Another weighty burden: how much responsibility do schools bear for addressing the obesity of their students?

Forgive the grammar, but the student body just ain't what it used to be.

Here's the hard, heavy truth: American kids are fat and getting fatter. In the late 1970s, about 7 percent of U.S. children between the ages of six and 11 were considered obese, according to the federal Centers for Disease Control. The percentage now is more than 13 percent, even higher among teens and in certain demographic groups.

The reasons why are no surprise. Children are simply a mirror of the country at large: 127 million American adults are overweight, almost half of them officially deemed obese.

These Americans typically eat poorly and exercise infrequently, if they exercise at all. It's pretty much the same with overweight children, whose diets tend to be dominated by fatty fast foods and sugary snacks; who watch too much TV (about four hours a day on average) and who rarely venture outside to play (less than two hours a day on average).

None of which bodes well for a child's education.

"That's the irony of all this," says Tom Templin, a professor of health at Purdue University and president of the National Association for Sport and Physical Education. "We've known for a long time that the body and mind work together. If kids aren't healthy, their academic prowess is affected."

A Leader's Role?

But what's a school leader to do? Generally speaking, the care and feeding of children is the job and duty of parents, not superintendents, principals and teachers.

"Parents are ultimately responsible for their kids' nutrition, for their education, for everything," says Joe Bast, president of the Heartland Institute, a Chicago-based organization that promotes libertarian ideals.

Yet over the years, responsibilities that were once the sole province of parents, such as teaching about sex or drugs, have fundamentally shifted to schools. At times, it sometimes seems, educators are expected to address--in one form or another--virtually every aspect of a child's persona and life.

That includes what they eat and their state of health.

"Making sure children eat right and well has been a shared responsibility of parents and schools ever since the first school sold or provided a food item or beverage to a student," said Dr. Howard Taras, an associate professor of pediatrics at the University of California, San Diego.

"So in that sense, it is not an unfair burden on schools. Whoever is providing food for our children should be responsible with what foods they provide. In fact, schools may bear a certain increased burden because, as a teaching institution, they need to be a role model."

Taras, who serves as a medical consultant to several K-12 districts, says there's nothing terribly wrong with a child drinking a soda now and then. "But selling or otherwise providing sodas in school is inappropriate," he contends. "Why? Because schools should be setting a positive example. What schools serve is almost an endorsement of what is healthy, of what is OK to eat.

"The same can be said for physical activity. Every man, woman and child should be active during the day, and children spend the greatest portion of their days in school so physical activity must occur there. So again, schools bear a larger burden. They share the responsibility with parents to educate students on how and why to do this," Taras adds.

Presumably, few educators would argue otherwise.

"Our top priority is academic achievement. It's not our job to make sure kids eat right," said Dr. Dexter Louie, a physician and board of education member in the Moraga School District, east of San Francisco. "But as school leaders, we have the opportunity to do a really good thing. Kids are there to learn and being healthy helps them learn."

Louie backs up his words with actions, visiting schools to discuss proper nutrition and health as part of an outreach program sponsored by the California Medical Association Foundation.

"I tell kids immediately that we're not going to talk about the food pyramid and stuff like that," said Louie. "I ask them if they know any diabetics. I talk about that disease and others, what they do to people's bodies and how you can avoid them if you avoid obesity. I tell them that when they reach adulthood, the two things they will value most are their families and their health. I don't lecture down to them. I tell them to figure it out."

But Louie is clearly an exception to the rule.

Snacks Everywhere

According to a Centers for Disease Control study in 2000, roughly half of all school districts with middle and/or high schools had distribution contracts with soda vendors. Almost 80 percent of these districts negotiated to get a specified share of receipts. In these districts, students typically can buy sodas from vending machines, snack bars, school stores, even the cafeteria.

