Small Steps, Big Change

Childhood obesity is a growing problem with serious consequences.

We cannot blame it all on fast food, sugary drinks and high calorie snacks. Lack of physical activity is a major contributor to the issue.

Less than a century ago, children had a pretty easy choice when deciding what to do with their free time. The tempting options were to play outdoors or to play indoors, and these came in endless variations of participants and games you can invent, but all involved moving around. Sedentary activities were limited: Surely you could read a book, or daydream, but very few children chose these solitary activities for extended periods of time. Kids were moving around for a good part of each day.

Contrast this picture with the many lures kids have now to sink into a couch: TV, video games, computers, MP3 players. In today’s world, the Wii is applauded as a calorie burner, because you move a little bit while playing it. But when you compare that to a kid running after a ball, the Wii is an afternoon nap.

Combine sedentary lifestyle with an unprecedented increase of food availability and intake -- especially tempting junk food -- and the pervasive advertising and marketing directed at kids, and you get a perfect recipe for a childhood obesity crisis.

As with any other health problem, prevention is much more effective and painless than treatment. There are many proposed programs to combat childhood obesity, and most of the successful ones involve a multidisciplinary approach, combining diet change, increased physical activity and nutrition education. Kids spend half of their waking hours at school and eat one or two of their meals at school, therefore school-based intervention programs make a lot of sense.

One such intervention is the School Nutrition Policy Initiative. The striking results of a two-year study of this intervention were published in the journal Pediatrics this month. You can read the full text here

Nearly 1,400 students in grades 4-6 from 10 schools in Philadelphia participated in the study. At the beginning of the study, 40.7% of the 1,349 children were overweight or obese (!). At least 50 percent of the students were eligible for free or reduced-price meals.

Half the schools were randomly assigned for the intervention. The other half served as a control.

The intervention consisted of relatively small changes:

• Food service: All soda and sweetened drinks were removed from the vending machines and cafeterias, as were snacks that did not meet the committee's standards. (Snacks were capped at 7g total fat, 2g saturated fat, 360 mg sodium, and 15g sugar per serving.)

• Staff training: All school staff members were offered 10 hours of nutrition education training, and were given supporting materials.

• Nutrition education: The students were given 50 hours of integrative and interdisciplinary food and nutrition education per year.

• Incentives: Students who ate healthy snacks and beverages were included in raffles and could win prizes.

• Family outreach: Nutrition educators reached family members, and encouraged them to eat healthier, and be less sedentary.

After 2 years 15% of the children who were not overweight at the beginning of the study became overweight in the control schools, compared to only 7.5% in the intervention school.

The unadjusted prevalence of overweight in intervention schools decreased by 10.3%, compared with a 25.9% increase in the control schools.

That’s about 50% reduction in new obesity incidence.

The intervention had no effect on those students that were overweight or obese at the beginning of the study (they did not loose weight by this intervention).

So what can we learn from this study?

The authors, lead by Gary Foster, Ph.D., were encouraged by the 50% decrease in obesity incidence, but realize that a 7.5% increase in obesity in the intervention group is still a lot, and therefore additional interventions are needed, such as increased physical education, and a more aggressive nutrition policy.

The other aspect that merits attention is that once a child is overweight, simple easy interventions usually won’t bring him to an ideal weight. A more targeted and difficult program is needed.

In our own little world we can recreate the same mild intervention steps the study used for our own kids:

• Remove the sugary drinks and unhealthy snacks,

• Teach our kids healthy eating,

• Encourage fitness and activity, and

• Promote and prepare nutritious meals.

That is what I do personally. Now, don’t get me wrong -- we do eat dessert, in moderate amounts, and not every day.

Research shows that as few as 32% and as many as 90% of parents do not correctly identify their overweight child as overweight. The parents are the last to notice.

We should therefore just stack the deck in our kids’ favor, and provide an environment that is more favorable for healthy weight.

Ayala