Kentucky Children at Risk: The War on Weight

Position Paper for the Lt. Governor’s Task Force on Childhood Nutrition and Fitness

January 2002
(excerpt)

______________________________________________________________________________

Janet L. Tietyen, Ph.D., R.D., L.D.

Assistant Professor, Extension Specialist in Food & Nutrition

Colleges of Agriculture and Human Environmental Sciences

University of Kentucky

Maria G. Boosalis, Ph.D., M.P.H., R.D., L.D.

Associate Professor, Division of Clinical Nutrition

College of Allied Health Professions

University of Kentucky

Jody L. Clasey, Ph.D., F.A.C.S.M.

Assistant Professor, Department of Kinesiology and Health Promotion

College of Education

University of Kentucky

Kim Ringley, M.D.

Pediatrician, Department of Pediatrics

Chandler Medical Center

University of Kentucky

Stephen L. Henry, M.D.

Lieutenant Governor

Commonwealth of Kentucky

Summary

Over the past 25 years, the prevalence of overweight and obesity in the American population has increased at an alarming rate. Sixty-one percent of American adults are overweight or obese. Currently 300,000 Americans die annually from causes related to excess body weight. Surgeon General David Satcher predicts the extra pounds Americans are carrying could surpass tobacco as the leading cause of preventable death.

The Centers for Disease Control and Prevention (CDC) classifies obesity and overweight as a critical public health concern. According to Jeff Koplan, Director of the CDC, “As obesity rates continue to grow at epidemic proportions in this country, the net effect will be dramatic increases in related chronic health conditions such as diabetes and cardiovascular disease in the future.

Increased body weight among children and adolescents is of particular concern. The number of overweight children has almost doubled in the last two decades, increasing from 7% in 1980 to 13% in 1999. The number of overweight teens has nearly tripled over the same time period, increasing from 5% to 13%.

The Bogalusa Heart Study found that an estimated 77% of overweight children will become obese adults and that overweight children are 10 times more likely to become obese adults than normal weight children (Freedman 2001).

“Childhood obesity is at epidemic proportions in the United States,” states retiring U.S. Surgeon General David Satcher. “Today, we see a nation of young people seriously at risk of starting out obese and dooming themselves to the difficult task of overcoming a tough illness”. Any adult who has tried to lose weight can attest to the difficulty of losing weight and then keeping it off. Research indicates that the prevention of overweight and obesity is crucial for the future health of a population.

Why are Children and Adolescents Gaining Weight?

For most individuals, overweight/obesity results from an imbalance between energy in and energy out. In other words, a continual pattern of excess energy in (via calories in foods and beverages) coupled with a decrease in energy out (i.e., decline in physical activity or energy expenditure) results in an eventual weight gain. Thus, for the vast majority of individuals, being overweight or obese results from excess calorie consumption and/or inadequate physical activity.

According to one survey, only 3 percent of Americans interviewed met four of the five recommendations from the Food Guide Pyramid for the intake of grains, fruits, vegetables, dairy products, and meats (USDA 1998). Avoiding excess calories while maintaining a nutritionally adequate intake is one strategy to achieve and/or maintain a healthy weight for life. Inadequate nutrition education regarding healthy food selections coupled with the increased availability and consumption of high calorie, but relatively nutrient devoid foods, especially in the form of “snack foods”, contributes to the worsening epidemic of obesity.

According to a report titled “Junk Food in Schools” by the National Conference of State Legislatures (www.ncsl.org/programs/health/junkfood.htm) and data from the Center for Disease Control (CDC) and U.S. Department of Agriculture (USDA), more than 84% of children and adolescents eat too much fat; more than 91% eat too much saturated fat; and 51% eat less than one serving of fruit per day. In addition, most U.S. children and adolescents do not meet the recommended number of servings as outlined in the Food Guide Pyramid (Munoz 1997). In fact, only 1% of children surveyed met all of the food group recommendations and only 5% met the recommendations for four or more food groups. In addition, between 1989-91 and 1994-95, the consumption of soft drinks has increased while the consumption of dairy products has decreased.

