Fat land : how Americans became the fattest people in the world (23 page)

The results of the intervention surprised even its most enthusiastic and optimistic supporters. After seven months, TV use in the intervention group was down by one third, compared to the control group. Video game use and viewing of videocassettes were down as well. While not an anticipated outcome, the intervention group also "significantly reduced the frequency of children eating meals in a room with a television turned on." And, most important, children in the intervention group, in the words of the researchers, "had statistically significant relative decreases in BMI, triceps skinfold thickness, waist circumference, and waist to hip ratio." The results did not change with ethnicity or level of parental education.

The success of the San Jose experiment posed an intriguing

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question for its authors. Why did the children lose weight? After all, there were no reports that children had dramatically increased high-level activity when not watching TV, and when they were watching TV their level of snacking matched that of their more sedentary control group. Three answers emerged. One, children in the intervention group snacked less in toto. Two, they had been exposed to dramatically fewer advertisements for high-calorie foods. And three, they likely sought out and engaged in more low-intensity activity. Whatever the cause, the Stanford researchers concluded, reducing TV, video game, and video use "may be a promising, population-based approach to help prevent childhood obesity."

Jim Hill, at the University of Colorado Health Sciences Center, has come to a similar conclusion about larger interventions. As he and John Peters note in a recent issue of Obesity Reviews, "The challenge in changing the environment is not to 'go back in time,' but to engineer physical activity and healthy eating back into our lives in a way that is compatible with our socio-cultural value." As Peters and Hill see it, the challenge is to give everyday people the same cognitive tools — essentially a series of goads and rewards — that the more affluent always have had when it comes to managing weight. Hill and his colleagues have launched a program called "Colorado on the Move," a consortium of government agencies, private foundations, educational institutions, and business with one specific, measurable goal: to increase by 2000 steps a day the average number of steps the average Coloradan takes. To do so, they are underwriting the distribution of low-tech step counters around the state. Hill and his colleagues got the idea after comparing the average number of steps daily by an office worker (3000 to 5000) with the average number of steps by people in the National Weight Control Registry (11,000), the most successful single group to maintain weight loss after several years. Beginning with a modest 2000, Colorado on the Move could eventually encourage large numbers of citizens to take increasingly more steps per day. Already some six thousand people are enrolled in pilot programs.

WHAT CAN BE DONE

One of the best ways to combat obesity would be to reinvest in traditional public school physical education. Unfortunately, taxpayers have not yet seen fit to do so. (In California in 2001, the legislature was unable to pass even modest legislation that would have funded the creation of written standards for all PE courses in the state.) There is the occasional nod and bow toward the need to "do something" — usually when the ever dismal state fitness test results are published every two years — but there is usually little if any follow-up. Many policy makers believe that today's parents have forever separated school and fitness, preferring either to ignore the subject altogether or to fill their kids' sports cravings through private programs. Unfortunately, that means permanent underfunding of public school PE — the only alternative for the less economically advantaged.

Still, a small core of educators, many of them young PE teachers in some of the nation's most underfunded school districts, have plunged ahead, crafting unique programs specifically targeted at reducing obesity and increasing overall fitness. One of them is Dan Latham, a PE instructor at West Middle School in blue-collar Downey, California. Latham is, in many ways, the kind of fellow that many principals dream about; he is engaging, well-spoken, energetic, and full of ideas — all of which he is convinced he can pull off. When he first arrived at West back in 1991, Latham was struck by how few resources his fellow PE teachers had at hand. "And I was also struck by, frankly, how fat the kids had become." By 1995, he recalls, after-school coaches were coming to him "saying, 'Look, I can't get enough kids to make a whole team anymore.'" Later, "we all got together and started talking, and it became clear right away what the enemy was — it was video games. We decided we had to find a way to make PE compete with Nintendo."

