PUBLICATIONS AND TOOLS
- Educating the student body: Taking physical activity and physical education to school
- HBO’s Weight of the Nation™ series premieres new segment focused on children
- Salud America! releases set of materials exploring school snacks and Latino students
- Does better recess equal a better school day?
- Pre-ordering school lunches steer kids to healthier meal choices
- Unhealthy ads dominate Spanish children’s television shows
- Day care snacks lacking in nutritional value
- How state and local governments can address the obesity epidemic
CHILDHOOD OBESITY NEWS
- Coca-Cola anti-obesity promises include no advertising to kids
- National parks dishing up healthier fare this summer
- BMI measuring in schools proves controversial issue
- New school lunches get poor reviews
May 28, 2013, NCCOR
When public health organizations and the green building industry work together, the result can be more than better buildings. Increased collaboration between public health and the green building industry can also improve health outcomes, such as reducing childhood obesity, by driving changes in the design of buildings and outdoor space to promote physical activity and healthy eating, according to a new article published in the latest issue of the American Journal of Preventive Medicine (AJPM).
“A partnership between investigators in the fields of green building design and public health can not only help establish the evidence for what factors are important in developing healthy and environmentally sustainable buildings and communities, but can also help promote trans-disciplinary research in this arena,” said Dr. Rachel Ballard-Barbash, associate director of the Applied Research Program in the National Cancer Institute’s Division of Cancer Control and Population Sciences, and co-author of the study. “Such research has the potential to increase the availability and evaluation of built-environment projects designed to promote health.”
To facilitate this partnership, the National Collaborative on Childhood Obesity Research (NCCOR) and the National Academy of Environmental Design (NAED) co-sponsored a 2011 two-day workshop in partnership with the Center for Green Schools at the U.S. Green Building Council (USGBC). The workshop aligned with a green health research initiative NCCOR members developed in 2010 and included government researchers such as Ballard-Barbash, as well as academic, nonprofıt, and private sector researchers and practitioners from urban planning, architecture, landscape architecture, interior design, and law. Participants examined how environmental design strategies can be used to promote physical activity and healthy eating in school environments.
“The workshop allowed us to assemble professionals from a broad range of design, public health, and environmental sustainability disciplines at the table to learn about each other’s priorities and how they could be combined. It also laid the groundwork for the AJPM article, which describes a set of recommended strategies for green health environmental design research and practice,” said NCCOR contributor Dr. Matthew Trowbridge, the primary author of the study.
These seven recommendations, designed to guide the emerging field of green health research and practice, are the result of the discussion about green health partnerships that began in 2010 through NCCOR:
- Continue to develop evidence-based design guidelines and certification credits focused on improving physical activity and food environments for use within the green building industry.
- Use school environments as a joint focus for childhood obesity prevention and green building research.
- Foster green health environmental design research across a wide array of built-environment contexts and design disciplines such as architecture, landscape architecture, interior design, and graphic design.
- Support development of distributed health and environmental surveillance systems for use within green health environmental design research.
- Encourage application of systems science research frameworks and methodologies to accelerate progress within green health environmental design research and practice.
- Increase rapid-response research funding to better enable evaluation of green health environmental design “natural experiments.”
- Develop cross-disciplinary core competencies for use within training programs that address green health environmental design and health promotion.
“The field of green health research is emerging, inspired by the desire to understand, create, and promote buildings that actively contribute to human health and well-being. This transformation is motivated by a growing body of scientific evidence and inspired by compelling new opportunities for data-driven, evidence-based practice.” said study co-author Chris Pyke, vice president of research at USGBC.
NCCOR’s fifth “goal area” is to work with non-health partners on synergistic initiatives that integrate childhood obesity priorities and promote trans-disciplinary research. This goal area has resulted in a special partnership and portfolio of innovative “green health” activities.
For more information about this article and to view an infographic related to the recommendations, visit NCCOR’s Green Health project webpage: http://nccor.org/projects/greenhealth.
PUBLICATIONS AND TOOLS
The Institute of Medicine (IOM) released a report on May 23 recommending that schools provide opportunities for at least 60 minutes of physical activity each day for students and that physical education (P.E.) be designated a core subject. According to the report, only about half of U.S. children are getting at least 60 minutes of vigorous or moderate-intensity physical activity each day. Additionally, since the passage of the No Child Left Behind Act, 44 percent of school administrators report cutting significant time from physical education and recess, to increase time in reading and math. The IOM recommends “whole-of-school” approach where recess and school activities including sports are made accessible to all students to help achieve the 60-minutes-a-day recommendation for physical activity.