Lack of physical activity also contributes to the obesity crisis.

The stress of poverty coupled with intermittent periods of food insecurity and hunger appear to increase the risk of overweight and obesity among the poor (Alaimo 2001). Americans currently spend a lower percentage of disposable income on food than ever before (Putnam 1997). Foods providing a high number of calories, but limited nutritional value, are affordable and accessible. Disproportionate numbers of limited resource and minority populations struggle with the burden of excess body weight (Strauss 2001).

There are numerous benefits to losing weight. Even a modest weight loss of between 5 and 15 percent of total body weight has been shown to reduce certain risk factors associated with cardiovascular disease, at least in the short term. Modest weight loss has been shown to lower blood pressure and blood glucose levels and to improve blood lipid levels (NIH NHLBI 1998). Recent studies have demonstrated the importance of lifestyle interventions (such as weight loss, a healthful diet, and exercise) in preventing type 2 diabetes in obese and/or overweight individuals.

A Call to Action: Addressing Overweight and Obesity in Kentucky Children

Improving Nutrition in Kentucky Schools

Kentucky children rely heavily upon the food they receive at school to help meet their nutritional needs. The average daily participation rate in Kentucky’s school lunch program is approximately 72%, well above the national average of 54% (Kentucky School Food Service Association 2001). Participation in Kentucky’s breakfast program is more than double the national average (27% versus 13%). As such, if the nutritional value of food offered in school cafeterias could be improved, many children would benefit.

Kentucky can ensure that schools provide healthful foods and beverages by enforcing existing U.S. Department of Agriculture regulations that prohibit serving foods of minimal nutritional value during mealtimes in school food service areas, including vending machines

Schools can reduce access to foods high in fat, calories, and added sugars and reduce excessive portion sizes (American Dietetic Association 1999). One method for reducing calories and fat and increasing the satiety in school lunches would be to implement a requirement that school lunches contain at least six (6) grams of naturally occurring fiber per meal. This would ensure that more fruits, vegetables, whole grains and legumes would be offered through the school lunch program.

Competitive Food Sales in Schools

In addition to the school lunch and breakfast programs, many American students can purchase food in a variety of places in their schools including vending machines, snack shops, fundraisers and the a la carte section of the cafeteria line. These foods are not a part of the reimbursable school lunch and breakfast meals as outlined by USDA regulations and so are termed competitive foods.

The sale of competitive foods has become quite widespread. According to SHPPS 2000, 98% of senior high schools in the U.S., 74% of middle schools and 43% of elementary schools have a vending machine, canteen or snack bar (Weschler 2001). More than two-thirds of these schools allow students to purchase foods from these sources during school lunch periods. The vast majority of foods sold through these venues are considered to be “junk foods”.

In addition to jeopardizing the health of children and sending mixed messages to them, the sale of competitive foods may stigmatize participation in the school meals programs. Since only children with money can purchase competitive foods, children may perceive that school meals are primarily for poor children, rather than nutrition programs for all children.

Competitive foods may also affect the viability of the school meal programs. The increase of the sale of competitive food with its attendant decrease in student participation in the National School Lunch Program has implications of the overall viability of the program. Declining participation rates result in decreased cash and commodity support from USDA for school meals. This undermines the substantial federal investment in the program to provide healthful meals of the nation’s children.

The proposal, outlined in Appendix A, would result in improvements in the nutritional value of foods and beverages sold in vending machines, school stores, canteens, and items sold for fundraising activities, and as a la carte items in cafeterias during the school day.

Improving Physical Activity in Kentucky's Schools

Clearly there is a growing body of evidence indicating that there are important relationships between physical activity, brain development, and cognitive performance (Becraft, Gomez-Pinella 1998). In addition, several studies have indicated that there is concordance with the hypothesis that physical activity enhances academic performance.

