Donna Terjesen tosses a romaine and avocado salad with a soy-based dressing as 20 Head Start mothers assemble in a small room for their latest lesson on living a healthier lifestyle.
The group begins a review of healthy and unhealthy fats as Juan Carlos Gonzales, a health educator, provides a Spanish translation. On an easel, he begins listing such items as corn oil, cookies, and potato chips in one column, and fish, nuts, and olive oil in the other.
“The dressings I prepared today are fat-free and easy to make,” says Ms. Terjesen, a nutrition consultant, as she holds up a package of tofu.
In a classroom down the hall here at Public School 5, in Manhattan’s Washington Heights neighborhood, the Head Start pupils begin to sing what has become their new theme song.
“We need food that makes us go,” they shout, pounding the carpet with their hands. “Greasy food only makes us slow.”
Called Go! Kids, the parent and child classes are part of a new initiative designed by the Children’s Aid Society, a more than 150-year-old nonprofit social service agency, to prevent childhood obesity. According to the U.S. Centers for Disease Control and Prevention, childhood obesity is linked to type 2 diabetes—also known as adult- onset diabetes—as well as respiratory problems, high blood pressure, and other health risks.
By targeting preschoolers, the New York City program and others across the country operate with the same philosophy as other programs in early-childhood education: The early years, the thinking goes, are a valuable time to instill values and knowledge in the hope of guiding children as they get older.
Statistics show a rising need for American children to develop healthy nutrition habits and make physical activity a routine part of their day. According to the National Institutes of Health, childhood obesity has tripled since 1970. Currently, about 20 percent of U.S. children are overweight. And those who remain that way during their teenage years are highly likely to be overweight as adults.
Medical professionals are still learning about the connections between childhood obesity and health problems in adulthood, says Dr. Paula Elbirt, a pediatrician and the medical director of the Children’s Aid Society here in New York.
“It’s raised alarms among pediatricians, but the impact of weight on health takes time to put together,” she said. Because young children need fat in their diet for proper development of their nervous systems, she pointed out, no clear guidelines are available on the “healthiest percentages of body composition” for children.
Across the country from the Washington Heights school, 5-year-old Aaron stands among his classmates at the Hayden Child Care Center in Duarte, Calif., and opens his mouth in a wide yawn. As the rest of this class of preschoolers shake their arms and wiggle their legs to the tune from a familiar Disney song, Aaron barely moves.
But when Michele Silence—the instructor of this Kid-Fit class—taps him on his head with her “magic” wand, Aaron perks up, drops to the floor, and begins to spin on his hips like a break dancer.
After the group’s warm-up, Ms. Silence, who founded this physical education program for preschoolers with her husband, Jim Silence, in 1994, leads the 4- and 5-year-olds through a nonstop 30-minute workout.
The children grab plastic hockey sticks and maneuver foam balls around the floor. They wrap large rubber bands around their ankles and pretend to kick a soccer ball, working the muscles in their legs against the resistance of the bands.
“Who remembers what one of our leg muscles is called?” Ms. Silence asks the group.
“Quadriceps,” a child quickly responds.
Mr. Silence says he and his wife first noticed a need for a fitness program designed for preschoolers when their own son started preschool.
“When we brought him in, kids were eating doughnuts and bear claws. They didn’t look as active as they should be,” he says. “It’s supposed to be the most active time of their lives.”
When Ms. Silence asks the group who had a doughnut for breakfast now, not a hand goes up.
With five roving teachers, Kid-Fit is now in place in 20 preschools in an area east of Los Angeles, along the San Gabriel Mountains.
Marketing to Children
A variety of factors contribute to obesity in childhood, and spending a lot of time in front of the television or computer screen—instead of playing outside—is often assumed to be one of the leading ones.
A recent research review by the Henry J. Kaiser Family Foundation, a Menlo Park, Calif.-based think tank and philanthropy that focuses on health- care issues, showed only a weak link between the amount of time devoted to television viewing and a lack of exercise. But the report did point to food products marketed to children.
“During the same period in which childhood obesity has increased so dramatically, there has also been an explosion in media targeted to children,” says the report, which listed not only television shows, but also video games, special cable networks, and Web sites. The authors also write that such media are often full of “elaborate advertising campaigns, many of which promote foods such as candy, soda, and snacks.”
Cheese crackers in the shape of the Nickelodeon network’s popular SpongeBob SquarePants character and fruit snacks featuring Scooby-Doo and the gang are a couple of examples.
In response to the report, many advertisers called on parents to take more responsibility for their children’s health. Meanwhile, Nickelodeon has launched Let’s Just Play, an initiative promoting fitness and physical activity.
Healthy Minds and Bodies
But it’s not just the powerful influence of entertaining cartoon characters that keeps young children from eating healthy foods and getting enough exercise. School policies also limit the time children have for physical activity.
