October 2012

SPOTLIGHT

PUBLICATIONS & TOOLS

CHILDHOOD OBESITY RESEARCH & NEWS

Spotlight

Study: Older, heavier kids take in less calories

Sept. 10, 2012, MedPage Today

By Michael Smith

Despite stereotypes, overweight, and obese children older than age 9 actually consume fewer calories than their peers who have a healthy weight, researchers found.

But the reverse is true in younger children, according to Asheley Skinner, Ph.D., and colleagues at the University of North Carolina School of Medicine in Chapel Hill. The findings suggest that approaches to overcoming childhood obesity should vary depending on age, Skinner and colleagues wrote online in Pediatrics .

The findings come from an analysis of 19,125 children, ages 1 to 17, who took part in the National Health and Nutrition Examination Surveys from 2001 to 2008, Skinner and colleagues reported. They suggest that once a child has become obese or overweight, he or she actually needs fewer calories to maintain the weight, Skinner said in a statement, so that trying to cut down on their food intake is unlikely to be beneficial.

“It makes sense for early childhood interventions to focus specifically on caloric intake,” he said, “while for those in later childhood or adolescence the focus should instead be on increasing physical activity, since overweight children tend to be less active.” While cutting calories would work eventually, older children with a weight problem “would actually have to eat much less than their peers, which can be a very difficult prospect for children and, especially, adolescents,” Skinner added.

The researchers initially hypothesized that obese and overweight children of all ages would overeat, compared with their healthy weight peers, and were interested in pinpointing variations by age and sex. They used the measured heights and weights of the survey participants to categorize their weight status as weight-for-length percentiles for those under age 2 or body mass index (BMI) percentile for those ages 2 to 17.

The participants or their parents, depending on age, reported dietary intake in computer-assisted interviews. Overall, the researchers found, 15.4 percent of the participants were either obese or very obese, 14.9 percent were overweight, 66.3 percent had a normal healthy weight, and 3.4 percent were underweight. As expected, analysis showed that for girls younger than 9 and boys younger than 12, the obese and overweight took in more calories than those with a healthy weight, although the trends were for the most part non-significant.

But surprisingly, that pattern flipped in the older groups. Specifically, obese and overweight girls, ages 9 to 11 (P=0.045), ages 12 to 14 (P=0.003), and ages 15 to 17 (P<0.0001), ate less than their healthy peers and the trends were significant.

Obese and overweight boys, ages 12 to 14 (P=0.004) and ages 15 to 17 (P<0.0001), ate less than their healthy peers and again the trends were significant.

“For many children, obesity may begin by eating more in early childhood,” Skinner said. “Then as they get older, they continue to be obese without eating any more than their healthy weight peers.” The researchers cautioned that dietary intake used in the study was self-reported, either by children or by a proxy, which could introduce bias. But the automated multiple pass method that was employed has been repeatedly validated as a tool to collect dietary intake data in a way suitable for large surveys, they noted.

Also, the study utilized cross-sectional data, which says little about energy intake patterns and obesity within an individual child.

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Original source: http://www.medpagetoday.com/Pediatrics/Obesity/34655/

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Publications & Tools

New report finds adult obesity rates could exceed 60 percent in 13 states by 2030

The number of obese adults, along with related disease rates and health care costs, are on course to increase dramatically in every state in the country over the next 20 years, according to F as in Fat: How Obesity Threatens America’s Future 2012, a new report from the Robert Wood Johnson Foundation and Trust for America’s Health.

For the first time, the annual report forecasts adult obesity rates in each state by 2030 and the likely resulting rise in obesity-related disease rates and health care costs. It also shows that states could prevent obesity-related diseases and dramatically reduce health care costs if they reduced the average body mass index (BMI) of their residents by just 5 percent by 2030.

