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Published in Print: February 17, 1999, as Food for Thought

Food for Thought

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Schools take aim at junk food and inactivity in fight against childhood obesity.

Framingham, Mass.

Bob Davis has discovered a winning weight-loss prescription for students who may need to shed some extra pounds: Stop watching television.

The health teacher's message is hardly subtle: Kill "Buffy: The Vampire Slayer." Exterminate the "Rugrats." Dunk "Dawson's Creek."

With the motivational zeal of a personal trainer, Davis is prodding the 7th graders at Walsh Middle School in this Boston suburb to take a hard look at their weekly media intake.

As if making a confession in a self-help group, 12-year-old Manny Ortega admits to logging 40 hours each week in front of a television set. One of the other two dozen students in this health class says he's accrued 36 hours of tube time in the past seven days. The class average is 20 hours of television viewing a week. The goal, Davis says, is no more than 14.

Most of these preteens, gesturing to the snow-caked sidewalks outside their school building, blame the recent ice storm that blew through New England for their sedentary ways; the rest shrug and say they can't think of anything better to do.

Into that mental void, Davis throws his pitch: "How about cleaning your room? Walking the dog? Any activity is better than none!"

Davis emphasizes that he isn't asking his students--of varying weights and athletic abilities--to leap from coach potato to track star. He just wants to keep them moving.

This isn't Diet 101, but it may as well be. The Harvard University-developed curriculum that this middle school is using is the only published school-based program that has had a documented effect on reducing obesity in children, according to a new study.

Researchers at the Harvard University school of public health will release the results next month of a study in which they followed 1,295 6th and 7th graders at Walsh and nine other ethnically diverse Boston-area schools from fall 1995 to fall 1997. The Atlanta-based U.S. Centers for Disease Control and Prevention, which has reviewed the researchers' findings, has found them promising.

Early results show that after two years of using the Planet Health curriculum, which focuses on improving eating habits and increasing activity, students reported that they cut television viewing by an average of 4.2 hours a week. And the girls in schools using Planet Health were 5 percent less likely than those not exposed to the program to become obese in the two years the study was conducted, the researchers found. The research team concluded that the curriculum had a greater effect on girls than on boys--who showed no significant reduction in their obesity rate--because adolescent girls tend to be more focused on body image and weight loss than their male classmates are.

Students were considered obese if both their weight-for-height measurements and a skinfold-thickness test--essentially a pinch under their triceps--were at or above the 85th percentile for all children of the same age and gender.

In the world of behavior-change research, where a change as low as 2 percent is deemed significant, national experts say those results are impressive.

Davis is optimistic. "Ten years ago, smoking was high. Now we don't smoke in restaurants anymore. Why did this happen? It happened because of education," he says.

One in five children in the United States is obese as defined by the same weight-for-height measurement used in the Planet Health curriculum, national health statistics show. The childhood-obesity rate leaped from 14 percent in 1976 to 22 percent in 1991. Blacks and Hispanics, as well as children from low-income families, tend to have higher rates of obesity than their white and more affluent peers. In particular, a study released last month showed, the percentage of poor preschoolers who are obese has climbed in the past decade; in 1995, 10.2 percent of children under age 5 were obese, up from 8.5 percent in 1983.

Obesity is associated with a range of serious health problems, including diabetes, hypertension, heart disease, and some cancers.

Genetics may explain why a small percentage of obese people have more difficulty shedding unwanted pounds. Researchers recently have found that two out of 1,000 people in the United States who lack leptin, a protein released by fat cells that regulates appetite, have a genetic predisposition to become overweight.

Finding a genetic link to being overweight may help the public understand obesity as a health issue as opposed to a purely cosmetic one, says Bill Dietz, the director of the division of nutrition and physical activity for the CDC.

''Until quite recently, the prevailing attitude was, 'They got themselves this way, and let them take care of it,' " Dietz says.

But even with the discovery of a genetic predisposition in some people, he says, the increase in the percentage of overweight children in the United States is more culturally than biologically driven.

