Belief, behavior diverge, studies find
By Martha Mendoza, The Associated Press
Dailynews.com, 07/04/2007 09:34:50 PM PDT
PANORAMA CITY - The federal government will spend more than $1 billion this year on some healthy snacks and nutrition education - videos of dancing fruit and hundreds of hours of lively lessons about how great you will feel if you eat well.
But an Associated Press review of scientific studies examining 57 such programs found mostly failure. Just four showed any real success against the growing epidemic of childhood obesity.
"Any person looking at the published literature about these programs would have to conclude that they are generally not working," said Dr. Tom Baranowski, a pediatrics professor and nutrition researcher at Houston's Baylor College of Medicine.
The results have been disappointing, to say the least:
Last year a major federal pilot program offering free fruits and vegetables to fifth-graders showed the children became less willing to eat them than they had been at the start. Apparently they didn't like the taste.
In Pennsylvania, researchers went so far as to give prizes to schoolchildren who ate fruits and vegetables. That worked while the prizes were offered, but when the researchers came back seven months later, the kids had reverted to their original snacks:
In studies of schoolchildren who say they are eating better or exercising more, researchers usually find no change in blood pressure, body size or cholesterol measures. The children want to eat better, and might even think they're doing so, but they're not.
Knowing is not doing
The studies don't tell Leticia Jenkins, a teacher at Vista Middle School in Panorama City, anything she doesn't know. She's one of the bravest teachers in America - not because she gave 30 sharp knives to her students in seventh and eighth grades to chop tomatoes, onions, jalape os and limes for a lesson on salsa and nutrition, but because she understands the futility of what she is trying to do.
"Oh, it's so hard, because at the end of the day sometimes I take a moment. I think, gosh, I did all this, and we still see them across the street picking up the doughnuts and the coffee drinks," she said.
Since the 1970s, obesity rates have nearly quintupled nationally among children ages 6 to 11 and tripled among teens and children ages 2 to 5, according to the Centers for Disease Control.
The medical consequences of obesity in the U.S. - diabetes, high blood pressure and even orthopedic problems - cost an estimated $100 billion a year. Dr. James W. Holsinger Jr., a Kentucky cardiologist nominated as the next surgeon general, says fighting childhood obesity is his top priority.
Tough fight
The challenges to changing the way children eat are as numerous as the factors that have produced the obesity epidemic in the first place.
The forces that make kids fat "are really strong and hard to fight with just a program in school," said Dr. Philip Zeitler, a pediatric endocrinologist and researcher who sees a steady stream of obese children struggling with diabetes and other potentially fatal medical problems at The Children's Hospital in Denver.
What does he tell them?
"Oh, God, I haven't figured out anything that I know is going to work," he said. "I'm not aware of any medical model that is very successful in helping these kids. Sure, we try to help them, but I can't take credit for the ones who do manage to change."
Biology a factor
The obstacles are daunting:
PARENTS. Researchers agree that, although most funding targets schools, parents have the greatest influence, even a biological influence, over what their children eat. Zeitler says when children slim down, it's because "their families get religion about this and figure out what needs to happen."
But often, they don't.
"If the mother is eating Cheetos and white bread, the fetus will be born with those taste buds. If the mother is eating carrots and oatmeal, the child will be born with those taste buds," said Dr. Robert Trevino of the Social and Health Research Center in San Antonio.
By the time they reach age 10, most kids have learned what tastes good to them and what tastes nasty.
"If we don't reach (them) before they get to puberty, it's going to be very tough, very difficult, to change their eating behavior," said Trevino.
POVERTY. Poorer kids are especially at risk, because unhealthy food is cheaper and more easily available than healthy food. Parents are often working, leaving children unsupervised to get their own snacks. Low-income neighborhoods have fewer good supermarkets with fresh produce.
"If Mom can't find tomatoes in her local grocery store, nothing is going to change," said Zeitler.
Meanwhile, it's harder for children to exercise on their own. Parks often aren't safe, and sports teams cost money.
"Calorie burning has become the province of the wealthy," said Zeitler. "I fear that what we're going to see is a divergence of healthy people and unhealthy people. Basically, like everything else, it costs money to be healthy."
ADVERTISING. Children ages 8 to 12 see an average of 21 television ads each day for candy, snacks, cereal and fast food - more than 7,600 a year, according to a recent Kaiser Family Foundation study. Not one of the 8,854 ads reviewed promoted fruits or vegetables.
There was one ad for healthy foods for every 50 ads for other foods.
Taste irresistible
Children may be the best sources to explain why they eat junk food despite lessons about nutrition.
"I think it's because they like it so much, because like, I don't know if you've seen the new hot Cheetos that are like puffs. Oh my God, they're so good. Like everyone at the school has them, and they're so good," said Ani Avanessian, 14, of Panorama City.
Her classmate George Rico, a 13-year-old whose mother is a manager at a McDonald's, said he loves his nutrition class. But does it affect what he puts in his mouth?
"Well, no, but it makes me think about what I eat," he said. "I think kids don't change because they've been eating it for so long, they're just accustomed to eating that way.
"Their teacher, Jenkins, offers fact-filled and engaging nutrition lessons as part of a $7 million U.S. Department of Agriculture program that reaches about 388,000 students a year in the Los Angeles Unified School District.
The most recent evaluation of the eight-year-old program was disheartening: Kids participating in the program ate no more fruits and vegetables than nonparticipating kids ate. Teachers who spent more hours on nutrition education had no greater impact than other teachers. And parental behavior didn't change.
"It's true: It didn't change what they actually eat. But the program really made a difference in how kids were feeling about fruits and vegetables. They really had a more positive attitude toward fruits and vegetables," said Dr. Mike Prelip of the University of California, Los Angeles, who headed the evaluation.
Kate Houston, USDA deputy undersecretary for food, nutrition and consumer services, oversees most federal funds - $696 million this year - spent on childhood nutrition education. Funding has steadily increased in recent years, up from $535 million in 2003.
Exercise needed
When asked about the many studies that don't show improvement in kids' eating habits, Houston asked for copies of the research. And she said the USDA doesn't have resources for "long-term, controlled, medical-modeled studies" to determine the impact of its programs.
Dr. Tom Robinson, director of the Center for Healthy Weight at Lucile Packard Children's Hospital at Stanford University, said studies aren't needed; research has already shown nutrition education alone doesn't work.
"I think the money could be better spent on programs that are more behaviorally oriented, " he said.
There may be pieces of solutions found in limited studies being tested around the country. In some situations, obese children can lose weight and get healthy through rigorous hospital and clinic-based interventions including regular check-ins, family involvement and scheduled exercise, as well as nutrition education.
Increased physical activity at school is more likely to have an impact than nutrition education.
This spring the Robert Wood Johnson Foundation announced plans to spend $500 million over the next five years to reverse the trend of childhood obesity. It will fund an array of programs and encourage more exercise at school.
One thing it won't fund: school projects that only provide nutrition education.