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Implementing childhood obesity policy in a new educational environment: The cases of Mississippi and Tennessee

A new case study published in the July issue of the American Journal of Public Health found policies designed to address health and social problems in high-school settings face significant barriers to effective implementation. The study investigated the processes involved in, and outcomes of, implementing three new state-level, school-oriented childhood obesity policies enacted between 2004 and 2007. Researchers followed policy implementation in eight high schools in Mississippi and Tennessee. They found significant barriers to the effective implementation of obesity-related policies. These most notably include a value system that prioritizes performances in standardized tests over physical education (PE) and a varsity sport system that negatively influences opportunities for PE. These and other factors, such as resource constraints and the overloading of school administrators with new policies, mitigate against the implementation of policies designed to promote improvements in student health through PE.

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Declining childhood obesity rates — where are we seeing the most progress?

This research brief from the Robert Wood Johnson Foundation summarizes the declines in childhood obesity rates in Philadelphia and recent declines in New York City, Mississippi, and California. The brief notes that the places reporting declines are those that are taking comprehensive action to address the childhood obesity epidemic.

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Childhood Obesity Research & News

Soda purge in schools is largely successful, but obesity remains

Sept. 6, 2012, Newsday

By Kyle Nagel

Beverage companies decreased drink calories offered in schools by 90 percent between 2004 and 2010, according to a recent study, a strategy industry and school officials said was meant to help the country’s fight against childhood obesity.

The report comes six years after the country’s major soft drink companies partnered with the William J. Clinton Foundation and the American Heart Association in agreeing to lower beverage calories available in schools.

Nationally, full-calorie drinks available in schools dropped from about 8.2 billion ounces in 2004 to 294 million ounces in 2010, according to the American Journal of Public Health. The decrease of about 97 percent significantly limits students’ access to high-calorie drinks in schools, officials said.

The study’s authors were commissioned to confirm that the soft drink companies were following their agreed-upon guidelines, said lead author Robert Wescott.

“I would say the record of the companies is not perfect, but it’s pretty darn good,” said Wescott, president of Washington, D.C.-based economic research firm Keybridge Research.

Many school vending machines look much different than widely circulated machines. They contain mostly water, juice, sports drinks, and milk. Some are painted in the black and white pattern of a cow to underline their message. Many schools don’t sell any soft drinks to students.

Feeling that much of the work on school soft drinks has been done, officials have turned more attention to foods in the lunch lines and activity guidelines in the ongoing struggle with obesity. Last year, the Centers for Disease Control and Prevention reported that Ohio’s high school student obesity rate was 15 percent, making it one of 12 states to reach that level.

“I think it’s a good step in the right direction,” said Danielle Hodge, a registered dietitian at West Chester Hospital north of Cincinnati, of limiting drink calories in schools. “I think kids do drink too many sodas and too many flavored coffees, so I think this is a good step to try to curb some of those obesity problems in teenagers.”

As concern about student health increased, officials began to more closely watch what children were consuming at school. Those memories make the changes of the last decade even starker.

“Nine years ago I came into this segment of food service, and you’d see a Honey Buns and two Mountain Dews for breakfast,” said Christopher Ashley, supervisor of food and nutrition for Springfield, Ohio City Schools. “Now kids are going through the line and getting a better breakfast. That’s just the start.”

Hoping to make an impact on what children received in school, the William J. Clinton Foundation and American Heart Association combined to form the Alliance for a Healthier Generation in 2005. One of the new alliance’s first targets was the beverage industry.

In May 2006, The Coca-Cola Company, Dr Pepper Snapple Group, PepsiCo, and the American Beverage Association joined with the Alliance for a Healthier Generation to form the School Beverage Guidelines. Those guidelines eliminated certain drinks in some schools and limited the calories available for older students.

“It’s hard to say no to Bill Clinton, right?” said Kimberly McConville, executive director of the Ohio Soft Drink Association. “They were forming a big domestic project, and the beverage companies said they would be part of it.”

The results could be seen earlier this week at Centerville High School, where sophomores Leena Hirani and Mia Smith and freshman Kendra Phong ate lunch in a commons area. Each had purchased their lunches at school in suburban Dayton, Ohio (schools can’t forbid students to bring what they would legally like to eat or drink), and they were drinking chocolate milk and orange juice.

