Studies question value of U.S. nutrition education programs

PANORAMA CITY
Calif.
The federal government will spend more than $1 billion this
year on nutrition education fresh carrot and celery snacks, videos of dancing
fruit, hundreds of hours of lively lessons about how great you will feel if you
eat well.

But an Associated Press review of scientific studies
examining 57 such programs found mostly failure. Just four showed any real
success in changing the way kids eat or any promise as weapons against the
growing epidemic of childhood obesity.

“Any person looking at the published literature about
these programs would have to conclude that they are generally not
working,” said Dr. Tom Baranowski, a pediatrics professor at Houston’s
Baylor College of Medicine who studies behavioral nutrition.

The results have been disappointing, to say the least:

Last year a major federal pilot program offering free fruits
and vegetables to school children showed fifth graders became less willing to
eat them than they had at the start. Apparently they didn’t like the taste.

In Pennsylvania,
researchers went so far as to give prizes to school children who ate fruits and
vegetables. That worked while the prizes were offered, but when the researchers
came back seven months later the kids had reverted to their original eating
habits: soda and chips.

In studies where children tell researchers they are eating
better or exercising more, there is usually no change in blood pressure, body
size or cholesterol measures; they want to eat better, they might even think
they are, but they’re not.

The studies don’t tell Leticia Jenkins anything she doesn’t
know. She’s one of the bravest teachers in America
not because she gave her seventh and eighth graders 30 sharp knives to chop
tomatoes, onions, jalapenos and limes for a lesson on salsa and nutrition, but
because she understands the futility of what she is trying to do.

“Oh, it’s so hard, because at the end of the day
sometimes I take a moment, I think gosh, I did all this and we still see them
across the street picking up the doughnuts and the coffee drinks,” she
said.

Nationally, obesity rates have nearly quintupled among 6- to
11-year-olds and tripled among teens and children ages 2 to 5 since the 1970s, according to the Centers for
Disease Control. The medical consequences of obesity in the U.S.
diabetes, high blood pressure, even orthopedic problems cost an estimated $100
billion a year. Kentucky
cardiologist Dr. James W. Holsinger Jr., nominated as the next surgeon general,
says fighting childhood obesity is his top priority.

The challenges to changing the way children eat are as
numerous as the factors that have prompted the obesity epidemic in the first
place.

The forces that make kids fat “are really strong and
hard to fight with just a program in school,” said Dr. Philip Zeitler, a
pediatric endocrinologist and researcher who sees “a steady stream”
of obese children struggling with diabetes and other potentially fatal medical
problems at The Children’s Hospital in Denver.

What does he tell them?

“Oh God, I haven’t figured out anything that I know is
going to work,” he said. “I’m not aware of any medical model that is
very successful in helping these kids. Sure, we try to help them, but I can’t
take credit for the ones who do manage to change.”

The obstacles are daunting:

PARENTS

Experts agree that although most funding targets
schools, parents have the greatest influence, even a biological influence, over
what their children will eat. Zeitler says when children slim down, it’s
because “their families get religion about this and figure out what needs
to happen.”

But often, they don’t.

“If the mother is eating Cheetos and white bread, the
fetus will be born with those taste buds. If the mother is eating carrots and
oatmeal the child will be born with those taste buds,” said Dr. Robert
Trevino, at the Social and Health Research
CenterSan
Antonio, Texas. in

Most kids learn what tastes good and what tastes nasty by
their 10th birthdays.

“If we don’t reach a child before they get to puberty,
it’s going to be very tough, very difficult, to change their eating
behavior,” said Trevino.

POVERTY

Poorer kids are especially at risk, because
unhealthy food is cheaper and more easily available than healthy food. Parents
are often working, leaving children unsupervised to get their own snacks.
Low-income neighborhoods have fewer good supermarkets with fresh produce.

“If Mom can’t find tomatoes in her local grocery store,
nothing is going to change,” said Zeitler.

