A stronger stand on student health: Junk food out, recess in

The medical community can play an important role in helping schools achieve goals that include fighting obesity and curbing tobacco use.

By Susan J. Landers — Posted Nov. 12, 2007

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Schools are stepping up to the plate and removing many of the high-fat and high-sugar items that have been served for years and, many believe, contribute to the nation's obesity epidemic.

Cookies are disappearing from school vending machines and water is taking soda's place as an offering, according to a study released by the Centers for Disease Control and Prevention Oct. 19. It was published in the October Journal of School Health.

The CDC's School Health Policies and Programs Study 2006, or SHPPS, found the number of schools selling water in vending machines or school stores increased from about 30% in 2000, when the survey was last done, to 46% in 2006.

Also, recess and physical education are making a comeback. States that require recess in elementary schools increased from 4% in 2000 to 12% in 2006, according to the study.

This combination of lower fat and sugar intake and more physical activity may help trim pounds from the collective student body, say public health experts. In the past 30 years, the prevalence of obesity has doubled among children ages 2-5 and 12-19 and tripled for children ages 6-11, according to the Institute of Medicine.

Childhood obesity is cited as a risk factor for many diseases, including early-onset diabetes and hypertension, lending urgency to the quest for effective intervention. The AMA has been among the groups hosting meetings on obesity and has adopted policies to encourage physicians to promote good school nutrition and exercise programs and help young patients achieve an appropriate weight.

CDC leaders point to progress made in the six years since the last study was published. "Our goal with this report is to provide health and education officials with useful information that will help them develop and improve programs that can have significant benefit for our school-age children," said CDC Director Julie L. Gerberding, MD, MPH.

"If we want to build on the improvements that schools have made over the past six years, we need to involve many people and programs," said Howell Wechsler, EdD, MPH, director of the CDC's Division of Adolescent and School Health.

A broad look at health

The study went beyond nutrition and physical education to include information on tobacco and alcohol use, mental health services and the prevention of bullying. SHPPS has been conducted every six years since 1994. For the 2006 study, questionnaires were completed by state education agencies in all 50 states plus the District of Columbia, as well as by a representative sample of the nation's school districts and elementary, middle and high schools.

Given the numbers of schools in the nation -- 120,000 -- and students -- 53 million -- their significance as a measure of a community's health often has been overlooked, some physicians said.

"There is a disconnect," said Linda Grant, MD, MPH, an adolescent medicine specialist at Boston Medical Center in Massachusetts. "To me the village is in parallel play mode. People are working in their offices trying to deal with obesity, the schools are trying to deal with obesity, or any number of health issues, but what they are not doing necessarily is cooperative play. So you are missing the synergy of working together."

Jeffrey Lamont, MD, a physician at Marshfield Clinic, a large multi-specialty group practice in Wisconsin, did not remain on a separate track but jumped right into the fray when he ran for the Wausau school board in 2000. He served for six years, including two as president.

"The issue is 'Practice what you preach,' " he said. "If you are trying to promote a healthy lifestyle and at the same time you have vending machines giving a very different message, that is something that does influence children."

The learning that goes on in schools should include health and fitness, noted AMA President Ron Davis, MD. Plus, he noted, "Learning is enhanced when people are healthy and physically fit."

Physicians can play an important role in communicating with schools and parents and grandparents, as well as professionals, Dr. Davis said. "While it's great to see progress, there is much work that needs to be done and a lot of questions that need to be answered to make sure the progress we are seeing is substantive." For example, what type of physical education programs are offered in schools? Are they intensive enough to boost heart rates to optimal levels?

Such questions can be brought to a community's school board. Physicians who care about their communities and the well-being of children have a right to be heard at these meetings, Dr. Lamont said. "Because school board members are elected, they are very interested in what their constituents are thinking."

Also, many school districts have established health councils, which were recently mandated by the U.S. Dept. of Agriculture, said Marcia Rubin, PhD, MPH, director of the research and sponsored programs division at the School Health Assn., a Kent, Ohio-based multidisciplinary group of physicians, nurses and others concerned about schools. "Any physician interested in the health and well-being of young people would find that time spent in a meeting of the district health council would be invaluable and provide a better understanding of what the issues are."

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Eliminating the unhealthy stuff

A recent study by the Centers for Disease Control and Prevention based on survey responses from 1,103 schools (K-12) determined that the percentage of schools allowing students to buy unhealthy items from vending machines and school stores has begun to decline. Here is the drop from 2000 to 2006. Percentages reflect the number of schools offering the options.

2000 2006
Baked goods 38.4% 25.3%
Bottled water 29.7% 46.2%
Ice cream or frozen yogurt 21.3% 11.0%
Salty snacks 38.5% 26.5%
Whole milk 27.2% 13.9%

Note: Baked goods, ice cream or frozen yogurt and salty snacks are not low in fat.

Source: "The School Health Policies and Programs Study 2006,"Journal of School Health, Oct. 19

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