memorandum

to:

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department of health/community health administration

from:

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catherine barrie

RE:

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nutrition in elementary schools

date:

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March 4, 2015

POLICY OPTION BRIEF

Problem: Childhood Obesity Rate Hasn’t Plateaued

Childhood obesity has been on a steady incline over the past 30 years and is considered a serious public health concern, especially in elementary school aged children. According to the US Surgeon General, nearly one in three children are overweight or obese (US Department of Human Health & Services, 2014). The American Heart Association (2010) has age and sex specific growth charts that show the calculation of children’s BMI using their height and weight. When children’s weight is well above the average for their height and age they are classified as obese.Our nation’s obesity epidemic effects are immense: taxpayers, communities, and families spend hundreds of billions of dollars each year in medical costs and attempts to end childhood obesity (Robert Wood Johnson Foundation, 2014). Obesity is the reason our youth is predicted to live shorter lives than our parents and we need to change this.

Childhood obesity has long-term harmful effects on a child’s future health. Obese children are more likely to have high blood pressure and high cholesterol which put them more at risk for cardiovascular disease in the future (Center for Disease Control & Prevention, 2014). Childhood obesity can lead to type 2 diabetes, cancer, asthma, joint problems, and liver disease. Over a lifetime, the medical costs associated with childhood obesity total about $19,000 per child compared with those for a child of normal weight (Healy, 2014). These costs occur decades later when children are adults with long-term effects. Obese children normally consume more energy in the form of food and drinks then they burn off with physical exercise (Kids Health, 2014).One long-term effect of childhood obesity is poor self-esteem and eating disorders that can continue into adulthood. Obese children that are teased by their classmates often have difficulty forming meaningful social relationships.

The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012 (Center for Disease Control & Prevention, 2014). The American Heart Association (2010) states risk factors that increase the rate of obesity are racial and ethnic groups, social economic status, and geographic location. The prevalence of obesity is on a rise in African American and Hispanic populations. Children are at a greater risk of being obese if their families are of low social-economic status. The cost of buying healthy food is considered a barrier to providing a nutritious meal for some families. Low-income families don’t have access to gyms and sports leagues to enroll their children in. As stated by Moore and Diez (2006), predominantly minority and racially mixed neighborhoods have half as many supermarkets as predominantly white neighborhoods. There is a very high regional prevalence of obesity in Southern states such as Alabama and Florida (Center for Disease Control & Prevention, 2014).

Although the national childhood obesity rate is believed to have plateaued, childhood obesity remains a major public health concern (Ogden et al., 2014). Multiple approaches have been made to change the way children eat and incorporate physical activity in elementary schools. Six out of 10 children ages 9-13 don’t participate in any kind of organized sports/physical activity program outside of school (Robert Woodson Johnson Foundation, 2006). In many elementary school curriculums physical education has been cut in half, not encouraging out of school exercise. Elementary school children continue to have poor food choices that include fast and fried foods, soft drinks, and unhealthy snacks. These are just a few of the contributing factors to the childhood obesity epidemic that has dramatically increased since 1970 (Robert Wood Johnson Foundation, 2014).

I would recommend that elementary schools start using the Center for Disease Control and Prevention’s NutStat program. The NutStat program records and evaluates the length, build, weight, and the circumference of a child’s head and arm (Center for Disease Control and Prevention, 2014). It is believed that the grade effect and the high prevalence of obesity provides a basis for BMI screening in elementary schools. I would suggest that schools take into account their age, sex, race, and if they qualify for free or reduced fare lunches. The participants should be clustered into two BMI categories, <85th percentile or ≥85th percentile. The results would most likely be consistent with the prevalence of obesity predominantly in American children and Hispanic children. Most variation of elementary school aged children’s BMI would be accounted for by ethnicity, social economic status, and grade placement.

Public elementary schools in Oklahoma along with the Health Department designed a programed called It’s All About Kids (DeVault et al., 2009). The goal of the program was to improve elementary school student food choices while increasing the amount of physical activity during the regular school day. The program was designed to have six weekly 30-minute classroom lessons that included fun healthy-eating games, test taking, baking, and demonstrations on how to portion your plate. The researchers used a randomized control trial to document and evaluate the program. The results of the trial were measured by pre-, post-, and follow-up testing. These tests were preformed using an adapted version of the Pathways Knowledge, Attitudes, and Behaviors questionnaire as well as the Child and Adolescent Trial of Cardiovascular Health (CATCH) Food Checklist. CATCH (2014) is a coordinated approach program that focuses on lessons on healthy eating behaviors, increasing preference, willingness and intake of fresh fruits, vegetables, and health snacks and drinks can be implemented in more elementary schools across the county. The program includes over 500 indoor and outdoor activities to increase the overall physical activity of elementary school-aged children. Teachers can use this program as part of their curriculum each year to reduce elementary school obesity. The intervention students were noted to have gained significant knowledge of which foods contained more fat improving their scores. Both intervention and comparison students reported lower intake of foods containing saturated fat and sodium. The study concluded that their results supported a broader program implementation. It was recommended that over time students would need reinforcement to sustain their levels of improvement. Adding the same study to New York State elementary schools would benefit both the school and the children taking part in the program.

