Health experts are trying to move the battle of the bulge to an important new front: the schools.

Schools need to be more active in teaching heart-healthy behavior and they should offer more physical education and healthful meals, a new American Heart Association statement urges.

"The main way to prevent overweight is through physical activity and good nutrition and schools provide a very important avenue to reach the majority of youth," said Laura L. Hayman, chairwoman of the writing group for the statement and a member of the association's Committee on Atherosclerosis, Hypertension and Obesity in Youth.

"We would hope that this statement combined with several other initiatives -- including the recent Institute of Medicine report -- will provide the armamentarium and the push that's needed for school districts to adopt standards of physical activity and nutrition," she said.

Hayman is a professor in the division of nursing at New York University's Steinhardt School of Education in New York City. The statement appears in the Oct. 12 issue of Circulation.

Overweight and obesity are among the most critical problems facing many children and adults. The conditions can lead to a variety of serious health problems, including diabetes and heart disease. Recent statistics indicate that 15.5 percent of 6 to 19 year olds and 10.4 percent of 2 to 5 year olds in the United States are overweight. The prevalence is even higher among non-Hispanic blacks (23.6 percent) and Mexican Americans (23.4 percent).

Lifestyles are clearly a contributing factor. The proportion of students attending physical education classes every day has declined from 41.6 percent in 1991 to 29.1 percent in 1999. And almost 80 percent of children aren't eating the recommended five or more servings of fruits and vegetables a day, according to the heart association.

Among the AHA's specific recommendations:

• Schools should teach about the major risk factors for cardiovascular disease and how to modify behavior to avoid them.
• Schools should provide "behavioral training" so students can learn healthy behaviors, such as more exercise and better nutrition.
• Physical education should be required a minimum of three times a week from kindergarten through twelfth grade; elementary school students should have at least 150 minutes of gym during school each week, and middle school students should have a minimum of 225 minutes.
• Meals provided in schools should be heart healthy.
• Schools should be "tobacco-free environments."

To help meet those goals, researchers at Columbus Children's Hospital in Ohio have developed a tool that should help schools and students pick the right snacks from vending machines.

The Snackwise Nutrition Rating System, introduced last weekend at the American Academy of Pediatrics' annual meeting in San Francisco, is a software program that color-codes various foods based on their nutritional value.

The least nutritious foods (peanuts, most candy bars) are "red," meaning "choose rarely." The most nutritious foods (fruits, vegetables, yogurt, sunflower kernels, fruit bars) get "green" for "choose frequently." And those that fall in between (such as baked potato chips and flavored popcorn) get "yellow" for "choose occasionally."

Ridding schools of vending machines is unreasonable, health officials acknowledge.

"Schools can't get rid of vending machines. They're financially dependent on them," said Kristi Houser, a research dietitian with the Borden Center for Nutrition and Wellness at Columbus Children's Hospital. "What we want to be able to do is have good foods. If we have them, kids will eat them. Kids buy what's in front of them."

The program was originally designed to make changes at the hospital itself. "At the hospital, we're going to have green machines," Houser said. "We realized we needed to change and make alternative choices."

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Reference Source 101
October 12, 2004

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