“I would drink this anyway,” Smith said of her orange juice.

Other students carried a variety of beverages including Mountain Dew, Sunkist, milk, and fountain drinks from fast-food restaurants, as juniors and seniors can leave the campus for lunch. One student, sophomore Jadon Bischoff, carried a gallon jug filled with a mix of lemonade and iced tea.

“Most days I’ll bring something,” he said. “It can be expensive to buy.”

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Original source: http://newyork.newsday.com/news/health/soda-purge-in-schools-is-largely-successful-but-obesity-remains-1.3958221

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School lunch rules for healthier meals get mixed reviews from students

Sept. 14, 2012, Huffington Post

By Michael Hill

One student complains because his cafeteria no longer serves chicken nuggets. Another gripes that her school lunch just isn’t filling. A third student says he’s happy to eat an extra apple with his lunch, even as he’s noshing on his own sub.

Leaner, greener school lunches served under new federal standards are getting mixed grades from students piling more carrots, more apples, and fewer fatty foods on their trays.

“Now they’re kind of forcing all the students to get the vegetables and fruit with their lunch, and they took out chicken nuggets this year, which I’m not too happy about,” said Chris Cimino, a senior at Mohonasen High School in upstate New York.

Lunch lines at schools across the country cut through the garden now, under new U.S. Department of Agriculture (USDA) nutrition standards. Mohonasen students selecting pizza sticks this week also had to choose something from the lunch line’s cornucopia of apples, bananas, fresh spinach, and grape tomatoes, under the standards. Calorie counts are capped, too.

Most students interviewed in this suburban district near Schenectady seemed to accept the new lunch rules, reactions in line with what federal officials say they’re hearing elsewhere. Still, some active teens complain the meals are too skimpy. And while you can give a kid a whole-wheat pita, you can’t make him like it.

“I was just trying to eat it so I wouldn’t be hungry later on,” Marecas Wilson said of his pita sandwich served this week at Eastside Elementary in Clinton, Miss.

Though the fifth-grader judged his pita “nasty,” he conceded: “The plum was very good.”

Kim Gagnon, food service director in the Mohonasen district, said while students generally have been receptive to the fruits and vegetables, “we have noticed that kids are throwing it out or giving it to friends, leaving it on counters, so we haven’t quite gotten there yet.”

The guidelines approved by the USDA earlier this year set limits on calories and salt and phase in whole grains. Schools must offer at least one vegetable or fruit per meal. They can still serve chocolate milk, but it has to be nonfat.

The biggest update to federal school-food guidelines in 15 years might please parents who recall washing down cheeseburgers and tater tots with full-fat chocolate milk. In Pueblo, Colo., Megan Murillo said she feels more comfortable letting her first-grader, Sophie, eat cafeteria-prepared lunches knowing there are more vegetable and whole grains.

Reactions in schools so far this fall have been positive, according to Kevin Concannon, the USDA’s undersecretary for Food, Nutrition and Consumer Services.

“I don’t mind it because I always got the extra apple and fruit and veggies and all that,” said Anthony Sicilia, a senior at Mohonasen, who nonetheless was eating a Subway sub for lunch. “But I think it’s good because it actually forces kids to eat healthy.”

But new guidelines or no, many kids are still picky eaters. In Clinton, Miss., the elementary students served flatbread roast beef sandwiches with grated cheese ate most of the meat but left large chunks of whole-wheat pita. Most plums were gnawed to the pits, and several salads were half eaten.

“I liked the meat but not this,” fifth-grader Kenmari Williams said, pointing to his pita. “Every time you eat it, you get something white on your hands.”

One thornier complaint is that the new lunches are too little for active teens now that the calorie range for high school lunches is 750 to 850. Rachelle Chinn, a freshman from Clarence, Mo., who plays softball, said school lunches are now so slight it once left her with a headache.

“The fruits and vegetables are good at first but once they wear off, I get hungry,” she said. “It’s just not enough to get me through the day.”