In May 2012, HBO aired the four-part documentary series and public education initiative, “The Weight of the Nation™,” which explored the obesity epidemic in the United States. The project returned in May 2013 with a new series that focuses on the health of children and families called “The Weight of the Nation for Kids.” These three, half-hour films highlight young people actively improving the health of both themselves and their communities. At home, in school, and on the playground children are bombarded with choices, some healthier than others, and proper knowledge about nutrition and physical activity can help them make better selections. “The Weight of the Nation for Kids” shows young people taking an active role in their own health, as well as their families, while underscoring the importance of changing the environment to enable young people to make healthier decisions.
This summer, the Robert Wood Johnson Foundation’s Salud America! is releasing six packages of research materials—each with a research review, issue brief, video, and infographic—on different aspects of Latino childhood obesity issues and potential solutions. The first package, Healthier School Snacks, shows that Latino students are widely exposed to high-fat, high-sugar snacks and drinks sold in schools, but implementing stronger nutritional standards can yield healthier school snacks for this growing population at high risk of obesity.
Safe and healthy recess has the potential to drive better student behavior, health, and learning, according to a new study from Mathematica Policy Research and the John W. Gardner Center for Youth and Their Communities at Stanford University. The randomized controlled trial of Playworks, which provides an active, healthy recess and play throughout the day in low-income elementary schools in 22 U.S. cities, found that the program reduced bullying, enhanced feelings of safety at school, increased vigorous physical activity during recess, and provided more time for classroom teaching. The findings are reported in four evaluation briefs.
- Findings from a Randomized Experiment of Playworks
- Effects on School Climate, Academic Learning, Student Social Skills, and Behavior
- Effects on Play, Physical Activity and Recess
- Playworks Implementation in 17 Schools from Six U.S. Cities
May 6, 2013, TIME
By Alexandra Sifferlin
Along the lines of advice to avoid grocery shopping when you’re hungry, new research concludes that children who electronically pre-order their lunch are more likely to make healthier meal choices than students who pick and choose as they make their way through the cafeteria line.
The four-week study looked at the choices made by 272 students in grades one to five in two schools in upstate New York. When the students pre-ordered their lunches, 29 percent were more likely to pick a healthier entrée compared to 15 percent when the option to pre-order was unavailable. When students chose their entrée in the lunch line, they were 48 percent less likely to make a healthy choice and 21 percent more likely to choose a less healthy entrée.
In the study, published in JAMA Pediatrics, researchers from Cornell University suggest that preordering lunch entrées could prevent distractions like sights and smells that could prompt kids to make hasty and potentially unhealthy choices when picking their meals.
Anti-obesity advocates and public health experts continually look for ways to measurably change the food environments for children in schools. In January 2012 the U.S. Department of Agriculture (USDA) revised school meal guidelines and required more fruits and vegetables, whole grains, and stricter calorie limits.
The stricter guidelines were met with mixed reviews, with some children complaining the calorie limits didn’t fill them up. In response, the USDA allowed the schools more flexibility in meat and grain servings. But there’s still debate about the restrictions.
As school lunch nutritional standards continue evolving, research is showing that having healthier options in school cafeterias could effectively curb weight gain and cravings for unhealthy treats.
“I think that some of the great things that happened with updating the school meal standards was that there were more fruits and vegetables,” says Jessica Donze Black, project director for The Pew Charitable Trusts Kids’ Safe and Healthful Foods Project. Black is unaffiliated with the study. “We all recognize that kids don’t get enough fruits and vegetables and certainly giving them more is a good thing. When we look at the schools that have been successful with that, where the kids are really eating more fruits and vegetables, there are some strategies that are really working.”
Some schools have already seen success, and Black says some of the most successful and sustainable changes in lunchroom fare and eating habits have been among schools involving students in the menu decision-making process. “Giving children an opportunity to taste-test allows them to provide feedback and an opportunity to show their preferences,” says Black.
It helps also if schools are rolling the lunch room changes out over time; getting used to healthier options doesn’t happen overnight. “A lot of those schools who have done well with integrating the foods will say they started the process a couple of years ago,” says Black.
While pre-ordering meals may be a strategy for steering kids toward healthier choices, Black says that the overall food environment makes a greater difference in whether kids choose healthy food options. “It is not just what is in the meals, but what’s in the rest of the school food environment. What’s in the a la carte line, what’s in the vending machine, what’s in the school’s store. It’s important all those foods are also healthy so we are not making fruits and vegetables compete with cookies and cakes when it comes to students’ tastes,” she says.
The Kids’ Safe and Healthful Foods Project’s recent health impact assessment (HIA) showed that revising national nutrition standards for snacks and drinks sold in schools not only helps students maintain a good weight but also benefits school budgets by increasing revenue for school food services. Without unhealthy snacks, the research found students are more likely to buy school meals.
“This is also better for school budgets because they get reimbursements from the federal governments for all those meals. It’s a win-win,” says Black.
As researchers continue to pinpoint the most successful strategies for healthier students — and schools continue to implement them — there’s hope that that now and in the future children’s weight and energy will reach healthy levels.