A program called VERB (Center for Disease Control & Prevention, 2014) is a campaign that was developed for children between the ages of 9-13 years old to promote physical activity through colorful materials and contests. The campaign combined advertising, marketing, and partnership efforts to reach teenagers and their parents, teachers, and health care providers.

VERB included school programs consisting of many classmates whose habits mirror each other. During this program home economics classes were offered to parents from low socio-economic families to teach them how to make nutritious meals without spending their entire paycheck at the grocery store. Flyers were sent home with children informing parents of upcoming sport activities in their local community. If elementary school-aged children see their parents eating healthy and staying active, they will want to join in. Physical education teachers developed friendly competition such as field day to allow kids the opportunity for exercise. Nutritious items were added to elementary school kitchens while high caloric and sugary beverages disappeared.

Lastly, I would implement Traffic Light Eating into elementary school cafeterias. Elementary school officials should be working with kids and families to help them learn tools that will allow them to make healthier choices and to manage their weight. One of the most important tools is the Traffic Light Classification of food. Food items are labeled with either a green, yellow, or red sticker. Traffic Light Eating is just like driving a car. Green means “go”, yellow tells children to “slow down”, and red tells children to “stop” and think about what they are eating (Dr.Sears Wellness, 2015). Green light foods have high nutritional value while remaining low in calories, fat, and sugar. Food items included in this category are fruits and vegetables. Children should be eating at least one serving of fruits and vegetables with every meal. Yellow light foods include lean proteins and whole grains, which make up most of a child’s diet. Yellow light foods contain important nutrients but are moderately high in calories, sugar, and fat. Yellow stands for slow down and be aware of portions. Red light foods have very little, if any, nutritional value. These food items are high in calories, sugar, and fat. Red light foods should be limited and only given to children as a special treat. In May 2010, the White House Childhood Obesity Task Force identified the need to improve front-of package nutrition labels, which are meant to display nutrition information in an easily understood format that consumers can view quickly when making purchasing decisions. The White House study findings suggested that if the food item has an appropriate color lab it can improve the accuracy of an individual’s judgment about the nutritional quality of food and beverages (White House Taskforce, 2014).

Childhood obesity can be tackled by education, prevention and sustainable interventions related to healthy nutrition practices and physical activity promotion. If interventions are put in place in elementary schools across the country, we can hopefully see a decline in obesity in the future. The above interventions are a combination of family based and school based interventions that have been effective in targeting childhood obesity. With any solution there is a chance that it could create more problems but solving childhood obesity is clearing up one problem that needs attention. The major challenge faced by these intervention programs is financial support. Some of the above interventions have better cost/benefit ratio than others. The Government along with many elementary schools are taking effective actions like policy changing to improve the outcome of their student’s lives. There is no argument that these interventions are not practical in terms of cost, complexity, or implementability. What children learn about better food choices and physical education activity will help them achieve a healthier lifestyle. If we as role models, continue to focus on elementary school children and their habits in and out of school, we can reduce the rate of childhood obesity leading to a healthier society. If we act now to change the nutrition in elementary school’s we can improve the outcome of their lives. By enacting these policies, we will be able to focus on what truly matters, the children and creating a healthier future. Thank you for considering my proposal on elementary school nutrition.

References

American Heart Association (2010). Understanding Childhood Obesity. Retrieved from

Center for Disease Control and Prevention. (2014). NutStat. Retrieved from http://ftp.cdc.gov/pub/epodphsi/Español/NUTSTAT.HTM

Center for Disease Control and Prevention. (2014). U.S. Obesity Trends. Retrieved from http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Center for Disease Control and Prevention. (2014). Youth Media Campaign VERB. Retrieved from http://www.cdc.gov/youthcampaign/

Dr. Sears Wellness Institute (2015). Traffic Light Eating. Retrieved from

Healy, Michelle. (2014, April 7). Price tag for childhood obesity: $19,000 per kid. USA Today

Moore LV, Diez Roux AV. (2006, February). Associations of neighborhood characteristics with the location and type of food stores. Am J Public Health.

Ogden C. L., Carroll, M. D., Kit, B.K., & Flegal K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814.

Robert Wood Johnson Foundation (2006). A Nation at Risk, Statistical Sourcebook, Presents Facts about Obesitys. Retrieved from

Robert Wood Johnson Foundation (2014). Signs of progress on childhood obesity. Retrieved from

US Department of Human Health & Services (2015). Surgeon General

http://www.surgeongeneral.gov/initiatives/healthy-fit-nation/obesityvision_factsheet.html

White House Task Force on Childhood Obesity (2014). Solving the problem of childhood obesity within a generation. Retrieved from www.letsmove.gov/whitehouse-task-force-childhood-obesity-report-president.