Vital Signs

Putting Some Numbers into the Kids-Food Equation

By David Corriveau

In today's ad-saturated world, what does it take to get youngsters to eat healthy food, avoid sugary drinks, and exercise regularly? At least as much thought as money on the part of schools, parents, and local businesses, judging from the work of the Community Health Research Program (CHRP) at Dartmouth's Hood Center for Children and Families.

As part of a five-year study of environmental and family influences on overweight adolescents, CHRP researchers led by Madeline Dalton, Ph.D., visited school cafeterias; quizzed kids, their parents, and school officials; and scouted close-to-campus food options in two dozen New Hampshire and Vermont communities—most of them small towns. In April of 2009, they issued a 38-page report of their findings and distributed it to secondary schools and public-health organizations throughout the states.

Surprise: Did anything surprise the researchers? "In rural areas, where most kids do not walk or bike to school, creating daily opportunities for physical activity on the school grounds immediately before or after school may be a more effective strategy than focusing on active travel initiatives, which are more relevant to urban areas," says CHRP's Meghan Longacre, Ph.D.

"Further, convenience stores represent the vast proportion of all food outlets in rural towns—compared to urban areas, [where] most food outlets are restaurants." So, she adds, "improving the healthfulness of the community food environment should target different types of outlets, depending on town size."

On the subject of student size, 28.9% of the more than 1,600 8th- to 12th-graders surveyed reported being overweight—as defined by the body-mass index (BMI) standard of the Centers for Disease Control and Prevention. In a 2007 survey, the national average was 28.8%.

There has been "a threefold increase in overweight among children and adolescents over the past 30 years," according to the report. About 18% of 6- to 19-year-olds are now obese, and another third are overweight. As a result, the report points out, the life expectancy of today's children may be less than that of their parents.

The researchers observed a range of approaches to addressing the in-school "food environment"—some communities and schools do it more systematically than others.

"New Hampshire is one of only nine states nationwide with a statewide action plan to promote healthy eating and active living, called the HEAL Initiative," Longacre says. "Our research team is currently partnering with HEAL to develop a statewide collaboration that would enable communities to use evidence-based tools, research, and resources to identify and address the factors in their local environments that are most influential in promoting healthy eating and active living."

Meals: More than 90% of the schools studied offer free or reduced-price meals through the federal school lunch program. Of the 31 schools whose food-service directors and cafeteria managers returned surveys, all offer at least one fresh fruit and one fresh or steamed vegetable a day. And 20% of the schools reported offering no fried foods of any kind, though an equal number offer a fried entrée and a fried a la carte item daily.

Another factor is in-school snack bars; 12 of the surveyed schools have snack bars, and 83% of them sell cookies and chips. In addition, 31 of the 32 schools visited by Hood researchers have on-campus vending machines; 90% sell sweetened beverages, 58% chips or popcorn, 39% candy or chocolate, and 35% Pop-Tarts, doughnuts, or muffins.

Longacre says the CHRP report has caught the attention of public-health groups. "They have been excited about the prospect of being able to use our research results to inform their programmatic efforts."

So today, New Hampshire and Vermont. Tomorrow, the world? "Our first round of peer-reviewed manuscripts from this study are under review now," Longacre says. "Once our study results are published, I expect that our distribution will become more national than regional."