Her mom, Chris Chinn, now packs her protein-heavy snacks like peanut butter crackers and granola bars. Chinn, a critic of what she calls the “one size fits all” standards, said many athletes aren’t getting enough to eat. Similarly, Katie Pinke in Wishek, N.D., gave up on school lunches for her strapping freshman son Hunter and packs him meaty sandwiches.

Hunter is a 6-foot-5-inch, 210-pound football player who, based on his size and active lifestyle, needs more than 4,700 calories daily to maintain his weight. He said lunches topping out at 850 calories aren’t enough.

“I think it’s kind of ridiculous that people say how much we get to eat when there are a lot of kids that are big,” Hunter said. “When we can’t have our meat and bread, for a guy especially, it’s not fun.” Concannon noted the calorie ranges are adjusted for age, increasing as students move from elementary to middle to high school. If some children need more, Concannon said, schools have the option of offering an afternoon snack or parents can send snacks from home.

“If you look at colleges in the United States, if you’ve ever looked at the tables where they’re feeding just the football players. Good God … If you emulated that, we’d all be wearing size 48 suits by our 20s,” he said. “You have to use common sense.”

And just weeks into the school year, it’s probably too early for final grades. In Mississippi, Keba Laird, child nutrition supervisor for the Clinton district, said she is phasing in the nutritional changes to help children grow accustomed to eating healthier.

“We don’t want a revolt on our hands,” she said. “We want them to enjoy eating with us.”

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Original source: http://www.huffingtonpost.com/2012/09/14/mixed-grades-for-new-heal_n_1883763.html

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At school, overweight children carry a heavy burden

Sept. 23, 2012, NPR

By Kavitha Cardoza

One in three children in the United States is overweight or obese. Significant numbers of those young people are grappling with health problems like heart disease, high blood pressure, and diabetes. Those conditions can be difficult for children to manage in any setting, but they can pose particular challenges for children during the school day.

Dr. Yolandra Hancock used to be an elementary school teacher, and it shows. She’s patient, encouraging and has an endearing way of ending her sentences with “my love” and “my sweet.”

Her patients include a 13-year-old who weighs 400 pounds; a child whose teeth are so rotted she can’t bite into carrots; and many preteens who are diabetic. Today, Hancock is examining Derek Lyles, 13. He’s 4 feet 11 inches and weighs 256 pounds.

“When we look at his body mass index, which is how well his weight and height balance out, his BMI today is 46.7,” Hancock says. “For an adult male, we like to see a BMI of 30 or less.”

Hancock is also troubled by dark patches of skin around Derek’s neck.

“When little ones, especially around the back of the neck, have that sort of thick, almost velvety appearance to their neck, it means that their bodies are becoming less sensitive to insulin,” she says.

Back-to-school checkups for patients like Derek mean lots of follow-up work for Hancock. Their belly fat pushes down on their bladders, so she’ll have to write notes to principals, asking that her patients be allowed to go to the bathroom frequently. She must also draft requests to excuse children whose sleep apnea makes them appear drowsy in class, or whose joints hurt as they walk between classes.

Practical challenges, for kids and schools

These accommodations also mean more work for schools, says Camille Wheeler, a nurse at Bell Multicultural High School in Washington, D.C. “It’s a lot. It really is,” Wheeler says. “It takes a lot for the student, for the nurse, the parent, and the school. Especially the school. Because the majority of the time the students are here, you know?”

Wheeler says it’s not unusual for a child to arrive at school at 8 a.m. and depart at 6 p.m., depending on a family’s aftercare arrangements.

“That’s a large chunk of their time,” she says. On a recent afternoon, Wheeler is thumbing through stacks of paper, racing to process students’ health information.

“I have a whole stack here of many, many health certificates, dental forms, health records,” she says. “It’s about well over 200 forms in here, and I’m getting them daily.”

Many of the forms are related to obesity. Children with diabetes need midmorning snacks. Some are on special diets and some need medication. All this means time away from the classroom.

“It may not be in the forefront, like a broken bone for example, but it’s there and it affects the students every day,” says Shirley Schantz, nursing education director for the National Association of School Nurses.

