Helping Kids to Health

The role of Iowa public schools

Collaborators• Iowa Dietetic Association• Iowa Dental Hygienists Association• Iowa School Food Service

Association• Iowa Fit Kids Coalition• ISU Extension

Discussion Objectives

To understand and describe Three examples of health problems

that can be prevented How the school environment

impacts health and nutrition Policy changes that can impact

health of students

Children: A Valuable Resource

Invest in a Child’s Health

To help his/her… Ability to learn Physical ability Appearance Social opportunities Success in school and future employment

Health is key to a long and productive life!

Preventable & Interrelated Health Problems

Obesity Dental Caries Osteoporosis Psychosocial Concerns

Trends in Overweight

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

1963-65 1971-74 1976-80 1988-91 1999

NHANESBoys

NHANESGirls

Overweight and Obesity

Obesity has been related to changes in our lifestyle, including diet and physical activity

Efforts to lose weight have proven unsuccessful for many adults.

Obese children are 43.5 times more likely to have at least 3 cardiovascular risk factors. Nicklas, 2001

As many as 45% of children newly diagnosed with diabetes have type 2 diabetes.

The Problem of Childhood Overweight

Complex …but simple Cannot ignore that one cause is

caloric intake that exceeds caloric expenditure.

Experts recommend that we concentrate on preventing overweight.

No Simple Answer to the Obesity Epidemic

ObesityEpidemic

Food Industry

Candy

Genes

Soft Drinks

Pouring Contracts

Junk Food

Restaurants

Fast Food Computer

s

Working Mothers Povert

y

Poor Parenting

School Feeding

TV

Decreasing Physical Activity

Decreased PE in Schools

Sugar

Glycemic Index

Energy Density

Nicklas, TA, 2003

Genetic vs. Environmental

Obesity gene Children have higher risk of obesity when

either one or both parents are obese. Obesity associated with genetic syndromes

What has changed? … “Gene pool” has not changed Environment: has changed

Dental Health Tooth decay is the most common chronic

disease among children--5 times more common than asthma.

An estimated 51 million school hours per year are lost due to dental related illness

Children with chronic dental pain are unable to attend to school work. (Oral Health in America: A Report of the Surgeon General, 2000)

Poor oral health tied to decreased school performance, poor social relationships and less success later in life

Dental Health

20% of low income children in Iowa have untreated decay in permanent teeth.

68% of low income children have a history of decay compared to 52% of higher income children.

56% of children participating in the IDPH dental sealant programs have a history of decay.

“Pre-fluoride” conditions of mouths

What Dentists are Seeing

Bone Health Bones are formed during childhood and

adolescence. Milk and dairy products are the best

sources of calcium needed to form bones.

Lack of calcium in adolescence could lead to bone health in later years.

Weight bearing exercise is an important factor in bone formation and retention.

Bone Health Osteoporosis is “a pediatric disease

with a geriatric outcome” Physically active girls who consume

soft drinks have more bone fracturesWyshak, G, Arch Pediatr. Adolesc. Med, 2000; 154:610-613.

Over 10 million men & women are estimated to have osteoporosis in 2002; another 33.6 million have low bone mass and are at risk for osteoporosis.

National Osteoporosis Foundation http://www.nof.org/osteoporosis/state.htm

Psychosocial Concerns of Poor Health

Lowered self esteem Body image disturbances Depression Poor academic performance Increased behavior problems

Why be Concerned?

70 to 80% of overweight teens become overweight as adults.

Poor diet/inactivity in adults causes 300,000+ deaths annually.

Osteoporosis decreases mobility and increases pain and has been reported in women.

What has Changed? Physical Activity

22% children did not participate in moderate or vigorous physical activity

20% were not enrolled in physical education class

86% did not attend physical education class daily

(Youth Risk Behavior Survey, CDC, 2000)

Physical Activity

Physically fit children perform better academically – California schools

NASPE recommends 150 minutes/week of physical education

Qualified teachers can ensure safety and teach appropriate activities that are enjoyable, develop motor skills and maintain health related fitness.

What has Changed? Children’s Eating Habits Only 2% of kids meet all Food

Guide Pyramid Recommendations 16% do not meet any

recommendations 12% report skipping breakfast Only 11% eat a breakfast that

contains three food groups and provides >25% of RDA for energy

Compared to Recommendations

84% of kids eat too much fat; 91% eat too much saturated fat Only 15% get enough fruits Only 20% get enough vegetables Only 30% get enough milk Only 19% of girls aged 9 to 19 years

of age meet calcium recommendations

Soft Drinks Cancel Out Milk

Gallons Consumed Per Year

0

10

20

30

40

50

60

1970 1980 1990 1997

milk

soft drinks

Soft Drinks: The Facts

Who drinks soft drinks? 50% of all Americans 65% of adolescent girls 74% of adolescent boys

