- ObesityWeek preconference workshop will explore the impact of mobile health on child obesity research
PUBLICATIONS AND TOOLS
- New report shows childhood obesity rates have leveled off over the past decade
- New data on adult obesity prevalence shows no change in national obesity rate
- CDC report shows progress in school health practices
- CDC releases new website to address obesity disparities
- Obesity declining among low-income preschoolers in some states
- Obesity risk factors may vary for boys, girls
- Report: United States obesity prevention efforts fall short
- Study: Asthma more common, severe among obese kids
- Kids may not offset extra exercise at school
CHILDHOOD OBESITY NEWS
- 'Fat letters’ take the stage in childhood obesity debate
- Michelle Obama's newest initiative: Using hip-hop to fight obesity
- Mississippi school lunches among healthiest in United States
ObesityWeek preconference workshop will explore the impact of mobile health on child obesity research
Sept. 2, 2013, NCCOR
This November The Obesity Society is hosting a preconference workshop called “Mobile Health (mHealth) Boot Camp for Pediatric Obesity.” The workshop will introduce participants to the basics of mHealth and its potential to inform research and practice in pediatric obesity. The workshop is part of ObesityWeek, a scientific and educational conference for obesity health care professionals that combines both The Obesity Society (TOS) and American Society for Metabolic and Bariatric Surgery (ASMBS) annual meetings.
“Mobile health has so much potential for so many aspects of childhood obesity research,” said workshop co-organizer Erin Hennessey, a cancer prevention fellow at the National Cancer Institute (NCI) and member of the National Collaborative on Childhood Obesity Research (NCCOR). “There are more mobile devices in the world than toothbrushes, and even in the developing world – in places where people may not have consistent access to electricity or running water – people have access to mobile technology. So, the reach potential for mobile health is huge.”
The workshop will focus on how to use mHealth in pediatric obesity research. It will explore aspects like developing transdisciplinary teams; using sensor technologies to measure behaviors like activity, sleep, location, and social networks; making use of new and emerging research methodologies for collecting and analyzing large volumes of data (e.g., systems science); and developing flexible interventions that adapt to emerging behaviors and contexts in real time.
“From a measurement perspective, mobile technology allows for stealth data collection (e.g., through sensors, GPS) that requires almost zero participant burden and yields highly accurate data, ” said co-organizer Heather Patrick, health scientist at NCI and NCCOR member. “From an intervention perspective, engaging with people – parents, children and adolescents, educators, public health and medical practitioners – in the space where they already are has the potential to improve participant engagement and retention and the opportunity to develop adaptive interventions that address the needs of people operating at multiple levels within the childhood obesity landscape.”
The workshop is a collaboration between NCCOR, The Obesity Society’s Pediatric Section, and leading researcher in obesity prevention and treatment in minority youth: Dr. Donna Spruijt-Metz. Dr. Spruijt-Metz is an associate professor at Keck School of Medicine's Department of Preventive Medicine University of Southern California and chair-elect of The Obesity Society e-Health/mHealth section (EMS).
“Donna was starting to work on an EMS-supported workshop, and it turned out to be a great opportunity for the three groups to collaborate and capitalize on our respective strengths in some really exciting ways,” said Hennessey.
The workshop will also feature NCCOR tools and resources such as the Measures Registry and infographics. Participants will have an opportunity to discuss ways to enhance and expand NCCOR’s resources to be more mHealth-friendly and advance pediatric obesity research.
The workshop is designed for researchers, practitioners, and program evaluators at all career levels and disciplines who are interested in learning more about how to modernize their intervention, prevention, and evaluation skill sets.
“We hope that participants come away from the workshop with a newfound appreciation for how mHealth can be used to address the central disadvantages of current surveillance, prevention, and treatment approaches in pediatric obesity research,” said Hennessey.
“Mobile health is by no means a panacea that will solve all of the challenges we face in pediatric obesity research, so we also want participants to have a broader understanding of the issues mHealth can address and the limitations that mHealth may present,” added Patrick. “We want participants to develop a better understanding of the opportunities that mHealth presents, the kinds of ideas that are truly novel and innovative in mHealth, the current state of the evidence, and where additional evidence is needed.”
The preconference workshop will be held in Atlanta, Ga., on Nov. 12 from 8 a.m.-5 p.m. Though the conference is part of ObesityWeek, participants DO NOT have to register for the conference to attend the workshop.
To learn more about the preconference, visit http://www.obesity.org/about-us/ehealth-mhealth.htm. To register for the workshop, visit http://www.obesityweek.com. For questions, email email@example.com.
