Great Moves! building healthy lifestyles for kids

Building Healthy Lifestyles

Great Moves! co-founder Roberta Clarke and Clinical Director Suzanne Rostler write monthly column, entitled "Building Healthy Lifestyles", for the Wayland Town Crier and Weston Town Crier.

Wayland Town Crier and Weston Town Crier
www.wickedlocal.com/wayland

october article:
welcome to friday school lunch

august article:
don't blame the schools for unhealthy lunches

june article:
what really causes weight gain?

welcome to friday school lunch
THU OCT 30, 2008, 10:00 AM EDT

WAYLAND -

It’s 11:30 a.m. when the first class of second-graders trickles into the Happy Hollow School cafeteria. A few students sit down and unpack their homemade lunches; most take a place in line to buy the day’s hot lunch offering of pizza, a small salad with dressing, pudding with whip cream, and milk – chocolate, for the most part.

The other three second-grade classes soon arrive, with the majority of children taking a place in the lunch line. By the time every student gets through the line and finds a seat in the crowded cafeteria, it is 11:37 a.m. That leaves 13 minutes to eat.

Three minutes later comes the call: ice cream! All at once some 60 students spring from their seats, leaving trays of barely touched pizza and salad. In those few moments between the time the last student in line took a seat and the ice cream call was sounded, most of the students have finished their pudding, washed it down with chocolate milk and are now poised to polish off a bubble gum pink-covered ice cream bar. Altogether, their "meal" provides some calcium and 15 teaspoons of sugar.

Welcome to Friday’s school lunch.

In August I wrote a column calling on parents to stop blaming the school for unhealthy school lunch and start teaching their children to appreciate and accept healthy food at home. Only then will they buy healthy food offered in the school. I also said that the schools can and should do more to improve the quality of school lunch. Friday lunch is a good place to start.

Lunch on Fridays in Wayland is special because kids get to buy ice cream. Many kids look forward to this and as a nutritionist, I support an occasional treat. What I don’t support is the lack of time given to kids to finish the more nutritious part of their lunch before overloading on sugar.

Wayland Superintendent Gary Burton says that lunches at Happy Hollow are scheduled for a minimum of 20 minutes and a maximum of 30 minutes for individual students. The students say otherwise. A second-grader who brought her lunch and bought ice cream was asked why she didn’t eat her yogurt. "I didn’t have enough time," she answered plainly. "No time!" echoed a third-grader who was reminded to take a few more bites of pizza as he sprinted toward the ice cream box.

It’s true that students can opt to remain in the cafeteria to finish their lunch while their friends head outside to play. But honestly, is that realistic? It’s also doubtful that a child in the younger grades would remain seated while the older classes filed in.

The National School Lunch Association recommends that students be given at least 26 minutes for lunch – a period of time that aims to include 20 minutes of actually sitting at the table, socializing and eating. Our kids aren’t receiving that – and unfortunately they’re not alone. Schools in nearby towns such as Lexington and others have structured similar schedules, rushing kids out the door for recess.

Consider the consequences: An abbreviated lunch period has a dramatic impact on a child’s energy levels and ability to pay attention in school.

Why? Without enough time to eat a healthy lunch, kids will choose the least healthy part to eat first and sometimes only. A child who eats a meal loaded with sugar and/or refined carbohydrates will feel a rush of energy that is soon followed by a sugar low (sometimes called an insulin crash). This causes feelings of fatigue, irritability and hunger for more sugar.

What effect might this have on a child’s ability to pay attention in an afternoon class? How about the MCAS exam?

Rushing through a meal can also contribute to excessive weight gain. In fact, a study published just last week in the British Medical Journal found that fast eaters are three times more likely to be overweight.

It takes roughly 10 minutes for the stomach to send a chemical message to the brain that it is full. Kids and adults who eat quickly often overeat, feeling uncomfortably stuffed by the time that "full" message reaches the brain.

So what kind of changes can we make to help our kids?

Short of extending the lunch period, one way to provide more time to eat a healthy meal on Fridays would be to put the treat on the lunch tray rather than have students wait in line a second time.

