Supersized Kids

The skinny on childhood health, school nutrition and a growing population of … Supersized Kids

Fact  Centers for Disease Control and Prevention statistics show that the percentage of overweight children 6 to 11 years old more than doubled between 1980 and 2004, from 7 to 19 percent. Among their adolescent and teenaged siblings, the rate more than tripled, jumping from 5 to 17 percent. The obesity rates for those age groups are 11 and 14 percent respectively, double what they were thirty years ago.

Fact  Weight problems are known major risk factors for chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension and some cancers.

Fact  If the current epidemic of child and adolescent obesity continues unchecked, U.S. life expectancy could be shortened by two to five years in the coming decades, according to a special report in the New England Journal of Medicine last year. This would represent a reversal of the upward trend that has held for the last two centuries.

While “Supersize me!” has become a mantra among young and old alike, physical education requirements in our schools are increasingly sacrificed on the altar of No Child Left Behind. The result is a generation of supersized kids who, without intervention, will become the supersized adults of tomorrow. What can be done to turn the tide, to balance the “calories in, calories out” equation? The good news is that the first steps have already been taken.

As children return to class in Connecticut this fall, they’ll find the fizz is gone from school vending machines, banished by legislation signed by Governor Jodi Rell over the summer. Goodbye soda; hello milk, water and 100 percent fruit or vegetable juices.

Similar legislation with the lofty title Child Nutrition Promotion and School Lunch Protection Act awaits action in Congress. The House’s version is cosponsored by Representative Christopher Shays of Connecticut, who promises it will “make sure children have access to nutritious snacks on the school grounds and throughout the school day, not just in the cafeteria.”

And last May America’s largest beverage distributors agreed to halt nearly all soda sales to public schools by 2010 in a deal brokered by former President Bill Clinton, whose lifelong love affair with “heart attack on a plate” fare ended with a well-publicized near-death experience.

Still, it will be a scramble to stay ahead of the statistical curve, according to one of the authors of the 2005 longevity analysis reported in the New England Journal of Medicine. “The tsunami of childhood obesity has not yet hit the shore,” declares David Ludwig of Children’s Hospital Boston.

He predicts it will take years for the full impact to be felt. “If the clock starts ticking at age twelve or fourteen, the consequences to public health are potentially disastrous,” he warns. “Imagine heart attack or kidney failure becoming a relatively common condition of young adulthood.”

Ludwig attributes much of the epidemic to environmental factors, pointing to junk food’s rise to prominence in the national diet over the past four decades. Food advertising aimed at children has ballooned out of control — along with portion sizes — and lucrative contracts with the food and beverage industry have greased the skids for schools to become purveyors of less-than-healthy wares.

As is so often the case, parental complacency also plays a role. It’s a scenario Dr. George Tsimoyianis of Darien Pediatric Associates has dealt with throughout his twenty years in pediatric and adolescent medicine. “We live in a sophisticated, well-educated community, and that’s why I’m still surprised by the type of eating habits that I see in young kids,” he says. “When parents say, ‘The only thing they’ll eat is macaroni and cheese, so I give it to them,’ I tell them that’s not really a good idea. I’d rather that they let their kids get a little hungry and then give them two or three healthy choices.”

Given the premium placed on sports in communities such as Darien, New Canaan and Rowayton, Dr. T (as he’s known to his patients) thinks that the kids in this area may have an advantage over their peers in other parts of the country. But he’s still seeing more overweight kids now than he did at the beginning of his practice. Besides food issues, he zeroes in on inactivity as a major culprit.

“Between TV, computers and video games, kids are not as social today,” he observes. “They’re not going outside to play, and there are more situations where they’re on their own for a few hours. They have free access to the kitchen cabinets, and a lot of kids eat without realizing they’re eating. Parents want to be nice, so they don’t want to say no.”
As a result he’s screening more and more teens for metabolic syndrome, which increases their risk of coronary heart disease and adult onset diabetes. And he’s had to put patients with abnormal blood sugars on oral medication to stave off full-blown diabetes.

“With children and teenagers, you have to look at being overweight as a chronic condition, as opposed to a disease,” he says, adding that next to smoking, it’s the issue that most decreases life expectancy. “It’s not something you can take a medication for and it’s gone in a month or so. You need to create lifelong healthy habits.”

After home, the next logical place to focus attention is school, that bastion of the “whole child” that tends to academic and recreational needs. Or perhaps not, according to Jean Mee, health and physical education consultant to Connecticut’s Department of Education. “With the pressure to produce improved standardized test scores for both state and No Child Left Behind mandates, there is more time being spent by children in their seats in school,” she says.

Dr. Mee notes that standards set by the National Association for Health, Physical Education, Recreation and Dance call for 150 minutes weekly of PE for elementary students and 225 minutes for those at the secondary level, and at least 60 minutes of physical activity daily for all people. “The latest reports from the school districts in the state indicate that not a single district meets this standard — not even nearly,” she reports.