PUBLICATIONS AND TOOLS
Childhood obesity rates in the United States have more or less stabilized over the past decade, according to a report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). The report, titled "F as in Fat: How Obesity Threatens America's Future 2013," states that based on data from the Centers for Disease Control and Prevention, that rates of childhood obesity have remained statistically the same for the past 10 years, with the exception of the prevalence of obesity among boys (2 to 19 years old) which increased from 14 percent in 1999-2000 to 18.6 percent in 2009-2010. The report also states that despite this stabilization, the rates of obesity among children ages 2 to 19 are still far too high—more than triple what they were in 1980.
The Centers for Disease Control and Prevention (CDC) recently released the 2012 obesity map from the Behavioral Risk Factor Surveillance System (BRFSS). Although the map shows several states moved between categories from 2011-2012, only Arkansas showed a significant change (increase) and there was no significant change in the national obesity rate overall.
Specifically the map shows:
- By state, obesity prevalence ranged from 20.5 percent in Colorado to 34.7 percent in Louisiana in 2012. No state had a prevalence of obesity less than 20 percent. Nine states and the District of Columbia had prevalence between 20 to 25 percent. Thirteen states (Alabama, Arkansas, Indiana, Iowa, Kentucky, Louisiana, Michigan, Mississippi, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia) had a prevalence equal to or greater than 30 percent.
- Higher prevalences of adult obesity were found in the Midwest (29.5 percent) and the South (29.4 percent). Lower prevalences were observed in the Northeast (25.3 percent) and the West (25.1 percent).
- It is important to note that several updates were made in 2011 to BRFSS methodology that impact estimates of state-level adult obesity prevalence. Because of these changes, data collected in 2011 and forward cannot be compared to estimates from previous years.
Over the last several years, more schools nationwide have begun implementing nutrition and health policies and requiring physical education programs, according to a report released Aug. 26 from the Centers for Disease Control and Prevention (CDC).
Key findings include:
- The percentage of school districts that allowed soft drink companies to advertise soft drinks on school grounds decreased from 46.6 percent in 2006 to 33.5 percent in 2012.
- Between 2006-2012, the percentage of districts that required schools to prohibit offering junk food in vending machines increased from 29.8 percent to 43.4 percent.
- Between 2006-2012, the percentage of districts with food procurement contracts that addressed nutritional standards for foods that can be purchased separately from the school breakfast or lunch increased from 55.1 percent to 73.5 percent.
- Between 2000-2012, the percentage of districts that made information available to families on the nutrition and caloric content of foods available to students increased from 35.3 percent to 52.7 percent.
Physical education/physical activity
- The percentage of school districts that required elementary schools to teach physical education increased from 82.6 percent in 2000 to 93.6 percent in 2012.
- More than half of school districts (61.6 percent) had a formal agreement, such as a memorandum of agreement or understanding, between the school district and another public or private entity for shared use of school or community property. Among those districts, more than half had agreements with a local youth organization (e.g., the YMCA, Boys or Girls Clubs, or the Boy Scouts or Girl Scouts) or a local parks or recreation department.
The Centers for Disease Control and Prevention (CDC) Division of Nutrition, Physical Activity, and Obesity recently launched the Health Equity Resource Web Guide. This website is an instructional tool developed to complement the “CDC Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities,” released in August 2012.
In support of the toolkit, the guide:
- Provides access to the “Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities”
- Provides an overview of the toolkit content
- Provides supplementary information, examples, and exercises to reinforce or expand upon toolkit content
- Guides users in the most effective use of the toolkit sections
Aug. 6, 2013, NBC News
By Barbara Mantel
The fight against childhood obesity is beginning to show results, say government researchers.
After rising for decades and then stabilizing somewhat in the mid-2000s, the obesity rate among low-income preschoolers declined by small but statistically significant amounts in 19 states and U.S. territories between 2008-2011, according to a report from the Centers for Disease Control and Prevention (CDC) released Aug. 6.
“We are excited because we have seen so much work going on in the past several years at the local, state, and national level, and we believe these changes are beginning to make a difference,” co-author [and NCCOR member] Heidi Michels Blanck told NBC News.
Initiatives include first lady Michelle Obama’s Let’s Move! campaign to reduce childhood obesity; improvements in the nutritional content of the food provided by the federal government’s Supplemental Nutrition Program for Women, Infants and Children (WIC); and growth in the number of U.S. hospitals enrolled in the World Health Organization’s Baby Friendly Hospital Initiative, which encourages new moms to breastfeed.