That soda helps wash down a multitude of junk food: 70 percent of the schools surveyed by the CDC permitted the sale of low-nutrition snacks during lunch. At the other end of the spectrum, fewer than 10 percent of the districts surveyed provided daily physical education classes or the equivalent--this despite the fact the CDC and other health authorities recommend children and teens participate in moderate to vigorous physical activity for one hour five times a week.

Not surprisingly, school officials find themselves in a tight spot. Most say they would like to do more, but there are other considerations.

First, selling sodas, snacks and foods like pizza and chicken wings is a lucrative and arguably necessary business. Revenue from such sales helps keep a lot of school food service programs in the black and in some places funds school activities and field trips that might not exist otherwise. Many fear, whether they admit it or not, that banning junk food sales would cause financial disaster.

Second, the higher academic standards and greater accountability of No Child Left Behind have compelled many districts and administrators to roll back or eliminate programs that might detract from a core curriculum.

"Schools have all sorts of mandates and elevated expectations," says Purdue's Templin. "Educators begin looking at what they're expected to teach. They look at other activities like art, music, P.E. and health, and they prioritize what's most important. That makes for a very difficult situation for people who value those curricular activities that tend to get cut or minimized, like P.E. and health."

Besides, say many educators in moments of candor, solving student obesity is not really their job, even if they were adequately equipped or able to solve it.

"Our responsibility rests with that over which we have control," says Mike Redburn, superintendent in Bozeman, Mont. "If anyone depends on the school to do the heavy lifting on student nutrition and health, their hopes will be unfulfilled. Families and communities must meet their responsibilities."

School Food

Like it or not, schools must shoulder this weighty burden, if only because most children spend a good chunk of their waking hours five days a week there.

"We are responsible for these children for up to eight hours a day," says Pat Cooper, superintendent of the 3,000-student McComb, Miss., School District. "It is educationally and ethically our duty to take care of them."

The core issue for some in the food service field is the quality of what's served to students during lunch.

"We are obligated to serve healthy food. Districts that don't are simply being lazy. Whoever said it was OK for us to sell junk food?" asks Al Schieder, director of food services in the Folsom Cordova Unified Schools, a suburban K-12 district of 18,000 students north-east of Sacramento, Calif.

Beyond that, there's this: Fat children tend to become fat adults. And fat adults cost this country more than $11 billion annually in health care, lost productivity and other expenses. Teaching good eating habits and health is an economic imperative.

"Not to mention," says Louie, the board member in Moraga, Calif., "that fat adults have a reduced chance of becoming old adults."

McComb's Regimen

The good news about schools, nutrition and health is that there's plenty of good news. An array of school districts in states across the country have launched programs to eliminate or reduce sodas and snacks on campus, improve the nutritional quality and appeal of school lunches, bolster lessons and classes on health and increase opportunities for physical exercise.

The California legislature in 2001 established the first nutrition standards for so-called "competitive foods and beverages." These are products not sold as part of a school meal, but separately, such as pizza or soda, in cafeterias, student stores and vending machines. Because such fare had not been regulated previously, competitive foods tended to be junk foods high in sugar and fat, boasting only minimal nutritional value compared to school meals that are subject to government regulation.

The California Department of Education then ordered a pilot program involving 16 middle schools and nine high schools to evaluate how the new nutrition standards affected food service programs and income. Conducted by the state's Linking Education, Activity and Food program, the study found most test cafeterias actually boosted their income by reducing or eliminating competitive foods that did not meet the state's nutrition standards.

The reason? More students purchased the healthier school lunches, if only because they had no other option.

In Folsom, Schieder junked the a la carte menu and ended sales of unhealthy snacks and soda in the district's 30 schools. The lunch menu was redesigned to give all students the same eight daily options: salads, pasta, wraps, even sushi. Prices were adjusted so that even the poorest students could afford healthier meals, eliminating the stigma of some students having to buy the cheaper and definitely uncool government meal.

"And you know what? We're doing fine financially," Schieder says.

