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Originally published in the Spring/Summer 2005 Virginia Tech Research Magazine.

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Fat a BIG problem for kids

By Mary Ann Johnson, Extension Communications

Elena Serrano, Ruiby Cox, Virginia Extension agents, and public school teachers are teaching students in Virginia's elementary and middle schools how to be healthier. Photo by Michael Kiernan.

Nationally, almost two-thirds of children ages nine to 13 years do not participate in organized physical activities outside of school and almost one-quarter do not engage in any free-time physical activity. In 1998, children were reported to view an average of 3.6 hours of television per day. Photo by Michael Kiernan.

These fourth-graders participated in a healthy eating lesson. The purple pieces of paper show the different grease spots left by different brands of potato chips. Photo by John McCormick.

Elena Serrano (center) and Ruby Cox (right) explain grocery shopping from a nutrition point of view during a training session for the EFNEP/SCNEP technicians who help clients in the program. Photo by Michael Kiernan.

With more than one out of eight children considered overweight, childhood obesity is a national epidemic. Because of this, Elena Serrano and Ruby Cox in Virginia Tech's Department of Human Nutrition, Foods, and Exercise have not only been leading research projects to understand the problem, especially among youth in Virginia, but also are leading efforts to do something about it.

Excessive weight in children represents a major health concern — both physically and emotionally. The risk factors associated with diseases linked to overweight and obese adults can be tracked from childhood. Medical reports show increasing rates of Type 2 diabetes, a potentially debilitating disease. This increase is attributed to the growing rate of overweight individuals. Youngsters also suffer from the damaging social and psychological effects of being overweight in a society that stresses thinness and may even discriminate against large-sized individuals. For children, this problem is amplified. According to the researchers, large children report feeling isolated and lonely more than children who are not overweight. These youngsters indicated they are preoccupied with body image, lack self-confidence, have lower self-concept, and may also feel depressed and rejected by friends.

The problem may be especially evident in the South, where the percentage of overweight people exceeds the national average in all states except Florida. Additionally, of the five cities across the country with the highest obesity rates, three are located in the South: Charleston, W.Va.; San Antonio, Texas; and Jackson, Miss.

Understanding the problem

To learn the status of Virginia youngsters, Serrano and Cox collected weight and height data from five ethnically diverse and limited-resource elementary and middle schools in rural and urban areas ("limited resource" refers to schools where many students qualify for reduced-price or free lunches). Serrano and Cox found that nearly one-quarter of fourth and fifth graders in the study were overweight. Funded by the Southern Rural Development Center, the two researchers also looked at differences based on location and ethnicity. Their data indicated that white, rural children were significantly heavier and had larger waist circumferences than those in urban areas. Conversely, Latino and black children in urban areas were significantly heavier than those in rural areas. Age, gender, or school didn't seem to make any difference in being overweight.

"While we see some interesting trends in our data, the problem is clearly complex and has not only food, nutrition, and physical activity elements, but public policy issues as well," says Serrano.

She and Cox reviewed information from other researchers studying the concerns of overweight and found several contributing factors. More people are eating out. Many experts have reported that restaurant portion size has increased and that eating away from home is linked to higher caloric and fat intakes. Consumption of fast food by children increased five-fold between the 1970s and mid-1990s. And children who eat fast food consume more calories, total fat, and added sugars; less fiber and milk; and fewer fruits and vegetables than children who do not eat fast food.

Another part of the concern is lack of physical activity. Nationally, almost two-thirds of children ages nine to 13 years do not participate in organized physical activities outside of school and almost one-quarter do not engage in any free-time physical activity. In 1998, children were reported to view an average of 3.6 hours of television per day.

Serrano also noted that many schools are facing pressure to eliminate physical education programs to save money and to have more time for core subject areas in order to meet state Standards of Learning. Typically, physical education classes are much larger than core subject classes, making it difficult and challenging to offer individualized attention to youth and to promote quality physical education. Many youngsters no longer walk to school because of safety concerns. In some neighborhoods, families feel it's not safe for children to ever be outside. In Virginia, while recess is mandated, there is no minimum set time, so the periods vary from school to school. Some schools in other states have eliminated recess.

Doing something about it

Serrano and Cox are in positions in Virginia Tech's College of Agriculture and Life Sciences to use the research findings to help Virginia citizens. Serrano co-chairs Virginia Action for Healthy Kids, along with the first lady of Virginia, along with the first lady of Virginia, actionforhealthykids/ Lisa Collis, and Cathleen Grzesiek of the Virginia Council of the American Heart Association. The coalition is committed to improving the health of Virginia's youth by working to ensure that healthy snacks and foods are provided in vending machines, school stores, and other venues within the schools' control, and to promote quality physical activity during and after school, including in core subjects.

"We represent many organizations in Virginia Action for Healthy Kids and work with several schools and school districts," to help schools create healthy environments for students, says Serrano. The coalition has created best practices awards to recognize schools that have made efforts to improve nutrition and physical activity in schools and a resource guide of curricula in line with the Standards of Learning. The coalition is developing a toolkit to help schools make changes and resources to aid classroom teachers in incorporating physical activity into all classes.

The Virginia Action for Healthy Kids sent what it calls "nutrition integrity" recommendations to all the school superintendents in Virginia in 2003, Serrano says. The recommendations include replacing foods considered of "minimal nutritional value" with healthier snack items in vending machines. Examples include offering water, 100 percent juice, and low-fat milk in place of soda and fruit beverages, and keeping portion sizes of snacks offered in vending machines to less than 300 calories per item.

Serrano and Cox's studies of the five schools have provided a basis for these recommendations. For example, Serrano says, "An interesting finding was the relationship between self-reported grades, breakfast, and several other healthy behaviors. With the increasing pressure on schools to perform well on standardized tests, one solution may be to encourage principals and school officials to offer breakfast at school as part of the U.S. Department of Agriculture school breakfast program, and to ensure that foods offered in the school environment help promote healthy eating and, therefore, achievement."

Another way Virginia Tech is helping families with children avoid obesity is the program headed by Cox. She is coordinator of the Virginia Expanded Food and Nutrition Education Program (EFNEP) and the Smart Choices Nutrition Education Program (SCNEP). These federal programs bring food and nutrition education directly to families. Virginia Cooperative Extension agents provide education for program assistants who then lead programs in their own neighborhoods. It is aimed at helping limited-resource families make the most of their money for food and it has a 4-H youth development component to reach youngsters directly to teach them about healthy eating.

Training the program assistants to teach children helps the youngsters avoid becoming overweight or obese, says Cox. In one lesson, EFNEP/SCNEP assistants have the youngsters put their napkins like a placemat in front of them and put the food on the napkins. If the food makes a greasy stain, the child can conclude that the food probably has a lot of fat.

"It helps even very young children to know about the food they are eating," says Cox.

Serrano developed a Healthy Weights for Healthy Kids program that encompasses the recommendations from her and Cox's research, and the pair are implementing the program in the EFNEP and SCNEP. Healthy Weights for Healthy Kids offers youngsters experiential learning in nutrition, physical activity, and body image. The EFNEP/SCNEP is in almost all the counties and independent cities in Virginia, providing education programs for about 20,000 youngsters and 10,000 adults annually.

Serrano, Cox, Virginia Extension agents, and public school teachers are teaching students in Virginia's elementary and middle schools how to be healthier.