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NASP Communiqu=C3=A9, Vol. 33, #3
November 2004

Obesity Prevention in Children: Strategies for = Parents and=20 School Personnel

By Jessica Blom-Hoffman, PhD, NCSP
Northeastern=20 University

The high incidence of children classified as overweight or = obese in=20 this country has become a major national concern. In his = Call to=20 Action, the U.S. Surgeon General referred to obesity and = overweight as=20 "a public health issue that is among the most burdensome faced by = the=20 Nation" (U.S. Department of Health and Human Services, 2001, p.=20 1).

Risk Factors

Over the past 3 decades, the percentage of overweight = school-age=20 children has nearly quadrupled (4% in 1965 to 15% in 2001). = In=20 addition, data collected as part of the National Health and = Nutrition=20 Examination Survey (see "Resources" below) revealed that ethnic = minority=20 children and children from poorer families are at increased risk = for=20 overweight and obesity. For example, Mexican American and = African=20 American children and adolescents are twice as likely as their = Caucasian=20 peers to be overweight. Obesity is associated with a number = of=20 serious medical conditions including premature death, type 2 = diabetes,=20 heart disease, stroke, hypertension, sleep apnea, osteoarthritis,=20 gallbladder disease, asthma, breathing problems, cancer, and=20 depression.

Prevention Strategies

The epidemic rate of obesity in this country is a major = problem.=20 However, it is important to recognize that obesity in many cases = can be=20 a preventable health condition. While many factors = including=20 genetic predisposition contribute to obesity, dietary behaviors = and rates=20 of physical activity are two major factors that can be modified. = Schools,=20 families, and communities can work together to alter the trend = toward=20 obesity. Teaching about healthy diet and the importance of=20 maintaining a health activity level to young children is important = as=20 obesity is more easily prevented than treated. It is = important to=20 begin prevention efforts early in childhood because obesity = in=20 adolescence is the strongest predictor of obesity in = adulthood. The=20 following strategies are suggestions for parents and school = personnel to=20 work together to promote the health and well-being of our nation's = children.

Prevention Strategies for Parents and Caregivers =

Be good role models. Show your children how important = it is=20 for all family members to make healthy food choices.=20
Provide your children with healthy food choices. Provide = snacks that=20 are low in fat, sodium, and refined sugar and are high in fiber, = vitamins, and minerals. =20
Encourage young children to develop good eating habits and=20 preferences for healthful foods because eating behaviors that = develop=20 during childhood tend to track into adulthood.=20
Do not prohibit your children from eating unhealthy = foods. The=20 key is moderation. Limit fast food. =20
Watch your children's portion sizes and make sure the diet = is=20 consistent with the recommendations of the food guide = pyramid. =20
Consult your child's pediatrician or nurse to find out how = much food=20 your child should be eating if you are not sure what portion = sizes are=20 appropriate for your child, or consult the resource books listed = below. =20
Limit television viewing. Research suggests that = increased=20 television viewing is related to the development and maintenance = of=20 obesity. This is not surprising given the number of = advertisements=20 for unhealthy foods targeted at child consumers, the sedentary = nature of=20 watching TV, and the fact that most people eat while viewing = TV. =20
Encourage your children to be active, but ensure appropriate = safety=20 precautions. For example, make sure your children wear = protective gear=20 including a helmet when they ride a bike or roller blade.=20
Work with community groups to develop safe walk-to-school = programs=20 if it is unsafe for your children to walk to school.=20
Learn about supervised activities offered by after-school = programs=20 at schools and community centers if you live in a neighborhood = that is=20 unsafe for children to play in the street or on the playgrounds. =
Involve your children in food purchasing by taking your = children=20 food shopping and allowing them to help select healthy = foods. =20 Also, involve your in the food preparation process such as = washing=20 vegetables and pouring and stirring ingredients. =20
Give your children specific praise for making healthy food=20 choices. For example, "I like how you ate all of your=20 spinach! It will make you very healthy and strong."=20
Remember that food preferences develop over repeated = exposure and=20 time. Try to present new foods in small quantities and = encourage=20 your children to just take a bite at first. Over time, you = can=20 increase the portion size of the new food. =20
Make sure your children try to eat at least five servings of = fruits=20 and vegetables each day, such as 100% fruit and vegetable juices = and=20 raw, cooked, canned, or dried fruits and vegetables. Easy=20 accessibility to fruits and vegetables is important. Have = fresh=20 fruits and vegetables such as grapes and baby carrots washed and = placed=20 in a prominent location in the=20 refrigerator. =20
Be an advocate for your children at school. Does your = school=20 have a vending machine that allows children to purchase soda and = candy=20 at school? If so, speak with the principal and other=20 administrators and the parent-teacher organization about the = possibility=20 of having the vending machine disperse water, 100% fruit or = vegetable=20 juice, milk, and healthier snacks (such as granola bars, boxes = of=20 raisins, graham crackers, and pretzels). This alternative = enables the=20 school to earn money, but not at the expense of its students'=20 health. =20
Suggest fresh fruits and vegetables and low-fat and skim = milk be=20 served in the cafeteria if it does not do so. Speak with the = principal,=20 food service administrators, and the parent-teacher = organization. =20
Discuss alternatives with fundraising organizers if your = school=20 engages in fundraising activities that encourage children to eat = candy,=20 chips, and other foods that contribute to childhood overweight = and=20 obesity. Suggest a fresh fruit sale.