Schantz says that nurses from across the country are increasingly calling her organization, asking for guidance on how to deal with childhood obesity in schools — even preschools.

“They see students that can’t walk upstairs,” she says. “They see students that are absent because they’re overweight or obese, [who] don’t want to go to physical education.”

The physical aspects of living with obesity can be difficult enough for a child. But there’s an emotional toll, as well. Bullying is a common problem for obese kids. Derek says other students often called him fat in middle school.

Taking a toll on learning

All these challenges can also affect learning. Dr. Hancock says there is evidence that children who are obese score less well on standardized tests and basic classroom tests.

“Some researchers believe that there may be something physiologically that’s affecting the child’s ability to learn,” Bell says. “Others believe, because of self-esteem issues and bullying, it makes them less eager to attend school and participate in school activities.”

Derek wants to lose weight so he can “walk fast like other kids.” And he really wants to start playing football again this year.

“During training camp, I couldn’t do most of the, like, exercise that other people was doing,” Derek says. “I just couldn’t do it.” For many obese children, even maintaining their weight when they’re not in school is challenging. This summer, Derek could eat whenever he wanted, and the fridge was always stocked with food. At school, he says, he ate cereal or a muffin for breakfast. But over the summer, he often ate sausage and eggs. The pounds piled on.

Hancock hopes eating meals at school will help Derek get his weight under control. She embraces Derek as she says goodbye.

“All right, handsome, give me some hugs,” Hancock says, embracing Derek. “I have faith you’ll be able to make changes, because you’ve done this before.”

As Hancock reminds her young patient, it’s a brand new school year — an opportunity to start fresh.

***

Original source: http://www.npr.org/2012/09/23/161584477/at-school-overweight-children-carry-a-heavy-burden

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This is how Learning Gardens grow

Sept. 18, 2012, The Washington Post

By Jane Black

The slogan “Think Different” has become a mantra for a generation of Silicon Valley entrepreneurs. So when high-tech-millionaire-turned-restaurateur Kimbal Musk envisioned a network of Learning Gardens for public schools, he didn’t settle for the usual framed, raised beds.

Instead, he thought of swooping, curved planters made of food-grade plastic, each with an irrigation system tucked away inside: a “product” that could be replicated quickly, at relatively affordable prices.

Product is not a word usually associated with organic temples of experiential learning. But like chef-restaurateur Alice Waters, who launched the American school-garden craze 15 years ago in Berkeley, Calif., Musk, 39, says such gardens are essential to reversing obesity, which now afflicts one in three American children.

According to the Journal of American Dietetics, sixth-grade students involved in a garden-based nutrition education program increased their fruit and vegetable consumption by 2.5 servings per day, more than doubling their overall consumption. A class of fifth-graders who participated in garden-based lessons scored 15 points higher on science tests than students who learned in a traditional classroom.

“For me, there’s no point unless we are reaching a critical mass of people,” says Musk. “It’s not that small projects aren’t doing good things. If you serve four schools, you can feel very good about yourself. . . . The only way to solve the problem is to reach all of America’s 100,000 schools.”

Musk’s first step toward mass-producing school gardens is to install 60 Learning Gardens in Chicago, 60 in his home state of Colorado, and 60 more across the country over the next year. An announcement with Chicago Mayor Rahm Emanuel and the city’s schools chief, Jean-Claude Brizard, could come as soon as Sept. 20, depending on the city’s teachers’ strike.

“Learning Gardens are great for Chicago and for students, and I’m pleased that 60 more of these gardens are coming to our schools,” Emanuel said via e-mail. “These gardens teach our kids about sustainability and help them learn to make healthy food choices in an engaging way. By developing healthy lifestyles and gaining the hands-on experience of working outside, the Learning Gardens improve the lives of thousands of our students and their families.”

Musk left his native South Africa in 1991 for Canada. But he soon migrated down to Silicon Valley where, with his brother Elon, he started a software company called Zip2. The brothers sold it in 1999 to computer firm Compaq. That year, Elon started a new company called PayPal in which Kimbal was an investor.