Original source: http://healthland.time.com/2013/05/06/school-lunches/#ixzz2SczddAkb
Unhealthy ads dominate Spanish children’s television shows
May 6, 2013, NBCLatino
By Jacquellena Carrero
Latinos have some of the highest rates of obesity in the nation, and the results of a new study show that advertisers may be contributing to the problem.
A new study in the Journal of Health Communication is showing that the vast majority of food advertisements on Spanish language television shows are unhealthy. According to the study, more than 84 percent of all foods and beverages advertised are low-nutrient and high-calorie products. The study, which was called “Food Marketing to Children on U.S. Spanish-Language Television” is among the first that analyzes food and beverage advertising on Spanish-language children’s television. The study was funded by the Robert Wood Johnson Foundation through its Healthy Eating Research program.
Dale Kunkel, professor of communication at the University of Arizona at Tucson and the lead author of the study, said that researchers used an independent food rating system by the U.S. Department of Health and Human Services (HHS) to designate foods as healthy or unhealthy. The foods on the HHS scale range from “go” foods that are low in fat and calories to “slow” foods that should be eaten sometimes to “whoa” foods that are high in fat, sugar, and calories, and low in nutrition.
“The large majority of ads were in this ‘whoa’ category,” Kunkel says. “It’s still outrageously high on English channels, but we concede that food marketing on Spanish channels is especially problematic.”
More than three-quarters or 78 percent of all Spanish language food ads used popular cartoon characters to market foods that fell in the “whoa” category. That number dropped for children’s shows in English to 49 percent. Researchers also found that fast food commercials dominated all food advertising, taking up nearly half of all child-targeted food ads on Spanish language TV. Healthy food on the other hand, such as fruits and vegetables, were so rare that they accounted for just 1 percent or fewer of all advertisements in either language.
Childhood obesity is a huge problem and what Kunkel calls the number one threat to the nation’s public health. He says that while the reasons for childhood obesity vary, exposure remains a top factor.
“There are lots of factors such as not eating meals with your family, not exercising as much. But we know that children’s exposure is a big contributor to childhood obesity,” he explains.
According to Kunkel, the results are especially significant for Latino children, who spend an average of five hours a day watching television and have disproportionately high rates of obesity. In 2007–08, 41.7 percent of Mexican American children ages 6 to 11 were obese or overweight compared with 34.5 percent of white children the same age.
However, Kunkel believes the study also demonstrates that there are shortfalls with voluntary self-regulation. Television marketing leaders have recognized the need to reform food advertisements targeting kids. Major U.S. food manufacturers pledged in 2006 to advertise healthier food choices for children under age 12 as part of the Children’s Food and Beverage Advertising Initiative. But Kunkel says that the study shows that self-regulation hasn’t quite worked out.
“The program of industry self-regulation is defective,” he says. “The reason companies self-regulate is to avoid government regulation, but we know we need to do better.”
May 8, 2013, The Wall Street Journal
From animal crackers to gummy fruit snacks and calorie-laden juice drinks, kids in child care are not getting the nutrition they need from daily snacks, according to a new study from Cincinnati Children's Hospital Medical Center published online in the journal Childhood Obesity.
The study — the first of its kind to compare meals to snacks — shows that despite efforts to improve the diets of children in child care settings, meals — and particularly snacks — still lack nutritional quality. Snacks, while smaller than meals, are an integral part of preschool-aged children's diets, typically comprising 26 percent of their daily calorie intake.
Researchers from Cincinnati Children's reviewed menus at 258 child care centers in southwestern Ohio, analyzing the average weekly frequency for servings of fruits, vegetables, lean meats, juice (100 percent), and sweet or salty foods. They found that the composition of lunches differed from snacks in all food categories.
Fruits, vegetables, and meats were rarely included in snacks, but were listed almost daily as a component of lunches. Conversely, 87 percent of centers served sweet and salty foods — such as gummy snacks, pretzels, and crackers — at snack time more than three times per week, but rarely at lunch.
The study also found that:
- Eighty-seven percent of centers rarely listed non-starchy vegetables for snacks, but 67 percent included them at lunch more than three times per week.
- One-hundred percent fruit juice was listed as a component of snack at least three times per week in over a third of the centers surveyed, but rarely with lunch.
- Sixty percent of the centers reported serving 2 percent milk to children older than age three; 31 percent served whole milk.
“Snack time for kids is a missed opportunity,” said Kristen A. Copeland, M.D., from the Division of General and Community Pediatrics at Cincinnati Children's and the study's lead author. “With some 75 percent of kids ages 3 to 5 in child care, revising the types of foods and beverages served at snacks in child care may be a way to address the growing obesity problem.”
The U.S. Department of Agriculture is expected later this month to release new guidelines for meals and snacks served in child care programs under the Child and Adult Care Food Program. These guidelines are expected to call for increased variety in the types of beverages and foods served at snack times among participating programs, and specifically including more fresh fruits and vegetables and meat or meat alternatives as snacks.
