What's for lunch? When's recess? The fight against obesity makes its way into schools.

American kids are growing fatter. Since 1980, the number of overweight children has doubled. Three times as many adolescents are heavy.

In fact, 16 percent of children and adolescents age 6 to 19 are overweight. Compared to those of normal weight, they are 10 times more likely to have high blood pressure, three to eight times more likely to have cholesterol problems that can put them at risk for heart disease, and more than twice as likely to develop diabetes. Increased risks for asthma, sleep apnea and low self-esteem are also associated with childhood obesity.

Two strategies are key in responding to obesity:

* Reduce excess calories and ensure that food choices are nutritious.

* Encourage physical activity to burn calories and improve cardiovascular health.

Making sure kids eat a healthy diet and exercise regularly is not easy. A complex combination of social, cultural, environmental and behavioral factors contributes to the growing number of obese children.

LEGUME LEARNING

Although 44 states require health education, recent legislation in 17 states aims to prevent childhood obesity by requiring nutrition in school health curriculums.

"We want to teach kids to make good choices," says Colorado Representative Alice Madden. "There's also a connection between good nutrition and academic success." Along with Colorado Senator Paula Sandoval, Madden sponsored a school wellness measure that was signed into law this year. It calls on local school boards to adopt food policies that include healthy meals, nutritious items in vending machines and for fundraisers, nutrition content information on school menus provided to students and parents, access to fresh fruits and vegetables (especially Colorado-grown produce), nutrition education, and daily physical activity at school. It also encourages school districts to adopt local wellness policies by July 1, 2006.

Madden notes that Colorado legislators have been working on school wellness for several years, but this newest legislation also supports school efforts to meet the requirement of the federal Child Nutrition and WIC Reauthorization Act of 2004 that all participating schools create a wellness policy by the first day of the 2006-2007 school year.

To help kids make healthy choices, California, Colorado, Illinois, Kentucky, Massachusetts and West Virginia considered legislation to require schools to provide nutrition content information for school foods. Colorado's enacted measure gives both students and parents information about the nutritional content of foods sold at school by requiring schools to post the information on the district Web site, send it home on school menus, or post it in the school building. "I think it helps get kids to pay attention to what they eat, what they're putting into their bodies," Madden says.

A COMPREHENSIVE APPROACH

In Oklahoma, Representative Susan Winchester had a simple reason for sponsoring school nutrition legislation.

"I'm the mother a 9-year-old and I know what's eaten at our house. If there's a bad choice available it will be chosen. If there's a candy bar, kids will eat that before broccoli," she says.

Oklahoma lawmakers eliminated access to foods of minimal nutritional value (except on special occasions) in elementary schools, limited access to minimally nutritious foods to after school and special occasions (except for diet soda) in middle schools, and gave high school students healthy food options in addition to any available foods with minimal nutritional value.

Winchester notes that the diet soda provision was a compromise.

"I tried to make the point that Frito-Lay makes some good choices, Coke makes good choices; they all offer nutritional alternatives," she says. "There was the misconception that we were banning vending machines, but all we wanted to do was make good choices, especially for the little people."

Oklahoma's school nutrition bill and a unique school physical activity program is the result of a "terrific coalition statewide that really cared about kids and came out en masse to lobby for the bills," Winchester says.

"We have a wave of childhood diabetes, heart disease. If you can prevent them from ever happening, you save lives, you save money, you save our future." Winchester recalls one legislator who changed his vote on Oklahoma's school nutrition bill as the legislature worked late into the night at the end of the session. Combing the capitol for something to eat, he realized that the only things available were sodas and candy bars, which made him understand the predicament kids are in.

But nutrition is only one part of the equation. Encouraging kids to be active through exercise and sports is equally important.

RUNNING TO RECESS

Fifth graders at Bridge Creek Elementary School in Grady County, Okla., initiated a bold fitness challenge after learning that 32 percent of students in their school were overweight or obese while the statewide average was 24.4 percent. The students approached Winchester, who is their representative. She worked with them on a bill to encourage schools to participate in a fitness program that the students helped design.

Students developed a Walk Across Oklahoma program that combines physical activity with a virtual tour of the state. The students challenged themselves to walk 5 miles (10,000 to 12,000 steps) a day. Oklahoma's Institute for Child Advocacy funded pedometers for each child. Students in Winchester's district soon were outdoing themselves, walking laps at recess and jumping on trampolines or playing with the dog at home. When they meet their fitness goals, they're eligible for privileges like a snack of popcorn or being first in line for recess or lunch--"simple things that mean a lot to you if you're a fifth grader," says their teacher, Tammy Long.