The physical activities selected should above all be enjoyable to increase adherence and to promote positive childhood and youth physical activity experiences.

The National Association for Sport and Physical Education and the American College Sports Medicine recommend that all children should accumulate at least 30 to 60 minutes of age-appropriate physical activity per day on most or all days of the week. Further, some physical activity each day should last 10-15 minutes or longer alternating between periods of moderate to vigorous activity.

Elementary students participate in 1-2 days of physical education lasting 30-40 minutes in duration. Middle school students have physical education for 9-16 weeks per year. High school students are required to attend physical education 16 weeks to one year (depending on weekly frequency) to earn a mandated 0.5 credit hour for graduation. Even if all children and youth are physically active during the entire duration of the physical education period, the state of Kentucky is still falling drastically short of meeting the activity needs of its children and youth.

Extracurricular physical activity participation may help to provide the much-needed opportunity for the youth of Kentucky to meet daily physical activity requirements. However we cannot be assured that all children will chose to participate, or have available safe and/or accessible opportunities to engage in daily physical activity.

Sedentary activities, such as television/movie viewing and computer based activities, contribute to the problem of increasing incidence of childhood obesity. These types of sedentary activities reduce energy expenditure and often increase energy intake, as children are more likely to be consuming food during this time (Dietz 2001). A study in low-and middle income children reported that odds ratios of obesity were 12% higher for each hour of television viewing per day, but 10% lower for each hour of moderate or vigorous physical activity per day. The children in this study reported an averaged of 4.1 hours of television viewing per day (Hernandez 1999). Although there are no available data providing information concerning the time spent in sedentary behaviors of the youth of Kentucky, a study of large group of sixth and seventh graders in Boston reported total viewing (including television, videos, movies, and computer games) times of 3.35 hours per day combined with an average of 1.6 hours of reading and homework per day (Wiecha 2001).

In keeping with the findings and conclusions of the Surgeon General’s Call To Action to Prevent and Decrease Overweight and Obesity (2001), it is recommended that daily physical education be implemented in preschool through grade twelve.

Appendix A

Proposal for Addressing Obesity in Kentucky’s Schools

1). Requirements for School Food Service Directors

(American School Food Service Association Credentialing or Level 2 Certification and continuing education) and continuing education for school cafeteria managers.

A. Work with the Kentucky School Food Service Association (KSFSA) to recommend amending KRS 160.431 to provide the following:

That each Superintendent shall appoint a School Food Service Director who is responsible (pursuant to Kentucky Board of Education administrative regulations) for the operation of the food service program in each public school district, except as set forth in B. below;

That any person holding the position of School Food Service Director on the effective date of the Act who does not hold the School Foodservice & Nutrition Specialist (SFNS) credential or the Level 2 certificate issued by the American School Food Service Association (ASFSA) shall obtain the credential or Level 2 certification (if they are not eligible by ASFSA rules to obtain the credential) within three (3) years of the effective date of the Act and shall maintain it (as part of the maintenance of the credential or certificate at least ten (10) hours of the required continuing education shall be directly related to applied nutrition and healthy meal planning and preparation);

That any person appointed to the position of School Food Service Director after the effective date of the Act, shall be required to obtain the ASFSA credential or Level 2 certificate (if they are not eligible by ASFSA rules to obtain the credential) within three (3) years of the appointment and shall maintain it (as part of the maintenance of the credential or certificate at least ten (10) hours of the required continuing education shall be directly related to applied nutrition and healthy meal planning and preparation);

B. Create a new section of KRS 160 that would allow two or more contiguous districts to form one “School Food Service Area” and to allow the superintendents from the districts to appoint a School Food Service Director to oversee the program in the School Food Service Area.

C. Create a new section of KRS 160 that would direct the Department of Education to amend 702 KAR 6:045 to require that school cafeteria managers receive 2 hours of continuing education annually in applied nutrition and healthy meal planning and preparation.

