Jewish World Review
http://www.jewishworldreview.com | (KRT) LITTLE ROCK, Ark. - The state of Arkansas is tackling the rising problem of childhood obesity by testing all 447,000 of its schoolchildren in an ambitious program that has some parents up in arms and some educators warning of logistical problems.
Arkansas' program is the nation's first comprehensive statewide effort to identify severely overweight kids and raise parents' awareness that their children's lifestyles may need to change.
As such, it's on the leading edge of emerging state efforts to combat childhood obesity - a new policy arena that puts government in the delicate position of trying to protect public health while trying not to offend people whose kids' self-image is on the line.
Arkansas' effort begins this school year with a program to measure the "body mass index" - an indicator of body fat based on height and weight, adjusted for age and gender - of all schoolchildren. Results will be sent to parents next spring, along with educational materials about health risks, in the form of health report cards.
During the last several years, school districts in Pennsylvania, Florida, Massachusetts, Michigan and South Dakota have initiated limited programs to send out similar report cards - dubbed "fat letters" by critics - with mixed results. The reports also call parents' attention to schoolchildren who are severely underweight.
Some consider health report cards an important response to a growing nationwide epidemic of childhood obesity, likening them to past efforts to fight polio by targeting children in school. Over the last two decades, rates of childhood obesity have more than doubled in the United States as kids exercise less, eat unhealthy foods and consume larger portions.
Others consider such reports a misguided approach that could expose schoolchildren to taunting or induce them to try dangerous diets while straining schools' over-stretched resources.
"Call this what you want, it's going to be a form of labeling kids," said Nancy Rousseau, principal of Little Rock's Central High School. "To me, it's not the answer."
In middle school, where children are exposed to intense peer pressure, "it's almost inevitable that they'll compare scores and teasing will occur," said Daniel Whitehorn, principal of Pulaski Heights Middle School in Little Rock, and the impact on overweight kids' self-esteem could be "devastating."
School nurses are already overloaded with work, and many districts don't have sufficiently sensitive equipment to take accurate weight and height measurements, said Margo Bushmiaer, coordinator of health services for the Little Rock School District.
To Mary Katherine Smith, a 17-year-old senior at Central High, "It's not the school's business. You go to school to get an education, not to learn whether you're fat or not. I know I'm probably overweight, and I don't need a report card to tell me."
Arkansas is "certainly not out to embarrass anyone: We all know it's a tough thing being a child who is overweight," said state House Speaker Herschel Cleveland, a Democrat who is a prime mover behind the law. "But we have to start somewhere and try to protect children."
According to statistics he and experts cite, one in four Arkansas high school students is overweight; almost 9 percent of children 5 and under in the state are obese. Rates of Type 2 diabetes in children - once rare in any population but adults - have soared 800 percent in the state during the last decade.
Medical problems associated with obesity include hypertension, diabetes and lung problems in children; for adults those conditions are joined by heart disease and stroke.
The hope is that the receipt of body mass index scores will nudge some parents out of denial and encourage them to make simple changes such as buying Diet Coke instead of Coke, said Joe Thompson, a pediatrician and one of the architects of the state's program. Parents will also be advised to seek medical attention for their children, if warranted.
George Ziolkowski, director of pupil services for the East Penn School District just outside of Allentown, Pa., said a similar program there had a rocky start two years ago - with Ziolkowski denounced as an "obesity Nazi" - but it has since succeeded in making childhood obesity a key community concern.
Research shows health report cards might achieve at least some of Arkansas' objectives.
When parents in Cambridge, Mass., received reports on their children's weight, they were more likely to acknowledge problems, schedule physical activities, and plan to call a medical professional, according to an August report in the Archives of Pediatrics & Adolescent Medicine.
But lifestyles are hard to change, and tips on daily healthy living didn't appear to induce Cambridge parents to alter family eating or television-watching habits, the research found. Also unclear was whether the information eventually helped kids better control their weight.
Some experts on childhood obesity warn that health report cards can backfire if parents start nagging children about how they're eating or put them on diets.
"You're setting kids up to feel bad about how they are," and that could aggravate, not alleviate, weight problems, said Dr. Nancy Krebs, chairwoman of the American Academy of Pediatrics' Committee on Nutrition and an associate professor of medicine at the University of Colorado.
According to research, trying to put kids on diets or control what they eat can "create disordered eating," she said. Schools should focus on issues such as nutrition and physical education, the nutritional content of school lunches, and what's sold in vending machines instead of weight-related measurements, Krebs suggested.
The pediatrics academy last month issued its first policy statement on childhood obesity, calling for pediatricians to measure kids' body mass index yearly. Physicians are better prepared than schools to "interpret this information thoughtfully to parents," Krebs said.
Arkansas officials plan to work closely with physicians' groups over the next six months to prepare them for a slew of calls when health report cards arrive in the mail next spring.
"We want to make sure they know this is a major problem, you can do something, and it's time to step up to the plate," said Thompson, the pediatrician helping the state develop the program.
Will the reports make some people mad? Sure, said Grant Ballard, a Central High senior, "but maybe it'll take getting people mad to motivate them. If you don't get people involved with (this issue) now, the state's going to pay for all these medical problems down the line. This might not be the full solution, but it's a step in the right direction."
Linda Newborn, a parent of four children, isn't so sure.
"This is going to just bubble up to the top all the things middle-school girls struggle with: who weighs what, who looks like what, who is skinnier than whom," said Newborn, whose 13-year-old daughter attends Pulaski Heights Middle School.
There are other steps schools should take, suggested Kristen Dugan, 17, another senior at Central High. Make sure the lettuce in salad bars isn't brown, require more physical-education classes - 69 percent of Arkansas children don't participate in physical education at school - and add nutrition education to health classes, which now focus almost exclusively on sex and substance abuse. All this, it turns out, is also included in the scope of Arkansas' plan.
Over the next year, a new 15-member Arkansas child health advisory committee is to undertake a comprehensive review of school lunch programs, nutrition education, physical education, and vending machine contracts - all part of an effort to determine whether schools are promoting healthy lifestyles.
Within another year, the Arkansas advisory committee is charged with recommending statewide school standards for nutrition and physical activity; it may also formulate a statewide policy on vending machines in middle and high schools.
This fall, the machines were banned in Arkansas elementary schools under the new childhood obesity law, adding the Natural State to a growing list of areas excluding sales of soda pop and candy in schools, including New York and Los Angeles.
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