School Programs Trim Kids, but Gains Erased at Home

Nov. 8, 2007 — -- The success of school programs to trim the weight off of obese kids is often nullified by unhealthy habits at home, leading to a steady and continued worsening of the country's childhood obesity epidemic.

So says a new study by the Agatston Research Foundation in Miami Beach, Fla., which was presented at the American Heart Association scientific sessions in Orlando, Fla., Wednesday.

According to researchers, the Healthier Options for Public Schoolchildren (HOPS) study -- a school intervention program combining nutrition education, rigorous dietary changes in schools and physical activity -- successfully trimmed students' body mass index (BMI) during the school year.

However, when these children returned to school the following year after summer vacation, their BMI had increased significantly.

The findings come at a time when the prevalence of overweight and obese children in America is a leading public health issue. In 2004, it was found that 17.1 percent of children and adolescents between the age of 2 and 19 years old were obese.

Yet despite continued media attention and intervention programs in schools aimed at addressing this issue, the number of obese children and adolescents continues to rise each year.

"I would say that Americans can feel confident that when nutrition education is combined with real rigorous dietary changes in the school setting, that obesity issues can be successfully addressed and we will see a change in [children's] BMI percentiles," explained Danielle Hollar, director of research at the Agatston Research Foundation. "What limits these programs' success is that for a lot of children, the food they get in school is the most nutritious food they get that day."

Structure Helps Build Better Diet Habits

The HOPS study included 3,200 third graders in six elementary schools in the Osceola County School District of Kissimmee, Fla.

Four of the schools instituted the intervention program for obesity. Researchers collected data from the four intervention schools and two nonintervention schools in the spring and fall for a period of two years, measuring each child's height, weight, BMI, pulse and blood pressure. To get a snapshot of each student's lifestyle habits, researchers asked children general questions about their activity level and eating habits.

Although the specific results of the blood pressure substudy won't be released until next spring, results of the BMI percentile analyses have been presented, Hollar said they saw "statistically significant greater improvement" in the children's BMI percentiles during the school year in the intervention as compared to the nonintervention schools over the two-year study period. After returning from summer vacation, however, Hollar said the children's BMI levels from all six schools had increased -- though the children attending intervention schools gained less weight over the summer.

According to Dominic Sica, chairman of clinical pharmacology and hypertension at the Virginia Commonwealth University Medical Center, these results should impart an important lesson not only to schools but to parents.

"This shows that children work well in the structured environment, but when they aren't they revert back to the patterns of behavior they're accustomed to based on... the example of behavior set by their parents.

"The lesson learned is that school is more than just textbooks -- school is life," Sica said.

Poorer Families at Greater Risk

Hollar said the study also reflects the link between socioeconomic status and obesity. And inextricably tied to this is the differences in childhood obesity among various racial groups. Forty-eight percent of the children in the study were Hispanic, most of whom Hollar said came from working class families whose parents often didn't have the time, energy or money to encourage healthy diet habits at home.

It's not the first study to find a link between race and childhood obesity risk. According to the 2005 study "Preventing Childhood Obesity," published by the Institute of Medicine, the highest prevalence of childhood obesity in America occurs in the Hispanic and African-American populations.

In many cases, economic hardship experienced by a disproportionate number of these families may be to blame.

"A lot of these parents were working double shifts and didn't have the time or money to cook healthy meals at home, and since these are elementary children, they can't go out and buy their own food," Hollar explained. "So our hope is that the children will become more accustomed to these healthy eating and living habits with each school day and they will take that message home to teach their parents."

Moreover, a study published this month in the journal of the American Dietetic Association finds that the cost of healthy eating is often too high for low-income families, who would have to devote 43 percent to 70 percent of its food budget to fruits and vegetables to meet the 2005 Dietary Guidelines, which recommends five to nine servings of fruits and vegetables a day.

Leaders of the HOPS study tailored the program for low-income families by sending home newsletters to parents with tips for healthy living, including affordable recipes and simple dietary changes that could be easily incorporated into their busy lives, such as adding low-fat granola to salads instead of croutons, or adding sweet potatoes to a bowl of soup instead of cheese and salt.

"We need to enhance awareness of parents, and their passion for protecting the health of their children," said David Katz, associate professor of public health and associate director of the Nutrition Science, Rudd Center for Food Policy & Obesity at Yale University. "Then, we must empower them with tools, knowledge, skills and resources that allow them to do so."

But Katz adds that the childhood obesity epidemic affects families across the racial and socioeconomic board. And the stakes are high; obese children are 70 percent more likely to grow into obese adults, and they are at high risk of developing high blood pressure, high cholesterol and Type 2 diabetes.

"No question, the situation is worse in poorer households. But the middle class is not doing very well either," Katz explained. "This problem is nondenominational. There are disparities, but everyone is caught up in the epidemics of obesity and diabetes, and everyone must play a role in meeting the challenge successfully."