By Stuart Trager
8/24/04 -- When Ron Ziola drove by school playgrounds in his small, suburban Columbus, Neb., district several years ago, he noticed a disturbing pattern. During outdoor physical education classes, the school board vice president repeatedly observed "a bunch of kids not doing anything!"
Watching a game of softball or baseball became almost painful, "I'd see one kid batting, and the rest of the kids just standing around," he recalls.
Richard Izquierdo, a school board president in New York City's South Bronx, faced another challenge: fast food restaurants cropping up near many of his district's 26 preK-8 schools.
Although students were not allowed to leave school during the lunch period, they frequently purchased burgers, fried chicken, and tacos earlier in the day, or had relatives deliver them to the school.
Some students found offerings in the school lunch program unappetizing, especially canned vegetables.
These scenarios are not isolated. Sadly, lack of physical activity and the lure and availability of fast food are contributing to an exploding childhood obesity epidemic.
Nine million American children, ages 6 to 19, are overweight or obese. An additional 9 million are considered at risk of being overweight. At least 20 percent of 2 to 5 year-olds are overweight or at risk.
Childhood obesity rates have tripled since the mid 1970s, mirroring a rise in caloric and sugar intake and a sharp decrease in physical activity.
Sugar now accounts for 20 percent of the average teenager's calories, double what government guidelines recommend. Most teenage boys consume the equivalent of 34 teaspoons of sugar per day. Since the 1950s, soda consumption has leaped a staggering 500 percent.
Another study shows that nearly one-third of American children ages 4 to 19 eat at least one fast food meal a day. Researchers believe that pattern could increase a child's weight by six pounds each year.
Meanwhile, physical activity has taken a back seat. A recent study cited by the Kaiser Family Foundation concluded that the average child now spends five and a-half hours a day watching television, using a computer, playing an electronic game, or using some form of electronic media.
The American Academy of Pediatrics has called the scope of the obesity epidemic and potential consequences "staggering."
As many as half of all new Type 2 diabetes cases are among children. Overweight 6-year-olds are showing signs of heart disease. Hospitalization costs for obesity-related conditions like gallbladder disease have tripled to $127 million over the past 20 years.
A concerted effort by parents, educators, and the private sector to encourage a healthier lifestyle is critical to stemming the childhood obesity epidemic. School boards can have a meaningful impact on the crisis by helping to promote healthy behavior. With children spending 30 to 40 hours per week in school, the opportunity to effect lasting changes is significant.
In order to improve students' lifestyles, we need to give educators and parents the knowledge, tools, and incentives to help our children make better food and activity choices so they can live longer, healthier, and happier lives.
The efforts of some districts, acting on their own, are encouraging:
• In Dover, N.H., students are offered bunless hamburgers to reduce the amount of empty calories and refined white flour.
• Some schools in New Haven, Conn., have banned junk food entirely. Students are offered more salads and have access to exercise classes.
• New rules in Texas limit portion sizes in schools and reduce the amount of added fats and sugars.
• In California and New York, vending machine restrictions mean many schools sell only water, milk, or juice in place of soda. Dried fruit and fortified cereal bars are replacing candy and chips.
We believe a nationwide effort is needed to bring healthier environments to all schools.
In response to the staggering rise in obesity in children and adolescents, Atkins Nutritionals Inc. has launched the Atkins Education Policy Initiative, an education-based effort designed to encourage the consumption of whole, unprocessed foods and incorporate regular exercise.
The effort is not about putting children on the Atkins weight-loss program or marketing products to children. Rather, it is about helping children, parents, and educators choose healthier, nutrient-dense carbohydrates over those high in refined sugars, white flour, and manufactured trans fats (hydrogenated oils).
Central to the Atkins Education Policy Initiative is the establishment of partnerships with national education groups, parent and fitness associations, youth advocacy organizations, and the health care community. Based on our conversations with those groups, it is clear educators would like, and are open to, guidance on how to institute change.
We believe school boards can positively impact the health of their students by taking the following steps:
• Make healthier nutrition and regular physical activity a priority.
School boards should educate students about the components of healthy living. They should encourage the use of effective classroom tools that explain nutrition, offer nutritious foods that reinforce those lessons, and fund regular physical education.
• Inform parents about school nutrition issues.
One method of communicating could be to require a food service representative to appear in a public session to detail what is on the menu and provide a breakdown of foods by ingredients, sugar and fat content, calories, and other nutritional parameters. This information also could be placed on the school district's or community's website.
By establishing a dialogue with parents, businesses, and other concerned groups, schools can improve food choices and bring nutrition education into the home where it can be reinforced.
In the South Bronx, the school board established a nutrition committee that not only reaches out to parents, but also seeks input from students.
Board President Izquierdo says it's all about buy-in: "Children want to have a say in what they eat. For too long, they have not been consulted."
One small victory has been limiting the amount of junk food students bring into those schools. Because the school lunch program restricts students to one serving, Izquierdo says students are frequently hungry and carry unhealthy snacks to supplement their meal.
After asking students to suggest healthier alternatives, the schools now provide high-protein cheese sandwiches in addition to the school lunch.
To keep parents in the loop, Izquierdo says, food service representatives bring samples of cafeteria food to parent meetings for tastings. Recently, input from both students and parents resulted in an unpopular fish and cheese patty being pulled from the menu.
• Allocate sufficient resources. We understand the difficult financial constraints on most school systems. However, nutrition education and physical activity should be considered priorities, not add-ons.
In these financially troubled times, one creative approach is to add capacity gradually. Several years ago, the Columbus, Neb., school board set aside $12,000 to $15,000 to purchase exercise equipment.
The idea was to replace organized sports during physical education, such as basketball and softball, with aerobic activity that draws higher participation levels.
The board also improved the health curriculum to include more instruction on how the body works. Now, students learn about muscle development and heart rate in the classroom and work up a sweat in the gym or on the playground.
When considering requirements for new and renovated schools, boards should allocate resources for indoor gyms, outdoor playgrounds, and adequate PE staff.
• Engage the community. One useful approach is asking local businesses to help underwrite the cost of exercise and nutrition programs. Businesses have a stake in the success and health of students because today's students will be the work force of the future.
Empowering students to make healthier lifestyle choices in school, and persuading parents to reinforce those choices at home, can have a significant effect on reducing obesity. The challenge is considerable, but by working together we can achieve success.
Stuart Trager is medical director of Atkins Nutritionals Inc.