Obesity And The Schools

November 24, 2003 | by Pat Arnow

Walking home from school, fifth-grader Angel Rivera, who is stout and shorter by a head than the three girls he was with, volunteered that he likes the fruit punch best of the drinks in the new Snapple vending machine in his school, P.S. 134, on the Lower East Side. It's the sweetest, he says, and he needs his sugar.

Until this semester, he wouldn't have been able to get it. There weren't any vending machines in P.S. 134, or in most of the elementary schools in New York City. That is changing now that the city has a deal giving Snapple exclusive rights to sell juice and water in the city's public schools.

Giving Angel access to such a sweet beverage during the school day may not be in his best interests. Even though the Snapple in schools - unlike the Snapple in the corner grocery store - is all fruit juice and vitamin-fortified, it still packs more calories than soda. Angel isn't worried about calories. But health and education officials are.

On the opposite end of Manhattan, in Washington Heights, a girl visits her pediatrician, Dr. Paula Elbirt. The girl is eight years old, and weighs 200 pounds. She has what used to be called adult-onset diabetes. "They don't call it 'adult onset' anymore because children are getting it," said Elbirt. "They just call it Type II diabetes now." It's one of a host of health problems that are a direct result of a nationwide epidemic of obesity.

New York City public schoolchildren are particularly hard-hit by this epidemic, according to a study by the New York City Department of Health: 24 percent of those aged six to 11 are obese, compared to 15 percent nationally.

If the school system, with its 1.1 million students, had nothing else to worry about, maybe it could focus more on helping heavy children. But the schools are seriously overcrowded and understaffed. There are too few resources to promote quality education, never mind healthy weight. Still, school officials say they are taking action. Officials tout:
â€˘ healthier, lower-fat lunches being served this year
â€˘ a new free breakfast program
â€˘ new physical education programs
â€˘ snack machines stripped of junk food

and that lucrative contract with Snapple to sell juice rather than soda.

On the other hand, critics say, some school policies actually exacerbate the problems:
â€˘ Many playgrounds in overcrowded schools are clogged with trailers containing extra classrooms, leaving little space for exercise.
â€˘ Many schools don't have gym classes, nor enough personnel to supervise recess.

And then there's that lucrative contract with Snapple.

WHY NEW YORK CITY KIDS ARE FAT

Most observers offer the obvious explanations for the high rates of childhood obesity: Too many kids sit around watching television and eating fast foods.

"It used to be that exercise was cheap"--more workers did manual labor as part of their jobs--"and food was expensive," says Dr. Elbirt, medical director of the Children's Aid Society. "Now exercise is expensive and food is cheap. You can buy a lot of junk food that is very filling."

That doesn't explain why New York City public school children have higher weights than the national average. One reason is that obesity tends to afflict low-income households, and that describes the majority of students in NYC public schools; 75 percent of them qualify for free or reduced-rate lunches. (Many affluent NYC children go to private schools, which weren't surveyed.)

One of the major problems for low-income children is hunger and, paradoxically, families who experience periodic hunger--when small paychecks or food stamps run out--have high rates of obesity. They fill up on high-fat, high-calorie (but lower-nutrient) food when they can. Nutritionists call the phenomenon food insecurity. Ironically, says nutritionist Fern Gale Estrow, "malnourishment and obesity may go hand in hand."

Measuring Obesity

To determine if an adult is obese, health officials use a formula called Body Mass Index that factors in height and weight. The levels indicating obesity are the same for men and women of all ages. But these change for children as they age--and they are also different for boys and girls, reports the Centers for Disease Control, which uses a series of charts to show the differences. For instance, the charts show that the average 10-year-old boy is 4 foot, 8 inches tall and weighs about 70 pounds. At 100 pounds, he is considered obese.

The Centers for Disease Control provide separate worksheets to determine Body Mass Index for boys (in pdf format) and girls (in pdf format).

Since overweight children tend to turn into overweight adults, the charts can be useful for determining whether a child is at risk.

The Centers for Disease Control do not define children as obese in their charts, but as overweight. "Obesity usually indicates a longer-term condition. We don't want to classify children early on as obese. There's a lot of stigma attached," says Diane Thompson, who helped to develop the charts. The American Obesity Association and the New York City Health Department in its survey of New York City public schoolchildren use the same charts, but they do use the term obese to describe the most overweight children.

Lack of exercise is also more of a problem in poor neighborhoods, too. Safety concerns might keep children inside--and inactive--outside of school hours.

The survey of New York City children found that Hispanics had the highest rate of obesity--31 percent. The rate among black children was 23 percent, while it was 16 percent among whites and 14 percent among Asians.

