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Published in Print: February 1, 2003, as Food Fight

Food Fight

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In the war against youth obesity, schools have to be on the front line.

A century ago, being overweight often was a superficial sign of prosperity and good living. High-society dinners of the Gilded Age, for example, consisted of four, five, six, and sometimes even more courses: caviar, pâté de foie gras, oysters, terrapin, game. Such dinners certainly gave new meaning to the 1899 phrase "conspicuous consumption." But why not live it up if you could, when you could? After all, the life expectancy in 1900 was only about 47 years.

Fortunately, few people ate so lavishly then, and since the Gilded Age, we have been able to peer beneath the surface to understand the effects of nutrition—good and bad—on the human body. In addition, advances in science and medicine have nearly eliminated in America the infectious diseases that reached epidemic proportions a hundred years ago. Despite opening with an average life span of about 47 years, the 20th century closed with a life expectancy of about 77 years.

What took a century to attain, however, could be undermined in a few decades if we do not respond to the 21st century's own epidemic: obesity. As a nation, we have made serious strides inimproving our health in terms of infectious diseases, heart problems, and several forms of cancer, but we have failed when it comes to recognizing and addressing our overweight. The Age of Girth has displaced the Gilded Age. Then, few people enjoyed overeating and indulgence; now most of us are swayed by supersizes. And the bicycle craze of a hundred years ago has been replaced by the TV fascination of today.

Consequently, obesity is this century's pneumonia, this century's TB, this century's typhoid. Obesity is not an aesthetic problem— it's a health issue. It may not be infectious, but it is epidemic: In 1999, an estimated 61 percent of U.S. adults were overweight or obese, and 13 percent of children and adolescents were overweight.

Fortunately, in most cases curing obesity does not take years of complex research. Instead, it takes behavioral change on the part of individuals, families, schools, communities, work sites, media, states, and the nation. Of these, schools hold perhaps the most crucial role in effecting change because adult obesity can be prevented in youth. When I was surgeon general, I suggested in my December 2001 "Call to Action to Prevent and Decrease Overweight and Obesity" that schools are one of five key settings for public-health strategies to prevent and decrease the prevalence of overweight and obesity through what I call a CARE framework. CARE stands for communication, action, research, and evaluation. The fact is, children and adolescents spend a large portion of time in school, and schools offer many opportunities to engage them in healthy eating and physical activity.

At the risk of sounding trite, I will reiterate that today's youths are tomorrow's leaders. We must prime our children academically, but academic success will be moot if students do not realize their potential because of poor health or abbreviated lives. Academic achievement and good nutrition and exercise, in fact, are related. Studies continue to confirm that when children's and adolescents' basic nutritional and fitness needs are met, they learn better. Unfortunately, the reverse is true as well. In one study of 4th graders, for example, those who had the lowest amount of protein in their diets posted the lowest achievement scores. Additional research suggests that skipping breakfast has a negative effect on cognitive performance.

A century ago, being overweight often was a superficial sign of prosperity and good living.

On the other hand, studies show that the proper nutrition provided in the school breakfast program improves school performance, math and reading scores, and student behavior. Physical activity is an integral part of this equation because increased time for physical activity leads to increased test scores. Specifically, one study has found that redirecting 240 minutes of class time per week from academics to physical activity consistently leads to higher math scores.

Despite what we know about the positive links between nutrition, exercise, and student achievement, America's young people face a health crisis, in part because the factors that contribute to overweight—poor nutrition and decreased physical activity—have infiltrated school buildings. The past 20 years have witnessed nearly double the number of overweight children and nearly triple the number of overweight adolescents. And from 1991 to 1999, the percentage of students who attended daily physical education classes declined from 42 percent to 29 percent.

As educators, these statistics should alarm us. Excess weight presents a challenge as crucial as youth violence and teenage smoking because when kids suffer, our communities and our nation suffer, too.

Given that overweight children are much more likely to become obese adults, we should keep in mind that in 2000 alone, the United States spent nearly $120 billion on costs attributable to obesity. Today's overweight kids, who already have to contend with the negative psychosocial effects of heaviness, most likely will suffer the dire health consequences of adult obesity: diabetes, coronary heart disease, and hypertension. In fact, type II diabetes is no longer called "adult-onset diabetes" because it now affects adolescents and young adults.

Of course, schools most definitely are not to blame for the proliferation of weight problems among youngsters, and many factors outside school hours contribute to the problem. But soda machines and unhealthful foods—installed at schools to generate income as well as cuts in physical education budgets, threaten to undermine schools' efforts to integrate sound nutrition and fitness practices into the curriculum.

We can no longer afford to cut physical education and good nutrition: Doing so may be penny-wise, but it is literally pound-foolish.

Change must be comprehensive: from state leaders who allocate education budgets, to teachers who directly educate children and adolescents about good diet and exercise, to parents and caregivers who reinforce the models of good nutrition and fitness.

My "Call to Action" outlines ways for schools to address the epidemic that confronts us. Under the CARE framework, state departments of education, districts, and schools can work on several levels. First, we must build awareness among and educate teachers, food service workers, coaches, nurses, and other school staff members about proper nutrition and activity as both relate to lifelong healthy weight, and about school physical activity and nutrition programs and policies.

Second, we must ensure that the food available in schools is healthful. Meals offered through school breakfast and lunch programs must meet nutrition standards, and vending machines and school stores must provide nourishing options. Of course, all K-12 children must also have quality, daily physical education.

Finally, we should evaluate schools' behavioral interventions for the prevention of overweight in children, and we should conduct research to study the effect of school policies on the problem in children and adolescents.

There is much action ahead of us. But consider the point made by Nora Howley, the project director for school health at the Council of Chief State School Officers, during a July 2002 news conference on childhood overweight. Commenting on the extraordinary amount of money our nation spends each year on costs directly and indirectly related to obesity, Howley appealed: "Think what we could be doing for our schools with $120 billion a year." Indeed, the potential impact of such a redirection of funds is staggering.

We can no longer afford to cut physical education and good nutrition: Doing so may be penny-wise, but it is literally pound-foolish. As I say time and again, I do not blame schools for our obesity epidemic. Instead, I look to schools—and to everyone who has an influential hand in education—as a powerful force for change. For the health of the nation, we all must work harder for our students' health.

Vol. 14, Issue 5, Pages 32-34

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