured against figures from 2004 because that was the most recent data available for comparison.

Keybridge Research president Dr. Robert Wescott said in a statement: "The reduction of calories in schools is real and meaningful. The data truly speaks for itself."

OBESITY PLAGUE

To tackle broader consumption of soft drinks, California and Philadelphia have introduced legislation to tax soda and now New York Governor David Paterson and New York City Mayor Michael Bloomberg are urging state lawmakers to do the same.

Referring to the large numbers of obese and overweight Americans, Paterson told reporters on Monday: "It's not going to be on my conscience, I think we need a sugar tax."

Bloomberg said in a radio address on Sunday that taxing soda would raise nearly $1 billion to help plug the state's shortfalls in health care and education funding.

"And, at the same time, it would help us fight a major problem plaguing our children: obesity," he said.

The U.S. Institute of Medicine says local governments should consider zoning laws to limit access to junk food near schools, and CDC director Dr. Thomas Frieden supports taxes on soft drinks, as does the American Heart Association.

Speaking at Clinton's news conference on Monday, Susan Neely, American Beverage Association chief executive, said a soda tax would not solve "a complex problem like obesity."

Clinton declined to comment, saying: "It's dumb for me to get involved in (the tax) debate when I can save God knows how many kids lives by making other agreements."

The report on the initiative to cut the amount of sugary drinks sold in schools was unable to show if the changes meant children actually consumed fewer calories from the drinks available to them. But it suggested they bought fewer drinks.

And it echoes findings from the U.S. Centers for Disease Control and Prevention, which reported in October that a median of 63 percent of schools limited carbonated soft drinks in 2008, compared to 38 percent in 2006.

The Robert Wood Johnson Foundation and the Center for Science in the Public Interest both praised the results of the initiative, which is part of the Alliance for a Healthier Generation, but said more needed to be done.

"Children drink and eat an estimated 35 percent to 50 percent of their daily calories during school hours," said the foundation's chief executive Risa Lavizzo-Mourey. "Given the central role school plays in our children's lives, we must strive to make every school in the country a healthy school."

(Additional reporting by Maggie Fox, Phil Wahba and Basil Katz; editing by Todd Eastham)

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