To: Eric L. Adams

From: Khizra Shafiq

Date:  July 23, 2023

Re:  Preventing Childhood Obesity in School Aged Children

Statement of Issue: How can we decrease the incidence of childhood obesity in school aged children?

 

Background

Childhood obesity has become a major public health problem in the United States. There are a wide range of causes of obesity in childhood, such as inadequate physical activity and the lack of nutritional education resulting in poorly balanced diets. These poor habits increase the incidence of obesity, which in turn leads to poorer mental/physical health outcomes.  

• Obesity leads to chronic health conditions and increases morbidity. Children who are obese often develop comorbidities such as cardiovascular-related diseases and Type 2 diabetes which reduces their quality of life.¹ 
• Childhood obesity can lead to social stigma and discrimination. This has a detrimental impact on the mental health of individuals, resulting in eating disorders such as anorexia nervosa or bulimia.² 
• Children are suffering from a lack of a well balanced diet. Most parents report that their children consume sugary beverages and do not consume adequate amounts of fruits and vegetables.³
• Habits formed as a child carry into adulthood. Across the world, less than 30% of children are meeting the standard of a minimum of 60 minutes of physical activity per day.⁴ We subconsciously follow habits that we formed in our early years. 

Landscape

In addressing childhood obesity, there are many parties involved in a successful intervention. Governmental agencies such as the New York City Department of Health and Mental Hygiene and the New York State Department of Health would be involved in the development and enforcement of policies. They would allocate funding and oversee the initiatives to reduce childhood obesity. Schools are also vital stakeholders in promoting healthy eating and physical activity among children. They would be responsible for carrying out the nutritional and physical education programs and encourage active play during recess. Lastly, parents and caregivers are stakeholders in determining children’s behaviors and habits. Educating parents about healthy eating habits and the importance of physical activity can enhance the efforts made in schools.

Policy Options

1. Improve School Nutrition Standards: There should be an effort to implement and enforce improved nutrition standards in schools, which focuses on both meals served in the cafeteria and snacks sold in vending machines, school stores, and during fundraisers. These standards should place an emphasis on offering a variety of nutritious foods, such as fruits, vegetables, whole grains, and lean proteins. It should limit the options of sugary beverages and unhealthy fast foods. By offering healthier food options in schools, children are more likely to develop better eating habits, which can contribute to reducing childhood obesity. 

• Advantages: One of the main advantages of this mandate is its focus on improving the nutritional quality of school meals. By serving nutrient dense foods while limiting sodium and saturated fat, it provides students with healthier meal options, which could positively impact their overall health and well being. This also ensures that all students, regardless of their socioeconomic status, have access to healthy and balanced meals at school. By implementing nutrition standards across all schools, the mandate would consequently address food insecurity and health disparities among children.
• Disadvantages: This would pose financial challenges to schools, as implementing the improved nutritional standards requires additional resources and training for food service staff. Smaller schools and those with limited budgets may find it challenging to meet the requirements. Additionally, introducing healthier foods can lead to resistance from students who may not be accustomed to certain foods, leading to increased food waste as some healthier options may be discarded. Changes in school meal choices might also affect participation in school meal programs. If students chose not to participate in the school meal programs due to taste preferences, it could limit the intended positive effects of the mandate.

2. Increase Physical Education and Recess Time: There should be an effort to enforce policies that mandate a minimum amount of physical education and recess time for all school-aged children. Regular physical activity is essential for maintaining a healthy weight and overall well being. Schools should ensure that PE classes are engaging and focused on promoting enjoyable physical activities. By providing various opportunities for physical exercise and active play during the school day, children are more likely to meet recommended activity levels, reducing the risk of obesity and related health problems. 

• Advantages: Recess and physical education policies provide structured physical activity time during the school day, encouraging children to engage in moderate to vigorous exercise. Regular physical activity is essential for maintaining healthy weight, cardiovascular health, bone strength, and overall well being. Research also indicates that physical activity positively affects cognitive functioning, including attention, memory, and academic performance.⁵ By incorporating physical activity into the school day, these policies can potentially enhance students’ ability to focus and learn. During recess and physical education classes, children have the opportunity to interact with their peers, fostering social skills, motor skills, and teamwork.⁵
• Disadvantages: Schools face pressure to allocate enough time for core academic subjects, reducing physical education and recess time to accommodate academic requirements. Not all schools may have the same level of capacity to implement physical activity and recess policies. Schools in disadvantaged areas might face greater challenges in offering safe play spaces, contributing to inequality in access to physical activity opportunities. Weather conditions might limit outdoor recess, reducing the time available for active play.

3. Implement a Nutritional Education Program: In order to promote nutritional education to students, there should be a nutritional education program. As part of the curriculum for school aged children, there should be instructional learning modules regarding healthy eating choices. The aim is to encourage students to pick healthier choices. 

• Advantages: Nutritional education provides children with knowledge about the impact of various foods on their health. With this information, children can make more informed choices when it comes to their diet, leading to healthier eating behaviors. By educating children about healthy eating habits, the program can also enhance students’ ability to concentrate, learn, and perform well academically.
• Disadvantages: As previously mentioned, socioeconomic status is a major factor that contributes to a poorly balanced diet. Due to limited resources, children often face barriers in accessing healthier options. Despite their desire to make healthier choices after participating in these modules, circumstances may prevent them from doing so. It also depends on whether school aged children will actually be interested in paying attention to the modules. The modules would have to be different for each age group, as younger students may not have the same understanding capabilities as older students.

Policy Recommendation: 

I would recommend the Improved School Nutrition Standards as an essential policy to implement. By ensuring that schools offer healthier food options and limit the availability of unhealthy snacks and beverages, children are more likely to consume balanced and nutritious meals. This would also ensure that these healthier food options are available to a broad and diverse population of children, regardless of their socioeconomic background. In addition, children spend a large portion of their day at school, and their food choices during this time can shape their eating habits in the future. Lastly, proper nutrition is linked to improved cognitive function, concentration, and academic performance. By offering nutrient rich foods, schools can positively influence students’ learning abilities and classroom behavior.

Resources

1. Kansra AR, Lakkunarajah S, Jay MS. Childhood and Adolescent Obesity: A Review. Front Pediatr. 2021;8:581461. Published 2021 Jan 12. doi:10.3389/fped.2020.581461
2. Baran J, Weres A, Wyszyńska J, et al. 60 Minutes Per Day in Moderate to Vigorous Physical Activity as a Natural Health Protector in Young Population. Int J Environ Res Public Health. 2020;17(23):8918. Published 2020 Nov 30. doi:10.3390/ijerph17238918
3. Hoelscher DM, Butte NF, Barlow S, et al. Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study. Child Obes. 2015;11(1):71-91. doi:10.1089/chi.2014.0084
4. Fruh SM. Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. J Am Assoc Nurse Pract. 2017;29(S1):S3-S14. doi:10.1002/2327-6924.12510
5. Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2013;2013(2):CD007651. Published 2013 Feb 28. doi:10.1002/14651858.CD007651.pub2