Carrots (Not Sticks) to Encourage a Healthy Weight

Steps we can take to help preventchildhood overweight and obesity . . .

According to the National Center for HealthStatistics,¹ almost one-fifth of American childrenaged 6 to 11 years are overweight-a proportion that has been increasing inrecent years. Overweight children are morelikely to become overweight adults, following a pathwaytoward such health complications as heart disease, diabetes,and sleep apnea.² As pediatricians, we are constantlylooking for new ways to battle the obesity epidemic,and wonder what else we can do to slow theprogression of the trend.

Foster and colleagues³ recently conducted a 2-yearprospective study in which students in grades 4 through6 from 10 different schools in the Philadelphia areawere either exposed to a School Nutrition Policy Initiative(SNPI) or acted as controls. Following CDC guidelines,the SNPI included school self-assessment, nutritioneducation, nutrition policy, social marketing, andparent outreach.

In addition to traditional education about nutritionand physical activity, teachers in the intervention schoolswere shown how to encourage healthy lifestyles throughoutthe curriculum-such as using food labels to teachchildren about fractions. In the intervention schools,the foods sold and served were changed to reduce theamount of fat, sugar, and sodium. Only 100% juice, water,and low-fat milk were available as beverages.

Students who ate nutritious meals and snacks weregiven raffle tickets, with prizes that included items thatcould promote healthy lifestyle choices (such as bicyclesand jump ropes). Families were contacted by nutritioneducators and were encouraged to support diet and activitychanges through a variety of methods (eg, eliminatingunhealthy snacks at parent fundraisers and notgiving sweets to teachers for holiday gifts).

At baseline, 1 year, and 2 years, the researchers obtainedweight and height data and administered questionnairesabout diet, activity, sedentary behaviors, andbody image. Among children in the intervention group,significantly fewer became overweight than in the controlgroup over the 2-year period (7.5% vs 14.9%, respectively).However, there was no difference in obesityincidence. After the study period, the prevalence ofoverweight had decreased in the intervention schoolsand increased in the control schools.

While no significant differences were found amongthe groups regarding remission of overweight, reporteddiet, or reported activity, the intervention group didspend less time doing sedentary activities than the controlgroup. No difference was seen concerning bodyimage or becoming underweight, which were consideredpotential negative effects of the intervention.

While the Foster study is limited by self-reportingfor some outcome measures and by including only 10schools, it does point out some frightening trends andsuggests ways to mitigate them. Even in the interventiongroup, which was 50% less likely to become overweightthan the control group, there was still a 7.5% increase inthe incidence of overweight children. This increase-aswell as the lack of response in the incidence of obesityand the absence of remission of overweight-show thatthe interventions made in the study are not perfect.However, they are a start.

How can we use these results to help fight overweightand obesity? We can encourage schools in ourneighborhoods to stop providing and selling unhealthfulfoods, to have "bake sales" with nutritious snacks, and toincrease education about nutrition and physical activitythroughout the curriculum. In our day-to-day practice wecan give stickers instead of lollipops after kids get theirshots, we can encourage parents to set nutrition exampleswhen helping kids with their homework or whenshopping for food, and we can reward healthy lifestylesand growth parameters with coupons for nutritious foodchoices.

The overweight and obesity epidemic is overtakingus-let's get creative about how to stop it in its tracks.

References:

• National Center for Health Statistics. Prevalence of overweight among children and adolescents: United States 2003-2004. http://www.cdc.gov/nchs/ products/pubs/pubd/hestats/overweight/overwght_child_03.htm. Accessed April 15, 2008.

• Centers for Disease Control and Prevention. Overweight and obesity. http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/consequences.htm. Accessed April 15, 2008.

• Foster GD, Sherman S, Borradaile KE, et al. A policy-based school intervention to prevent overweight and obesity. Pediatrics. 2008;121:e794-e802.