2). Competitive Food Rules

Create a new section of KRS 156 to provide the following:

A. The “school day” is defined as the period of time between the arrival of the first student at the building and the end of the last scheduled instructional period;

B. That during the school day, schools are prohibited from selling the following items through vending machines, school stores, canteens, student, teacher or group fundraisers, etc.:

i. “chewing gum” as defined by 7 CFR 210, Appendix B;

ii. “soda waters” as defined by 7 CFR 210, Appendix B;

iii. “water ices” as defined by 7 CFR 210, Appendix B;

iv. “candy” as defined as any item that contains more than 40% added sugar by weight;

v. any juice or juice product that contains less than 35% real juice; or

vi. excluding seeds and nuts, other items not previously described that contain more than 8 grams of fat per serving.

C. High schools (as defined by the configuration of grades 9-12, 10-12 or 11-12) may sell soda waters but only after one-half hour after the close of the last lunch serving period.

D. That a school may offer for a la carte sale on the cafeteria line only those items that meet the USDA standard for a breakfast or lunch component.

E. That schools are encouraged to offer, serve, sell or otherwise make water available to students.

F. That any public school that violates the provisions of this Act shall be subject to a penalty assessed by the district or the Department of Education. The first violation shall result in a fine of no less than one week’s revenue from the sale of the competitive food or beverage. Subsequent violations shall result in a fine of no less than one month’s revenue from the sale of the competitive food or beverage. Habitual violations, defined as five or more violations in one sixth-month period, shall result in a six-month ban on competitive food and beverage sales for the violating school. Revenue collected as a result of the fines shall be transferred to Fund 51 of the local school district.

3). School Lunches

Require that school lunches provide at least 6 grams of naturally occurring fiber per meal averaged over the course of one week.

4). Daily Physical Activity

Under the authority of KRS 156.160, direct the Kentucky Board of Education to promulgate or amend administrative regulations to require the following:

That beginning in the 2003-2004 school year, thirty (30)-minutes of structured, moderate to vigorous physical activity per day shall be initiated in the preschool through intermediate programs (preschool–grade 5); beginning in the 2004-2005 school year, thirty (30)-minutes of daily, structured, moderate to vigorous physical activity be initiated in the middle school program (grades 6-8); beginning in the 2005-2006 school year, thirty (30)-minutes of daily structured physical activity be initiated in the high school program (grades 9-12). The required physical activity shall be completed in at least fifteen (15)-minute segments. The Department of Education shall develop alterative plans and activities that address how this requirement can be integrated into the school day.

Appendix B

Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity (2001)

$ Provide age-appropriate and culturally sensitive instruction in health education that helps students develop the knowledge, attitudes, skills, and behaviors to adopt, maintain, and enjoy health eating habits and a physically active lifestyle.

$ Ensure that meals offered through the school breakfast and lunch programs meet nutrition standards.

$ Adopt policies to ensure that all foods and beverages available on school campuses and at school events contribute toward eating patterns consistent with dietary guidelines.

$ Provide food options that are low in fat, calories, and added sugars, such as fruits, vegetables, whole grains, and low-fat or nonfat dairy foods.

$ Ensure that healthy snacks and foods are provided in vending machines, school stores, and other venues under the school’s control.

$ Prohibit student access to vending machines, school stores, and other venues that compete with healthy school meals in elementary schools and restrict access in middle, junior, and high schools.

$ Provide an adequate amount of time for students to eat school meals and schedule lunch at reasonable hours around midday.

$ Provide all children, from preschool through grade 12, with quality daily physical education that helps develop the knowledge, attitudes, skills, behaviors, and confidence needed to be physically active for life.

$ Provide daily recess periods for elementary students, featuring time for unstructured but supervised play.

$ Provide extracurricular physical activity programs, especially inclusive intramural programs and physical activity clubs.

