An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Combating Childhood Obesity

School- and community-based programs are showing significant progress in ongoing battle

 Combating Childhood Obesity

Over the past two decades, research has shown a general national decline in childhood obesity, including a steep 48 percent decline found in data published in 2014 in the Journal of the American Medical Association.

But individual states, like Texas, are seeing more modest declines in childhood obesity rates, or are simply holding steady. In fact, approximately 32 percent of children ages 6 to 19 are overweight or obese in the United States, and these rates are even higher in Texas.

“To those of us in the profession (of obesity research), any decline in the childhood obesity rate is good news,” says Steven Kelder, Ph.D., co-director of the Michael & Susan Dell Center for Healthy Living and Beth Toby Grossman Distinguished Professorship in Spirituality and Healing at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health Austin Regional Campus. “But we still have a very large obesity problem we need to continue to address.”

How large? Consider the stats: Texas has one of the highest rates of obesity among adolescents, and nearly a quarter of fourth-grade children are obese. Obesity strikes poor and minority children at even higher rates — for example, more than one-third of Hispanic fourth-grade boys are obese. And recent data doesn’t show a significant decrease in childhood obesity in Texas, possibly due to the recession and a lack of financial support for childhood obesity interventions, say obesity experts.

Understanding its causes and effects

Encouraging more social interaction for children rather than just limiting TV time and enforcing strong nutritional policies in schools are two of the ways to decrease child obesity rates, according to researchers from the Dell Center for Healthy Living.

UTHealth researchers recently published eight new articles as part of a special obesity issue of the International Journal of Behavioral Nutrition and Physical Activity. The issue, titled “The Science of Childhood Obesity: An Individual to Societal Framework,” provides insights into how to solve the child obesity epidemic and close the gap in the current understanding of its causes.

“Ongoing scientific updates of our understanding of the childhood obesity epidemic are important and urgent due to the rapid increase in the prevalence of obesity in both developed and developing countries during the last 30 to 40 years, despite countless initiatives to address childhood obesity,” says Cheryl Perry, Ph.D., regional dean and Rockwell Distinguished Chair in Society and Health at UTHealth School of Public Health Austin Regional Campus.

Watching television has typically been viewed as one of the causes of obesity in children. However, according to UTHealth researchers, overweight or obese children may spend more time in front of the television because of social factors and friendship dynamics that lead them to spend less time with friends.

The authors of this paper examined data from the Child Development Supplement to the Panel Study of Income Dynamics, which included information about the health, development and time use of 2,908 students ages 5 to 18. According to the study results, the more time children spent with friends, the more they engaged in physical activity, which in turn lowered rates of obesity.

“Efforts to reduce child obesity could benefit from careful attention to peer and friendship dynamics rather than simply focusing on time spent watching television,” says Elizabeth A. Vandewater, Ph.D., lead author and associate professor in the Department of Health Promotion and Behavioral Sciences at UTHealth School of Public Health Austin Regional Campus.

In regard to nutrition, many states have banned the sale of soda in high schools and some schools have chosen to substitute soda with other sugar-sweetened beverages in vending machines.

Daniel Taber, Ph.D., and co-authors examined how these policies that regulate the sale of sodas in high schools affect alternate sugary drink consumption, such as tea, coffee, energy and sports drinks. The researchers drew their data from the National Youth Physical Activity and Nutrition Study, conducted in 2010 with 10,887 participants.

In schools and states that regulated both vending machines and soda sales, there was no increase in alternate sugary drink consumption. However, states and schools that regulated either the sale of soda or the availability of vending machines, but not both, saw the highest increases in alternate sugary drinks consumption.

“Banning soda, but allowing sports drinks and coffee drinks in vending machines, just shifts sugary drink consumption from soda to the alternatives,” says Taber, assistant professor in the Department of Health Promotion and Behavioral Sciences at UTHealth School of Public Health Austin Regional Campus.

UTHealth researchers also found the following:

  • Obese children are more likely to have school absences, school problems and lower school engagement than non-overweight children. This study provides evidence that obesity in children is associated with immediate poorer educational outcomes.
  • Students in economically disadvantaged schools were 1.7 to 2.4 times more likely to be obese, regardless of their individual family’s income. The causes of child obesity extend beyond the home and schools are an important environmental influence, according to the study authors.
  • The home food environment, including mealtime structure and availability of healthy or unhealthy foods, was able to account for the differences in children’s’ diet quality across socioeconomic and neighborhood factors.
  • The most important barriers influencing healthy food shopping behaviors are the prices of food and lack of access and poor quality of the available healthy food.

In a separate paper published recently in the Journal of Affective Disorders, researchers at UTHealth School of Public Health San Antonio Regional Campus found that negative body image significantly increases the risk of obesity regardless of whether youth have depression.

“Our last study found that participants who were depressed were twice as likely to be obese six years later, implying a cause-and-effect relationship between depression and obesity. In this new study, when body image was introduced, we found no association between major depression and obesity, meaning that body image is the mediating factor,” says Robert E. Roberts, Ph.D., first author and professor in the Department of Health Promotion and Behavioral Sciences at UTHealth School of Public Health San Antonio Regional Campus.

Roberts and his co-author examined data from a study called Teen Health 2000 (TH2K) which surveyed youth ages 11 to 17 in the Houston area. The youth were asked to describe themselves as skinny, somewhat skinny, average weight, somewhat overweight or overweight. They were also measured for height, weight and whether they had a major depressive episode in the last year.