Experts say American children are getting plumper because of several factors: Children are increasingly left to regulate their own television viewing in the after-school hours, junk food is easily available, and the current generation of young people tends to be less physically active than earlier ones. Children in poor families are more at risk for becoming overweight in part because the least expensive option for dining out--fast-food restaurants--is often the most laden with calories.

A national survey published last March in the Journal of the American Medical Association found that 80 percent of children ages 8 to 16 were physically active--defined by sweating and hard breathing--three or more times a week; federal health officials recommend at least 30 minutes of daily exercise. The survey also reports that 67 percent of all children in the United States watch at least two hours of television each day; 26 percent watch four hours daily.

Despite the increase in obesity among young people, weight-loss companies have not aggressively marketed their products to children. Adults--of whom 33 percent are overweight--flock to Jenny Craig and Weight Watchers, which have counseling and support groups. Children are targeted by only a handful of pricey summer camps that promise to help them lose weight. And while these specialized camps, with their full-time nutritionists and personal trainers, may be helpful for some children, experts on obesity doubt that a short course has the staying power to change diet and exercise habits in the long run.

That's where Planet Health comes in, says Jean Wiecha, the project director of the Harvard Prevention Research Center on Nutrition and Physical Activity and the co-author of the curriculum. Wiecha says schools don't need to, and shouldn't, become weight-loss centers.

But the Planet Health study shows that schools can be ideal venues for modifying student behavior because they have a captive audience for a long stretch of time.

Wiecha hopes that by sprinkling messages to students in classes throughout the day, the Planet Health philosophy will sink in.

This snack-saturated culture is one reason why America leads the developed world in childhood obesity.

For George Baccus, a math teacher at Morse Elementary School in Cambridge, Mass., which is one of the schools trying out the curriculum, it was just another geometry lesson.

As part of a Planet Health unit, students spent a few days calculating and comparing the fat, carbohydrate, and protein content of low-fat chocolate milk and whole milk. (Chocolate milk, they discovered, is 5.3 times fattier). The next week, the students polled their fellow 6th, 7th, and 8th graders to find out how much television they watched each week. They made colorful pie charts to display the results.

Baccus hopes the posted wall charts will have shock value: The student survey showed that 59 percent of 6th graders reported watching four hours of television a day (double the national average for children); only 5 percent watched one hour or less.

Across the hall in Karen Spaulding's 6th grade science class, students are talking about snack-food advertisements in a nutrition lesson. The CDC estimates that some 13,000 new food products--many of them sweet snacks--tumble onto supermarket shelves each year. When asked to repeat advertising slogans, the students don't hesitate: "Sprite: Obey your thirst." "Skittles: Taste the rainbow." "Snickers: Hungry? Why wait?" "Pringles: Once you pop the top, you can't stop."

Such commercial spots with catchy slogans don't talk about fat content, calories, or nutrients. "They push taste," says Spaulding, who then directs her students to compare the nutritional information of various snack foods. "How many calories are you really getting in a 'reduced fat' Snackwell chocolate sandwich cookie?" the teacher asks.

"It's 200 calories for one serving!" yells 12-year-old Jean Olenick. "If that's reduced fat, I'd like to see the fatty kind," she says.

Serving sizes are often deceptively small, Spaulding warns the adolescents. "Ice cream labels base information on a one-half-cup serving size. That's barely one scoop. I usually have four when I eat ice cream. I don't know about you ... "

This snack-saturated culture is one reason why America leads the developed world in childhood obesity, says Peter N. Stearns, a professor of social history at Carnegie Mellon University. Stearns is the author of Fat History , a book that compares American eating habits with those of the French. In France, which has the thinnest population in the Western world, children are discouraged from eating between meals, and their lunches and dinners--while they may be lathered in fatty sauces--come in much smaller portions than Americans typically eat.