One day Latham had a brainstorm: What if they could create a gym that was one part video parlor and one part health club? He found a 2000-square-foot building on the school lot that was going unused and got the school principal to give him and his buddies permission to rehab it, with the condition that the project

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would not cost the district any money. Latham raised $50,000 from a local philanthropist for material costs; the labor was donated by "my coaching buddies." To equip the gym, Latham began acquiring stationary bicycles — the fancy kind used in many expensive high-tech urban health clubs. These he had wired into big video screens. On the screens appeared a number of competitive video games — which could only be played as long as the users kept on pedaling. "What we found startled us all — kids who, if you asked them to run a mile outside, would just sort of look at you and hide, they were crazy for it. I have a kid who used to weigh 310 pounds who has already dropped 50 pounds — he laughed and sweated his way through it." By 1999 Latham had raised more than $250,000. His center, which he has dubbed Cyberobics, can now accommodate up to fifty students at a time. "It's always packed," he says. It is also attracting notice. Last year, West Middle School registered big gains on the semiannual California fitness test. Students at West Middle School were number one among schools its size in the category of aerobic capacity. "Next we've gotta get that upper body strength back up," says Latham.

Perhaps the most controversial way to use schools to prevent obesity has been undertaken not by academics and health professionals, but by parents, teachers, and school administrators, who have in recent years fought a high-stakes guerrilla war with the fast-food companies that have come to dominate the school nutrition scene. The most tense battleground is that of soft drink pouring contracts, in which high schools are paid large sums of cash in exchange for an agreement to sell only one kind of soda, usually Pepsi or Coke. Also called exclusivity deals, these contracts can run into the seven-figure range — a great deal of money for any chronically hard-strapped school system. Nationally, there are thousands of such deals in place. They have, in fact, become the norm in most large school districts, with principals — and parents and administrators — justifying the consequent omnipresence of soda (and soda ads) on campus as a way to pay for athletic uniforms and a variety of after-school programs.

WHAT CAN BE DONE

Such was the initial justification of most members of the Sacramento school board last year when they considered a lucrative pouring contract from Pepsi. Over a five-year period, the soft drink behemoth promised to pay the board $2.5 million in return for the exclusive right to sell and advertise Pepsi products on Sacramento public school campuses. "Frankly, it was such a done deal that when it came before us, it was expected to be fast-tracked to approval," recalls Michelle Masoner, a thirteen-year veteran of the school board. But then, after reflection, "it did not feel right to me. After all, we already had some vending machines on campuses, and many parents, and myself as a parent with kids in the district, had always felt conflicted about that. I came to believe that this contract would hook us into something long-term that we should not be selling." An associate on the board, Manny Hernandez, soon came to feel the same way. "We looked closely at the contract and saw that we were locking the kids into a long-term cycle that would be skewed to the worst nutritional situation rather than the best."

But first Masoner and Hernandez had to convince their fellow board members, who were not wont to give up the $2.5 million in free operating funds. "We decided that we had to make the health case, in very clear terms," Masoner says. At the next board meeting, her fellows heard testimony from the county coroner, who noted that arterial streaking and early signs of bone disease were being seen in children as young as ten years old. The head of the regional dental association presented epidemiological data indicating that, as he put it, "our area has the worst dental health record in the state." At the next meeting, the board unanimously rejected Pepsi's offer.

But the board did not stop there. The inquiry into the pouring contract had made them curious. And concerned. They decided to look into just how much junk food was present on campus. "What we found was stunning," Masoner says. "Candy and pop were everywhere. In almost any classroom in the district, you could find kids with soda and candy at their desk. Teachers were actually using them as a reward." Presenting all of this at a subse-

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quent meeting, the board voted to present its principals with an ultimatum: They would have ten years to eliminate all high-sugar and high-fat foods from their campuses. The initial reaction was predictably truculent, but, say Masoner and Hernandez, the principals have more than risen to the occasion. By the end of winter break, they had already met the board's first incremental mandate of providing as much bottled water on campus as soda. "The kids were telling us they loved it," says Hernandez.