“We know that breastfeeding leads to healthy weight in the first year,” said Blanck, chief of the CDC's obesity prevention and control branch.
Still, there is no proof that specific government interventions have led to the declines in obesity noted in today’s report, acknowledged CDC director Dr. Tom Frieden in a media conference call.
Government researchers analyzed measured height and weight for 11.6 million preschoolers aged 2 to 4 years who participate in federally funded nutrition programs. States and territories report that data to the Pediatric Nutrition Surveillance System. The researchers included data from 40 states, the District of Columbia, the U.S. Virgin Islands, and Puerto Rico and excluded others that did not report data consistently or changed their methods of collection and reporting. Children with a body mass index in the 95th percentile or greater for their age and sex were categorized as obese.
Obese preschoolers are more likely than normal-weight children to be obese adolescents and are five times as likely to be obese as adults, according to the CDC. Obesity is associated with high cholesterol, high blood sugar, asthma, and mental health problems.
“It is important for us to look at this age group in that demographic,” says Dr. Lindy Christine Fenlason, director of Vanderbilt University’s Pediatric Weight Management Clinic. “With financial barriers, you run into limited access to healthy foods, limited places for safe physical activity,” and sometimes limited educational resources about good nutrition, says Fenlason.
Six of the 19 states and territories showing progress — Florida, Georgia, Missouri, New Jersey, South Dakota and the U.S. Virgin Islands — had at least a one percentage point decrease in the obesity rates. Twenty-one states had no significant change, while three states — Colorado, Pennsylvania, and Tennessee — saw an increase.
“The best way to deal with many health problems, as with obesity, is prevention,” said Frieden. “That’s why we are so encouraged to see these decreases, even though they are small, in this age group.”
“But the prevalence is still high, and so there is still a lot of work to be done,” CDC epidemiologist and lead author Ashleigh May told NBC News.
In contrast, between 2003-2008, just nine states showed a significant decline in obesity among low-income preschoolers, 11 had no change, and 24 had a significant increase.
There was wide variation in obesity rates across states in 2011. Hawaii’s 9.2 percent obesity rate for this group of young children was the lowest. California’s 16.8 percent was the highest.
New Jersey, which showed improvement, still has a relatively high rate of obesity among low-income preschoolers of 16.6 percent. In comparison, Colorado, though losing some ground, has a relatively low obesity rate of 10 percent.
“Each state has different populations and different initiatives,” said May, making it difficult to generalize why some states have higher obesity rates than others.
For example, health officials in Michigan — where 13.2 percent of low-income preschoolers were obese in 2011 compared to 13.9 percent in 2008 — credit the slight improvement, in part, to a national intervention called the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC). Since 2009, the program has reached nearly 100 child care centers serving low-income families in Michigan and more than 7,000 preschoolers in the state.
“Child care centers are an ideal place to work on obesity prevention efforts,” says Lonias Gilmore, a public health consultant with the Michigan Department of Community Health. These young children “receive most of their nutrition and opportunities for physical activity in these settings.”
The program has led to increased physical activity, a reduction in salty and sweet snacks, and greater availability of water and lower fat milk at centers. Michigan officials hope to expand the program state-wide.
Nationally, one in eight preschoolers, regardless of income, are obese, according to government statistics. That breaks down to one in five black preschoolers, one in six Hispanic preschoolers, and one in 11 non-Hispanic white preschoolers.
To bring those rates down, the CDC recommends that doctors routinely measure children’s body mass index and counsel parents about physical activity and nutrition. Parents are advised to serve nutritious foods, make water easily available, and limit TV time. And the agency calls on state and local governments to help local schools open gyms, playgrounds and sports fields during non-school hours, to provide access to free drinking water in parks, child care centers and schools, and to make it easier for families to buy healthy, affordable foods.
“Every community can work to make the healthy choice the easy choice so that our nation’s children grow up and thrive,” according to Frieden in an online video.
Aug. 12, 2013, U.S. News & World Report
By Kathleen Doheny
While some behaviors increase the risk of obesity for both boys and girls, new research shows there are gender differences.
For instance, although being on a sports team reduced the risk of obesity for middle school-aged boys, it did not for girls, said study author Dr. Elizabeth Jackson, an assistant professor of medicine at the University of Michigan School of Medicine.
On the other hand, "Girls who drank milk seemed to have more protection [against obesity]," she said.
Meanwhile, certain behaviors raised the risk of obesity for both boys and girls, the study found. Eating school lunch regularly increased the risk of obesity by 29 percent for boys and 27 percent for girls. Watching two or more hours of television a day boosted the odds of obesity by 19 percent for both genders.
