Disease prevention strategies and public health approaches

Childhood Obesity Epidemic

Disease Prevention

Tackling the Childhood Obesity Epidemic through School Reforms

Tackling the Childhood Obesity Epidemic through School Reforms

A current health crisis facing developed nations is the obesity epidemic. In the United States, the prevalence of obese adults has doubled over the past fifty years (reviewed by Hurt, Kulisek, Buchanan, and McClave, 2010). Today, close to a third of Americans are obese and another third are overweight. The increase in childhood obesity is also a major concern, with the prevalence rising from 6% to 19% between 1985 and 2010. Current estimates suggest that close to a third of U.S. children are obese or overweight (reviewed by Salvy, de la Haye, Bowker, and Hermans, 2012). With an estimated yearly healthcare cost of $150 billion, obesity has become a major public health issue and is expected to soon overtake tobacco as the number one cause of preventable disease and death in the U.S. (Hurt, Kulisek, Buchanan, and McClave, 2010).

Being obese or overweight are not diseases per se, but these conditions have been shown to contribute to a number of serious medical problems including type 2 diabetes, high blood pressure, liver disease, and coronary artery disease (reviewed by Hurt, Kulisek, Buchanan, and McClave, 2010). In addition, the increased prevalence of childhood obesity has resulted in the diagnosis of diseases in children that were previously considered adult-only, including type 2 diabetes and heart disease. Being obese and overweight therefore contributes to a number of comorbid conditions, in addition to the social stigma and related psychological problems common to this demographic.

To provide a glimpse of public health efforts to reduce the prevalence of childhood obesity in the United States, the following essay will review several recent studies examining obesity trends and interventions in urban schools.

The School Obesity Environment

Efforts to reduce the incidence of childhood obesity naturally focus on the role schools can play (reviewed by Story, Nanney, and Schwartz, 2009). Next to the home environment, which public health officials have little control over, schools represent the best route for influencing the lifestyle habits of children and adolescents. Of primary concern are the foods made available to students and the opportunities for physical activity in U.S. schools.

The availability of sweetened beverages and energy-dense snacks are widely considered a significant factors contributing to the childhood obesity epidemic. Accordingly, the number of schools prohibiting vending machines, which tend to offer these foods, was increased from 4% to 30% between 2000 and 2006 (reviewed by Story, Nanney, and Schwartz, 2009, p. 2-3). Similar trends were reported for school canteens and school stores. Despite these promising trends, such findings highlight how pervasive these foods are in the school environment. Attitudes also seem to be a problem, with 37% and 50-60% of elementary and middle/high schools, respectively, holding fundraisers offering similar types of foods and beverages. The practice of teachers rewarding classroom performance with sugary snacks is equally troubling. The reason such practices represent a threat to student health is because one study found that the body mass index of children increased by 0.1 unit for each permissive food practice allowed in schools.

Energy-dense, low nutrition foods are considered competitive foods, since they compete with more nutritious choices offered by schools (reviewed by Story, Nanney, and Schwartz, 2009, p. 3-4). A number of empirical studies have shown that when such foods are available, children and adolescents tend to reduce their consumption of healthy, nutritious foods. One study compared the eating habits of a class that transitioned from elementary to middle school and found that the sudden access to competitive foods resulted in less consumption of fruits, nonstarchy vegetables, and milk, and more consumption of sweetened beverages and high-fat vegetables. Competitive foods had not been available to these children in elementary school.

Another factor contributing to the consumption of competitive foods is the inadequate caloric and nutritional value of school meals (reviewed by Story, Nanney, and Schwartz, 2009, p. 5). The United States Department of Agriculture (USDA) has established nutritional guidelines for school lunches, which many schools must meet in order to qualify for federal subsidies. These subsidies allow schools to provide reduced cost or free meals to students from low-income families, thus increasing the health and academic performance of these students. A recent study found that less than a third of public schools offer meals that meet UDSA standards for percent calories from fat. Total calories offered were also lacking, with only 79% and 50% of elementary and high schools, respectively, providing enough calories to meet the USDA minimum standards.

Ongoing Reform Efforts

The New York City (NYC) public school system is the nation's largest school district, providing breakfast and lunches to 1.1 million students (reviewed by Perlman, 2012). According to a study published in 2009, 39% of NYC children attending kindergarten through 8th grade are overweight or obese and 75% qualified for federally subsidized lunches. Breakfast is offered to all school children regardless of family income. The NYC public school system therefore provides an ideal laboratory within which to test the effects of school nutritional reforms designed to reduce the prevalence of childhood obesity.

Over the past decade, the NYC Department of Education engaged in a series of school nutrition reforms (Perlman, 2012). Beginning in 2001, menus were revised to improve the nutritional value of offerings after a team of professional chefs and a registered dietician were hired. With these professionals at the helm, sodium and cholesterol levels were reduced and a number of additives were eliminated. When possible, lean beef was offered and turkey products were substituted for pork. Products containing trans-fats and high-fructose corn syrup were eliminated and whole grain offerings began to appear. Low-fat milk became the only milk option. Water fountains were replaced with new models that provided cold water and a stronger stream, thus providing a healthier alternative to sweetened beverages. In 2003, competitive foods sold through vending machines were limited to water, milk, 100% fruit juice, and low-fat snacks. Such offerings were further revised in 2009 to meet the same nutritional standards that the school food offerings had to meet. This meant that all beverages had to be free of caffeine, artificial ingredients, and could not supply more than 10 calories per 8 ounces. In addition, school bake sales had to limit the sale of competitive foods to once a month.