Compounding the situation under Connecticut education law, “less than one credit in physical education is required for high school graduation,” a small fraction of what is required in the academic subjects. The final decision as to exactly how many PE credits students need to rack up over their high school careers is left to the local districts.

“Something is wrong with our focus,” maintains Dr. Mee, a thirty-year veteran in the field. In the absence of mandates and laws, she adds, districts are free to develop their own priorities. “Sometimes they’re not the ones that we think are good for the bottom line, and that is the kids,” she says.

She relates how she often receives phone calls from district administrators, usually around the time they’re looking at their budget and staffing for the next year, asking how many PE credits are actually required. “I answer, ‘I’m going to tell you the facts, but first I want to tell you that I have a feeling that you’re asking me this because you want to cut.’” They always reply yes.

Dr. Mee buttresses her argument that the three R’s and physical activity are not mutually exclusive by citing Finland, a country with one of the lowest obesity rates in Europe. “It has a national education policy that every forty-five minutes classroom teachers must have their kids get out of their seats and move around,” she explains. “Perhaps not coincidentally, they have the highest reading literacy scores in the world.”

Meanwhile school districts across this country are finally being forced to address the situation. The Child Nutrition and Women, Infants and Children Reauthorization Act of 2004 requires that all schools that participate in the Department of Agriculture’s Child Nutrition Program (which provides free or reduced price breakfasts and lunches) establish a local wellness policy by the first day of the 2006–2007 school year.

While New Canaan Public Schools (NCPS) does not participate in the program, the district has chosen to comply with both the legislation and USDA nutrition guidelines. Last fall Superintendent of Schools David Abbey formed an ad hoc committee of school personnel, parents and community health experts to study the district’s food services program, with particular attention paid to student nutrition.

“Our role as a school district is to educate,” says Michael Lagas, NCPS business manager and cochairman of the Wellness Committee. “We began with the objective of studying what was served in the food service department. Our recommendations evolved more into what’s a healthy lifestyle, and what are some of the things we could do to advocate that.”

Among their suggestions: Eliminate food choices of questionable nutritional value; offer healthier choices in New Canaan High School and Saxe Middle School vending machines; publish nutritional content information; schedule recess before lunch; and offer a lunchtime walking program for students, an idea that was tested at East School last year.

In its report to the board of education in February, the committee noted that a student who buys a school lunch every day for the entire academic year eats 17 percent of his or her meals on the district’s premises. The goal, therefore, is to make those meals as nutritious as possible, says Bruce Gluck, a former chef who has been director of the food service program for the New Canaan schools for the last dozen years.

During his early years on the job, he observed that children filled up on snack foods first and then dumped the rest of their lunch in the garbage can in a mad dash to recess. Gluck reached his breaking point a few years ago, driven there by his own dismay and parental complaints about the availability of junk food in the cafeteria.

Virtually overnight, potato chips, ice cream, cookies and the like disappeared. “I wish I could tell you that it was nobility, and partially it was because, quite frankly, it turns my stomach to sell anything I wouldn’t give my own children,” he says of his decision.

What he didn’t anticipate, however, was the backlash that his action generated, ranging from newspaper stories to angry letters and phone calls. “How dare you take snacks away from my children! That’s what they look forward to!” says Gluck, recalling some of those calls. “Our response was, ‘Look, we’re not saying you can’t send snacks to school with your children, but you need to be the one who makes that choice.’”

Since the purge, Gluck has kept careful tray counts and reports that wasted food in the lunchrooms has been reduced by 73 percent. And he has started tailoring the menus at the elementary level to the health curriculum. “If they’re discussing low-fat foods or carbohydrates in class, I want to be able to say, ‘This was your health lesson today and this fits into that lesson,” he explains.

At the high school, students savor fresh mozzarella, pasta and bread made on site, and regular menu items such as grilled salmon, chicken Caesar salad and made-to-order fajitas. Gluck knows that since it’s an open campus and students are free to leave for lunch, there’s stiff competition out there.

“We weren’t sure how well we were doing until I started getting calls from the delis in town to see if we wanted to buy sandwiches from them because they weren’t seeing the kids as much,” he reports happily. “It turns out that most of the students are staying at school.”

The changes that Gluck introduced get two thumbs up from Gitte Toft-Nielsen and Lise Reddin, moms who served with him on the Wellness Committee. The women share a fresh perspective on the school lunch issue since they were both raised in Denmark under very different circumstances than they find in their adopted country.

“My school’s cafeteria sold only a small sandwich, some whole-grain bread or chocolate milk, fruit and raisins. Never a chocolate bar, never ice cream or cookies,” recalls Gitte, who adds that she and the vast majority of her classmates packed their lunches. The food pyramid was displayed in every classroom, and from elementary school on, there were weekly cooking lessons that covered nutrition and food-prep basics.