Cooper, who directed the Centers for Disease Control's National School Health Education Coalition before becoming McComb's superintendent, did something similar in his conservative, low-income district. At the K-8 level, he and his school board banned all fund raising using candy or other less nutritious offerings. The district set guidelines for what sorts of snacks could be brought to school. At the high school, the lunch menu was revised and soda sales restricted to after school.

"If we're going to do what No Child Left Behind says--and I think we should--then we can't ignore the health issues," says Cooper. "It's a cop-out to say you can't change the way kids eat. If there's nothing else to eat but what you feed them, you can be assured that kids are going to eat the right foods."

A Parental Complaint

But such sentiment isn't easily swallowed everywhere or by everyone. One of the chief objections to restrictions or outright bans of non-nutritious foods at school is the matter of choice. Witness what happened in 2004-05 in the Millburn Township School District in Essex County, N.J.

Meme Roth, the mother of two young children, became increasingly alarmed at how much cake, cookies and candy her kindergarten-age son was eating at school and the booty from classroom parties and celebrations he was bringing home. Roth, who says her family has long battled weight and health problems, also objected to the food options in the school district's elementary lunch program, which is run by the volunteer Parent-Teacher Organization.

Because the affluent district does not participate in the federal lunch program, none of the Millburn PTOs are obliged to meet government nutritional requirements when developing their schools' menu.

"So a typical lunch (at her son's school) would be a white bagel with cream cheese or butter, a side of Pringles, maybe some watermelon and some Smarties," Roth said. The lunches are very popular and are among the school's most effective means of raising funds.

Eventually, Roth got approval to organize an alternative lunch program that featured whole grains, organic meats, fresh fruits and vegetables. The four-week pilot proved to be a hit with children, she contends, even though the lunches were more expensive. But when she lobbied the school to junk the PTO lunch program in favor of healthier fare, she says she hit a wall.

Support from other parents was lukewarm at best. "A teacher I talked to said there was nothing she could do, that she was 'just a teacher.' The principal said it wasn't his responsibility. The head of the PTO said what was being served 'wasn't heroin.' Nobody thought it was an issue," Roth says.

Richard Brodow, superintendent of the 4,000-student Millburn district, sees things somewhat differently.

"We certainly support good nutrition. Just two years ago, we removed from the middle school a number of sweets and candies that kids could purchase. And there was a loss of income," Brodow says.

"But the question here is really whether the district should dictate to parents who volunteer what they should and shouldn't be serving their children, whether the district should ban things like cupcake celebrations.

"I believe in moderation," Brodow explains. "I don't want to order bans, decree that at no time can a parent bring in cupcakes for a class. That seems very harsh, but we also don't want a situation where kids are bombarded with snacks during the day. That's unhealthy and that's not what school is all about. What we need is simple common sense."

Exactly, says Marshall Manson, vice president of public affairs for the Center for Individual Freedom, an Alexandria, Va.-based advocacy group.

"It's not unreasonable to say that local schools and local districts ought to be able to do what they want without oversight from the state or federal food police. Everybody wants children to eat healthy," Manson says. "But the correct solution involves balance. You don't want every vending machine on campus to sell only Cokes or only carrots. People who espouse limiting choice because kids might make the wrong choice are supporting a point of view that can only lead to other limits on freedom down the road."

Freedom of choice was the reason Connecticut Gov. M. Jodi Rell recently vetoed a state bill that would have restricted the sale of some snack foods and beverages in all public schools while requiring a minimum of 100 minutes a week of recess for younger students. Rell, a Republican, said the bill usurped the longstanding authority of local districts to decide such issues for themselves. Critics said her veto was a blow to children and a nod to the powerful snack food lobby.

Societal Impact

In the end, it seems, the question of how much responsibility public school leaders shoulder for the health and well-being of students ultimately depends upon the individual administrator.

If he or she decides to act, there can be no half-measures, says Mary Ann Lopez, food service director for the 5,500-student South Windsor, Conn., district.