In Hispanic and black communities, studies show higher social acceptance of heavy people than in white communities. Scientists point out that many Hispanics carry genes that help them to store fat and use calories efficiently. That adaptation came about during centuries of rural life with uncertain food supplies. Today, the constant availability of food has tuned their "thrifty gene" from a survival mechanism into a predisposition to overweight.

Given this array of causes and effects in New York, nobody lays the epidemic of obesity entirely at the feet of the school system. Still, charges City Councilmember Eva Moskowitz, head of the council's education committee, "the schools have been unhelpful in addressing the problem."

SCHOOL FOOD

The Department of Education sees it differently, pointing in particular to the new school lunches. Marty Oestreicher, head of the Office of School Support Services, says the cafeterias maintain standards above those recommended by the United States Department of Agriculture, which funds school lunches.

This school year, the menus look the same as they did before, but there's less fat, no more than 30 percent of the calories offered per day. The cafeterias also serve fresh or frozen (rather than canned) fruits and vegetables five days a week, up from three days a week last year. Including lunches and the new free breakfast program, the schools serve 800,000 meals a day. The only trouble is the taste. "It's not particularly appetizing, though it's scientifically nutritious," says Moskowitz.

Carmen Santana, the parent of a 7th grader at IS 119 in Queens, agrees. She sampled a New York City school lunch a couple of weeks ago. It was "some kind of compressed hamburger" and the roll "tasted fermented." Last summer, when she tried a breakfast, she got a battered box of Cheerios, chocolate milk to put on it, and a muffin. "It's institutional, like mini-prisons. It's horrible, it's insulting," said Santana, who is a board member on the Commission on the Public Health System in New York City.

Her son, Cameron Gonzalez, usually throws away most of his lunch, he says, and his friends skip lunch altogether.

There is at least anecdotal evidence that this is widespread. It's hard to know what the kids are getting from the school lunches nutritionally because there is no formal measurement of what gets eaten and what gets thrown out. Oestreicher says he gets information about the most popular foods anecdotally from the food managers and kitchen staff, and by visiting school cafeterias himself around the city. "Today I had the chicken parmigiana, fish nuggets and macaroni. I was looking around and the kids were eating it."

But pediatrician Paula Elbirt has also visited school cafeterias, and she sees students throwing away a lot of food: "The kids are throwing away the apple and the banana. They're eating the hamburger and the bun--or just the bun with lots of ketchup on it."

Kelsie Jameson, a fifth grader at P.S. 134, is indignant about some of what is offered: "I'll eat vegetables--but cold broccoli?" she says. A few times she's got fruit she couldn't identify. That would be a throwaway.

SNAPPLE

To the Department of Education, its deal with Snapple giving the beverage-maker the exclusive right to put vending machines in the schools has at least two benefits - it will bring in revenue, and, educators hope, it will foster healthier habits.

Before Snapple, each school made its own deal for vending machines. In some cases, the machines held drinks that weren't up to United States Department of Agriculture requirements for schools, says Oestreicher. "The only way to control the situation was to have a central contract." The sponsorship will mean at least $3 million a year.

And the new vending machines--Oestreicher estimates that 1,400 have been installed so far and another 300 are on order--sell only juice and water. (School officials said they did not know how many of these machines were going into elementary schools, as opposed to high schools or middle schools -- an odd admission of ignorance, considering that one of the points of the contract was to give officials more control.)

But critics knock the Snapple deal for the very reasons that education officials tout it. Several public officials question the contract, Assemblyman Steve Sanders saying the lack of competitive bidding makes it "smack of a sweetheart deal," and City Comptroller William Thompson calling on the Department of Education to cancel the contract. Ellen Raider, a member of the People's Coalition to Take Back the Schools, objects to "the commercialization of the kids' minds by having product ads all over the place."

Others object on nutritional grounds. Though the Snapple juices do have added vitamins and nutrients, they are reportedly even more calorie-laden than Coca-Cola

Nutritionist Estrow would rather see juices than soda in the schools, but she worries. "Children won't know the difference between Snapple in the school, which is juice, and Snapple outside, which is sugar water." (Commercial Snapple fruit drinks do contain 5 percent to 10 percent juice, but not 100 percent, as the school vending contract requires.)

Even pure fruit juice is not great for kids if they drink more than 8 to 12 ounces a day, says Estrow. "Why are we encouraging our kids to drink juice? Why not eat fruit?"

Unswayed by the criticism, the Department of Education plans to secure Snapple-like sponsorships for snack vending machines. Though there are not yet system-wide contracts that would bring in sponsorship revenues, the machines now in schools are supposed to maintain nutritional standards adopted in June--no chocolate candy, jellied candy, or gum. Baked potato chips rather than fried are allowed, as are pretzels.