“Our findings suggest that these guidelines would represent a sharp departure from what is typically served in these programs at snack times, which for centers in our study was typically juice and a refined grain such as crackers,” said Dr. Copeland.
“We may need to think about the messages we are teaching children by serving these types of foods at snacks. If bitter-tasting vegetables are reserved for meals, but snacks are filled with tasty crackers and sweets, it's no wonder that children may start to prefer to eat at snack times rather than meals.”
“Theoretically, there is no reason for the nutritional value of snacks to differ from lunches,” said Dr. Copeland.
Highlighting others' research that shows that the preschool years are a time for establishing eating habits, she said, “Parents and child-care providers play an important role in shaping the eating habits and food preferences of young children. We might want to rethink how we're looking at snacks, both as a source of nutrition and for promoting healthy eating habits.”
May 9, 2013, Medical Xpress
With simple and innovative measures, public agencies at state and local levels can play a significant role in promoting healthier eating habits—steps that could make a difference in curbing the nation's obesity epidemic. One effective option, according to researchers at the Johns Hopkins Bloomberg School of Public Health, is requiring restaurants to include calorie counts on menus, along with the physical activity equivalents required to burn off a meal.
The researchers, who examined studies on calorie labeling and regulatory options available to local governments, offer several recommendations to enhance the effectiveness of menu labeling. The suggestions are especially applicable to chain restaurants with fewer than 20 locations, a category that represents more than half of the restaurants in the United States.
These eateries are not subject to the federal Affordable Care Act's menu-labeling provision. It requires chain restaurants with more than 20 locations to provide calorie information on their menus and menu boards, as well as a statement addressing daily, recommended caloric intake. The findings are featured in a perspective piece in the May 9 issue of the New England Journal of Medicine.
“The current standard is for restaurant menu boards to present information as the absolute number of calories, such as telling customers that a hamburger has 450 calories. If customers do not understand what 450 calories means or how it fits into their overall daily requirements, posting that information on menu boards may not be that useful,” said Sara N. Bleich, Ph.D., lead author of the perspective and an associate professor with the Bloomberg School's Department of Health Policy and Management. “All of the recent research suggests that if you make calorie information easy for consumers to understand you have a bigger impact on their purchasing behavior. This is particularly true for minority groups at higher risk for obesity since they often have lower than average levels of nutritional literacy.”
The authors recommend presenting calorie information to consumers in the form of a physical activity equivalent, e.g., telling consumers the amount of running required to burn off a particular food or beverage. According to the authors, this approach has been shown to reduce calorie consumption and lead to healthier choices. A 2011 study led by Bleich and colleagues examined the impact of calorie information on beverage choices and found that consumers were half as likely to buy a sugary beverage when presented with caloric information in the form of a physical activity equivalent.
Another recommendation is that restaurants change their menu default options such as replacing default fries and soda in a kid-friendly meal with apple slices and low fat milk. According to the authors, empirical research has shown that changing the default items by listing healthy choices on the front of a menu is significantly associated with the purchase of lower-calorie sandwiches, whereas simply listing the calories on a menu is not as effective.
The authors call for state and local governments to craft innovative menu-labeling regulations that focus on smaller chain restaurants and build on the current scientific data.
“A state or local government could pass a menu-labeling regulation that requires restaurants with fewer than 20 locations to list their lowest calorie food items first to encourage the selection of healthier, lower calorie items,” said Lainie Rutkow, J.D., Ph.D., M.P.H, co-author of the perspective and an assistant professor with the Bloomberg School's Department of Health Policy and Management. “As the Food and Drug Administration finalizes the federal menu-labeling regulations, which will include specific requirements for how calorie information is presented on menus and menu boards, it's important to consider the opportunities that remain for states and localities. Local governments are well positioned to augment the potential effectiveness of the Affordable Care Act's menu-labeling provisions, in part, because they have already begun engaging in innovative regulatory activity related to obesity prevention.”
CHILDHOOD OBESITY NEWS
Coca-Cola anti-obesity promises include no advertising to kids
May 8, 2013, Los Angeles Times
By Tiffany Hsu
Coca-Cola is making major promises to fight obesity — ceasing advertisements directed at kids, slapping calorie counts on all its packaging — as the soda giant stares down a rising tide of concern over sugar-stuffed beverages.
On May 8, as part of an initiative it’s calling “Coming Together,” the Atlanta company made a series of pledges that also involved offering low- or no-calorie drinks globally and backing of physical activity programs.
Coca-Cola said its new rules, announced in part to commemorate the brand’s 127th anniversary, will apply in more than 200 countries where it does business.
“Obesity is today’s most challenging health issue, affecting nearly every family and community across the globe,” said Chief Executive Muhtar Kent in a statement.