"Schools that try to do both, offering good foods and bad, aren't going to succeed," Lopez says. "Kids will always buy the bad. It's all or nothing. You just have to know going in that you're going to take a hit at first. Kids need time to adjust to new menus that don't have the usual unhealthy foods. But they all learn."

Taras at UCSD goes further, saying good school leaders do as much as they can, not just because it's educationally or economically the right thing to do, but because lives hang in the balance.

A recent study, published in The New England Journal of Medicine, said childhood obesity threatens to create the first American generation of kids whose average life span will be shorter than that of their parents.

"As a society," Taras says, "we have to ask ourselves what it is we want for our youth. Do we want kids who are literate and math-ready, but who are significantly more likely than necessary to drop dead at a young age from medical ramifications of a poor lifestyle?

"If this is not what we want in our society, then the mandated core curriculum as it is currently written (for literacy, math and science) is deficient. It should also include outcomes that will help us produce productive citizens who will live long enough to demonstrate their full productivity."

Resources

Howard Taras, a member of the American Academy of Pediatrics' Task Force on Obesity, suggests these resources relating to schools' role in combating obesity.

* "Health, Mental Health and Safety Guidelines for Schools." Guidance for schools on nutrition, physical activity and other school health issues. www.nationalguidelines.org or call 800-433-9016

* "School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide." www.cdc.gov/nccdphp/dash

* "Fit, Healthy and Ready to Learn: A School Health Policy Guide." www. nasbe.org/healthyschools/fithealthy.mgi

* CATCH. An effective set of curricula for physical education improvements and nutrition education, including a module on cafeteria changes. www.sph.uth.tmc.edu/catch/

* Action for Healthy Kids. A nonprofit organization, operating in all 50 states, formed specifically to address the epidemic of overweight, undernourished and sedentary youth by focusing on changes at school, www. actionforhealthykids.org

* TEAM Nutrition. Explains to schools how to easily comply with the local wellness policy (law applying to any school participating in the federal lunch program), with emphasis on obesity prevention activities, www. fns.usda.gov/tn/Healthy/wellnesspolicy.html RELATED ARTICLE: Denver's balancing act for obesity and vending.

BY ANDRE N. PETTIGREW

Recognizing that well-nourished children are better equipped to learn and acknowledging the proven link between adequate nutrition and academic performance, Denver Public Schools developed a comprehensive approach to school nutrition that viewed policies and procedures systematically. We decided to look at the big picture instead of simply focusing on one issue, such as the content of vending machines,

The school environment has a powerful influence on children. In schools, healthy behavior can be modeled and reinforced so we can educate students to make the choices that will develop into lifelong healthy habits.

We established a "one vend" concept where all food and beverage vending was under the management of the school district's Food and Nutrition Department. This approach provides uniform management, leading to tighter central control and continuity. It has enabled us to establish and enforce healthier nutrition standards throughout the district.

Our district's efforts built on the state legislature's passage of a bill that encouraged school districts to ensure at least 50 percent of their food- and beverage-vended products meet acceptable nutrition standards (defined in Colorado State Senate Bill 04-103). We went a step further and decided that not only would we meet the 50 percent standard, but all snack vending and a la carte food products would not be sold if they did not meet our own higher nutrition standard. (Calories from fat cannot exceed 40 percent, saturated fat cannot exceed 10 percent and sugar cannot exceed 35 percent by weight.) This led to the elimination of all candy sales and other popular food items in our schools.

A Dairy Link

To improve student nutrition further, the district added 10-ounce milk (in plastic bottles) at all secondary schools as part of a reimbursable meal. We specifically sought out glass-front coolers with cow graphics to improve the display of the milk (white, chocolate, strawberry and orange) and capture student attention.

This has been a big hit with the students, and milk consumption has increased significantly--59 percent in middle schools and 48 percent in high schools during the first year of implementation. In addition, we encourage the consumption of milk over other beverages by making it available to students all day through our milk vending machines and having it priced lower than other beverages.

