Nutritional Environment in Primary & Secondary Schools Rebecca Nowachek Walden University In partial fulfillment of the requirements for PH 6165-5 Rebecca Heick July 19, 2009 Audience: Board of Education and Parent Teacher Organizations (PTOs)/ Parent Teacher Associations (PTAs) Good evening ladies and gentlemen, I am Rebecca Nowachek and I am a Public Health Educator working on the issue of childhood obesity and Nutritional Environment. I would like to take this time to thank you for agreeing to have me come and present on the topic of nutritional environment.

Purpose To inform stakeholders on how the school environment can have a major impact on the childhood obesity epidemic. The main purpose for tonight’s presentation is for us to walk away from this meeting with more information about how the school environment can help with the childhood obesity epidemic and possible steps your board and PTA/PTO can take to implement improvements in the nutritional environment.

Objectives To understand the criteria used to determine if a child or adolescent is overweight or obese. To understand the childhood obesity problem facing families and communities. To understand why primary and secondary schools have an important role in reducing childhood obesity. To learn ways to change the nutritional environment for students. To learn the importance of added educational topics on nutrition for students. The objectives for tonight’s meeting are for us….(go over the objectives listed in presentation).

Background Overweight vs. Obesity Determination of weight status Cause of Obesity Consequences Obesity in the United States Obesity in Iowa I will briefly cover some background information on the overweight and obesity issues both throughout the United States and here in Iowa. We will look at the differences between overweight and obesity and how children and adolescents’ weight status is determined. It is also important to look at what causes someone to be overweight or obese. Due to the time limitation and for the purpose of the presentation we will be looking specifically at the environmental factor.

Overweight vs. Obesity Overweight= BMI at or above 85th percentile and lower than 95th percentile. Obese= BMI is at or above the 95th percentile CDC. 2009. Overweight and obesity: Defining childhood overweight and obesity. Retrieved from July 11, 2009 from http://www.cdc.gov/obesity/childhood/defining.html Overweight and obesity is measured with the body mass index (BMI). BMI is a number calculated from a child’s weight and height. For children and adolescents ages 2 to 19 the measurement is plotted on the growth chart to determine the corresponding BMI for age percentile (CDC, 2009). A child will be classified as overweight if their BMI is at or above the 85th percentile but lower than 95th percentile and a child or adolescent would be considered obese with a BMI at or above the 95th percentile (CDC,2009). It is important to remember that weight status for a child and adolescent is determined based on their age and gender rather than the BMI categories used for adults.

Cause of Obesity Imbalance between calories consumed and calories used. Imbalance can be influenced by: Genetics Behavioral Environmental CDC. 2009. Overweight and obesity: Contributing factors. Retrieved July 11, 2009 from http://www.cdc.gov/obesity/childhood/causes.html Childhood obesity is caused by the imbalance between calories consumed from food and beverages and calories used. The imbalance of calories can be influenced by a number of factors including genetics, behavior, and environment. It is actually the interaction of these factors instead of just one single cause that are thought to be the cause of obesity. Studies have shown that some genetic characteristics may increase an individual’s susceptibility to excess body fat (CDC, 2008). There are a number of behavioral contributors such as energy intake, physical activity, and sedentary lifestyle. And lastly is the a child’s environment. “Home, child care, school, and community environments can influence children’s behaviors related to food intake and physical activity” (CDC, 2008). Although all of these factors are very important we will be concentrating on and talking about the environment, specifically the school environment.

Consequences of Obesity Psychological risks Cardiovascular disease High blood pressure High cholesterol Asthma Sleep apnea Type 2 diabetes CDC. 2009. Consequences. Retrieved on July 11, 2009 from http://www.cdc.gov/obesity/childhood/consequences.html There are a number of consequences associated with being overweight or obese. In many cases of overweight and obese children there are psychological risks involved due to the fact that these children may be targets for discrimination and may cause low self-esteem which can in turn effect academic and social functioning. Cardiovascular diseases are a group of diseases that affect the heart and blood vessels. When a child or adolescents is overweight or obese they are at greater risk for high blood pressure and high cholesterol. There has been an association between asthma and obesity. Asthma is a lung disorder where it is difficult for people to breathe. Sleep apnea is not as common in children as in adults but one study showed about 7% of obese children did have the condition (CDC, 2009) And just in the past few years we have been seeing Type 2 diabetes being diagnosed in children which can also lead to further complications with CVD (CDC, 2009).

