Sunday, August 20, 2006

Wellness or Swellness

Today, the New York Times magazine brings us an interesting article about the veracity of the national drive toward healthier kids. The question being, Is there any evidence that these improved school lunch programs will, in fact, work?

From: The School-Lunch Test by LISA BELKIN, Published: August 20, 2006. [The bolded sentence is my annotation of the piece.]

By any health measure, today’s children are in crisis. Seventeen percent of American children are overweight, and increasing numbers of children are developing high blood pressure, high cholesterol and Type 2 diabetes, which, until a few years ago, was a condition seen almost only in adults. The obesity rate of adolescents has tripled since 1980 and shows no sign of slowing down. Today’s children have the dubious honor of belonging to the first cohort in history that may have a lower life expectancy than their parents. The Centers for Disease Control and Prevention has predicted that 30 to 40 percent of today’s children will have diabetes in their lifetimes if current trends continue.

The only good news is that as these stark statistics have piled up, so have the resources being spent to improve school food. Throw a dart at a map and you will find a school district scrambling to fill its students with things that are low fat and high fiber.

In rural Arkansas, a program known as HOPE (Healthy Options for People through Extension) seeks to make nutrition a part of the math, science and reading curriculums. At the Promise Academy in Harlem, all meals served in the cafeteria are cooked from scratch, and the menu (heavily subsidized by private donations) now includes dishes like turkey lasagna with a side of fresh zucchini. In Santa Monica, Calif., there is a salad bar at every school in the district, with produce brought in from the local farmer’s market. At Grady High School, outside Atlanta, the student body president, a vegetarian, persuaded the company that runs the cafeteria to provide tofu stir fry, veggie burgers and hummus. In Irvington, N.Y., a group of committed parents established No Junk Food Week last March, where all unhealthy food was removed from the cafeteria and replaced with offerings from a local chef called Sushi Mike and donations from a nearby Trader Joe’s. At the Hatch Elementary School in Half Moon Bay, Calif., children learn songs like “Dirt Made My Lunch” and then taste fruits and vegetables they have grown in their own garden.

School lunch (and actually, breakfast, because schools that provide free and reduced-cost lunches must also provide breakfast) is now a most popular cause. Any number of groups, from the W.K. Kellogg Foundation and Kaiser Permanente (they both underwrite many of the above programs) to the William J. Clinton Foundation (it brokered an agreement among soft-drink manufacturers to stop selling soda in elementary and middle schools) have gotten in on the act.

But there is one big shadow over all this healthy enthusiasm: no one can prove that it works. For all the menus being defatted, salad bars made organic and vending machines being banned, no one can prove that changes in school lunches will make our children lose weight. True, studies show that students who exercise more and have healthier diets learn better and fidget less, and that alone would be a worthwhile goal. But if the main reason for overhauling the cafeteria is to reverse the epidemic of obesity and the lifelong health problems that result, then shouldn’t we be able to prove we are doing what we set out to do?

The smattering of controlled prevention studies in the scientific literature have decidedly mixed findings. “There just isn’t definitive proof,” says Benjamin Caballero, the principal investigator on the largest study, of 1,704 students over three years in the 1990’s, which showed no change in the body-mass index of those whose schools had spent $20 million changing their menus, exercise programs and nutritional education. A second study, of more than 5,000 students undertaken at about the same time, came to similar conclusions. “There are a few smaller studies with more promising results,” Caballero went on to say, “but right now we can’t scientifically say that all the things that should work — by that I mean improving diet, classroom nutrition education, physical activity, parental involvement — actually do work.”

This is a long article well-worth the time to read because the theory of cost and effect is once again the question.

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