We piloted breakfast in the classroom where all students K-5 eat free. We deliver food items, including milk, and pick up trash after the breakfast period. Attendance rose, tardiness fell and student behavior improved when more children ate breakfast.

Leveraging Providers

We worked with our beverage exclusivity contract to change product mix that goes beyond the recommendation that 50 percent of the product be healthy. We also incorporated other enhancements into the contract that promote healthy products such as:

* Only water can be sold in public areas in the elementary schools;

* Machine graphics must promote physical activity or water products; and

* Water may not cost more than other beverages.

We have worked with different manufacturers to lower the fat content in three popular lunch offerings--chicken fingers, pizza and french fries, then tested the products to see whether students noticed any difference in taste or appearance.

We have partnered with the Integrated Nutrition Education Program (sponsored by the University of Colorado Health Science Center) to ensure that what we teach in the classroom is available in the school cafeteria.

Board Role

Nutrition and physical activity go hand in hand when trying to fight student obesity and raise academic performance. The Denver Board of Education passed a resolution establishing an independent commission of community experts to address the quality of school nutrition and physical activity. The Commission on School Nutrition and Physical Activity examined effective practices in schools and recommended policies and procedures to the school board in June.

The board passed all 13 of the commission's recommendations. Some of the more notable measures are:

* A new wellness policy is being prepared for introduction in our district this fall;

* A districtwide nutrition policy is being readied that will include nutritional guidelines for all food and beverages sold on campus, including school stores run by the Distributive Education Clubs of America. The policy will restrict all food and beverages sold to strict nutritional guidelines.

* More health education, including behaviorally focused nutrition education, is being integrated into existing course work and programs;

* The district is pursuing the goal of all students participating in at least 60 minutes of moderate to vigorous physical activity every day. Suggested steps include adding recess time and promoting before- and after-school physical activities.

The final report of the Commission on School Nutrition and Physical Activity can be found online at: dcsnpa. dpsk12.org.

Andre Pettigrew is assistant superintendent for administrative services in the Denver Public Schools, 900 Grant St., Room 501, Denver, CO 80203. E-mail: [e-mail]

RELATED ARTICLE: AASA assists on wellness policies.

AASA will be providing guidance to school system leaders on student health policies and practices in advance of new federal requirements that take effect during 2006-07.

Coca Cola is funding a superintendent-in-residence to provide on-site assistance to school districts on developing wellness guidelines, respond to information requests and develop a website promoting health policies.

The one-year AASA project will help school districts participating in the school breakfast and lunch program administered by the U.S. Department of Agriculture to meet the new requirements of the Child Nutrition and WIC Reauthorization Act of 2004. The law requires school districts adopt a school wellness policy by July 1, 2006, that addresses the availability of all food and beverages in cafeterias, vending machines and school stores.

Gayden Carruth, who retired in June after 20 years in the superintendency, most recently in the Park Hill School District in Kansas City, Mo., will serve as AASA superintendent-in-residence through August 2006. She is a former chair of the AASA federal legislative committee. She can be reached at [e-mail].

RELATED ARTICLE: A pediatrician's prescription to stem childhood obesity.

HOWARD L. TARAS

Should school administrators, consumed by woefully underfunded mandates to leave no children behind, be asked to shoulder responsibility for the latest health epidemic in America--childhood obesity?

Societal changes undoubtedly have contributed to the rise in obesity. High numbers of working parents have little time to cook. Fast-food outlets are ubiquitous. Safety-conscious parents worry about children's unsupervised outdoor play. Cyberspace, virtual reality and thumb games make recreation something done in a seated position. These are only some of the countless potential targets for reversing obesity-causing trends outside of school. So can't we let schools off the hook for this health problem?

The truth is schools also have changed dramatically. How many of us in our 40s or 50s remember drinking sodas in a high school class? The proportion of schools providing daily physical education has plummeted. Exposure in school to colorful, backlit advertisements for high-sugar beverages did not exist until recently.