$ Encourage use of school facilities for physical activity programs offered by the school and/or community-based organizations outside school hours.

$ Evaluate the financial and health impact of school contracts with vendors of high-calorie foods and beverages with minimal nutritional values.

Appendix C

Snacks Available to Meet Proposed Vending Guidelines

(The following are available through Lexington area vendors)

Doritos Nacho Cheesier (1 oz. snack package) Andy Capp’s Hot Fries (1 oz. package)

Doritos Cooler Ranch (1 oz. snack package) Zoo Animal Crackers

Cheese Nips Air Crisps (1.75 oz package) Chex Mix Original

Rold Gold Tiny Twist Pretzels Fig Newtons

Rold Gold Classic Thin Pretzels Rice Krispies Treats

Snyder’s Thin Pretzels Keebler Elfin Crackers

Snyder’s Olde Tyme Pretzels Snack Well’s Cr�me Sandwich

Baked Lays Crisps Regular Grandma’s Oatmeal Raisin Cookies

Baked Ruffles Cheddar and Sour Cream Saltine Cracker 8 pack

Baked Lays KC Masterpiece Nature Valley Granola

Lance Products: Cinnamon

Pistachios/ long tube Oats & Honey

Grilled Cheese Crackers Chewy Fruit & Nut Trail Mix Bar

Salsa and Lanchee Crackers Kellogg Nutri Grain Bars

Reduced Fat Toast-Chee Crackers Strawberry

Reduced Fat Toasty Crackers Blueberry
Apple Cinnamon

Wahoo’s (.75 oz package) Kellogg Poptarts

Original Strawberry

BBQ Brown Sugar Cinnamon

Nacho Fiesta

Kentuckiana Vending and Williams Food Service noted that the following could be made available:

Austin’s Reduced Fat sandwich crackers:

Cheese & Peanut butter

Whole Wheat and Cheese

Other reduced fat varieties

Reduced Fat Cheez-its Gold Fish Crackers

Sun Chips (1oz. package) Famous Amos Reduced Fat

Original Ginger Snaps

French onion Famous Amos Reduced Fat

Harvest cheddar Lemon Snaps

Other vending size products that meet guidelines:

Corn Nuts

Original (0.8 oz, 1.7 oz)

Ranch (1.7 oz.)

Beverages available

Juices

Welch’s 100% Apple 100% Orange

100% Purple Grape 100% White Grape

Minute Maid Orange Juice Apple Juice

Tropicana 100% Apple 100% Orange

100% Grapefruit

Water

Milk products (Skim, 1%, 2%, whole)

* * *

Examples of Snacks Eliminated by Proposed Guidelines

Candy Bars Cookies

Snickers Oreo

Twix Nutter Butter

Milky Way Grandma’s Peanut Butter, Molasses, Chocolate chip

Hershey Milk Chocolate Famous Amos regular variety of cookies

Baby Ruth Austin’s Cr�me filled cookies

Butterfinger Keebler (Fudge Stripes, Pecan Sandies, Droxies,

Pay Day Chips deluxe, Rainbow chips, Soft Batch)

Reese’s Stix

Nutrageous

Nestle Crunch

Candy Fried Snacks

Reese’s Cups Regular Lays Chips (all flavors)

M & M’s Lays Bistro

Twizzlers Fritos (all flavors)

Starbursts Cheetos (all varieties)

Skittles Bugles (all flavors)

Rollo’s Gardetto’s Snack mix

Spree’s Cheddar Chex mix

Sweet Tarts Snack Crackers

Austin’s (peanut butter,

Cakes cheese, all regular fat varieties)

Zingers Ritz Bitz (peanut butter

Honey Bun or cheese sandwiches)

Hostess Cupcakes (other brands) Frito Lay (Peter Pan,

Hostess Brownies (other brands) Dorito, or Cheeto brand)

Other Cheez-its

Cracker Jacks

Chester’s Brand Butter or Cheese Popcorn