The study, which found links but not cause and effect, is published online Aug. 12 and in the September print issue of Pediatrics.
Childhood obesity is a major public health concern. During the past 30 years, obesity has increased dramatically among children and teens. Among middle-school children, for instance, nearly 20 percent were obese, according to a 2010 report.
Earlier this month, a new report from the Centers for Disease Control and Prevention held a glimmer of hope: Obesity rates among low-income preschoolers had dropped slightly in at least 19 states. However, there is still a long way to go, experts agreed.
In the new study, Jackson looked at data obtained from more than 1,700 sixth-grade students from 20 schools in Michigan between 2004 and 2011. The researchers had information on body mass index (a measure of body fat), blood pressure, cholesterol, blood sugar and other measures of health, along with habits such as TV viewing. More than 37 percent of boys and about 31 percent of girls were overweight or obese.
The obese boys and girls had lower HDL ("good") cholesterol, higher blood pressure, and other indicators of heart disease risk than the normal or underweight students.
When Jackson looked at the habits, she found the "predictors" of obesity.
Sports-team activity reduced the risk of obesity in boys by 23 percent. Milk drinking reduced the risk of obesity in girls by 19 percent. Jackson said it's possible that those who drank milk may be less likely to drink sugary beverages, which are linked with weight gain.
The link between TV viewing and weight issues is well known. The risk of obesity linked with eating school lunches regularly, she said, may be related to the fact that children who often eat school lunches (sometimes subsidized) may be from lower-income families, and lower socioeconomic status has been linked with a higher likelihood of obesity.
Jackson said sports may not have shown up as a risk-reduction behavior for girls because they may have underreported. For instance, they may not have considered dancing or cheerleading as sports activities.
"There are no big surprises really in the major findings, all have been previously reported," said Michael Goran, a professor of preventive medicine and director of the Childhood Obesity Research Center at the University of Southern California Keck School of Medicine. He reviewed the findings.
Strategies to reduce the risk of obesity vary by age, Goran said. For middle-school children, he suggests that parents reduce the intake of sugary beverages, set limits on television and other media time, limit desserts and other treats. "Establish patterns as early as possible for healthy eating and active living," he said.
"Shop, cook, and eat together and include children in the decisions and planning around meals, treats, and activity," he said.
To that, study author Jackson added that schools and parents could also encourage girls to participate more in sports.
Aug. 2, 2013, HealthyDay
As the obesity epidemic continues among young and old alike, a new report finds the United States lagging behind other countries in evaluating and selecting the best programs and policies to curb the problem.
Investment in the issue "is too sporadic, presenting serious barriers to understanding the impact of interventions and the need for future investments," according to a news release from the Institute of Medicine (IOM), which advises the federal government on health issues.
The report also said current national monitoring of these programs and policies lack adequate leadership, coordination, infrastructure, guidance, accountability, and capacity.
One expert said the report is welcome because obesity rates continue to rise.
"During the past 20 years, there has been a dramatic increase in obesity in the United States, making the United States the number one country with the highest incidence of obesity worldwide," said Dr. Alan Saber, director of bariatric and metabolic surgery at the Brooklyn Hospital Center in New York City.
"More than one-third of U.S. adults and approximately 17 percent (or 12.5 million) of children and adolescents aged 2 to 19 years are obese," Saber said.
But the IOM said local communities lack the necessary resources to evaluate the scope of obesity problems or develop and monitor obesity-prevention efforts.
One expert said funding is a priority.
"This report is most important," said Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City. "Sadly, it will find that current efforts are not working, especially in economic-challenged areas."
For obesity-prevention programs to have an impact, "more funding and tough choices will need to occur," Roslin said.
The alternative — letting the obesity epidemic continue — could cost the nation billions, Saber said.
"In addition to the medical, psychological, and social effect of obesity, the economic impact of obesity is tremendous," he said. "According to the Centers for Disease Control and Prevention report in 2008, medical costs associated with obesity were estimated at $147 billion and the medical costs for people who are obese were $1,429 higher than those of [people of] normal weight."
But the IOM report concluded that "more systematic and routine evaluations could help determine how well obesity-prevention programs and policies are being implemented and which interventions work best."
Saber said he agreed that specific plans — both nationally and locally — for evaluation of obesity-prevention efforts were necessary.
The IOM recommended the creation of an obesity task force to oversee and lead the implementation of any national anti-obesity plan and to provide support for the community plan.
The institute is an independent, nonprofit organization that provides unbiased advice to decision-makers and the public.