Prevention Strategies for School Personnel

Be a good role model. Show your students how important = it is=20 for you and them to make healthy food choices.=20
Be an advocate of healthy eating in school. If your school = has a=20 vending machine that allows students to purchase soda and candy = at=20 school, work with administration and parents to limit = vending=20 machine options to water, 100% fruit and vegetable juice, milk, = and=20 healthier snacks (such as granola bars, boxes of raisins, graham = crackers, and pretzels). Your school will still earn money = without=20 compromising students' health.=20
Incorporate nutrition education lessons into the = curriculum. =20 Learning is improved when new information is presented in a = familiar=20 context. You can implement nutrition education information = into=20 science, math, language arts and health lessons. =20
Incorporate a family involvement component when working with = young=20 children, because young children rely on caregivers to purchase = and=20 provide healthful foods. =20
Inform families about what their children are learning = regarding=20 healthy eating in school.=20
Offer concrete, culturally appropriate suggestions for = parents to=20 help their children make healthful choices. =20
Avoid using candy as a reward. When candy is used as a = reward,=20 children are more likely to develop preferences for these = foods. =20 In effect, when candy is used as a reward, its value will=20 increase. =20
Suggest and use alternative fundraising activities that do = not=20 involve the sale of candy, cookies, and cake. =20
Discourage junk food and candy in school. Institute no = junk=20 food days in your building. Help students understand that = foods=20 high in sugar and fats are fine to eat as long as they are eaten = in=20 moderation. =20
Expose students to healthful foods during nutrition = education=20 lessons. Taste testing is an enjoyable activity for=20 children. Many children have never eaten certain types of = fruits=20 and vegetables. However, before doing taste-testing = activities at=20 school, check with your students' caregivers to make sure they = are not=20 allergic to any of the foods you will be serving. =20
Supplement nutrition education lessons with class trips to = the fruit=20 and vegetable section of a local grocery store or a farm. = Lessons=20 can focus on selecting ripe fruit and vegetables, learning how = fruits=20 and vegetables grow, and tasting fresh fruits and=20 vegetables. =20
Establish a class-wide motivational system to encourage = students to=20 eat a healthful breakfast every day. For example, you can = set up a=20 weekly raffle with a mystery motivator prize that students can = enter=20 each day by bringing in a signed breakfast raffle ticket to the=20 classroom. If students are eligible to participate in the = school=20 breakfast program, you can give them a blank raffle ticket that = they can=20 have the food service staff sign that they ate breakfast that = day. =20 If students eat breakfast at home, their caregivers can sign the = breakfast raffle ticket. =20
Understand that the provision of knowledge does not = necessarily=20 translate into behavior change. Simply informing students = about=20 the importance of daily physical activity and healthy eating = behaviors=20 does not mean they will adopt these behaviors. It is also=20 important to provide students with an environment that supports = these=20 behaviors, motivation and reinforcement for engaging in these = behaviors,=20 and role models who espouse these behaviors.=20
Help students set realistic, well-defined, measurable goals = for=20 themselves regarding healthy eating and physical activity. = For=20 example: "I will eat five servings of fruit and vegetables each = day." "I=20 will eat breakfast every day this week." "I will play basketball = at=20 least 4 days this week." In addition to setting the goal, = have=20 them record their progress over time. Students' = performance=20 on their goals can be graphed and incorporated into a math=20 lesson.

Resources

Center for Disease Control. (2003). National Health and = Nutrition=20 Examination Survey. Available: www.cdc.gov/nchs/nhanes.htm

Dietz, W. H., & Stern, L. (1999). The official = complete=20 home reference guide to your child's nutrition. = Elk Grove=20 Village, IL: American Academy of Pediatrics. Available:=20 888-227-1770.

Shield, J., & Mullen, M. C. (2002). The American = Dietetic=20 Association guide to healthy eating for kids: How your children = can eat=20 smart from five to twelve. New York: Wiley. ISBN: = 0471441449.

U.S. Department of Health and Human Services (2001). = The=20 Surgeon General's call to action to prevent and decrease = overweight and=20 obesity. Rockville, MD: Author. Available: www.sur= geongeneral.gov/topics/obesity/default.htm=20

Websites/Organizations

American Obesity Association-www.obesi= ty.org/subs/childhood/prevention.shtml

Dole 5-A-Day-http://www.dole5aday.com/

Food and Nutrition Information Center (food and nutrition = resources for=20 grades preschool through 6)-www.na= l.usda.gov/fnic/pubs/bibs/edu/preschool.html=20

=C2=A9 2004, National Association of School Psychologists. = Jessica=20 Blom-Hoffman, PhD, NCSP, is an Assistant Professor of School = Psychology at=20 Northeastern University in Boston, MA. Her research is = focused on=20 developing, implementing, and evaluating school-based programs = that=20 promote healthful eating behaviors in young children. Reprinted = from=20 Helping Children at Home and School II: Handouts for Families = and=20 Educators (NASP, 2004).


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