Educating Our Children
Today's Dietitian
By Jennifer Thomas, RD
Vol. 6 No. 4 p. 28

Americans are in a national nutrition crisis. Most tragically, so are our children. The Centers for Disease Control and Prevention labels the obesity problem in this country as an “epidemic.”1 Among children and teens aged 6 to 19, 15% (almost 9 million) are overweight according to the 1999-2000 data, or triple what the proportion was in 1980 (see Table 1). In addition, more than 10% of younger preschool children between the ages of 2 and 5 are overweight—up from 7% in 1994.2 For many reasons, the increase in overweight children is twice that seen in adults. There are a variety of possible contributing factors—environmental, behavioral, genetic—that have been linked to the cause of this obesity epidemic.

One of the National Health Objectives for the year 2010 is to reduce the prevalence of obesity among children and adolescents to less than 5%.3 But, how do we propose to do that? It is important that we dig to the root of the problem before deciding the best way to solve it, but educating the public, and especially our children, is imperative to witness a positive change.

A second goal of the Healthy People 2010 objectives is to increase the proportion of schools that teach essential nutrition topics such as balancing food intake and physical activity in at least three grades.4 Because eating habits developed during childhood have the potential to last a lifetime, it is important for children to learn about the benefits of good nutrition. The key to success is giving our children the education to build a foundation of healthful eating habits early in life. By doing this, we will arm them with the proper tools they will need to make informed decisions to enhance their health now and later in life.

Investing in the future of our children is and always has been important to Americans. We ensure our children are vaccinated. We make certain they wear their helmets when riding a bike. We always buckle their seat belts. We teach them to look both ways before crossing the street. It is also just as crucial that we educate our children about the importance of good nutrition and how to make sensible food choices that will lead to a lifetime of good health. It is not enough to change the food on their plates; we must also provide the knowledge and skills that enable children to make choices that lead to a nutritious diet and improved health. Schools are an ideal place for kids to learn and practice good nutrition. And, the classroom is the best place to start.

Advocates and Innovators
More and more school districts are demanding the expertise of nutrition professionals and are turning over the responsibility of nutrition education in their schools to RDs. A few years ago, RDs as nutrition educators in the school systems were uncommon. Today, nutrition educators in schools are still not the norm, but they are becoming increasingly popular, especially in larger school districts.

The School District of Philadelphia, a leader in making great strides toward providing optimal nutrition and nutrition education for their students, employs 16 nutrition educators. Livia M. Genova-Pagano, RD, nutrition education trainer for the School District of Philadelphia, believes it is exceptionally vital that schools play a role in educating students to prevent childhood obesity because of the epidemic proportions it has reached. “Many people feel nutrition is not an important subject. But, as we are seeing today, nutrition is a subject that you will utilize for the rest of your life.”

Four years ago, when the Pennsbury School District in southeastern Pennsylvania signed a five-year contract with a foodservice management company, part of the contract included a provision for the foodservice management company to provide an RD to act as their nutrition educator. Ralph M. Nuzzolo, the district’s superintendent, comments, “We saw the growing concerns about nutrition and obesity and the number of students who were inflicted with diabetes and struggling with eating disorders, and we wanted to get a head start [on dealing with these problems]. We knew it was important to teach our students sound nutrition practices—how to eat healthy, well-balanced meals.”

Lindsay Wissinger, RD, LDN, is a nutrition educator for Metz & Associates, a foodservice management company that is primarily responsible for nutrition education in the North Allegheny School District in a suburb of Pittsburgh. Wissinger agrees that the school environment is ideal to encourage healthful eating and exercise habits, but she adds, “The most important place these dietary changes need to begin is in the home. It is imperative that parents serve as positive role models and demonstrate healthy behaviors.”

Kathy Gonzalez, RD, MEd, director of education and nutrition services with Metz & Associates, agrees. “With my background and experience in nutrition education, I believe that registered dietitians are the best choice to be nutrition educators in schools,” she says. “With the education and training that RDs have concerning the life cycle and principles of education, who else is more suited for the task?”

Amount and Quality of Nutrition Instruction
A mere 50% of schools in this country—grades kindergarten through 8—have district or state requirements for students to receive nutrition education.5 Even worse off are ninth- and 10th-graders in which only 40% have nutrition education requirements. An insignificant 20% of 11th- and 12th-graders have nutrition education requirements in place.

One important element of effective nutrition instruction is devotion of adequate time. Fifty hours has been found to be the minimum needed to have an impact on nutrition behavior.6 Teachers were asked to report the total hours they spent in the current year (school year 1996-1997) on nutrition education, including time dedicated specifically to nutrition lessons and time spent on integrated lessons.7 Data in Table 2 indicate that among the teachers who did teach nutrition, the mean number of hours spent on nutrition education by elementary school teachers was 13—well below the 50 hours thought to be necessary for impact on behavior. Genova-Pagano says, “Classroom teachers encounter challenges implementing nutritional concepts into their core curricula because of districtwide education standards and time restraints. [To solve this problem,] nutrition educators can be guest speakers, teaching nutrition as a special subject twice per month.”