Aug. 9, 2013, Chicago Tribune
Overweight and obese children are more likely to be diagnosed with asthma, according to a new study — and when they do have the condition, it tends to be more severe than in normal weight youth.
Researchers found that heavier kids and teenagers with asthma had more emergency room visits for the condition and used more "rescue" medications.
"If parents are noticing that their overweight or obese child is having asthma-like symptoms, one thing to pay attention to, instead of just addressing the asthma, is to potentially address the child's weight," said Mary Helen Black, the study's lead author from Kaiser Permanente Southern California's department of research and evaluation.
For their study, she and her colleagues analyzed the electronic health records of 623,000 children aged 6 to 19 covered by Kaiser's health plan in 2007-2011. None of those children initially had asthma. Over an average of three years, just under 32,000 of them — about 5 percent — were diagnosed with the condition.
The researchers found that the more children weighed, the more likely they were to develop asthma. Compared to normal weight kids, those who were overweight but not obese were 16 percent more likely to be diagnosed with asthma, and the most obese were 37 percent more likely.
That was after taking into account children's age, gender, and race, the study team wrote this week in the American Journal of Epidemiology.
Among those who developed asthma, heavier kids and teens in the study also tended to have more complications than their slimmer peers. In the year after their diagnosis, for example, 106 out of every 1,000 extremely obese youth went to the ER for asthma, compared to 87 of every 1,000 normal weight kids with asthma. And obese children were more likely to have an asthma "exacerbation" (that is, worsening of their condition) and to need "rescue" medicines, called short-acting beta agonists, when their usual medicines weren't enough.
According to the Centers for Disease Control and Prevention, one in 11 U.S. children has asthma. In 2008, asthma caused 10.5 million missed school days.
Black said it's possible the body-wide inflammation seen in obesity may affect asthma risk and severity. Or, she added, the link between obesity and asthma could be due to the direct effect of extra weight on the airways.
"Especially those (children) who are extremely obese definitely have a more restricted capacity for air exchange and things like that," Black told Reuters Health.
"It's a little more difficult for them mechanically to breathe." If that's the case, Black said, "If an extremely obese child is able to get down into even the overweight range, they may have a much greater capacity for breathing normally."
Dr. Peter Michelson, a pediatrician who has studied obesity and asthma at St. Louis Children's Hospital, said a limitation of this and other studies is that it's not clear whether asthma was diagnosed with lung function tests.
Without those measures, he said, it's possible some kids were being treated for shortness of breath due to being obese and out of shape, and not true asthma.
"The results would be interesting, but I feel that it's incomplete because the characterization of how severe the asthma is really needs pulmonary function (measurements)," Michelson, who wasn't involved in the new research, told Reuters Health.
"We need more data specifically about lung function to characterize these patients more definitively and to see if asthma and obesity are as definitively linked as we think."
"Having an actual quantitative measure of lung function would be ideal," Black said.
But, she added, "I don't think there's gross misclassification going on here."
Dr. Carlos Camargo, an epidemiologist from the Harvard School of Public Health in Boston who has also studied this topic, said the new report "confirms observations from several prior studies."
Camargo told Reuters Health in an email that in order to learn how to improve asthma control in people with the condition, and to prevent asthma in the first place, the next step will be to conduct more reliable trials, in which people are randomly assigned to different therapies.
Aug. 12, 2013, Reuters
By Kerry Grens
Children who exercise at school don't make up for the extra effort by being less active at home, according to a new U.S. study that used accelerometers to track kids' activity levels.
"What this argues for is we should be increasing activity in schools," said Michael Long, the lead author of the new study and a post-doctoral research fellow at the Harvard School of Public Health in Boston.
The Centers for Disease Control and Prevention recommend that kids get at least one hour of physical exercise during the day, but less than a third of high school students meet that goal.
Physical education at schools has also taken a back seat in recent years to academic preparation.
In May, the Institute of Medicine urged education leaders to encourage physical activity in schools, recommending that younger kids get at least 30 minutes a day of exercise and older students at least 45 minutes a day.
Some previous research has suggested, however, that kids have a built-in "activitystat" that regulates the total amount of energy they expend...
That would imply that raising kids' activity levels at school will not raise their overall activity, just shift it to school hours, and will therefore do little to combat obesity and poor fitness.
For instance, Terence Wilkin, a professor at the University of Exeter in the United Kingdom, and his colleagues have found that kids who exercise a lot at school will exercise less at home, and kids who are relatively inactive at school will spend more time physically active outside of school.
His studies compared the activity levels of children at different schools.
