Policy Memorandum

Catherine Barrie

Bernard M. Baruch College

EXECUTIVE SUMMARY

The rate of childhood obesity has continued to be on an upward climb becoming a serious public health concern. It is estimated that 11% of children in elementary schoolsare obese. Children who are obese are more likely to have multiple health issues, including heart disease, type 2 diabetes, and asthma. Obese children are also at risk for mental health related issues such as low stigma and self-esteem. Obese children can be picked on or bullied in elementary school due to their weight, leading to poor development of their social skills. Many studies show that if elementary schools limit the amount of junk food and sugary beverages while adding more time for physical education they can have a positive impact against childhood obesity. Policies can be put into place, including interventionswithin elementary schools that will benefitthe future health of children.

Keywords: obesity, elementary school, physical education, health issues.

memorandum

to:

department of health/community health administration

from:

catherine barrie

RE:

nutrition in elementary schools

date:

May 03, 2015

PROBLEM: CHILDHOOD OBESITY RATE AMONGST ELEMENTARY

SCHOOL – AGED CHILDREN

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. Children whose BMI- for age is in the 95th percentile or higher are considered to be obese. Obese children normally consume more energy in the form of food and drinks then they burn off with physical exercise (Kids Health, 2014).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. 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).

Many theoretical models and conceptual frameworks have been used with childhood obesity prevention, especially targeting elementary school age children. The Social Cognitive Theory (McLeod, 2011) developed by Bandura closely relates to childhood obesity. The Social Cognitive Theory describes a continuously dynamic process in which personal factors, environmental factors and human behavior all tie into each other. The Social Cognitive Theory is focused on self-efficacy and can be applied in many different arenas such as mass media, public health, and education (Clark, C.C & Paraska, K.K, 2014). Bandura believed that behavior is learned from the environment through the process of observing other individuals. Elementary school aged children are surrounded by many influential role models in our society today; whether it be their family and friends, teachers, actors, or social media. It is very common that children will image the behavior of role models around them (McLeod, 2011).

I propose four policy options to reduce the childhood obesity rates about elementary school aged children. All policy options are programs that are currently in place in different states with proven to be effective. The first policy option I proposed is called The NutStat program that was developed by the Center for Disease Control and Prevention and provides a record of students BMI. The second policy option I propose is a program called VERB developed by the Center for Disease Control and Prevention that promotes physical activity through colorful materials and contests. The third policy option I propose is Traffic Light Eating, a classification program that would be used within elementary school cafeterias to label the nutritional status of food items offered. Lastly, the fourth policy option is called “It’s All About Kids”, a program that improves elementary school student food choices while increasing the amount of physical activity during the regular school day.

CENTER FOR DISEASE CONTROL AND PREVENTION’S NUTSTAT PROGRAM

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. This program would only allow for elementary schools to gather the appropriate data and choose which one of the other proposed policy options would best fit into their curriculum.

CENTER FOR DISEASE CONTROL AND PREVENTION’S VERB 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. VERB was the only federal program aimed at childhood obesity that's been evaluated and found to be effective. With a target audience of 21 million, VERB’s funding started off with $125 million, which works out to about $6 per child per year (CDC, 2005). Over the 5-year period that VERB was in effect, the federal support dropped as low at $36 million, averaging out to $68 million per year. 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. Bringing back this federally funded program can benefit our elementary schools that are located in low socio-economic areas.

TRAFFIC LIGHT EATING CLASSIFICATION PROGRAM

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. The cost of implementing the Traffic Light Eating system into school cafeteria’s can be inexpensive if each school has a nutritionist on payroll. 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).

“IT’S ALL ABOUT KIDS” PROGRAM

Public elementary schools in Oklahoma along with the Health Department designed a programed called It’s All About Kids (DeVault et al., 2009). Following a needs assessment in the community, partnerships were formed, funding was allocated, and logistics were identified. 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 is designed to decreased cardiovascular risk by decreasing fat, saturate fat, and sodium in the diet of school children, while increasing their physical activity. 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. This study was able to identify modifiable behaviors and environmental factors that impacted childhood obesity and document the intervention process and outcome measures that lead to more widespread implementation. It was recommended that over time students would need reinforcement to sustain their levels of improvement. Since 2004 when It's All About Kids made its first debut, it has helped thousands of school children improve their knowledge, attitudes and behaviors toward nutrition and exercise. “Each year, the program reaches over 8,500 students in Tulsa, Union and Sand Springs public school districts, and hosts more than 40 informative and exciting events for parents and families” (Tulsa Health, 2015). The program was recognized in 2008 as a Model Practice by the National Association for City and County Health Officials (NACCHO) in Tulsa.Adding the same study to New York State elementary schools would benefit both the school and the children taking part in the program.

RECOMMENDATIONS

The “It’s All About Kid’s” program would be the best program for elementary schools targeted. This program incorporates increasing physical activity, healthful eating, family and community involvement and a school curriculum. This program is comprehensive and targets many issues to combat childhood obesity while achieving their goal of providing a prevention model for elementary school aged youth to improve healthy lifestyles, reduce obesity, improve school performance and enhance decision making and negotiation skills. This program can be offered to every public school that has alarming cases of childhood obesity. The panel found one concern regarding how this program will affect change amongst the youth in the low performing schools, with poor attendance rates, schools lacking a physical education instructor, schools with poor parental involvement, and schools with limited access to healthcare services. The elementary schools that the panel finds will face these challenging issues are linked to income disparity, poverty, and high levels of crime and violence within the communities. The program has gone through some changes since it started in 2004 to make it stronger. The program provides services such as health education, oral health education, nutrition, physical education, as well as community health and social services, health promotion for school personnel, parental involvement programs, trainings and technical assistance for schools, and community outreach activities (Tulsa Health, 2015). With the new addition of parental involvement programs and trainings each school district can alter the program slightly to provide the best activities for their community. The program is aimed at youth development in and out-of-school time and is built on family and community engagement along with partnerships from the neighborhood.

CONCLUSION

Childhood obesity can be tackled by education, prevention, and sustainable interventions in schools related to healthy nutrition practices and physical activity promotion. The home is also likely to have a great influence on a child’s eating and physical activity choices. The policies are a combination of family and school based interventions that have been effective in targeting childhood obesity. Enacting It’s All About Kids or any of these policies will help teach children early about better food choices and physical education, helping reduce the rate of childhood obesity and achieve a healthier future. Thank you for considering my proposal on elementary school nutrition.