PHYSICAL EDUCATION

Good nutrition goes just part of the way to keep New York schoolchildren growing taller rather than wider. They have to get moving, too. That is hard in New York City. With overcrowding, many schools lack the facilities to fulfill the state requirements for physical education--every day through third grade, three times a week for 4th to 6th graders, and two to three times a week for grades 7 to 12.

There is no "consistent physical education program" in 41 percent of New York's public elementary schools, reported the New York Times Magazine recently.

One reason for the lack of physical activity in the city's 673 elementary schools, according to a study by State Assemblyman Jeff Klein's oversight committee, is that many of them do not have functioning playgrounds; that space is filled with "temporary" trailers for extra classrooms needed for these overcrowded schools. Some of the trailers have been there for as long as eight years.

A bill Klein introduced in the Assembly requires that any loss of playground space be compensated with comparable space elsewhere. "It's a very simple concept. If you take away space, you have to give it back." Klein would like to see Snapple revenues funding the playground space.

In the meantime, nearby parks could theoretically substitute for the school playground space. But Cecilia Blewer, who is president of her daughter's school, P.S. 163, says because of the layoffs of paraprofessionals and teacher's aides, there isn't anyone to accompany the children: "I have this school a block and a half from Central Park. We don't have the personnel to take the kids to the park. We can't get there. You see the private school kids in the park."

The lack of personnel means that even in those schools where students have a place to play, recess is a time of chaos, not necessarily of physical activity. "You have maybe 200 kids being supervised by three adults," Blewer said.

Mindful of the problems, the Department of Education has just launched a centralized effort to revamp the physical education program, headed by Lori Benson in a newly created position, the Director of Fitness and Physical Development. Benson, who has been a New York City teacher, a "Fit for Life" coordinator and Deputy Director of Public School Athletic Leagues, is rolling out the new program in Southern Queens and Northwest Brooklyn.

The program is filled with upbeat acronyms: The core is called CHAMPS--Cooperative, Healthy, Active, Motivated, Positive Students. The first portion is called PROJECT F.I.T.--Fitness Integrating Technology.

Benson realizes she has to be creative to overcome some of the conditions. In schools that don't have a gym--or where the gym has been taken over for classrooms or lunchrooms--the program will work with "non-traditional facilities," says Benson. "A lot of times there's a smaller multipurpose room, the stage of an auditorium, even the aisles of the auditorium could be used to set up fitness circuits. It's something we have to be creative as possible about."

She also has to be creative about organizing after-school programs including a citywide intramural program for middle schools. She's starting nearly from scratch and without money. "There are a lot of after-school programs, but they're sporadic," she says.

AFTERSCHOOL, BEFORE SCHOOL

A "recess enhancement program" aims to jump into the breach of playground anarchy. Chris Capobianco, a former Peace Corps volunteer, is the recess enhancement coordinator for Asphalt Green, a sports and fitness nonprofit organization on the Upper East Side. Through a federal grant, staff members regularly visit 21 schools in Manhattan and Queens. Half are in Harlem.

They train student leaders to work with kids in their own age group with cooperative games and lessons about sportsmanship and teamwork. One game, Alaskan kickball, incorporates each child on every play.

But many who work with children believe that school programs are not enough, nor even afterschool programs. It is far better to reach children before they even start school. "If you wait until you establish eating habits, the kind of expectations as to what a meal is, you're too late," says Dr. Elbirt. That is why the Children's Aid Society last month launched an early obesity prevention program for Headstart pre-schoolers and their parents at two community public schools in Washington Heights.

Very young children will reach for the apple or string bean that older children shun, says Dr. Elbirt. Familiarity breeds fondness. If the fresh fruits and vegetables aren't available in the neighborhood, though, the children and their parents won't develop the habit of eating them. The staff at the Children's Aid Society talks area stores into carrying fruits and vegetables. With the parents, they also encourage walking for exercise. "If they live in an unsafe neighborhood, they're not going to walk. We've identified a little park for them to walk in, right along the FDR drive."

Another early education program, Cookshop, a Community Food Resource Center project at P.S. 261 in Boerum Hill, Brooklyn, shows young children and their parents how to cook and eat New York-grown produce.

Programs like Cookshop and the one run by the Children's Aid Society show what kinds of partnerships could be created in the schools to slow the growth of children's girth. Foundation and government grants and charitable donations fund these efforts. Regular funding for widespread prevention and education programs is not likely. In the overcrowded, underfunded public schools, for the moment, modest efforts to improve health will have to do.

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