Americans' penchant for heaping plates is deeply rooted in this country's national identity as the land of plenty, Stearns says. Since the first Thanksgiving, Americans have seen large portions as a sign of wealth. And making sure children ate all the food on their plates was long considered a significant test of good parenting, Stearns notes. Eating large meals didn't matter in the 18th century, when people did a great deal of physical labor, he says, "but we should have reduced the portions when we stopped pushing the plow."

Part of the reason for Americans' culinary excess is convenience, the CDC's Dietz says.

While it now may take two working parents to put food on the table, the breadwinners often aren't the ones doing the cooking. Americans eat out more than people in other countries; families now spend 35 percent of their food money on meals outside the home, which means children and adults have less control over the quality and quantity of the food they consume, Dietz points out.

"The opportunity to eat garbage has increased because everyone is eating on the run," adds Brenda Greene, the school health coordinator for the National School Boards Association in Alexandria, Va. Add to that the fact that as many as 14 percent of high school students in the United States skip breakfast--even when they qualify for the meal free through the school breakfast program. And children who are hungry tend to gorge on snacks, Greene says.

Considering these cultural trends and time constraints, it helps for students to have a role model, Mary Ann Cusack argues. A veteran English teacher at Morse, Cusack has taken the Planet Health curriculum to heart.

During the two years that Cusack taught units on a balanced diet and regular cardiovascular exercise to her 7th and 8th graders as part of the Harvard study, the 5-foot-5-inch teacher dropped 70 pounds herself.

"If I tried to teach this as a 200-pound person, I would be embarrassed. It would be hypocritical," says the 40-something Cusack. "Before, I didn't exercise. Now, I can bench-press 55 pounds, and kids ask what I eat for lunch."

But Cusack says it's hard to make classroom lessons stick when they aren't consistently applied.

Since the federal government changed the dietary guidelines to trim the fat content in school lunches in 1994, districts nationwide have devised menus with more nutritious, leaner meals. And the 5,500-student Cambridge school district just hired a new food-services director to spice up and slim down its school meals.

But, at the same time school lunches are going on a health kick, fast food is moving onto campus. One school in the 7,500-student Framingham district plans to open a McDonald's or other fast-food restaurant on-site soon. Cusack says it's hard to preach healthful eating habits when the "golden arches" are going up next door.

While teachers like Cusack rail against the incursion of fast-food chains, Robert McGowan, the lead physical education teacher at Morse, is pushing the other part of the Planet Health regimen.

"Get your arms up. Energy!" McGowan yells to the two dozen kindergartners wildly flailing spaghetti-like cords in their first foray into jumping rope last month. As the 5-year-olds giggle and fall in heaps, McGowan laughs and says, "Just wait for the Hula Hoop lesson."

Many districts are looking to federal grant money to expand after-school physical activities for students.

McGowan estimates that about 20 percent of students in the 265-student K-8 school are overweight--about the national average. But it was an extremely heavy 9-year-old in his PE class who was reluctant to participate in school sports that inspired McGowan to make obesity prevention his mission. He is even writing a doctoral thesis on the subject of childhood obesity.

"I've had kids who were overweight before, but nothing that drastic," says McGowan, who still keeps tabs on some of the students who were in the study and are now in high school. McGowan says he hasn't seen a major change among the overweight students since Planet Health was in place, but he doesn't expect things to turn around overnight.

He would like to have more fitness options for students--especially for girls, who have fewer team sports than boys do--but as usual it's a matter of finances.

"The biggest thing is money," says McGowan, standing in room bulging with basketballs and wall-climbing apparatus. Greatly expanding the district's physical education program is difficult in a climate of school budgets that are tailored to the academic basics.

Last year, Massachusetts slashed the K-12 PE requirement, allowing schools to offer as little as one class a week. McGowan says the Cambridge schools require more than the minimum--at two 45-minute PE periods a week--but just barely.

The situation is not unique to Massachusetts, says Paula Keyes Kun, a spokeswoman for the National Association for Sports and Physical Education in Reston, Va. Only one state, Illinois, requires daily physical education for K-12 students, and districts nationwide are increasingly allowing marching band and other activities to substitute for PE, she says.