But most of May 8 oaths aren’t new.
Coca-Cola vowed back in 2009 to start labeling its packages with calorie details, a goal it now says it’s met. In October 2012, along with rivals such as PepsiCo, the company said it would also list nutritional information on U.S. vending machines.
And in advertisements launched earlier this year in the United States, Coca-Cola trotted out a parade of statistics about its various low- and zero-calorie products.
On May 8th, the company said that 19 of its 20 top brands fit the bill or feature alternatives that do. Executives also mentioned the mini-cans with smaller portions that debuted in 2001.
But the part of Coca-Cola’s pledge likely to get the most attention is the promise not to market to audiences where children under age 12 make up more than 35 percent.
The company has often said in the United States that it does not buy advertising directly targeting such demographics, but now appears to have expanded the policy globally. Commercials on television, radio, print, the Internet, and mobile phones are all affected.
It’s unclear what will become of the cuddly polar bear Coca-Cola likes to employ in its advertising.
But the company seems to be hustling to cover its bases in a year that has already seen an attempted ban on large sugary drinks by New York Mayor Michael Bloomberg, outcry over pop star Beyonce’s role as a Pepsi spokeswoman and concerns over the effects of caffeinated energy drinks on young consumers.
National parks dishing up healthier fare this summer
June 5, 2013, USA Today
By Nanci Hellmich
Visitors to the national parks this summer will not only get a taste of nature, they'll get a taste of healthier fare at the parks' restaurants, snack bars, and stores.
On June 5 the National Park Service announced a new nationwide plan — the Healthy and Sustainable Food Program — to make certain all its parks offer healthy food and beverage choices.
Some of the options: lentil soup, bison hot dogs, grass-fed beef, black-bean sliders, fish tacos, fresh tomato soup, and produce from local farms. About 23 million people buy meals in national parks each year.
"There's no reason you should have to take a vacation from healthy eating when you're on vacation," says Jonathan Jarvis, director of the National Park Service. The prices of the foods at parks are set so they "are affordable to all Americans," he says.
"Going outside to visit a national park has a lot of benefits," Jarvis says. "You can spend time with your family. You can get away from the hustle and bustle of everyday life. You can learn about nature and American history.
"You're taking a walk to get a little exercise. You're breathing fresh air, hearing the birds. It has physical and mental benefits. If you want to maximize that health benefit, we need to provide you an opportunity to eat healthy food."
But if you want a treat, don't despair: The parks will continue offering long-time favorites such as hot dogs and ice cream. There will be plenty of choices out there, Jarvis says.
The park service worked with the companies that supply foods and beverages to come up with new menu items and is encouraging companies to use locally grown and raised food when possible, Jarvis says.
Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest, says, "Often times the parks are isolated so there may not be many other food venues nearby. You think of going to a park as a healthier vacation because you are hiking and walking around. But if the food isn't healthy, you may come back one or two pounds heavier and never lose it."
Some parks have already worked on cleaning up their nutrition acts. Among the healthy options offered:
- Grand Canyon South Rim serves vegetarian options and serves vegetables or fruit as a substitute for french fries, including for kids' meals. Among the healthy entrees: a garden vegetable pasta dish, healthy wraps made with veggies and lean protein, and entree salads such as a Mediterranean salad. "There has been a paradigm shift the past few years with people wanting and demanding healthier food and wanting to know where their food comes from," says Matthew McTigue, executive chef at the Grand Canyon South Rim for Xanterra Parks and Resorts, which runs the concessions.
- Yellowstone National Park in Wyoming, Idaho, and Montana uses Montana-grown lentils and split peas in soups, salads, and some entrees, says Lu Harlow, Xanterra's director of food and beverage at the park. She tries to buy locally as much as possible. "We buy lamb and grass-fed beef from several nearby ranches which use no growth hormones or antibiotics," she says.
- The food served at the Statue of Liberty (which reopens again July 4 after cleanup from Superstorm Sandy) was revamped last year to provide healthier food to visitors. The park now offers 15 meals under 550 calories and several under 300 calories. "What we tried to do is take everyday foods and make them healthier," says Brad Hill, president of Evelyn Hill Inc., a family business that provides the food and beverages for the park. "People expect a cheeseburger, but our quarter-pound cheeseburger has only 515 calories. It has low-fat cheese and oat-topped wheat bun, which tastes really great. We also offer a turkey burger and veggie burger."
- Muir Woods in California has healthy sandwiches made with foods such as line-caught tuna and free-range, hormone-free chickens, says Keith Mahoney of Ortega National Parks, which does the concessions. Breads and muffins come from a nearby organic bakery. Muffins and scones cost about $2.95 to $4.95; sandwiches, $7.95; grilled cheese, $5.95; fresh tomato soup, $9.95.
