Promising anti-obesity programs in schools

Students at Aurora's Park Lane Elementary participate in the Go, Slow, Whoa! program. (Hayleigh Colombo)

Keeping kids thin and fit is no small order in 2011.

Schools experiment with countless ideas to battle children’s obesity. They’ve tried cooking classes, nutrition education, inviting kids to work in school gardens, improving cafeteria food, banning sugary snacks.

They’ve upgraded playgrounds, tinkered with recess, mandated daily physical activity, organized bike clubs and revised physical education standards. They’ve coached parents, coached teachers, coached lunch ladies, coached coaches.

Yet for all the different approaches, the empirical evidence proving what works and what doesn’t  is remarkably sketchy.

Evidence-based anti-obesity programs that repeated studies have proven effective simply don’t exist – yet, according to James O. Hill, director of the Center for Human Nutrition and the Colorado Nutrition Obesity Research Center and one of the nation’s leading experts in anti-obesity efforts.

“If we’re really looking at programs shown to address obesity, there are none out there,” Hill said. “I recall one school study where they just spent millions of dollars, and they found the group that didn’t get the intervention did just as well as the group that did.”

That doesn’t mean, however, that schools shouldn’t keep trying, he said. And some efforts do seem to hold more promise than others.

What follows are three different approaches in place in Denver-area school districts that Hill and others say bear study in hopes their early successes can be replicated. One focuses on nutrition, one on physical activity and one on school environment:

Aurora: Go, Slow, Whoa! nutrition education

Knowledge is power, so they say. But sadly, it’s not willpower.

Knowing of the nutritional facts of life often doesn’t equate to actually making the best food choices. Just ask anyone who’s ever struggled to resist a doughnut, or intended to say “I’ll take the fruit,” but at the last second caved in to the allure of French fries.

Kids are no different from adults on this point. That’s why so many well-intentioned nutrition education programs succeed in teaching youngsters all about many wonderful fruits and veggies, food pyramids, caloric requirements and all the other tools needed to create a balanced diet – yet fail to make a dent in their real-life eating habits. Study after study shows such programs ultimately don’t change the ways kids eat.

It’s still early in the game, but initial results from one nutrition education program being piloted in Aurora Public Schools show it really may be having a measurable impact on children’s food choices.

Funded by a grant from LiveWell Colorado, the Go, Slow, Whoa program was introduced last year in one Aurora school, Laredo Elementary. This year, in partnership with KMGH Channel 7, the U.S. Department of Agriculture and LiveWell, it has been expanded to seven more schools, and officials hope to eventually expand it to all elementary schools in the district.

Created by the nutritionists at the National Heart, Lung and Blood Institute, Go, Slow, Whoa involves a color coding system that helps youngsters make smart food choices by making it easy for them to identify and eat lots of nutrient-dense foods, but not making any foods totally forbidden.

“It’s a simplified food-guide pyramid,” said Mona Martinez-Brosh, a registered dietitian and director of nutrition services for the school district.

As students go through the cafeteria line at school, they see the color-coded symbols above each option. Foods tagged with a green apple symbol are “Go” foods. They are high in fiber, low in fats, and good to eat any time you want. They’re things like fresh fruits and vegetables, lean meats, nuts, low-fat milk.

“Slow” foods, tagged with a yellow circle, are still nutrient-dense, but have a little more fat and sugar: they’re things like pancakes, turkey sausage or peanut butter. They’re things that are still wise choices, but shouldn’t be eaten quite as often or in as great a quantity as the “go” foods.

“The pizza we serve at school – with low-fat cheese and whole wheat crust – is a ‘slow’ food, but we tell them that the pizza you get from your local delivery is not,” Martinez-Brosh said.

“Whoa” foods get a red light symbol. The message is “proceed with care.” It’s on foods high in fat or sugar, typically fried foods, sugary sodas and desserts. Don’t give them up entirely, but they should only be eaten once in awhile.

“You don’t often find these foods on our school menu, but salad dressing can be a ‘whoa’ food,” Martinez-Brosh said. “If you eat it frequently, in larger portions, it can lead to gaining weight.”

But beyond simply coding foods in the cafeteria, Go, Slow, Whoa seeks to involve parents, and to see to it that students hear a consistent message all day from their classroom teachers and the physical education teacher.

In Aurora, parents were invited to come to a breakfast at the start of the year, and to learn how to program works.

“We tell them we need their help in making sure they’re buying more of those types of ‘Go’ foods at home,” Martinez-Brosh said. “I have one of my own employees who came to me and said her child came to her and said ‘No, we can’t eat that. That’s a ‘Whoa!’ food.’ ”

In addition, students get some hands-on food preparation instruction and food tastings in their classrooms as part of their regular lesson plans. And occasionally, students who do a good job of selecting ‘go’ foods with their lunch can win prizes.