Obesity in the United States Prevalence (NHANES) Impact About ½ of diabetes cases are type 2 61% of obese 5-10 year olds have risk factors for heart disease Obese children and adolescents more likely to be obese adult Cost direct and indirect costs for 2002 were $92.6 billion 1976-1980 2003-2006 2-5 5.0% 12.4% 6-11 6.5% 17.0% 12-19 17.6% The table in this slide is here to provide you more information on the prevalence of childhood obesity. The National Health and Nutrition Examination Survey (NHANES) assesses the health and nutrition of adults and children within the United States. This table compares the data taken from a survey in 1976-1980 with survey taken in 2003-2006. As you can see there has been an increases in the prevalence in obesity in all three age groups. It is also important to note that obesity does have a major impact on health and cost. About ½ of diabetes cases in children and adolescents are type 2 , 61% of children aged 5-10 have risk factors for heart disease, and obese children and adolescents are more likely to become an obese adults. The direct and indirect cost for 2002 was 92.6 billion dollars. Which is a tremendous amount of money that can be decreased by prevention efforts. CDC. 2009. Childhood overweight and obesity. Retrieved July 11, 2009 from http://www.cdc.gov/obesity/childhood/index.html American Heart Association. 2005. A Nation at Risk: Obesity in the United States. Retrieved July 13, 2009 from http://www.americanheart.org/downloadable/heart/1114880987205NationAtRisk.pdf Institute of Medicine.2004.Childhood obesity in the United States: Facts and figures. Retrieved July 13, 2009 from http://www.iom.edu/Object.File/Master/22/606/FINALfactsandfigures2.pdf

Obesity in Iowa About 80,000 children 10-17 years of age in Iowa are overweight or obese Overweight and obesity prevalence is almost double in poor families compared to children in higher income families (39.6% to 21.4%). NICH.(nd). Childhood obesity action network. Retrieved July10, 2009 from http://nschdata.org As you can seen from the previous slide, obesity is a serious health concern for children and adolescents in the United States. It is also a major concern right here in Iowa. Of the approximately 314,000 children aged 10-17 years of age in Iowa about 80,000 are classified as overweight or obese. In Iowa there is also a health disparity, the prevalence of overweight and obesity in poor families is 39.6% compared to children in high income families which is 21.4%. This may be due to the cost of healthier foods.

“Every school day, 54 million young people attend nearly 123,000 schools across the country. Influencing and enhancing the ability of schools to provide a healthy environment could be one of the most effective ways to shape the health, education, and well-being of our next generation” – President Bill Clinton President Bill Clinton stated…

Healthy Eating Podcast SHPPS – School Health Policies & Programs Study: Healthy Eating Released September 9,2009 CDC. 2009. School health policies & program study: healthy eating. Retrieved July 12, 2009 from http://www2a.cdc.gov/podcasts/player.asp?f=10045 At this time in the presentation I would like for us to listen to about a five minute pod cast from the Centers for Disease Control and Prevention, Division of Adolescent and School Health about the results from the School Health Policies & Programs Study looking particularly at Healthy Eating.

School Environment Status 77% 75% 64% 52% 50% 47% 28% In this chart we compare Iowa’s school environment status with the United States’ status. As you can see Iowa schools do a better job at having fruits and vegetables available for students to purchase and on average do better at not allowing students to purchase foods and beverages high in fat, sodium, or added sugar during lunch periods. And on the other hand Iowa rates compares very closely with the United States in allowing students to purchase soda, fruit drinks, and chocolate candies. I do want to point out that when we talk about fruit drinks they are drinks with added sugar not the 100% fruit juice. Iowa schools are on the right track for making the school environment healthy but there are more steps that we can implement to improve the environment for our students. 18% CDC. The obesity epidemic and Iowa students. Retrieved on July12, 2009 from www.cdc.gov/HealthyYouth/yrbs/pdf/obsesity/yrbs07_iowa_obesity.pdf CDC. The obesity epidemic and United States students. Retrieved on July12, 2009 from www.cdc.gov/HealthyYouth/yrbs/pdf/obesity/yrbs07_us_obesity.pdf

Students & Nutrition Only 2% of youth meet all recommendations of food guide pyramid < 15% of school children eat recommended fruit servings <20% eat recommended vegetable servings <25% eat recommended servings of grains <30% consume recommended milk servings Teens drink 2 times more soda than milk 12% of students report skipping breakfast United States Department of Agriculture. (nd). Healthy school nutrition environment: Promoting healthy eating behaviors. Retrieved July 14, 2009 from www.teamnutrition.usda.gov/healthy/call2act.pdf According to the USDA there are very few children and adolescents that meet the food guide pyramid recommendations.