- Yosemite National Park's customers love fresh greens and tomatoes, says Robert Anderson, a chef who works for Delaware North Companies Parks and Resorts. "You get in this grand surrounding, and you're inspired to eat healthfully. You don't want to eat chips; you want good fuel."
"One of our challenges in all of this is that when some people are on vacation, they want to splurge," Harlow says. "Our goal is to provide healthy options that guests want to splurge on. We continue to offer hot dogs and hamburgers, but we are offering bison hot dogs and grass-fed beef burgers. Visitors can still find a french fry, at least for now. Before long they may all be baked fries."
BMI measuring in schools proves controversial issue
May 17, 2013, Chicago Tribune
By Julie Deardorff
Like other fourth-graders at Evanston's King Laboratory School, Jennifer Dreller's daughter was discreetly weighed during gym class as part of a routine fitness assessment. But the experience took a toll on the 10-year-old's self-esteem, her mother recently told a panel of health experts.
“'How much do you weigh?' became the question of the month among fourth-grade girls,” Dreller said during a forum on childhood obesity. “My daughter has cried many nights worrying about her weight since this experience.”
As the nation's schools take an expanding role in the fight against obesity, they are increasingly flagging at-risk children with the help of an imperfect weight measure called the body mass index (BMI), a measurement calculated from weight and height.
But a backlash is building in Evanston, Ill. and across the country, sparked by concerns that BMI screening, which can be misleading, has no place in a school. Critics also argue that putting the sensitive information in the hands of self-conscious young students can cause bullying, trigger eating disorders, and intensify the pressure to diet.
Nevertheless, BMI remains the primary tool for classifying people as normal weight, overweight, and obese. The Institute of Medicine (IOM) specifically recommends school-based BMI screenings, in part because studies have found that many students don't have access to a primary care doctor.
“Schools have a changing role in wellness because that's where kids spend most of their waking time,” said pediatrician Lynn Gettleman Chehab, who runs the school clinic obesity program at Evanston Township High School. “It's a crucial time for prevention, but many kids aren't going to the doctor unless they're sick.”
The screenings are meant to cast a wide net, Gettleman Chehab added, acknowledging that BMI is flawed. “But if it's done in the right way, where privacy is protected and the child is not subject to embarrassment, it's useful information,” she said.
Experts say obesity must be tackled at an early age, given the potential long-term consequences. Obese children have a 70 percent chance of becoming obese adults, putting them at risk for heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. Childhood obesity rates nationwide more than doubled to 18 percent over the past three decades, federal data shows.
Simple, cheap, and noninvasive, BMI is a widely accepted surveillance tool used to track trends in a population. The formula indirectly measures excess body fat — the real culprit behind a variety of illnesses and medical conditions — and a high BMI level correlates with future health risks.
Yet it can be problematic as a screening tool for individuals. Age, sex, ethnicity, and muscle mass can influence the relationship between BMI and body fat. BMI also can't distinguish between excess fat, muscle, or bone mass. As a result, athletes, muscular people, and racial and ethnic minorities with different body compositions can have a high BMI.
About half of children whose BMI labels them as overweight (but not obese) are healthy and have no increased risk of diabetes or other conditions, said Kristine Madsen, an assistant professor at the University of California at Berkeley's School of Public Health and the UC San Francisco Department of Pediatrics.
The IOM recommended in 2005 that all schools annually assess their students' weight, height, and BMI and send the information to parents as part of a national strategy to address weight problems in children.
Today, at least 19 states require school-based BMI screening. Nine states recommend it alone or as part of a broader health-related fitness assessment such as FitnessGram, developed by the Cooper Institute and licensed to at least 65,000 schools nationwide.
In Illinois, BMI information is required on school entrance health exam forms, along with data on vaccinations and dental and eye exams. But there's no statewide BMI monitoring system, and obesity data is sparse, according to the state public health department. At least 1,000 Illinois schools have incorporated the FitnessGram program, including Evanston's District 65.
Schools use and share BMI data in different ways. Some notify parents of the results; others don't. In 2011, parents complained when Hawthorne Elementary School in Elmhurst planned to include BMI results as part of a physical fitness grade. The school hastily dropped the idea; today the information is reported to the state but not given to individual students. Chicago Public Schools also reports only aggregated information.
Ideally, BMI scores are used to help correct any misperceptions about weight and to motivate parents to follow up with a doctor. Multiple studies have found that parents of overweight or obese children often fail to perceive that their children have a problem.
It's not clear, however, whether sending the information home does any good. In the largest study to look at the issue, Madsen and her team found no difference in pediatric obesity between children in California whose parents who had received letters and those whose parents had not.
When the researchers dug deeper, they found that the letters sent home were poorly designed, too complicated and lacked context, Madsen said. “I think that we just do not know what works,” she said.
Parents also need information on how to respond appropriately to the BMI scores.