Students also learned an important civics lesson when they helped make the program available statewide through the bill Winchester sponsored. "They followed the process all the way through, did a presentation in committee and lobbied individual legislators," she says. Their efforts paid off in passage of the Oklahoma Kids Fitness Challenge Act.

In Colorado, where legislation also encouraged school boards to ensure that every student has daily access to age-appropriate physical activity, Majority Leader Madden says: "I'm a big believer in having access to physical activity at school. Younger kids have recess. In middle schools and high school physical education drops off. If you're a basketball player or on the volleyball team, you're OK. But otherwise physical education drops off. A physical education program might be the best access you have to physical activity."

Legislators in many other states agree that physical education classes are a way for all children to begin to build physical activity and fitness into daily living. At least 37 states considered legislation related to physical activity or physical education in schools in 2005, and 17 of those states enacted legislation, including Arizona, Arkansas, California, Colorado, Kansas, Kentucky, Louisiana, Montana, New Hampshire, New Mexico, Oklahoma, Rhode Island, South Carolina, Texas, Virginia and West Virginia. State laws have focused on refining or increasing physical education requirements or encouraging positive physical activity programs for students during and after the school day.

Both the cost of physical education programs and an emphasis on academics have sometimes been considered barriers to increasing physical education in schools.

According to the Centers for Disease Control and Prevention, however, "A growing body of evidence indicates that physical activity may have a positive impact on academic achievement among young people." A systematic review of 14 studies by the Centers for Disease Control and Prevention's Task Force on Community Preventive Services found that enhanced school-based physical education that increased the intensity and the number of minutes students spent in moderate or vigorous physical activity during class was effective in improving physical fitness across diverse racial, ethnic and socioeconomic groups, among both boys and girls at all grade levels, and in urban and rural settings.

STARTING EARLY

Starting early to build healthy lifestyles is a challenge that legislators are ready to tackle. "There was support from members across the spectrum, especially those with elementary school age children," says Representative Winchester. Through collaboration, community support and creative efforts to provide incentives for healthy behavior, a landscape of learning is emerging in schools to encourage nutritious choices and fun physical activities that may bolster students' academic achievement and life-long health.

STATES TAKE ACTION

This year at least 17 states enacted legislation to improve the quality of school foods--Arizona, Arkansas, California, Colorado, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas and West Virginia.

New Jersey Governor Richard Codey initiated school nutrition standards to be implemented by the state's Department of Agriculture. Utah passed a resolution encouraging schools to adopt nutrition and physical activity policies.

NEWS IDEAS

State legislators have also taken the approach of providing incentives to recognize schools that are doing a good job of addressing childhood obesity by supporting a healthy lifestyle. Louisiana lawmakers passed legislation in 2004 to provide awards for schools with outstanding physical activity and nutrition programs. In lllinois, legislators approved a bill this year to recognize schools that have programs to increase physical activity and promote healthy nutritional choices. And governors in Wisconsin, South Dakota and Missouri have initiated healthy school award programs.

Aiming for national impact, a bipartisan effort teams up former President Bill Clinton with current Arkansas Governor Mike Huckabee to enlist governors, schools, young people and the food industry in a national campaign to turn the tide of childhood obesity.

The U.S. Department of Agriculture launched a HealthierUS School Challenge in 2004. This is a voluntary certification and award program for elementary schools that meet required nutrition standards for school meals, establish nutrition standards for foods and beverages beyond the school meals programs, and teach students about the importance of nutrition and physical activity.

As part of the Healthy Virginians effort, the Governor's Nutrition and Physical Activity Score-card rewards schools for encouraging healthy habits. The Web-based Scorecard application allows schools to compete locally and on a statewide level to see which school is healthiest.

The federal Child Nutrition and WIC Reauthorization Act of 2004 requires each school district participating in the National School Lunch or Breakfast Program to establish a wellness policy by the beginning of the 2006-2007 school year. Legislation was considered or enacted in 2005 independently or in response to the federal requirement in California, Colorado, lllinois, Ohio, Rhode Island and Tennessee.

Amy Winterfeld covers obesity, nutrition, physical activity and wellness issues for NCSL's health program.