Greene of the NSBA says she's troubled when schools preach one thing in the classroom and another in the gym or the cafeteria. Standards-based reforms are putting more pressure on schools to perform academically, she says, while preventing obesity--though seen as a laudable goal--is rarely a pressing concern. Teachers in Massachusetts are focusing these days on preparing students for rigorous assessments that many students flunked last year.

"Schools have a lot on their plate when they make financial decisions. If schools don't see health as integral to their educational mission, they are going to give it a low priority," Greene says.

Many districts are looking to federal grant money to expand after-school physical activities for students.

If Jim Coady, the principal at Morse, had his way, the school would be open from 7 a.m. to 5 p.m. daily and have fitness services that rivaled those of the YMCA. Students need more organized sports activities during and after school, he says.

"I grew up in East Cambridge when most of the people worked in soap, candy, and rubber factories, and we kids lived at the playground. It was always filled. I don't see that anymore," Coady says.

"Nowadays, parents are terrified to send kids out" to play, adds Howell Wexler, a spokesman for the CDC's division of adolescent and school health. "They say, 'Yeah it's terrible to let kids watch TV, but at least there aren't bullets falling down on them.' "

On top of crime concerns is the New England cold, some Cambridge parents say. "It's hard for the kids to get out in this weather," says Laura Levins, who drove to Morse on a recent icy day to pick up her children. "There's a park across the street from us, but it's covered in snow."

As Coady watches the phalanx of cars, minivans, and school buses pack into the ice-lined parking lot at the end of the school day, he says it's ultimately up to parents to make fitness a priority for their children.

Davis, the health teacher at the 900-student Walsh Middle School, agrees that prodding his class to exercise more is practically worthless unless the students are nudged by parents or peers.

Gail McNeill, at home in Framingham one day last month, says she's pleased to help her son, Gregory, with his homework assignment for health class.

"I think I'll cut out 'Fresh Prince of Bel Air' and 'Sister, Sister,' " says Gregory, a freckled 13-year-old, who says he usually watches sitcoms from 6 p.m. to 9 p.m. His mother, a veterinarian, says that her son, though stocky, is at a normal weight for his prepubescent stage, but Gregory says he wouldn't mind "being a little skinnier."

Gregory says his goals are to "start working in the little gym in our garage and riding my bike around the [banks of the nearby] reservoir" when the winter ice finally thaws.

Thirteen-year-old Julianna Sokolova, a tall, thin student sitting in Davis' health class at Walsh last month, says she belongs to a fitness club and regularly works out there after school. Besides aerobics, she swims, uses weights, and even does sit-ups while talking to friends on the phone. "It sort of became an obsession," the teenager says on a recent day after school.

Maura Overlan, a social worker at Walsh, says Julianna's preoccupation with thinness is typical of teenage girls who devour glamour magazines that idealize slender supermodels.

On a recent day after school, Samantha Anderson is curled up in a recliner in the downstairs recreation room at home. It's too icy to sled, so she's clicking between "Rocko's Modern Life," a cable favorite, and a "Superman" cartoon. "When I watch TV, I usually get cookies or ice cream if we have it," the 12-year-old says. Today, she's eating popcorn.

Her mother, Marjie Anderson, is upstairs making spaghetti for dinner. "Poor girl. She's got bad genetics. We could all stand to lose 20 pounds," she says.

"We eat junk food every day. And when I'm not paying attention, the default is TV. I don't want to nag, but we all need to do more as a family," Anderson, a stay-at-home mom, says.

Anderson says she likes the Planet Health course because it teaches children to think about how to manage their time productively. The mother of two also likes the fact that Samantha's health homework in Davis' class dovetails with her daughter's household obligations.

A diligent student who mostly makes A's or B's, Samantha is reminded by her mother that she gets fitness points in health class for folding her crocheted bedspread and for tucking her 83 Beanie Babies into a wicker basket. So Samantha clicks off the afternoon shows and heads upstairs to clean her room.

Vol. 18, Issue 23, Pages 42-46

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