Does it work? One study found that elementary-aged children who’d been exposed to a similar program were, three years later, drawing 67 percent of their total calories from heart-healthy foods, compared to less than 57 percent of the total daily calories for children who didn’t go through the program. That same study also confirmed what many parents and nutritionists have long suspected: that just about all children, regardless of their level of nutrition education, still consume about a third of their total daily calories from snack foods, desserts and pizza.

In Aurora, officials do have a little evidence that their efforts may be making a small but measurable difference. Just before the program was introduced at Laredo in April last year, 200 students were surveyed about their ability to recognize healthy eating choices. For example, they were asked if they should choose popcorn with or without butter at the movies. At a restaurant, should they choose a breaded fried chicken sandwich or a grilled chicken sandwich. A month later, they were given the same survey and the results were compared.

“For most of the choice pairs, it went up from about 75 percent who made the healthy choice in the beginning to about 80 percent on the post-test,” said Mya Martin-Glenn, program evaluator for the school district.

Of course, “should” and “would” are two different things, Martin-Glenn acknowledged. But other questions also indicated a measurable increase in the children’s intentions to make healthy choices.

“We asked them how likely they were to do things like drink low-fat milk instead of whole milk, and we had about 65 percent said they were likely to in the beginning, and that increased to 73 percent on the post-test,” she said. “But we didn’t actually follow them around to see if that’s what they did.”

A more concrete measure of success came in the Laredo cafeteria, where the quantity of fresh fruits and vegetables consumed went up between 50 and 75 percent during the month-long pilot program, Martinez-Brosh said. She’s seeing similar increases in the schools participating in the program this year.

“I think the kids at this age want to make those right choices,” she said. “They just don’t know which foods are which until we educate them.”

Denver: SPARK engaging physical activity in class

The minute the fourth-graders walked into the gym at Denver’s Force Elementary School, P.E. teacher Deborah Ellis had them moving. And for the next 45 minutes, no one stood still for more than a minute or so.

While a group of three or four children climbed ropes, another small group worked on the balance beam, another group worked on a climbing wall, another worked on a tumbling mat, and others were jumping rope.

Every few minutes, the groups would trade places, with the rock climbers moving on to the balance beam, the rope climbers moving on to the tumbling mat, and so forth. But between each shift, Ellis turned on the music and every student did a minute of cardio-pumping dance moves or exercise routines.

“Our whole emphasis is that in a 45-minute period, students should be active at least 50 percent of the time – and in this class I’d say it’s at least 75 percent of the time,” said Eric Larson, director of physical education for DPS, as he watched Ellis put the youngsters through their paces.

“We really stay away from something like five-on-five basketball, where 10 kids are playing and the rest are on the sidelines watching and rotating in. Instead, we do things that are one-on-one or two-on-two or three-on three. There’s a lot of touching the ball or working on skills. We want them all active.”

Last year, Force was one of the first elementary schools in DPS to move to a new PE curriculum called SPARK. This year, the curriculum is in 58 DPS elementary schools, and will be in the remaining 30 next year. It was introduced into DPS middle schools in 2004.

The SPARK curriculum really isn’t new. It’s been around for 22 years. In 1989, a team of researchers got funding from the National Institutes of Health to create and evaluate a PE program that could become a national model. The acronym stands for Select fruits and vegetables, Play actively, Avoid excess sugar and fat, Reduce TV/media time, Keep H2O the way to go.

Today, SPARK has research-based physical activity programs for not only school physical education classes but also early childhood, after-school and coordinated school health programs. It’s been honored as exemplary by everyone from the Surgeon General to the U.S. Department of Education to the Centers for Disease Control. A 2009 survey of anti-obesity programs, conducted by the HSC Foundation, lauded SPARK as one of the best physical education models available.

But it’s not inexpensive. Keeping children constantly active requires lots of equipment – enough so that every child has ready use of a ball or a hoop or whatever fitness gear is required for a given lesson. Stocking the suggested equipment for an elementary school runs between $5,000 and $9,000 per school, and can top $14,000 for a middle school. And Ellis – the P.E. teacher at Force for the past 19 years – has an equipment budget of just $300 a year.

A $450,000  3-year federal grant allowed DPS to put the SPARK curriculum – and the required equipment – into every school. In addition to seven days of intensive training in the curriculum, Ellis and her fellow DPS elementary PE teachers each got $7,000 worth of equipment.

“I had already accumulated a lot of equipment on my own through the years, but when I got all this SPARK equipment, it was like I’d died and gone to heaven,” said Ellis.

The district is in the process of measuring the impact of the SPARK curriculum on its elementary students’ fitness levels. Results of cardio, flexibility and strength tests conducted before the students began the program and again after several months’ exposure to it won’t be available until spring. But if the elementary students respond like the middle school students did, Larson is expecting noticeable improvements.

When the SPARK curriculum was introduced to DPS middle schools six years ago, students averaged a 17 percent increase in their aerobic fitness, a 13 percent boost in upper-body strength and a 5 percent increase in flexibility.