Nutritional Standards in United States 19 states have nutritional standards for school lunches, breakfasts and snacks that are stricter than USDA requirements 27 states have nutritional standards for competitive foods sold a la carte, in vending machines, school stores, or school bake sales 25 states have passed requirements for BMI screenings RWJ Foundation. (2009). New reports find obesity epidemic increase, Mississippi weighs in heaviest state. Retrieved on July11, 2009 from www.rwjf.org/childhodobesity/products.jsp?id=45348. Now let us take a look at how the nutritional standards rate in the United States. According to Robert Wood Johnson Foundation 19 states have nutritional standards for lunches, breakfasts, and snacks that are stricter than the USDA requirements. In addition, 27 states have nutritional standards for competitive goods sold a la carte, in vending machines, school stores or bake sales. And half of the states have passed BMI screening requirements. As you can see we have states that are setting precedence in providing nutritional environments for the youth in their schools. But it is obvious that there is much more that can be done to improve the health of children and adolescents throughout the United States. Moving on we are going to be talking about the implementation of Nutritional education programs in schools.

Implementation of Nutritional Educational Programs 99% of public schools offer some kind of nutritional education Nutrition education showed accomplishment of 3 objectives: Nutritional facts so students can make better decisions about healthy eating Change unhealthy attitudes Teach positive skills Home & School collaboration Celebuski,C.,Farris,E.,Carpenter,J. 1996. Nutrition education in public elementary and secondary schools. Retrieved July16,2009 from http://nces.ed.gov/pubs/96852.pdf A majority of United States public schools are providing some sort of nutritional education to their students, in fact 99% do. There are three objectives to a nutrition education program. First, providing students with the facts so they will be knowledgeable about healthy practices. Second, programs should work to change unhealthy attitudes which will help students develop the motivation to establish healthy eating practices. And lastly, by teaching them the positive skills they will have the tools to accomplish their nutritional goals. Another important aspect of nutritional education programs is to have homes and schools collaborate to promote healthy eating. Both a students' home and school setting can influence a child’s eating and physical activity. So having a consistent message from both environments allows students the opportunity to learn and build skills to make healthier choices in order to live a healthy life. Nutritional education is just one part of improving the Nutritional environment but there is more that can be done.

Healthy Environment Doesn’t end at School Lunch programs Breakfast Snacks Vending machines Concessions School parties There are a number of opportunities in which for the school can to make their environment nutritious and healthy. We know that breakfast is one of the most important meals of the day. Research suggests that not having breakfast can effect children’s intellectual performance (CDC, 2009). According to the USDA, only 11% of youth reported eating breakfast containing food from 3 food groups. In schools that provide the opportunity for students to purchase breakfast there must be standards put in place to offer healthy nutritious foods from the food groups. As the environment for students during the day, schools need to make sure students are getting healthy snacks whether they are in class, from a vending machine, or are for a party. There are healthier options that are available through the vending companies - all schools have to do is ask for some of their healthier options. Students are always looking forward to the class parties and it may be a bit difficult to control what students choose to bring. However, this too can be controlled by having an approved list of items for a class party. By providing both education and implementing a few of these steps schools are being consistent with their nutrition messages. It is hard for students to choose a more nutritious snack if they are not available at the schools.

Benefits of Healthy Environments Encourages healthy eating Greater academic achievement Improved attendance Healthier lives Healthy growth & development Lowered risk of Dental caries Eating disorders Malnutrition Iron deficiency CDC.2008. Nutrition and the health of young people. Retrieved on July 16,2009 from www.cdc.gov/HealthyYouth/nutrition/Facts.htm Healthy Nutritional Environments encourages not only youth to eat healthy but also encourages staff to do the same. When students are eating healthy it helps with greater academic achievements, improved attendances, healthier lives, and healthy growth and development. It also lowers the risk for dental caries, eating disorders, malnutrition, and iron deficiency.

Outcomes To start a school wellness council. Assess school environment to identify areas of improvement Develop an action plan Identify resources Take action to create a healthier school environment Celebrate your success The majority of 5-17 year olds are enrolled in schools and spend much of their days there. The schools provide students with an ideal setting for teaching students to adopt healthy lifestyles. Students have the opportunity to eat a large portion of their daily good? intake at school. More than ½ of youth eat one meal in school while one in ten eats two of their three meals at school. This is why it is so important for schools to implement nutrition programs and make the school a Nutritionally healthy environment. As a public health educator I am deeply concerned with the childhood obesity issue in the United States and right here in Iowa. I hope from this presentation that the school board and PTA/PTO will look into how to improve their Nutritional Environment with the outcomes that I hope come from my presentation.