With money in the bank, Musk headed to New York to explore his interest in cooking. He enrolled at the French Culinary Institute and graduated right before the Sept. 11, 2001, terrorist attacks. In the weeks following, he cooked for firefighters and police working near Ground Zero.

“The energy I felt — that awful and incredible energy — made me want to open a restaurant,” he says. “One with that sense of community I had experienced in New York.”

The result was the Kitchen, which opened in 2004 in Boulder, Colo. It was a farm-to-table restaurant before the term became fashionable; supporting farmers was one way to build community. The Kitchen offered students cooking lessons and took them on farm tours. Soon, it started raising money for the Growe Foundation, a local school-garden organization.

Colorado might seem like an odd place to become radicalized about the threat of obesity. It is the leanest state in the country with an adult obesity rate of 20.7 percent. But the rate of childhood obesity is rising faster there than in any other state except Nevada, according to the National Survey of Children’s Health. Musk thought school gardens could halt, and possibly reverse, those numbers. In 2011, he and his business partner, chef Hugo Matheson, established a nonprofit organization called the Kitchen Community to bring Learning Gardens to schools across the country.

The gardens are designed to fit into any school footprint, whether it has acres of surrounding fields or only a small rooftop. Designed by Musk’s wife, artist Jennifer Lewin, the plastic containers come in three sizes and fit together to create an array of curves and spirals. Additional pieces create shaded areas, benches for seating and “art poles” for students to decorate.

So far, the costs are still high. A large garden and installation can cost as much as $50,000 — a huge sum for schools in challenging economic times. (Through fundraising — JP Morgan Chase has been the lead donor in Chicago — the Kitchen Community has raised $1.3 million to cover the costs.) But the modular nature of the gardens means that a small plot can cost as little as $3,000. As the program grows, Musk says, the costs will come down.

The planters are all but indestructible. And that’s important, says Musk, because Learning Gardens are integrated into school playgrounds. “I wanted a place kids could hang out,” he says. “The layout is like a maze. It’s easy to run around. It’s easy for them to come check on their planters. It’s a place that they’d like to be.”

At Irma C. Ruiz Elementary in Chicago, the Learning Garden is called Playground 3. Unveiled in May, it has 19 planters, in which the students grow collard greens, peppers, Swiss chard, tomatoes, and herbs. There’s a metal arbor with large rocks beneath it that serve as chairs, tables and objects to climb on.

Seventh-grader Luna McWilliams says the garden is different from the playground but just as fun: “The garden constantly offers a place to work and learn in nature. I find it a lot of fun to care for the plants, and I know my classmates do as well.”

Principal Dana A. Butler says the garden has been transformational “in the sense that beautification and things growing distract” from some ugly realities of the school’s tough neighborhood.

“It’s one more opportunity for authentic learning,” he says. It’s “an outdoor science lab. It’s about health and restoration. It’s a lot of wonderful things that the kids can be a part of and be connected to.”

Butler applauds Musk’s ambition, but he cautions that Silicon Valley timelines won’t be easy to pull off in a byzantine public school system, where even conducting a simple survey, as the Kitchen Community suggested last spring, requires multiple levels of approval and translation into foreign languages. “They need to come to terms with working with [Chicago Public Schools], which doesn’t work in ways that many people might think are efficient or common sense. I think they will be successful if they do it slowly, if they don’t try to do too much too fast,” he says.

But the challenges inherent in the country’s third-largest school district are exactly what attracted Musk to Chicago. The city has alarming rates of childhood obesity: More than 20 percent of low-income children aged 2 to 4 are obese, according to the Centers for Disease Control, compared with 14 percent nationally.

“If we can make it work in Chicago, with harsh demographics, the diversity, the difficult weather,” says Musk, “we will prove it can be done.”

***

Original source: http://www.washingtonpost.com/lifestyle/food/this-is-how-learning-gardens-grow/2012/09/18/94322aca-fcff-11e1-b153-218509a954e1_story.html

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