“What astonishes me here is when I go to the school at lunchtime and see children with two packets of Oreos, a fruit roll-up, prepacked cheese-dip lunches, chips and Gatorade in their lunch bags,” she says. “That’s not a homemade lunch — that’s a home-packed lunch.”

Lise remembers her childhood lunchtimes as being more relaxed than what her two children experience at school today. “The kids spend most of their time standing in line and they don’t have time to eat,” she notes of the twenty-minute lunch break. “Then they run out for recess, and when they come back inside they’re starving. They have no energy, and no food in their system for the rest of the afternoon.”

Both women applaud the banishment of snack foods from the cafeteria. “How can we expect young children to make healthy choices if their choice is buying a chocolate cookie or an apple?” asks Gitte. “They’re going to go for the cookie, even if we educate them, because they’re children. So of course these things have to go away. They shouldn’t be an option.”

Experts agree that even if diet and exercise are addressed and modified, supersized kids are going to be around for a while. There’s no quick fix for a crisis that has been simmering for decades. It’s clear that the long-term resolution lies in a concerted effort by parents, schools and the community at large.

Dr. Tsimoyianis offers several simple suggestions. He urges families to carve time out of their hectic lifestyle to eat together as often as possible. “Studies show things are better nutritionally, emotionally and psychologically when parents have dinner with their kids every night,” he says. When it comes to promoting physical activity, he suggests  making a deal: a half-hour of activity for every hour children are in front of the TV or online.

Following the Finnish model, Dr. Mee promotes incorporating movement throughout the day because it’s been proven to sharpen thinking. And she envisions school fitness programs that offer instruction in both individual and team sports, noting that surveys of adults reveal that only a small percentage ever engage in a team sport after high school.

Finally, she applauds the USDA’s wellness policy mandate for forcing the conversation. “It’s causing school districts and communities to talk about what’s healthy, what’s physical activity and overall wellness for everyone,” she says. “What’s going to benefit the kids of today so that they become healthy, well-adjusted and successful adults of the future.”

Overweight vs. Obese
The terms overweight and obese are not interchangeable. Clinically, “overweight” means an individual weighs more than is recommended for his or her height. “Obese” is an excess of body fat, generally defined as 20 percent over the recommended weight for height.

Body Mass Index (BMI) is a reliable indicator of body fatness for most children and teens. It is calculated from a child’s weight and height and is age- and gender-specific. A BMI calculator for children and teens ages two through nineteen is available online at cdc.gov.

Children are considered overweight if their BMI is above the 95th percentile for their age; a BMI above the 85th percentile puts them at risk of becoming overweight. A pediatrician or health-care provider should be consulted for a diagnosis.
Source: Centers for Disease Control and Prevention

The Campaign Trail
A new crop of programs and initiatives are aiming to educate children on health and nutrition. Here are a few that you can tap into locally. Healthyville
Stepping Stones Museum for Children’s interactive traveling exhibit that opens in November is part of a $2 million, statewide health initiative called “Healthy Children, Healthy Communities.”

Based on the premise that early intervention and prevention are critical for establishing a healthy lifestyle, the project uses landmarks familiar to children to get across fun-filled lessons about the human body and health-related messages on nutrition, fitness, hygiene and safety.

Explore the intricate functions of the Main Brain, or check out local TV station WBOD and report “live” from inside the heart. Hungry? Check out the Good Foods Market & Café to learn how to make smart choices about what you put in your mouth.
Stepping Stones Museum for Children, Norwalk, steppingstonesmuseum.org; 899-0606

No Child Left Inside
Launched last spring by the Connecticut Department of Environmental Protection at Dinosaur State Park in Rocky Hill, the campaign promises to “unplug” kids from their TV, CDs and video games and reconnect them with the great outdoors. With 137 state parks and forests to explore and enjoy, the theory is there’s something for everyone, and then some.
No Child Left Inside, nochildleftinside.org 
 
Stir It Up!
This is a grassroots campaign across the United States that rallies parents to improve their children’s nutrition and wellness in school, at home and in their communities. It encourages them to put pressure on Congress, state legislatures and school administrators to get junk food out of and more physical activity into schools while incorporating healthy choices into their own families’ lives.

Stir It Up! was founded by Parents’ Action for Children, a nonpolitical organization dedicated to advancing the interests of children and families.
Stir it Up!; stiritupamerica.com.

Walking Bus
Live within walking distance of your child’s school? The Walking Bus, as described by its sponsor, Kia Motors, is “just like a normal bus, but on foot.” It takes the same route to school every day and picks up kids along the way — it even has adult volunteers who act as a “driver” up front and a “conductor” in the rear.

For kids, the Walking Bus means a shot at exercise and fresh air before their school day starts; for parents, it offers peace of mind, knowing that their youngsters will arrive at their destination safely and on time.
Walking Bus, walkingbus.org.

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