Additional Resources Changing Scene: Improving School Nutrition Environment www.fns.usda.gov/TN/resources/changing.html Making it Happen: School Nutrition Success Stories www.cdc.gov/HealthyYouth/nutrition/Making-It-Happen/download.html Nutrition Standards for Food in Schools: Leading the Way Toward Healthier youth www.iom.edu/cms/3788/30181/42502.aspx A Nation at Risk: Obesity in the United States. http://www.americanheart.org/downloadable/heart/1114880987205NationAtRisk.pdf In the next two slides you will see additional resources that may be of assistance to you in deciding what the next steps are for you and your school to improve the Nutritional Environment for your students.

Additional Resources Team Nutrition / Fitness Guide: For K-12 Classrooms http://www.impactchildhoodobesity.org/images/docs/K-12_Nutrition_Lesson_Plans.pdf

Conclusion As stated earlier in the presentation childhood obesity is a major concern in the United States and right here in Iowa. Although there are some factors that can cause a child to be overweight or obese that we cannot change, the environment is one that we can improve. The Nutritional Environment can be improved by providing healthy food options for breakfast, lunch, in the vending machines, at concessions stands, and at class parties. By providing education and healthier options to students in Kindergarten through twelfth grade you can empower the students to make decisions that can improve or maintain their current health status. As a part of the school, whether being as a school board member, teacher, or parent you have a wonderful opportunity to help in the fight against childhood obesity.

References American Heart Association. 2005. A Nation at Risk: Obesity in the United States. Retrieved July 13, 2009 from http://www.americanheart.org/downloadable/heart/1114880987205NationAtRisk.pdf Blom-Hoffman,J.,Wilcox,K.,Dunn,L.,Leff,S.,& Power,T. 2008. Family involvement in school-based health promotion: bringing nutrition information home. School Psychology Review, 37(4), 567-577. Retrieved July 16,2009 from Academic Search Premier Database. CDC. 2009. Consequences. Retrieved on July 11, 2009 from http://www.cdc.gov/obesity/childhood/consequences.html CDC. 2009. Overweight and obesity: Contributing factors. Retrieved July 11, 2009 from http://www.cdc.gov/obesity/childhood/causes.html CDC. 2009. Overweight and obesity: Defining childhood overweight and obesity. Retrieved from July 11, 2009 from http://www.cdc.gov/obesity/childhood/defining.html CDC. 2009. School health policies & program study: healthy eating. Retrieved July 12, 2009 from http://www2a.cdc.gov/podcasts/player.asp?f=10045 CDC. The obesity epidemic and Iowa students. Retrieved on July12, 2009 from www.cdc.gov/HealthyYouth/yrbs/pdf/obsesity/yrbs07_iowa_obesity.pdf CDC. The obesity epidemic and United States students. Retrieved on July12, 2009 from www.cdc.gov/HealthyYouth/yrbs/pdf/obesity/yrbs07_us_obesity.pdf CDC. 2009. Childhood overweight and obesity. Retrieved July 11, 2009 from http://www.cdc.gov/obesity/childhood/index.html Celebuski,C.,Farris,E.,Carpenter,J. 1996. Nutrition education in public elementary and secondary schools. Retrieved July16,2009 from http://nces.ed.gov/pubs/96852.pdf

References (Cont.) Daniels,S.R., Arnett,D.K, Eckel,R.E., Gidding,S.S., Hayman,L.L., Humanyika,S.,Robinson,T.N., Scott,B.J., Jeor,S., Williams,C.L.2005. Overweight in children and adolescents: Pathophysiology, consequences, prevention, and treatment. Retrieved July 16, 2009 from http://circ.ahajournals.org/cgi/content/full/111/15/1999?ck=nck Institute of Medicine.2004.Childhood obesity in the United States: Facts and figures. Retrieved July 13, 2009 from http://www.iom.edu/Object.File/Master/22/606/FINALfactsandfigures2.pdf NICH.(nd). Childhood obesity action network. Retrieved July10, 2009 from http://nschdata.org RWJ Foundation. (2009). New reports find obesity epidemic increase, Mississippi weighs in heaviest state. Retrieved on July11, 2009 from www.rwjf.org/childhodobesity/products.jsp?id=45348. United States Department of Agriculture. (nd). Healthy school nutrition environment: Promoting healthy eating behaviors. Retrieved July 14, 2009 from www.teamnutrition.usda.gov/healthy/call2act.pdf