With the advent of higher state academic standards and the federal No Child Left Behind Act, school leaders have tried to increase the time dedicated to academics. As a result, the time spent in physical education classes at the elementary level has been reduced in some districts, according to Charlene Burgeson, the executive director of the Reston, Va.-based National Association for Sport and Physical Education, which recommends a daily PE period for elementary-age students totaling 150 minutes a week.
While no national statistics on the time elementary children spend in physical education are collected, Ms. Burgeson said, “we do hear about schools that have either reduced or eliminated PE.”
But because of the growing awareness of the rise of childhood obesity, she said, some states and districts have increased PE requirements.
“People realize we need healthy minds and healthy bodies,” she said.
For example, bills introduced in the Florida legislature would look at ways to strengthen physical education requirements and provide parents with a “student health report.”
Physical education, like any subject, Ms. Burgeson observed, can easily be connected to academic content—a point Ms. Silence demonstrates during the children’s exercise routine at the Hayden center in California.
Scrunching up their shoulders as tight as they can, and walking on their tiptoes, the children pretend to walk on the letter I. Later, they act out the movements of different animals as they take an imaginary tour of the zoo.
“You can teach kids anything through activity,” Ms. Silence says.
The proliferation of vending machines in schools, offering sodas, chips, and other snacks, has also made access to unhealthy foods even easier for children. School districts can receive millions of dollars a year from vending contracts, which they then use to provide educational and recreational programs.
But knowledge about the spread of childhood obesity has recently led to restrictions on when students can purchase items from the machines. And in some locations, they’ve been banned at the elementary level. (“States Target School Vending Machines to Curb Child Obesity,” Oct. 1, 2003.)
Another response to increased academic requirements in the early grades has been to cut down on recess—sometimes eliminating it altogether—or in many places, making it part of a 30-minute lunch period, said Rhonda Clements, the president of the American Association for the Children’s Right to Play. She is a physical education professor at Hofstra University in Hempstead, N.Y.
“I’m totally convinced that concentrated learning over several hours is not more productive than intermittent learning,” said Ms. Clements, whose organization advocates a mandated daily recess period. “I’m not asking for an hour. For a child, 15 minutes is an event.”
But simply giving children a daily recess period doesn’t ensure they will use the time to exercise, Mr. Silence said.
“A lot of times, the ones who need the activity the most are the ones who, if you let them outside, are going to go sit in the sandbox,” he said. “Just because they’re outdoors doesn’t mean they’re active.”
Here in Washington Heights, other circumstances help keep these mostly Dominican families from changing their behavior.
Parents don’t consider the local parks and playgrounds to be safe places to take their children, Dr. Elbirt said.
“You can’t expect people to walk short distances if it’s safer to take a bus,” she said. There is also a “perception that exercise is for rich white people,” she added, “and you have to spend a lot of money.”
Moreover, the local markets don’t sell a lot of fresh fruits and vegetables, because they’re not in demand, according to Dr. Elbirt. So she’s been urging the mothers to ask for fruits such as mangos, which, like potatoes and yams, are popular in the Dominican culture.
Both Go! Kids and Kid-Fit are also careful not to tell children that all junk food and treats are off limits. Desserts are an important and appropriate part of holidays or family celebrations, Dr. Elbirt says. The message is one of balance and moderation, and that parents and children can make healthy choices together.
‘Can’t Drop the Ball’
Even though research on childhood obesity is just beginning to emerge, one small study from Australia offers hope that altering behavior in young children can make a difference. Daniel Green, a researcher at the University of Western Australia, Nedlands, found that increased exercise for children as young as 6 can reverse the buildup of fatty deposits, or plaque, in the arteries. Such buildups can lead to heart disease.
After an eight-week exercise program, the overweight children in the study were found to have improved vascular function, as measured by an ultrasound. But in presenting his findings to members of the American Heart Association in Orlando, Fla., last fall, Mr. Green stressed that physical activity must continue in order to maintain the benefits.
To determine whether the Go! Kids program leads to any changes, the parents and children received screenings of their height, weight, body-mass index, blood pressure, and cholesterol levels before the 24-week program began. As a comparison, the same tests were done with children at Public School 8, also in Washington Heights, but those children and their parents are not receiving the weekly nutrition and exercise lessons.
Post-tests at both schools will be conducted before school is out this spring. But Dr. Elbirt said she knows that efforts to teach the value of proper nutrition and exercise during the early years are not enough to prevent children from acquiring poor habits as they get older, when temptation is even greater.
“You can’t drop the ball,” she said. Therefore, the Children’s Aid Society plans to continue offering the program as the children move through the elementary grades by somehow blending it into the health or physical education curriculum.
Both Dr. Elbirt and Mr. Silence also note that for programs like theirs to spread, they will need to train teachers who will then train others. The Silences are already branching out in that direction. Last month, they traveled to Taiwan and Hong Kong to train preschool teachers there.
“This is a foundation for changing the health of society,” Mr. Silence said, “and we can only reach so many ourselves.”