April 7, 2008 -- Schools can help kids keep a normal weight if the whole school pitches in and takes a positive, healthy approach, a Philadelphia experiment shows.
Those are "dramatic" results, "but we still have a lot of work to do," says Gary Foster, PhD, director of the Center for Obesity Research and Education at Temple University in Philadelphia.
Much of that work has to happen beyond school campuses, says Reginald Washington, MD, chief medical officer of Denver's Rocky Mountain Hospital for Children and a member of the American Academy of Pediatrics' expert committee on childhood obesity.
Many kids live in an "obesogenic environment," says Washington, meaning their homes, habits, and communities are geared to weight gain.
"This study clearly shows that changing things in the schools will have an impact, but as long as all those other things are out there, this problem will continue," Washington tells WebMD.
Childhood Obesity Study
Americans are heavier than past generations. That includes children. According to the CDC, 19% of children aged 6-11 were overweight in 2003-2004, up from 11% in 1988-1994.
Foster's team tested school-based obesity prevention in five inner-city Philadelphia schools. Those schools drew up their own plans, within a framework provided by the researchers, to emphasize healthy eating for all kids in grades 4-6.
The words "obesity," "overweight," and "weight" weren't part of the program.
"Although our purpose in doing this study was to look at effects on overweight and obesity, weight wasn't talked about," Foster says. Instead, the schools promoted healthy eating as a way to get stronger, which appealed to the kids.
"Nobody wants to stigmatize kids. Nobody wants them to feel bad about themselves," Sandy Sherman, EdD, director of nutrition education at The Food Trust, a Philadelphia nonprofit group involved in the study. "Focus on the positive and reward it."
School staff received nutrition education, and teachers wove 50 hours of nutrition education into their lessons, such as explaining fractions with pizza slices. Cafeteria food and vending machine items had to meet certain dietary standards.
"We didn't have a lot of money, we didn't have a lot of space, and nobody could afford ... to give more minutes to nutrition or physical activity," Sherman says. "There were no extras in what we did, but we made it work."
Normal-weight children at the experimental schools were half as likely as their peers at other schools to become overweight during the study.
"That's the good news," Foster says. But even at the schools that took part in the experiment, 7.5% of normal-weight children became overweight during the study. "We may have to up our efforts around things that we didn't touch in this study, like physical education," he says.
Those efforts also include working with stores near the schools to promote healthy eating. "Kids were buying food on the way to and from school, replacing what we had taken away," Sherman says.
Sherman wants the stores to offer cut-up fruit as an option, and for children to learn to make healthy choices at the stores. For example, "we're not saying never buy chips, but limit it to one serving," Sherman says.
The study, published in April's edition of Pediatrics, was "well done," Washington says, noting that the school program was designed to prevent -- not treat -- childhood obesity.
"I think two things are very clear in the study," he says. "One is that prevention is far more effective than treatment and that prevention in the school setting alone will not get the job done."