Just as importantly, the time the students spent being physically active during PE class zoomed from 29 percent to 66 percent. And after the teachers were trained using the SPARK methods, the percentage who encouraged their students to be physically active outside of school went from three out of 11 to all 11 – 100 percent.

Will the increased physical activity time in PE class translate into leaner, fitter students over time?

“It’s tough to correlate that,” Larson acknowledges. “There are some national studies that have drawn correlations between fitness levels and academic performance, but no one has come up with a measure to show whether kids’ BMIs (body mass index) are lower because of increased moderate to physical activity. There are just so many factors that come into play.”

Cherry Creek, Douglas: Workplace wellness for staff

School districts across the nation are devising ways to not only slim down their students, but to slim down their faculty and staff too. The hope is that it will result in an environment in which fitness is “catching,” a schoolwide ethos of healthy diet and exercise and a healthier, cheaper-to-insure workforce.

Since 2004, most school districts have been required to develop wellness plans, though their commitment to implementing and evaluating them varies widely. But two Denver-area school districts – Douglas County and Cherry Creek – have been especially aggressive in creating workplace wellness programs for teachers and staff, to complement programs targeting children. It’s too soon to know whether this approach will ultimately prove effective, but James O. Hill finds such workplace wellness programs especially promising – if they last.

Cherry Creek schools recently partnered with Kaiser-Permanente, which will provide funding to launch five worksite wellness pilot programs at five elementary schools. Schools were invited to apply to be a pilot site, and the winners haven’t yet been selected. But those who are chosen will each be given $10,000 to spend as the school sees fit to develop the wellness activities most appropriate for its teaching staff.

“It’s unprecedented for a school to receive money that goes to supporting staff in this way, especially when times are tight like they are now,” said Janise McNally, wellness coordinator for the district.

Schools will have freedom to do what they think best, but the district wants them to concentrate on one or more of the district’s goals: improving physical fitness and making healthy food choices; stress management and strengthening resiliency; and making environmental or structural changes to support physical activity.

“This is not just about bringing in a bunch of programs and classes, but about shifting our culture to be more supportive of fitness and wellness in general in our schools,” McNally said. “It will require the building’s leadership to be behind it full force.”

Throughout the district, staffers have been provided with pedometers and wellness officials are launching a “Flat 14er” challenge to get employees to begin walking more and tracking the steps they take every day, charting their progress online. The district’s second annual Family Wellness Summit is set for April.

“We know our adults are models for our kids,” McNally said. “We can’t expect our students to be well if our adults aren’t well. If our staff is stressed-out or not well, it’s more difficult for them to meet the needs of the students.

Points of view
“We know our adults are models for our kids. We can’t expect our students to be well if our adults aren’t well.”
Janise McNally, Cherry Creek“We believe that modeling wellness for kids is huge. But budgets being what they are, we had to make decisions based on what was best for students in the classroom.”
Sean McGraw, Douglas County

While Cherry Creek is just ramping up its workplace wellness program, Douglas County started strong two years ago but is already reassessing its efforts. At one point, two-thirds of all district employees were participating in some form of district-sponsored fitness program, fueled by prizes for the faithful and promises of financial incentives if they kept it up.

But budget cuts forced the district to curtail most of the incentive programs and to drop its contract with Andrew Sykes, chairman of the Chicago-based Health at Work, a company that specializes in workplace wellness programs.

“From our point of view, it looks like abandonment,” complained Sykes. “Douglas County was far ahead of the other school districts, but not now. And we’re only interested in working with clients who are seriously interested in working on wellness.”

“It’s still a high priority,” insists Sean McGraw, executive director of the Douglas County Educational Foundation, a non-profit association developed 20 years ago to develop private resources to enrich education in the county. The DCEF has now taken over the district’s workplace wellness program.

“We believe that modeling wellness for kids is huge. But budgets being what they are, we had to make decisions based on what was best for students in the classroom. We had to abandon the pedometer program because we ran into an incentive issue,” McGraw said. “But I believe health and fitness can’t be driven by a financial reward. Our pedometer program will have to change, but it’s just one of the many options people will have. But the options will have to be free or at low-cost to the district.”

The DCEF has hired Carla Sassano, a teacher on special assignment, to oversee workplace wellness. Sassano says she is preparing to roll out a whole series of classes – things like Zumba, strength and conditioning, boot camp, yoga, Pilates, and a combination of Pilates and yoga called Pi-Yo – geared to teachers, staff and parents. They will be scheduled for every day of the week at various schools around the county. Cost will be $5 per person per class.

Sassano also plans a healthy recipe exchange, a districtwide 5K and other motivational events.

“It’s a proven trickle-down effect,” said Sassano. “But if you don’t have buy-in from your administrators and teachers, there’s not going to be passion in teaching about the necessity of physical activity and nutrition. This is the whole lead-by-example thing. If the kids leave school but see their teachers staying for an exercise class, that’s their role model. And there’s no doubt in my mind that the healthier the staff is, the healthier our kids will be.”