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Obesity

by Sue Young Wilson, Aug 12, 2003
 

 

According to an alarming study released last month by the city's health department and Department of Education, almost half (43 percent) of the children in New York City's public elementary schools are overweight to some extent, and a quarter qualify as obese. Hispanic children had nearly double the obesity rates of white and Asian children (31 percent versus 16 and 14 percent, respectively). African-American children fell in the middle, with a 23 percent obesity rate.

The city's 24 percent obesity rate among children in kindergarten through fifth grade is significantly higher than the national rate, which in 2000 was 15 percent. City health officials say that some, though not all, of that difference can be attributed to New York's high proportion of Hispanic and African-American children. (The study also did not include children in the city's private schools, about one-quarter of local schoolchildren. Since obesity correlates with low income, including these relatively privileged children would almost certainly have lowered the proportion of the total found to be overweight.)

In many ways, the statistics on excess weight among New York's schoolchildren mirror those of their elders. A 2002 health department survey of nearly 10,000 adult New Yorkers found that 53 percent are overweight, with 18 percent qualifying as obese. Poorer and heavily minority communities have higher rates of obesity - in neighborhoods like Central and East Harlem, the South Bronx, East New York, Flatbush, Canarsie-Flatlands, Bedford Stuyvesant, Crown Heights, Williamsburg, and Bushwick, as many as one in four adults are obese. Poor diet and lack of exercise are contributing factors. In some of these neighborhoods, almost 15 percent of the population has diabetes, a weight-related disease that can have severe complications and shorten lives. (see previous health topic page update on this subject.) In the case of Hispanic adults and children, who suffer from significantly higher rates of overweight and obesity than whites, researchers think a combination of physiological vulnerabilities, diet, cultural factors, and possibly lack of exercise may be responsible. (In a study published in the Archives of Internal Medicine, 65 percent of Mexican American men and 74 percent of Mexican American women reported that they participated in little or no leisure-time physical activity.)

Still, New York's adults are doing no worse than the average American. It's no secret that Americans have been growing steadily fatter over the past decades; and today nearly two-thirds of all American adults are overweight, with nearly one-third ranking as obese. (Both New York City surveys and the national one all use the Body Mass Index, or BMI, method of categorizing people as "healthy weight," "overweight," or "obese.")

It is disturbing, though, to find significant weight problems starting so very young, among so many of the smallest New Yorkers. The health and education departments' report on children showed that obesity was already common among kindergarteners, with 21 percent qualifying; by the first grade, obesity levels had already topped out at one in four.

Obesity in childhood is associated with serious long-term health consequences, including diabetes, heart disease, asthma, depression, high blood pressure, and some cancers. Obese children frequently grow into obese adults, and a RAND study done last year found that obesity raises a person's healthcare costs by 36 percent and medication costs by 77 percent - much more than do, say, smoking and problem drinking.

"I am deeply concerned about the troubling childhood obesity figures found in the survey," said Schools Chancellor Joel I. Klein.

In June, the Department of Education announced plans to remove soda, candy, snack cakes, and other junk food from the thousands of vending machines in New York City schools and replace the sugar- and fat-laden offerings with snacks that meet nutritional standards the department specifies. One hundred percent fruit juice will replace sugary fruit drinks, and Twinkies will give way to energy bars. Schools will also have to use a Department of Education central contract to supply and fill their vending machines according to department nutritional standards; rather than individual schools and districts contracting with a hodgepodge of different vending machine companies, as is currently the case.

More ambitiously, the education department plans sweeping changes, aimed at making them more nutritious and less fattening, in the more than 800,000 breakfasts and lunches that city public schools serve each day. Working with the Department of Health and Mental Hygiene, the Department of Education came up with a set of nutritional standards for school meals that will take three to five years to fully implement.

Children returning to school in September will find that cafeterias have already retooled some of their most popular items, such as Jamaican beef patties, chicken fingers, and cheese pizza, to cut back on fat, sugar, and salt. Rich foods will be served in smaller portions. Some items that resist "lightening" may disappear from school menus altogether, among them lunch classics like macaroni and cheese and various mayonnaise-based dishes such as potato salad. Federal guidelines recommend that the percentage of calories in school lunches coming from fat should not exceed 30 percent, averaged over a five-day period. The city Department of Education says it plans to meet that 30 percent goal each and every day.

Some onlookers, however, feel that the city's emphasis on cutting fat from school meals and replacing vending-machine sodas with juice won't help kids lose weight. Alice Lichtenstein, a professor at the Friedman School of Nutrition Science and Policy at Tufts University, said that the key to losing weight is cutting back on total calories, not cutting out fat per se; and she noted that 100 percent apple juice has as many calories, ounce for ounce, as a Coca-Cola. "Kids are eating too many calories and not getting enough exercise to burn them off," she said. "You have to focus on reducing calories, not fat or the tiny nutritional difference between sweetened and unsweetened apple juice."

Lichtenstein does approve of some of the city's other planned menu changes, including smaller portions for snack foods, more fresh vegetables ("They're calorically less dense than most other foods"), and substitution of more whole-wheat bread for white ("Whole grains increase your sense of fullness, so you eat less").

The Department of Education also plans to serve fresh fruit five days per week rather than the current three days per week, serve more fish and plant-based products, cut the number of mayonnaise-based salads offered daily from three to one and replace the jettisoned ones with fresh vegetables, and serve fewer highly processed foods.

Recent research on Americans' eating habits, obesity rates, and "environmental" food factors like portion size and ready availability suggests that these measures should, in fact, be helpful to some extent. For example, studies have shown that people, including children, do eat more, sometimes much more, when served larger portions, and don't tend to eat less at later meals to compensate. And the visibility and ease of access of tempting (i.e., fat-laden and sugary) snack foods in people's everyday environments have much to do with whether people eat these foods or not.

And then there's the exercise factor. Although the state Education Department requires children in kindergarten through third grade to have gym every day, in grades 4-6 at least three times a week, and in grades 7-12 at least twice a week, breaches of this rule are common and seldom investigated, according to a report in the New York Daily News. Some New York City public schools don't hold physical education classes at all, the Daily News reported, because they don't have room - gyms may have been turned into classrooms long ago due to overcrowding, and outdoor play areas may be nonexistent or unusable because of repairs or the danger of falling debris from crumbling school buildings. Some schools have no physical education instructors on staff.

Schools Chancellor Klein said the city is taking steps to try to make sure public schoolchildren get a chance to exercise. "We have selected a central Director of Physical Education to coordinate the efforts of the city's twelve hundred schools to promote fitness among our children and teach youngsters the vital significance of physical exercise," he said.

Addressing parents, the health department recommends that they try the following to help keep their children at a healthy weight:

Increase their activity by:
• Reducing television-viewing hours;
• Walking with the children when possible;
• Encouraging active play-time; and

Cut calories by:
• Reducing soft-drink consumption;
• Eating less fast food and serving more meals at home;
• Having healthy snack foods such as fruits and vegetables available; and
• Replacing whole milk with low-fat or skim milk for children over two years old.

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.


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