A Heavy Toll

Childhood obesity is as widespread as it is preventable.

The statistics make it clear that there will be no quick fixes: One in three U.S. kids is overweight or obese. The rates have tripled since 1980, when studies looked at the prevalence of obesity in children ages 6-17. And related medical conditions—from high blood pressure and asthma to cancer and diabetes—have been steadily rising. The medical community has long known of these adverse effects—in adults, not children.

Once a disease found only in adults, Type 2 diabetes was the focus of a National Institutes of Health study that was a prime motivator behind First Lady Michelle Obama’s “Let’s Move!” anti-childhood obesity campaign. Published in the New England Journal of Medicine, the research involved 6,000 middle-school students selected from 42 randomly assigned schools, six of them in the Philadelphia area.

“The rationale is pretty straightforward,” says Gary Foster, the internationally known obesity researcher based at Temple University who led the study. “If you want to make a difference with kids, you have to go where most are—and that’s in school.”

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The study looked only at middle schools serving low-income, black and Hispanic communities—a segment especially at risk for Type 2 diabetes and most likely to be accustomed to federally subsidized meal programs. Even so, the results have broad implications, says Foster, director of Temple’s Center for Obesity Research and Education.

Many of the study’s key intervention tactics are also part of the White House campaign. They include changes to school menus that include more foods high in fiber and low in fat, plus more fruits and vegetables. Students at the intervention schools also had access to water or low-fat milk instead of soda.

During a three-year period, the study showed a significant reduction in students’ body fat or body mass index. Gym classes were also revamped to intensify workouts, and other healthy food choices were added in vending machines and on food carts at after-school events.

Perhaps the most important revelation of the study is the generational aspect—that if a child is overweight by the age of 8, he or she is more likely to be overweight or obese as an adult.

From the start of the study, students and their parents—in both intervention and control schools—took part in educational programs that promoted long-term healthy behaviors. That might explain why even the control schools, where healthy programs were not in place, saw nearly the same 4-percent reduction in what’s called the primary outcome: the combined prevalence of overweight and obese students. The secondary outcome was the improvement in students’ BMI, plus glucose and insulin levels, in the intervention schools.

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Foster says the school environment was an important aspect of the study. “The last thing we wanted to do was to say to kids, ‘You’re overweight. You’ve got to do this.’ With the whole school taking part, we were not singling out kids.”

It’s no accident that the First Lady’s campaign is called “Let’s Move!” Nationwide, school and online surveys conducted by the Centers for Disease Control and Prevention show that the average teen (ages 13-18) spends three or more hours a day parked in front of some sort of screen. “Let’s Move!” addresses the need to get more children physically active by targeting “built” environmental buffers like safe neighborhoods and parks.

Foster’s study examined the subtle ways in which gym class could actually hamper activity. It found benefits in breaking down classes of 30-40 students into smaller, more manageable units, with pairs taking part in activities like playing catch or exercise stations. “Things like having an active roll call, so you don’t have kids sitting out for 15 minutes while you’re taking attendance,” says Foster.

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Central to the “Let’s Move!” campaign is putting what we’ve long known about exercise and diet within easy reach for every American. Under the plan, no fewer than 12 federal agencies are involved in making changes on the state and county levels. And while it’s been described as a sweeping initiative, with the ambitious goal of eliminating childhood obesity within a generation, “Let’s Move!” is only a year in the making and relies heavily on continuing input and real-life recommendations from the public. Its “Call to Action” campaign includes public service announcements and a presence on Facebook and other social networking sites.

On the school-menu front, a recent report from the Institute of Medicine has uncovered a disturbing disconnect between the research community and the public. Public schools are still following the USDA’s 1995 dietary guidelines and its 1989 recommended dietary allowances.

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“Since the school meal programs were last updated, we’ve gained greater understanding of children’s nutritional needs and the dietary factors that contribute to obesity, heart disease and other chronic health problems,” says the report’s chair, Virginia A. Stallings, an expert in pediatric nutrition at the Children’s Hospital of Philadelphia. “The changes are needed to assure parents that schools are providing healthful, satisfying meals.”

In addition to bringing school meals in line with the latest dietary guidelines, the White House wants to give kids no choice but to eat healthy. In some cases, that means outright substitutions like replacing refined grain products with those rich in whole grains, or going with 1 percent or nonfat milk.

Perhaps the biggest change—especially in schools offering free or federally subsidized meals—is the focus on specific requirements rather than general guidelines. For the first time ever, school lunches will have minimum and maximum calorie levels, plus increased protein, vitamins and minerals, and lower levels of sodium, sugar and fat.

For now, only a handful of area school districts have acknowledged “Let’s Move!” initiatives. Radnor provided a link on one of its websites to encourage participation in the First Lady’s kids’ poll. Several local schools will participate in the White House’s “Chefs Move to Schools” program, including institutions in Elkins Park, Ridley Park and Overbrook. And Great Valley School District, East Caln Elementary School and Downingtown West High School have expressed interest in the visiting-chef program.

To learn more, visit letsmove.gov.

5 Components to “Let’s Move!”

1) All children deserve a healthy start early in life.
To be addressed in prenatal care, breastfeeding programs and the development of quality daycare.

2) Parents and caregivers need a clear action plan. New requirements on food labels and menus are a start. Other options include new rules on marketing unhealthy food to children and requirements like body mass index measurements for all kids.

3) All students should have access to healthy food in schools. Includes upgrading the nutritional value of school lunches, plus food found in vending machines and served in breakfast and after-school programs.

4) Accessibility to healthy and affordable foods is an American right. Eliminating “food deserts” in urban and rural regions is just the beginning.

5) Staying physically active should be easy.
Recess and gym are only part of it. Major changes are needed in areas that lack public parks and in unsafe neighborhoods that discourage walking or biking.

6 Ways to Begin a Healthy-Living Action Plan

• Talk to your family doctor if you suspect your teen is crash dieting or your child is overweight.

• Read up on new guidelines—like the recent announcement made by the American Academy of Pediatrics that will make body mass index tests available to young patients.

• Visit the “Let’s Move!” website for the interactive family “contract” that will help you set goals and track your success.

• Get your community involved by researching the USDA’s first-ever Food Atlas, an interactive database that maps components of healthy food environments down to the local level across the country.

• Visit mypyramid.gov and put the latest dietary guidelines into practice.

• Attend a public hearing or start a letter campaign targeting the food industry’s labeling practices. Instructions for doing so can be found at fda.gov.

Our Best of the Main Line & Western Suburbs Party is July 25!