To see whether the activitystat idea holds up for the same child on different days, Long and his colleagues analyzed data from a large U.S. survey on health and lifestyle.
As part of that study, children wore an accelerometer on their waists to measure the amount of time they spent moving around and also the intensity of their activity.
The 2,548 kids participating wore the monitor for about six days. On average each day, the younger kids, aged 6 to 11, spent 86 minutes moderately or vigorously active, and 37 of those minutes were at school, according to the results published in the American Journal of Preventive Medicine.
Kids aged 12 to 19 spent 41 minutes moderately or vigorously exercising, and 18 of those minutes occurred during the school day. Long's group found that for each extra minute that kids were exercising at school, they had slightly more than an extra minute of total exercise for the day.
In other words, they did not reduce vigorous activity outside of school to offset the "extra" minutes of exercise in school.
"We didn't find any evidence youth were compensating for higher levels of activity during school hours (with less) activity outside of the school period," Long told Reuters Health.
Wilkin does not think the new results invalidate the activitystat concept.
For one, Wilkin said, children don't necessarily compensate for the extra energy on the same day, and his evidence for compensation was seen over the course of a week.
He noted as well that the study did not take into account the season or the weather, and only examined time spent moderately or vigorously active, rather than total activity.
"However unpalatable and counter-intuitive, we believe that the experimental data is clear - an activitystat defends the physical activity of a child against more physical activity than is necessary for survival," Wilkin said in an email to Reuters Health.
While more experimental research is needed to confirm whether or not children compensate for exercising at school, there is little argument about the benefits of physical activity for kids.
Long said that it's important not only for their health, but it may also improve children's mood and their ability to concentrate. "But the question remains — how do you get children who do less to do more?" Wilkin said.
CHILDHOOD OBESITY NEWS
Aug. 21, 2013, HealthDay
By Alan Mozes
If their kids are frequently tardy, truant, or failing to turn in homework, parents of U.S. schoolchildren expect to be notified. And in some districts, they might be contacted about yet another chronic problem: obesity.
The "fat letter" is the latest weapon in the war on childhood obesity, and it is raising hackles in some regions, and winning followers in others.
"Obesity is an epidemic in our country, and one that is compromising the health and life expectancy of our children. We must embrace any way possible to raise awareness of these concerns and to bring down the stigmas associated with obesity so that our children may grow to lead healthy adult lives," said Michael Flaherty, a pediatric resident physician in the department of pediatrics at Baystate Medical Center in Springfield, Mass.
About 17 percent of U.S. teens and children are obese — three times the number in 1980, according to the Centers for Disease Control and Prevention. And one in three is considered overweight or obese. Being overweight or obese puts kids at risk of developing serious health problems, such as heart disease. Too much weight can also affect joints, breathing, sleep, mood, and energy levels, doctors say.
Massachusetts — which has had a weight screening program since 2009 — is one of 21 states that have implemented statutes or advisories mandating that public schools collect height, weight, and/or BMI (body mass index) information. Some states further require that parents receive confidential letters informing them of the results, advising that they discuss the findings with a health care provider.
But some parents in the Bay State and elsewhere consider such policies an unwelcome intrusion into private family matters. Other objectors say "fat letters," as they are sometimes called, have the potential to trigger bullying or eating disorders among the very children they're trying to help.
In Massachusetts, where parents are letter-informed of BMI results for students in grades one, four, seven, and 10, the state department of public health is currently debating a possible repeal of the letter portion of its screening protocol.
This would be a grave mistake, Flaherty believes. "The growing number of children and adolescents seen day in and day out in our clinics with hypertension, high cholesterol, diabetes, and musculoskeletal issues secondary to weight do not lie," he said. Flaherty, a clinical associate at the Tufts University School of Medicine, outlines his thoughts in a "perspective" piece published online Aug. 19 in Pediatrics.
While acknowledging that the effectiveness of such programs remains to be determined, Flaherty notes that school screenings are nothing new, with many states having done so for many years. And in 2005, the U.S. Preventive Services Task Force determined that calculating a child's BMI — a calculation of body fat based on height and weight — should be considered the "preferred measure" for tracking weight issues.
What's more, he suggests that parental fears that BMI assessments may accidently identify healthy muscular children as overweight is a misplaced concern over a relatively rare phenomenon.
"Additionally, no studies have shown any increased risk in bullying, eating disorders, or unhealthy dieting patterns," Flaherty noted. "While these risks exist, they have not been proven in states where these programs have existed for several years."