“We want to correct parents' perceptions, but what are parents going to do with that information?” said Dianne Neumark-Sztainer, a professor of epidemiology and community health at the University of Minnesota's School of Public Health. “My fear is that their intentions will be good, but they may inadvertently do something that will be harmful.”
Some groups that work to raise awareness about eating disorders oppose mandatory BMI reporting in schools over concerns that it may trigger disordered eating in vulnerable students. Experts, however, say that if one follows the other, it is likely a coincidence of timing, as eating disorders typically develop during the preteen years or adolescence.
Moreover, obesity is the bigger problem, said Goutham Rao, clinical associate professor at the University of Chicago Pritzker School of Medicine and vice chair of the American Heart Association's Obesity Committee. “The proportion of children with eating disorders compared to those with overweight or obesity is very small,” he said.
Rao said he frequently works with adolescent girls who want to be thinner.
“You show them their BMI and it's actually reassuring,” he said. “They may be prone to a distorted body image and it shows, 'No, you're not overweight.' That's more common than pushing people in the other direction.”
As more schools institute the screenings, their role has grown more controversial. In Massachusetts, the parental notification letters have been dubbed “fat letters.” After the student-athlete son of a politician received a letter classifying him as “obese,” legislation was introduced to prohibit the public health department from collecting data on students' height, weight, and BMI. The bill has been referred to a committee.
In Evanston, a small group of parents has voiced concerns about everything from how the BMI scores are sent home to whether preteens are emotionally equipped to handle the information. Next month, the District 65 school board plans to discuss whether to continue BMI testing as part of FitnessGram, though parents have always been allowed to opt out of the program.
At participating schools, physical education teachers weigh students in the fall and spring. They aren't shown or told the results, but “most want to know,” said P.E. teacher Denise Rossa, the district's middle school department chair.
Once parents receive the BMI number along with other fitness scores — aerobic capacity, muscle strength, muscle endurance, and flexibility — students can access the information via computer unless their parents opt out. In class, students discuss what BMI measures, why it's done and its shortcomings, Rossa said.
“We want our students to understand that healthy comes in all shapes and sizes and that weight alone is just a number,” she said.
Michele Hays, who has a son at Chute Middle School, doesn't see the value of BMI screening outside a medical environment, especially since nutrition and fitness information is covered in class. “The only function of showing kids their BMI scores is to personalize the information, which strikes me as being dangerously close to shaming,” she said. Hays also has a problem with sending the scores home to parents “unless we are also providing adequate information on what to do with the result and how to access health care,” she said.
Other parents say the scores can motivate children and help them set goals.
“My kids used the yearly FitnessGram results to push themselves to work harder and improve and/or beat their scores the next year,” said Jill Moore, whose son, Alex, attends Chute.
Moore, a nurse, agrees that students disclose numbers to one another, leaving some feeling bad. But she added, “I think this type of comparing is inevitable at the middle school level.”
At the school district's recent community forum on obesity, Rao stressed that parents should send children a consistent message: Develop healthy habits. “Never mention the word 'obese' or 'overweight' to your child,” he said. “Target the behavior and take the stigma of weight and body image completely out of the equation.”
Dreller, who attended the meeting hoping to learn more about BMI, remains unconvinced that the measure should be calculated at school. Her daughter, one of the tallest girls in the class, weighed more than most of the others. That's something the 10-year-old hasn't forgotten.
“Aren't we trying to teach good body image and high self-esteem to our girls?” she asked. “Body image is so much a part of who a person is that it seems like we're regressing.”
New school lunches get poor reviews
May 19, 2013, Boston Globe
By Dave Eisenstadter
Conor Curran said chocolate chip cookies used to be among the most popular snacks at Dedham High School [located outside of Boston].
But Curran and his friends agreed that the ones available this year, made with whole grain as required by the state’s new school nutrition law, are among the worst items the school offers.
“We once lived in a golden age of cookies; now we’re suffering through a dystopian world,” said Curran, a senior. “It was the rise and fall of cookies.”
Cookies are just the tip of the iceberg. Though officials say that students will eventually adjust to their new choices, school budgets have taken a hit because of lost revenue from snack items such as cookies and added expenses resulting from the federal Healthy, Hunger-Free Kids Act, which regulates school lunches.
The state and federal laws took effect last fall, and officials are projecting a $58,000 deficit for the Dedham food service department this school year. In April, the School Committee approved price hikes for school lunches throughout the district. At the high school, the price will rise to $3.50 from $2.75.
The federal law aims to bring more nutritious food into public schools to attack both childhood obesity and hunger. The Massachusetts law, meanwhile, covers foods that aren’t on the lunch plate, such as a la carte items, snacks from vending machines, and concession stands. Overall, the laws require a wider selection of fruits and vegetables, more whole grains, and a reduction in calories, sodium, and trans fats.