Meanwhile, it’s harder for children to exercise on their
own. Parks often aren’t safe and sports teams cost money.

“Calorie burning has become the province of the
wealthy,” said Zeitler. “I fear that what we’re going to see is a
divergence of healthy people and unhealthy people. Basically, like everything
else, it costs money to be healthy.”

ADVERTISING

Children between 8 and 12 see an average of 21
television ads each day for candy, snacks, cereal and fast food more than 7,600
a year, according to a recent Kaiser Family Foundation study. Not one of the
8,854 ads reviewed promoted fruits or vegetables.

There was one ad for healthy foods for every 50 for other
foods.

Children may be the best sources to explain why lessons
about nutrition don’t sink in.

“I think it’s because they like it so much, because
like, I don’t know if you’ve seen the new hot Cheetos that are like puffs? Oh
my God, they’re so good. Like everyone at the school has them and they’re so
good,” said Ani Avanessian, 14, of Panorama
City.

Her classmate George Rico, a 13-year-old whose mother is a
manager at a local McDonald’s, said he loves his nutrition class. But does it
affect what he puts in his mouth?

“Well, no, but it makes me think about what I
eat,” he said. “I think kids don’t change because they’ve been eating
it for so long they’re just accustomed to eating that way.”

Their teacher, Jenkins, offers fact-filled and engaging
nutrition lessons as part of a $7 million USDA program which reaches about
388,000 students a year in the Los Angeles
Unified School District.

The most recent evaluation of the 8-year-old program was
disheartening: No difference in the amount of fruits and vegetables eaten by
kids participating in the program and those who weren’t. Teachers who spent
more hours on nutrition education had no greater impact than those who didn’t.
And parent behavior didn’t change either.

“It’s true, it didn’t change what they actually eat.
But the program really made a difference in how kids were feeling about fruits
and vegetables. They really had a more positive attitude toward fruits and
vegetables,” said Dr. Mike Prelip, a UCLA researcher who headed up the
evaluation.

Kate Houston, the deputy under secretary of the USDA’s Food,
Nutrition and Consumer Services, oversees most federal funds, $696 million this
year, spent on childhood nutrition education in this country. Funding has
steadily increased in recent years, up from $535 million in 2003. Houston
insists the programs are successful.

“I think the question here is how are we measuring
success and there are certainly many ways in which you can do so and the ways
in which we’ve been able to measure have shown success,” she said.

But isn’t the goal of these programs to change the way kids
eat?

“Absolutely that’s the goal,” she said.

And they’re successfully reaching that goal?

“We’re finding success in things in which we have been
able to measure, which are more related to knowledge and skill. It is more
difficult for us to identify success in changing children’s eating
patterns.”

When asked about the many studies that don’t show
improvement, Houston asked for
copies of the research. And she said the USDA doesn’t have the resources to
undertake “long term, controlled, medical modeled studies” necessary
to determine the impact of its programs.

Doctors like Tom Robinson, who directs the Center for
Healthy Weight at Lucile Packard Children’s Hospital at Stanford
University, said those studies
aren’t needed. The research has already shown they don’t work.

“I think the money could be better spent on programs
that are more behaviorally oriented, as opposed to those that are educationally
oriented, or studies that just describe the problem over and over again,”
he said.

There may be pieces of solutions found in limited studies
currently being tested around the country. In some situations, obese and
overweight children can lose weight and get healthy through rigorous hospital
and clinic-based interventions that involve regular check-ins, family
involvement, scheduled exercise and nutrition education.

School programs that increase physical activity are also
more likely to have an impact than nutrition education.

This spring the Robert Wood Johnson Foundation announced
plans to spend $500 million over the next five years to reverse the trend of
childhood obesity. It will fund programs that bring supermarkets into poor neighborhoods,
studies that measure the weight of children who exercise more at school,
meetings of advocates who are seek to restrict junk food ads.

One thing it won’t fund: projects that only provide
school nutrition education.


– Associated Press



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