In addition to the diminutive requirements for nutrition education, the intensity and quality of the nutrition messages students are receiving is not known. Without the proper nutrition background, most classroom teachers do not have the resources to get reliable, accurate, and up-to-date nutrition information to appropriately educate their students. Nuzzolo explains, “With all of the conflicting information about nutrition today, teachers are unsure what to tell their students.” In Wissinger’s view, this presents quite a problem because “misinformation is much more damaging than no information at all.”

Most of the successes seen in school districts came from those school districts that rely on one person or one small group of people who are responsible for the overall nutrition education. Research has shown that schools where the nutrition education efforts are coordinated by a person or group have an opportunity to present a more focused message to students about the importance of healthful eating. However, the majority of schools (61%) have no nutrition education coordination, meaning each teacher is responsible for his or her own lessons.

Barriers to Educating Students
Although most people will agree that schools definitely have a role to play in the war against childhood obesity and the ailments it causes, such as diabetes and early heart disease, schools are not without obstacles. Nuzzolo comments, “I worry that [the schools] alone will not be able to solve the problem of childhood obesity. It will take a concerted community effort to see positive change.”

Nuzzolo also points out that students show up on the first day of school at 5 years of age with preexisting poor eating habits. “We can offer students healthy meals under the National School Lunch Program, and we can teach students about proper nutrition, but getting them to actually eat the healthy food can be a real challenge.” If students aren’t exposed to broccoli or expected to eat broccoli at home, parents can’t expect the schools to get their children to eat broccoli for lunch.

Genova-Pagano agrees. “It is also important for nutrition educators to reach parents since caregivers lack nutrition knowledge and get most of their nutrition information from the media, which is oftentimes misleading or just plain wrong,” she says.

Schools are also in tight competition with the media. Television advertising is the most powerful source of information for children, and they are getting a steady diet of fast food on TV. Children watch an average of 20 hours of television per week and are exposed to tens of thousands of commercials each year.8 A majority of the commercials that are aimed at children are for fast food, “junk” food, or sugar-sweetened beverages. Children have become extremely sophisticated and savvy and demand these types of foods at school. It is difficult for parents and schools to compete with the powerful influence that the media has on our children.

Financing a Nutrition Education Program
Lack of funds is an obstacle for a successful formal classroom nutrition education program in most school districts. According to the School Health Policies and Programs Study, 16.6% of schools utilize an outside foodservice management company to operate the school foodservice program.9 For many school districts that now utilize a contract foodservice management company to handle their school meals, a nutrition educator is becoming an important piece of the contract. Foodservice management companies are realizing this, and nutrition educators may someday become standard as part of their bid for new school districts.

A Big Job
The rate of obesity in this country did not spiral out of control overnight, so we shouldn’t expect it to go away overnight, either. It will be a long uphill battle to regain control of this frightening epidemic. Placing RDs in the schools to educate our kids about overall good nutrition is a great place to start. Many schools are taking matters into their own hands and doing just that. Nutrition educators have a big job on their hands, so it will also require a committed team approach. It will take the parents and caregivers, schools, media, food industry, medical community, and government and community leaders to see positive change. Without a total commitment, we will most likely fail our children.

— Jennifer Thomas, RD, is a regional nutrition educator for Metz & Associates, Ltd., Nutrition Education Services.

References
1. Centers for Disease Control and Prevention. Obesity and overweight: A public health epidemic. CDC Web site. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/epidemic.htm. Accessed July 21, 2002.
2. National Center for Health Statistics. Obesity still on the rise, new data show. CDC Web site. Available at: http://www.cdc.gov/nchs/releases/02news/obesityonrise.htm. Accessed on October 8, 2002.
3. Health and Human Services. Healthy People 2010: Understanding and improving health. Conference Edition. Washington, D.C.: Government Printing Office; 2000.
4. Ibid.
5. NCES National Center for Education Statistics. Nutrition Education in Public Elementary and Secondary School Highlights. Available at: http://www.nces.ed.gov/surveys/frss/publications/96852/notes_008. Accessed January 20, 2004.
6. NCES National Center for Education Statistics. Training to Teach Nutrition. Available at: http://nces.ed.gov/surveys/frss/publications/2000040/3.asp#amount. Accessed January 20, 2004.
7. Ibid.
8. American Academy of Pediatrics. Required TV programs in schools encourage poor lifestyle choices. Available at: http://www.aap.org/advocacy/reid1100.htm. Accessed February 8, 2003.
9. Centers for Disease Control and Prevention. School Health Policies and Program Study. Fact Sheet: Food Service. Available at: http://www.cdc.gov/nccdphp/dash/shpps/factsheets/fs01_food_service.htm. Accessed February 2, 2004.

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