A national survey by the Centers for Disease Control in 2000 found half of all school districts have a contract with a soft drink distributor. Of these, nearly 80 percent receive a specified percentage of the sales receipts. Almost two-thirds are financially rewarded if sales surpass a minimum amount.

Even though U.S. Department of Agriculture guidelines discourage sales of "foods of minimal nutritional value," 70 percent of schools allow students to buy such snacks during lunch.

Schools' contributions to combating the obesity epidemic are no less critical than those of the public health system or the food and beverage industries. It is the cumulative effect of many changes in children's and adults' environments that is necessary to reverse our current deadly course.

Reversing Obesity

The first step schools can take is to implement programs shown through research to work or to be promising. For example, staff development, curricular modification and adequate supplies have been shown to optimize the aerobic quality of physical education class.

Will daily, aerobic physical activity increase test scores? Results of controlled experiments to date do not support this. Yet evidence suggests that supplanting academic time with physical education does not hurt academic performance as measured by cognitive and standardized tests. Immediately after engaging in physical exertion, children are more attentive. Increased attention to class content likely counterbalances class time lost to physical activity.

Schools have joined with community partners to arrange for safer bicycle and walking routes to and from school and for healthier after-school programs that promote physical activity. Schools have hosted community gardens and opened playgrounds on weekends. They have hosted media events to advertise their healthy programs.

We know what it takes to improve the school nutrition program. Food services must be coordinated with students' families (to meet cultural food preferences), the district business office and school health educators. This leads to competitive pricing and income as well as availability of healthier food choices in cafeterias, vending machines, school stores, fund-raising events and classroom celebrations.

Against the Odds

Is prohibiting or discouraging students from consuming sugary beverages and fried snack foods at school worth the effort when students may simply consume that much more of these unhealthful products at home and elsewhere? Isn't it going a bit too far to mandate serving mangos instead of pizza or ice cream at a rare classroom celebration?

Actually, these are not unreasonable changes. School may be the only place where a child tastes healthier choices and learns that intake of some foods ought to be limited. Lifestyle improvements that arise from setting a healthy example at school may be delayed for years. But given the dire consequences of inaction, this is an effort schools cannot easily justify denying to today's youth.

Howard Taras is a professor of pediatrics at University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093; E-mail: [e-mail]. A medical doctor, he is a member of the American Academy of Pediatrics' Task Force on Obesity.

RELATED ARTICLE: Pursuing answers to obesity.

REBECCA NELSON

AASA has been named a partner in Active Living Leadership, a national initiative funded by the Robert Wood Johnson Foundation to support state and local leaders in the campaign against the growing obesity of America's youth.

The foundation's goal is to support the creation and promotion of policies, programs and practices to improve the health, well-being and vitality of communities. AASA's role is to focus on school districts to promote collaboration between the community and its public schools.

AASA is working with superintendents and school districts to identify the challenges that district leaders face with regard to student obesity, physical activity and diet--the factors relating to healthy, active living.

The project, which began in May 2005, also will identify informational resources, including publications, web-based tools and presentations at conferences. By promoting this as a timely and important issue, AASA is mobilizing commitment among superintendents.

AASA also is working with other organizations to explore ways that school and government leaders can work together to fight childhood obesity.

Based at San Diego State University, Active Living Leadership is a partnership among the International City/County Management Association, the Local Government Commission, National Association of Counties, National Conference of State Legislatures, National League of Cities, National Governors Association, Council of State Governments, U.S. Conference of Mayors and now AASA.

AASA would like to hear from districts already addressing the issue of childhood obesity and other healthy living initiatives whether in place or in planning.

Rebecca Nelson is an AASA project director. E-mail: [e-mail]

Scott LaFee is a science and health reporter with the Union-Tribune San Diego. E-mail: scott. [e-mail]