Participants who perceived themselves to be overweight, regardless of how much they weighed, were twice as likely to be obese a year after they were surveyed. Young women in the group were three times more likely to be obese at the one-year mark.

According to the paper, previous research has indicated that negative body image is associated with greater psychological distress, more disordered eating, binge eating and fewer health-promoting behaviors such as physical activity and consumption of fruits and vegetables.

“Clinically, addressing body image in depressed patients who are obese may improve outcomes,” says Roberts, who is also part of the Dell Center for Healthy Living.

What works?

Since founding the Dell Center for Healthy Living in 2006, Kelder and Deanna Hoelscher, Ph.D., director of the Dell Center for Healthy Living and John P. McGovern Professor of Health Promotion at UTHealth School of Public Health Austin Regional Campus, have found success reducing childhood obesity when they implemented evidence-based, school-based health programs backed by parental and community support, similar to the Centers for Disease Control and Prevention’s (CDC) whole child model.

“In areas where we are able to implement obesity prevention school-based interventions and have community support, we have seen significant decreases in childhood obesity,” Hoelscher says.

Hoelscher and Kelder encourage parents and community members to become advocates and push for programs in their neighborhoods. Here are their suggestions on how to make what’s working in other communities work for your community:

Target schools

“Schools are a great conduit for obesity programs,” Kelder says. “The kids are there for most of their day from kindergarten to high school. It is a perfect opportunity to address their nutrition and physical fitness during that time.”

One of the Dell Center’s most successful school obesity interventions is CATCH, or Coordinated Approach to Child Health. If you have a child in public school in Texas, you may know of the CATCH program from packing your child’s CATCH break — a healthy snack for school. That’s just one component of the program, which is designed to promote physical activity and healthy food choices. The CATCH program provides in-depth materials about nutrition and physical activity for classroom teachers, child nutrition services staff, physical educators and families. CATCH also offers an early childhood program and after-school program.

The program has been a success in Texas. Since an initial study in El Paso in the 1990s helped lower the weight of low-income school children by 8 percent, follow-up studies have had similar results. A follow-up study in Austin reduced obesity by 7 to 8 percent. Since then, the program has been adopted by more than 9,000 schools in the United States and abroad.

Kelder says the program’s focus on energy balance — balancing the amount of foods you eat with enough exercise to burn off excess calories — is the key to the program’s success, together with family involvement.

Introduce healthy foods

“Many kids aren’t exposed to fresh fruits and vegetables,” Kelder says. “One way to solve that is to have taste testing. When you look at our tongues, they are hardwired for certain flavors. The most nutritious vegetables taste a little bitter. You need to have kids try the new food many times before they get used to the taste. It may take one bite, up to 15 times.”

To make that first bite happen, the Brighter Bites program provides fresh fruit and vegetables to low-income families. UTHealth is a partner in the program, which gives weekly bags of 50 servings of produce to families in areas identified as food deserts, combined with nutrition education for children and their families over a 16-week program.

Teaching kids to grow their own fruit and vegetables also increases exposure to healthy foods, and makes children more likely to eat them. Texas Grow! Eat! Go!, in collaboration with Texas Agrilife Extension Service and Texas A&M University, is teaching kids at 32 CATCH elementary schools in Texas how to become master gardeners. The pilot program was tested in three Nueces County elementary schools in the spring of 2012. Nearly 24 percent of boys in the program and 13 percent of the girls transitioned from an unhealthy weight to a healthy weight by the end of the pilot project.

“Results from the pilot study are very promising, suggesting that students participating in the study increased their fruit and vegetable intake and decreased their weight,” says Alexandra Evans, Ph.D., a Dell Center for Healthy Living researcher and associate professor in the Department of Health Promotion and Behavioral Sciences at UTHealth School of Public Health Austin Regional Campus and the study’s principal investigator.

Get kids moving

Exercise is a key part of maintaining a healthy energy balance, but children are getting less of it, as schools increasingly focus on academics at the expense of physical education programs, Kelder says. The U.S. Physical Activity Guidelines recommend children engage in at least 60 minutes of moderate to vigorous physical activity every day. The CATCH program helps schools increase the amount of physical activity through its curriculum, including lessons on how kids can reduce sedentary behavior, like screen time, and engineer physical activity into their daily lives. The program also encourages the formation of school wellness teams, and encourages schools to look for opportunities for more physical activity, such as classroom activity breaks and “open gym” policies before and after school.

Involve the entire community

“For programs to work, we need other organizations supporting and assisting our schools in encouraging healthy dietary habits and activities that encourage physical activity, such as Boy Scouts and Girl Scouts and after-school programs,” Kelder says, giving the example of the Texas Childhood Obesity Research Demonstration (CORD), a CDC-funded program that connects the dots between families, pediatricians, school and local youth organizations. Families in the program are referred from physician’s offices, take educational classes about cooking, healthy eating and physical activity at their local YMCA, and participate in sports teams at local YMCAs.

Other initiatives, such as farmers’ markets and community exercise classes, also help make a difference and communicate the message that overall health is important. People can offer support by organizing community wellness efforts, meeting with school leaders about nutrition and physical education issues or getting involved with their local school district’s School Health Advisory Council (SHAC).

While progress is being made to reduce childhood obesity, further research and action remains. Kelder compares the fight against obesity to efforts to curtail smoking.

“It is going to take some big societal changes to eliminate the problem of childhood obesity,” he says. “I am pleased that we are leveling off, but we still need to pay attention to childhood obesity and focus our attention on reducing it.”

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