The very point is to have a "confidential way of mailing letters directly home to parents where these issues can be addressed in the privacy of the home without any other students being aware of other children's BMI," he said.
Other specialists are less enthusiastic about school BMI screenings.
Dr. David Dunkin, an assistant professor of pediatric gastroenterology at the Icahn School of Medicine at Mount Sinai in New York City, cautions that simply legislating parental notification of school screening results will not help curb the obesity crisis without comprehensive and well-designed follow-up.
"While I feel that the intention is good [to] raise awareness among parents about their children being obese, and thus instilling motivation for behavioral changes or lifestyle modifications, this is unlikely to have effects in and of itself," Dunkin said.
To bring about change, notifications should include referrals to programs that could help parents make lifestyle modifications for their children, he added.
But Dunkin would prefer to see weight issues addressed by a family's pediatrician.
"I think it is the primary responsibility of the pediatrician to discuss obesity on a case-by-case basis with the child and the family, and try to help them with life changes," he said. "As a pediatrician I often speak to the family about this, and can assist them with advice on what to do to improve their child's health."
While Flaherty agrees that pediatricians should measure a child's BMI at every child's well-care visit, he said these check-ups are only performed annually.
"Pediatricians have 15 to 20 minutes per year to deal not only with BMI, but a variety of other preventive health issues," Flaherty said. "The public school system is a universal organization that has been used as a forum to reach children and parents for a variety of other issues: vaccinations, dental exams, and hearing and vision screening."
Aug. 5, 2013, U.S. News & World Report
By Elizabeth Flock
In June, first lady Michelle Obama appeared in a hip-hop music video that featured rapper Doug E. Fresh, singer-songwriter Jordin Sparks, and TV medical personality Dr. Oz. The catchy song urged kids to "work hard/eat right" and "tell somebody/it's your body/c'mon." The song was just the first of a 19-track album, the majority of which are hip-hop, to be released by the Partnership for a Healthier America, the anti-obesity nonprofit that launched in conjunction with Michelle Obama's Let's Move! anti-obesity campaign, and a New York-based group called Hip Hop Public Health.
The full album, which includes songs with names like "Veggie Luv" by Monifah and J Rome, "Hip Hop LEAN" by Artie Green, and "Give Myself a Try" by Ryan Beatty, will be released on Sept. 30.
Let's Move! Executive Director and White House assistant chef Sam Kass says the White House is fully behind the initiative to use hip-hop – and other genres of music – as a tool to get kids to live healthier lives.
"Cultural leaders and visionaries in our country can give these messages to kids in a way that's not preachy. Kids are going to be dancing and listening to the music," he says. "I think hip-hop in particular – so many kids love hip-hop. It's such a core part of our culture...and particularly in the African-American community and the Latino community which is being disproportionately affected by those health issues."
African-American children are more than 50 percent more likely to be overweight or obese compared with white children, and Hispanic children are nearly 30 percent more likely, according to a 2008 study published in Journal of the American Board of Family Medicine.
If all goes according to plan, some 10 of the 19 songs on the new album will be made into music videos, much like the hip-hop video in which Michelle Obama appeared. Those music videos will then be distributed to schools across the nation – starting with 40 schools in New York City, and then to schools in San Antonio, Philadelphia, and Washington D.C. The hope is that teachers will use the videos during recess, physical education classes, or even passing periods to encourage kids to get moving.
Though the White House has only recently gotten behind using hip-hop to fight obesity, the initiative has been almost a decade in the making. Back in 2005, an academic neurologist at Columbia University in New York, Olajide Williams, started thinking and experimenting with how hip-hop music could be used to encourage his stroke patients to live healthier lives. His efforts seemed to work and so Williams, who has done extensive research on community-based behavioral interventions, founded Hip Hop Public Health to educate African-Americans and Latinos through hip-hop about the diseases plaguing their communities.
"We also started looking at the communities with obesity in New York, and a lot of these communities just happened to be poor communities, and happened to be African-American, Hispanic, Latino. We needed to develop an interventionary tool for the community," says Williams. "Hip-hop was born as a platform to bring our interventions to the youth."
By 2011, Kass, the White House chef, had noticed the program, and by 2012, Hip Hop Public Health was working with the Partnership for a Healthier America on the anti-obesity album.
If Thurgood Marshall Lower School in Harlem is any indication, making hip-hop part of the school day could put a dent in the obesity epidemic. In 2010, obesity was affecting more than one third of children and adolescents, according to the Centers for Disease Control and Prevention.