Now, districts across the Commonwealth are feeling the effects. Dedham Food Service Director Jeanne Johnson put together a list of 25 nearby districts, including Canton, Needham, Norwood, and Stoughton that also are losing money.
Districts that have been the most successful with the new lunch regulations started early, according to Kathleen Millett, executive director of the Office of Nutrition, Health, and Safety in the state education department.
She said districts such as Somerville and Lawrence have been working to meet the regulations since the HealthierUS School Challenge, which began in 2010, and felt less of a financial impact when the regulations were implemented this year, Millett said.
Around the country, the average daily participation in school lunch as of February had dropped about 3 percent in the past year, according to statistics from the U.S. Department of Agriculture.
On the lunch trays in Dedham, federal regulations have resulted in smaller portions. Instead of the six-inch subs the cafeteria used to offer, four-inch sandwiches with less meat and cheese are served. Sean Birchall, a senior, said he usually buys two lunches to compensate.
“I’m starving every day,” Birchall said. “I play three sports and I’m dying.”
Unlike last year, when fruit and vegetable items were optional, students are now required to take a fruit and a vegetable item. Many put them on their plates in the lunch line, then slide them into the trash untouched at the end of the period.
That is unfortunate, said Johnson, because the cost of providing those vegetables in 1,500 meals is about $111 per day.
And that doesn’t include the loss of revenue from students like senior Megan Gallagher, who now brings her lunch from home.
“I used to get school lunch all the time; now I just don’t because it’s a waste of money,” she said.
To save money in her budget, Johnson has resorted to buying less-desirable options at times. Fresh fruit cups used to be popular and were offered each day, but Johnson switched to less-popular canned fruits three days a week so she could afford to buy kale, cauliflower florets, and different beans and legumes that are called for by the regulations and unfamiliar to students, she said.
“I hate to see the options decline for kids who were interested in taking them just to increase options for kids who don’t want to take them,” Johnson said.
For senior Marko Onyskiv, the saving grace is the Caesar salad. But now that’s available just once a week, while other salads are offered on other days.
“They force the vegetables on us,’’ said Onyskiv, but when the Caesar is available, “everyone gets this salad.”
Johnson also laments the complexity of the federal law. Vegetables are broken up into five subgroups — dark green, red/orange, legumes, starchy, and other — with each containing specific vegetables (sweet potatoes are in the red/orange category; yams are in the starchy category).
High school students must take a half a cup of each type of vegetable per week, except for the red/orange group, of which students must take 1¼ cups, and the “other” group, which has a requirement of ¾ cup, Johnson said.
Total vegetables per week must add up to five cups, in addition to the mandated five cups of fruit, according to Johnson.
In addition, high school students must have 10 to 12 ounces of grains per week and the same amount of meat or meat alternative, she said. The amounts are different for middle school and elementary school students.
“I describe it as a jigsaw puzzle of food,” Johnson said. To get the amounts correct, Johnson sometimes told her staff to cut off portions of wraps because the full wrap would exceed the maximum grain or protein standards.
In December, the grain and protein maximums were temporarily lifted, meaning sandwiches no longer had to be cut, but the standards may be reinstated in the 2014-2015 school year, according to Millett. Moreover, there are fewer snacks and drinks that students can buy this year, Johnson said.
These were some of the items students lamented losing most. “When we were freshmen, they sold lemonade and Coke, but they got rid of that,” said senior Elizabeth Wadman. “They used to have ice cream.” Johnson came before the School Committee in April to request price increases to make up for the losses. The increases were unanimously approved, and the new laws came under some criticism.
“I’m opposed to what I view as excessive regulation,” committee member Tom Ryan said before the vote. “I didn’t think what we were serving the children before was so catastrophic to their well-being.” Fellow committee member Jennifer Barsamian said last week that the time spent at school makes up a small portion of a student’s day.
“I’m glad they are trying to make the school lunches healthier and expose kids to different foods and vegetables, but I agree with what Tom Ryan was saying that night,” Barsamian said. “Schools are not making our kids obese.”
Instead of regulating lunches, Barsamian said, there should be more recess and gym.
Barsamian also said her children, a first-grader and a fourth-grader in the Dedham Public Schools, are adapting to some of the changes.
“They’ve been upset about the mac and cheese with broccoli inside of it — they use that example always — but they’ve come to like the bean and rice burrito, which they were saying ‘gross’ to earlier in the year,” Barsamian said.
As Dedham’s food service director for 13 years, Johnson said she knows from experience which items have been popular and which have not. Her staff is learning how to work with the new regulations.
“I believe the kids are resilient and they will adapt to the new options — every year they become more familiar with kale and corn salad and pea salad and bean salad,” Johnson said. “They will get closer to what we are offering, and we’ll get closer to what they want, and we’ll meet in the middle.”
That meeting may take a while. Asked if they liked any of the new foods, senior Brittney Almeida and her friends reflected before answering.
“The sugar cookies are good,” she said.