Lessons in Good Health

Administrators, parents, and health workers are finding simple, effective ways to get kids exercising more and eating right.

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Health advocate Patty Boyd has a secret weapon in the campaign against childhood obesity: the power of play.

"It's just amazing. When you put a playground in, kids will come," says Boyd, who works on health issues for the Tri-County Health Department serving schools near Denver.

Spruced-up playgrounds that give students more opportunity to get out and move are just one item in the area's
K–12 antiobesity toolbox. Programs to encourage physical activity have been springing up at districts around the country—community and school gardens, safer walking routes, and fresh-produce cooking courses for cafeteria workers, among them. Several of these were highlighted on The Weight of the Nation, a four-part HBO documentary, produced in conjunction with the Institute of Medicine. (To watch it online for free, visit theweightofthenation.hbo.com.)

The goal is simple: Do something about obesity. Seventeen percent of the country's children and adolescents are obese, according to the Centers for Disease Control and Prevention (CDC)—that's three times as many as a generation ago. But doing something about it can be tough in an environment where the local playground is an asphalt wasteland, and where french-fry-loving youngsters are hard-pressed to identify a potato in its natural state.
 
The Power of Partnerships
Boyd, a program manager for the tri-county Communities Putting Prevention to Work (CPPW) initiative, a CDC-funded effort aimed at starting local initiatives to fight obesity and tobacco use, says three things help stack the deck for success: parental support, stakeholder involvement, and adequate funding.

In the tri-county area—which encompasses 15 school districts in Arapahoe, Adams, and Douglas counties, near Denver—the push for better health began two years ago, when the CDC awarded the department $10.5 million to create programs that promote healthy eating and physical activity. Each school district was able to hire a grant coordinator dedicated to work on the initiatives. "That was one thing that really made a difference," says Boyd. Even as the initial funding has been exhausted, several schools have indicated they will keep the coordinator positions. 

Getting stakeholders involved has also worked well in Pima County, Arizona, where CPPW and community teams have established gardens in low-income neighborhoods where there is a high risk of obesity. So far, the effort has yielded close to 50 community gardens, 17 of them at school, says program manager Donald Gates.

The garden project dates back to 2009 and an umbrella effort known as Activate Tucson, consisting of several stakeholder groups, including the YMCA, Community Food Bank, United Way, the University of Arizona, and the Pima County parks and rec department.
 
In a region blessed with a climate that allows for three growing seasons, the gardens have yielded an abundance of produce. Officials estimate the effort, including community, urban, and home gardens, is producing 500,000 servings of fresh fruits and vegetables per year. In an innovative touch, some of the produce is sold at school mini-farm stands that open one afternoon a week, around pickup time. A little income comes in to continue the gardens; some fresh produce goes home with the students.
 
Pima County looked for on-site champions, people who were enthusiastic about the gardens and could be counted on to promote them—say, teachers willing to sign their classes up for weeding duties. The county also provided a small stipend for "wellness coordinators," charged with administering the program. Next year, the county will continue support for a limited number of schools, but a year-end evaluation indicated that 95 percent of participating schools will keep the coordinator positions irrespective of the stipend. "You have to plan ahead for what will happen when the attention and [initial] funding drops off," says Gates.

In Colorado, part of the long-term approach includes encouraging schools to forge partnerships that can provide crucial support. New playgrounds, for instance, are often built in areas with few recreational facilities, and they benefit the entire community. So the Mapleton Public Schools were able to open a new playground at the K–12 York International School in partnership with the city of Thornton and the CPPW program. City officials will help maintain the playgrounds, which serve the larger community as well as schoolchildren.

At the formal opening of another playground, at Virginia Court Elementary, in Aurora, Boyd saw firsthand the benefits of the improved space, which already had been in use for a few months. A mother told Boyd that her daughters wanted to get up earlier so they could play on the playground before school started. And, the mother said, a counselor had noticed that one of her daughters was more focused and doing much better in class.

Colorado is also building more exercise into the day by making it easier for students to walk to school. In 2011, the state Department of Transportation awarded a total of 52 Safe Routes to School grants. A number of them went to districts in the tri-county area, ranging from $17,000 to $226,000. CPPW urban planners helped district coordinators with the application process; the funds are being used to put in crosswalks, flashing signs, and better signage, and to redesign some streets.

One Step at a Time
Making schools healthier places doesn't happen overnight, and there are inevitably complications along the way.

Inside Jefferson County, Alabama, an initiative to incorporate more fresh, local produce into school cafeterias amounted to much more than just shipping boxes of broccoli to campus kitchens.

The initiative constituted a policy change, so stakeholders from many of the county's 12 districts—including parents, athletic directors, nurses, and child-nutrition directors—met over the course of two years to discuss school wellness policies. Topics included food marketing, which covers how, or whether, a school will promote healthy menu choices, and how to handle low-nutritional items like sugary snacks and drinks.

The working group established relationships over the course of a year "so that we weren't outsiders coming in and telling school districts what to do," says Ashley Obiaka, the CPPW program manager for the Jefferson County Health Action Partnership who worked on the policy side of the initiative.

They gave consideration to each step in the process. For example, cooking with raw ingredients takes more effort than warming up processed foods. So training was arranged for cafeteria workers in things like knife skills and using herbs, rather than salt, to make meals flavorful. More than 500 child-nutrition program managers, supervisors, and cafeteria staff visited Jones Valley Teaching Farm, in Birmingham, to learn about fresh produce and using it in their cooking.

Since fresh produce can be more expensive, new menu items need to come with a plan B, so when Chris Vizzina, executive chef of Campus Dining Inc., a local food service company, showed cafeteria staff how to make ratatouille, he also demonstrated how the ingredients could be turned into pizza sauce if the original dish flopped.
 
Buying food for school lunch is highly regulated; schools must follow nutritional guidelines and work within the constraints of small budgets. But Jefferson County schools learned they had options.

Two of the county's districts have amended their nutritional guidelines; two others are working on changing their bid language to get more fresh produce; and two, including Birmingham city schools, are featuring a "harvest of the month" menu item for school lunch.

As in Arizona, there's also been activity in the realm of community gardens and after-school markets. "We found that people can ease into change if they do it incrementally," says Obiaka. "It really makes it easier for schools to say, ‘Hey, we can do that.'"

—Fall 2012—