Dawn Decosta, principal of the elementary school, says before partnering with Hip Hop Public Health, the school relied on just one aide to encourage the kids to get moving at recess time. When the weather was bad, the kids often didn't move at all.
Today, it's a very different story, with half of the school's cafeteria transformed into a space for physical activity, a student advisory board that meets weekly to talk about making the school more healthy, and a recess that involves dancing to hip-hop music – rain or shine.
"We probably don't have one family [in the school] that doesn't have a member touched by diabetes or obesity," Decosta says. "But now, if the weather is good, bad or whatever, we have physical activity every day. We have conversations about what to eat. And we have kids walking around with pedometers, and they want to have more activity, because they want to be recognized as having more steps."
Aug. 18, 2013, Clarion Ledger
By Jasmine Aguilera and Deborah Barfield Berry
Two years ago, the Hattiesburg School District removed deep fryers from its schools, eliminating fried foods from the lunch menu.
“We wanted to offer our students healthier meal options at school,” said Jas N. Smith, a spokesman for the school district. “Schools kind of have a unique situation. We have, for lack of a better word, a captive audience.”
It was one of many efforts by school districts across the state to offer students healthier lunches.
Today, more than 80 percent of Mississippi school districts are meeting federal regulations for serving healthy lunches to students, according to the U.S. Department of Agriculture (USDA).
Regulations issued under the Healthy, Hunger-Free Kids Act of 2010 require schools to increase portions of fruits and vegetables and limit meat and grains per age group. Fat-free milk must be served, and the regulations bar trans fats.
In Mississippi, 83.4 percent of school districts meet the regulations, according to March data. The state has received $2.8 million from USDA based on a formula that sends states $0.06 cents per lunch for school districts in compliance.
“We took charge by starting regional training sessions,” said Scott Clements, director of healthy schools and child nutrition at the Mississippi Department of Education. “We made it a priority to make sure they had what they needed.”
As of March, Mississippi’s compliance with the regulations ranked the state number two behind South Carolina, where 92.6 percent of school districts meet the standards.
State agriculture officials in Florida said 100 percent of schools there had met the regulations as of July 22. Federal agriculture officials didn’t know how many other states may have attained 100 percent since March.
“The schools have realized that we have an obligation to our students to try to educate them about healthy eating, about healthy choices,” Smith said. “... And they are taking it seriously and they’re following through on it.”
Clements credits the Healthy Students Act that Mississippi enacted in 2007 with helping the state meet the regulations at a faster rate than most states. The act gave school districts a head start transitioning to healthier menus, but Clements said the process hasn’t been easy.
“The reason Mississippi is only at 82 percent instead of 100 is because school districts are very small, which makes it harder to manage,” Clements said. “There are also shelters, juvenile detention facilities, and some private schools that participate in the school lunch program. Those have a more difficult time meeting federal standards.”
Mary Hill, executive director of Jackson Public Schools Food Services, said officials have made several changes, including offering students fruits and vegetables as snacks throughout the day. “I think we have caused them to think a little more about what they are eating,” she said.
Hattiesburg school officials have implemented district-wide changes, including removing some vending machines. In some schools, beverages such as soda have been replaced with water, sports drinks, and juice. The district also changed the way meals are prepared, checks menu items for calorie counts and offers more fruits and fresh vegetables.
In some schools, deep fryers have been replaced with a combi oven — a combination convection oven and steamer.
“We had a good response,” Smith said. “Students were able to get the familiar texture of (fried) foods, which is big for students especially younger kids . . . without all of the bad side ramifications.”
The efforts come at a price. The combi ovens are so expensive the district has only put them in a few schools so far, Smith said. “It’s a slow process, that’s why we don’t have a combi oven in every school, but we are working on it.”
Districts are relying on grants from the USDA and other federal aid to help implement changes.
Officials at Jackson Public Schools were unable to provide a dollar amount for how much the district has been reimbursed, but Hill said the money will be used to continue providing more nutrition options. Data from the Centers for Disease Control and Prevention show almost 40 percent of children ages 10 to 17 are overweight in Mississippi, a problem Clements said the state is trying to solve through the Healthy Students Act and the Healthy, Hunger-Free Kids Act.
The national rate is 31 percent, according to the Kaiser Family Foundation, a national research group. Mississippi and Louisiana have the highest rates in the country, data show.
“That’s always in the back of our mind,” Smith said. “We’re fighting kind of an uphill battle.”
Earlier this year, first lady Michelle Obama visited Mississippi to tout its successful efforts to reduce childhood obesity. Obama teamed with celebrity chef Rachael Ray in Clinton to talk about the importance of serving nutritious foods in school.