Even when the contracts themselves go unchallenged, the pouring contract disputes are increasingly fueling a new wave of parental activism. The target is junk food advertising in schools, which in recent years has become ubiquitous. The most common comes in the form of "sponsored educational materials": nutrition curriculum by McDonald's; math lessons using Tootsie Rolls and Domino's Pizza wheel graphics; reading texts that teach first graders to start out by recognizing logos from Pizza Hut and M&Ms. There is even a nutrition guide put out by McDonald's that teaches kids with diabetes how to calculate the number of diabetic "points" (the system advocated by the American Diabetes Association) in a typical McDonald's meal.

In an era when many school districts can't keep up with demand for basic texts, free supplemental materials are hard to turn away. But that is increasingly what is happening, says Andrew Hagelshaw, head of Berkeley's Center for Commercial-Free Public Education. "We are seeing hundreds of groups across the country take this issue on," he says. "The key is the parents. It's like a sleeping giant has been roused. Once they find out this has been happening right under their noses, they are unstoppable. They don't buy the notion that school is about educating consumers. It isn't. It's about educating citizens."

What can be done on a national level? Certainly obesity, with its $100 billion a year (and growing) price tag in health services, justifies some involvement by the government, or at least by large national organizations. Concern about it is now well established. On the day after the September 11, 2001, attacks, one of the few

WHAT CAN BE DONE

nonwar stories to break through was one about the latest obesity statistics (the national rate had jumped again — to 26 percent). A few weeks later, the army released its latest fitness study, with its own alarming obesity numbers. How can America capitalize on this growing awareness?

One way might involve expanded federal funding for safe public playgrounds and parks. There is a broad and potent constituency for such a measure, given that half of the nation's parents believe that their neighborhoods are not safe enough to let their children go outside and play. There is also the issue of pure economic equity. Recent studies in California and other states show that park and playground development has taken place disproportionately in new suburban areas, often at the expense of older — and poorer — urban centers. These same urban areas are increasingly the address of new immigrant communities who have yet to flex their political muscle on the most basic of health issues. What is needed is a revival of two older organizations, one governmental, the other private. The former would involve rein-vigorating VISTA, an effective, if chronically underfunded, program that helped millions of urban Americans win basic housing and health benefits. During the 1970s and early 1980s, VISTA trained young college students to go out to poor communities and to teach residents how to organize themselves around such core issues. Another tack would focus on reviving the organizing groups of the Community Areas Foundation (CAF). Founded in the 1930s by the social activist Saul Alinsky, the CAF has successfully trained generations of urban activists on the fundamentals of how to empower local groups of citizens to demand what is their due. In the past, such groups have forced school boards to open more schools in underserved areas, pushed insurance companies to discontinue the practice of redlining, and turned back attempts to locate incinerators and toxic waste dumps in poor communities. Unfortunately, in recent years, many of the CAF groups have become bogged down in the ideological and personal antagonisms of the self-proclaimed "progressive" left. Their effectiveness has been muted, and will likely remain so un-

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til that old left dies and is replaced by a younger, more pragmatic leadership.

In California and around the nation, a perfect opportunity exists for such organizations to move the public fitness agenda forward. This is because almost every urban school district is, to one degree or another, out of compliance with state rules mandating minimal hours of physical education. California requires elementary schools to provide ioo minutes of physical education every two weeks. But few schools even come close to meeting the requirement, instead relying on recess and "unstructured playtime" to fulfill their obligations. In middle and high schools, required to provide 400 minutes every two weeks, the situation is even grimmer; studies have shown that as little as 20 percent of PE time is actually spent "in motion," the rest taken up with administrative work, suiting up, showering, and getting dressed for the next class. As one might expect, the situation degrades as the overall school performance degrades. Attempts to reduce class size in academic courses often translate into increases in PE class size. Average PE class size in Los Angeles stands at 55, with some schools logging as many as 85 kids per class. The recommended class size is 25. As the head of the Amateur Athletic Union of Los Angeles put it recently, "Someone needs to make parents aware that their children are not getting what they are entitled to, and to teach these parents how to get in the school board's face and demand what is theirs."