Borrud, et al., Community Nutrition Inst, 1997

7.0

6.0

5.0

4.0

Plaque pH

critical pH

0 20 40 60 80 100 120 minutes

single glucose rinse

Acidity in the mouth after drinking a sweetened beverage

7.0

6.0

5.0

4.0

Plaque pH

critical pH

0 20 40 60 80 100 120 minutes

First sip

Second sip

Third sip

Fourth sip

Acidity after repeated exposures to a sweetened beverage

Acidity (pH) Sugar (tsp)

Water 7.00 0.0

Diet Coke 3.39 0.0

Mountain Dew 3.22 11.0

Diet Pepsi 3.05 0.0

Gatorade 2.95 3.3

Coke 2.53 9.3

Pepsi 2.49 9.8

Double Trouble: pH and Sugar Content

Challenges for Change

Public Health cannot compete with industry’s advertising budget

Mandated changes are controversial Lifestyle changes are difficult for

individuals

Aim for small improvements over time

Hope for Change

Simple policies can promote health Activity promotion fits in well with

fun school events Alternative fund raisers Children adapt to new ideas and

experiences School provides a venue for

experiencing new tastes and activities

Why Change the School Health Environment?

Education is a process of planning and preparing for a successful future

Why Schools?

Schools play a role in demonstrating to the parents and community the elements that lead to a successful and healthy lifestyle

Children spend time in school

Roles for Schools

Continue to provide nutritionally balanced meals to children Coordinate nutrition education with

opportunities to eat healthy foods. Support nutrition education messages in

the overall school environment. Provide tools for lifelong physical

activity and healthy eating.

Nutrition for Schools in the 21st Century

Budget constraints for schools and school meal programs

Shortened meal times Weak regulations for physical activity

and health in schools School meals must compete with

offerings both on and off campus Foods sold in competition with the

school lunch program for revenue are often of minimal nutritional value

Carbonated Soft Drink Sales• Source of revenue for schools• Competes with goals & revenue of

school lunch• Conflicts with nutrition education

message• USDA regulations only limit

placement & timing of vending machines

Carbonated Soft Drinks in the School

Potential to disrupt the classroom Sugar intake gives children a surge of

energy followed by a drop of energy. More than 51 million school hours are

lost each year to dental-related illness.

American Dental AssociationPolicy: 2000

House of Delegates : oppose contracts that offer

increased access of soft drinks to children and influence their consumption patterns.

calls for continued monitoring of scientific facts and data on the oral health effects of soft drinks.

(2000)

Taking a Position on Healthy School Environments American Dietetic Association American Academy of Pediatrics Society for Nutrition Education Centers for Disease Control and

Prevention Center for Food and Justice American School Food Service

Association

• Create school meal advisory teams of students, parents and teachers to assist in selected menu items.

• Survey students on preferred foods. • Educate students about serving sizes• Employ economies of scale to increase

revenue• Ensure that food sale revenues for

competitive foods are credited to the school food service

Develop positive, healthy options for vending, school stores,

cafeteria environment Ask soft drink companies to

market healthier alternatives. Provide water, 100% juices, milk

and soy drinks

Require closed campuses during lunch periods.

Competitively price healthy foods Sell items that increase physical

activity: pedometers, water bottles. Establish relationships with local

food producers Participate in school gardening

projects

• Ensure that adequate time and space is available for all children to eat comfortably

• Schedule recess before lunch• Encourage teachers and staff to

eat with children

Limit use of food and candy as a reward.

Encourage fund raising efforts associated with healthy lifestyles

Provide daily recess Plan physical education that is

inclusive of all students, including those with disabilities

Fruit & Vegetable Pilot Project 25 schools in Iowa Free fruits & vegetables provided

throughout the day Children learned new foods; enjoyed

them Decreased use of vending machines Positive influence on school

environment

ResourcesSchool Health Index• http://www.cdc.gov/nccdphp/dash• http://www.cdc.gov/nddphp/dnpaChanging the Scene• www.fns.usda.gov/tnFit Healthy & Ready to Learn• http://www.nasbe.org/HealthyScho

ols/healthy_eating.html

More Resources

Team Nutrition• www.fns.usda.gov/tnHealthy Schools Summit• www.actionforhealthykids.orgAlternative ways to raise money

– http://www.scn.org/edu/cccs/– www.commercialfree.org

Conclusions

Schools can positively impact the health of students

A number of options are available to implement school health programs.

A number of tools are available to evaluate environments within schools

AcknowledgementsThanks to the following persons who have

provided expertise and visual support for this presentation

Dr. Michael Kanellis, DDS, MSDr. Jonathan Shenkin, DDS, MPHLinda Snetselaar, RD, PhDEva Tsalikian, MD

University of Iowa School of Dentistry, College of Public Health and College of Medicine

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