Kids who bring their lunch could purchase the treat with the lunch buyers, or they could wait until the line shrinks. Lunch monitors could remind kids to eat their lunch before their treat. In this way, a health message (hopefully) heard at home would be reinforced in the schools. If kids were to get their treat on their tray, ice cream may not be a viable option because it melts. Why not take pudding off the list of foods automatically given to students and offer it up as the treat? This could help to reduce the overall amount of sugar kids are taking in.

And speaking of sugar, parents should support the proposed ban on flavored milk. With its 35 grams or nearly 9 teaspoons of sugar, the bottle of chocolate milk might as well be served as dessert. But because it has some calcium, and school lunch is required to provide a certain percentage of the daily calcium requirement, chocolate milk is considered part of the meal.

In a move to eliminate chocolate milk from the menu, the Happy Hollow Wellness Committee is surveying parents from both elementary schools on whether they support a ban.

To be sure, the schools have already made a good effort at trying to improve the nutritional quality of the foods they provide. Jim Lee, the principal of Happy Hollow, notes that the vegetables they serve are all fresh, and they changed the menu to offer whole wheat pizza and dark bread instead of white bread, as well as desserts that include fruit.

But banning flavored milk is one more way families can support the schools in providing more nutritious lunches. Teaching kids to drink milk in its natural state and not sweetened with artificial flavoring and 9 teaspoons of sugar would make it more likely that kids would drink real milk when it is offered in the schools.

Wayland resident Suzanne Rostler is clinical director at Great Moves!, which provides pediatric and adolescent weight management services at its center in Newton. She also serves as senior dietitian in the Optimal Weight for Life (OWL) program at Children’s Hospital Boston.

Weston resident Bobbi Clarke, co-founder of Great Moves!, is an associate professor in the Health Sector Management Program at Boston University.

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don't blame the schools for unhealthy lunches
THU AUG 21, 2008, 12:04 AM EDT

In most towns, the school lunch menu is an easy target. Even the kids who buy these lunches would agree that French toast sticks with maple syrup; mozzarella sticks with chocolate milk; and popcorn chicken with mashed potatoes are hardly the ingredients of a well-balanced meal.

But offering a healthy lunch is just part of the problem. Getting kids to eat it is another. According to a report released this month by Action for Healthy Kids, a partnership of more than 60 national organizations and government agencies representing education, health, fitness and nutrition, a significant obstacle preventing kids from eating healthy food at school is their simple lack of interest in doing so.

"The greatest barrier to improving school lunch is the students," agreed Cheryl Judd, director of food services with the Wayland Public Schools. When students are asked to weigh in on their favorite lunch menu items, they overwhelmingly cast their vote for foods like French toast sticks and fries. Not surprisingly, black beans don’t even make the list: when the food service department tried to introduce black bean salad to students at Happy Hollow school by putting a small serving on each tray, the students rebelled by collecting all the samples on a single tray and returned them to the kitchen.

When different types of fresh fruit to were offered to elementary school students, the biggest consumer turned out to be the garbage can.

Incidents like this one are not good for the bottom line, and food service departments cannot operate at a loss. Parents who advocate for healthier choices on the menu (myself included!) need to understand the competing pressures under which food service directors operate.

"I need to be aware of what we are ordering, work on ways to reduce waste, and at the same time provide a balance between what the students want to eat and what the parents want to see being offered," Judd explained.

It’s time, then, for parents to stop putting all of the blame on the schools for poor quality lunches and focus on cultivating a taste for real food in their children. Only when kids learn at home what real food tastes like, will they accept it in school.

So what can parents do? One way to shape a child’s food preferences at home is to keep a safe food haven. This means bringing only real, whole foods into the home and limiting what Michael Pollan, in his recent book "In Defense of Food," refers to as "edible foodlike substances." These are the highly processed products (think frozen chicken nuggets and pizza; packaged macaroni with neon-orange colored cheese; 100-calorie snack packs; fruit roll-ups and juice boxes -- even the "100 percent real juice" varieties) that can sit in your freezer or pantry shelf for years without spoiling. This is not natural. Real food rots.

The rationale for keeping a safe food haven is simple: make healthy food convenient and accessible at home, while limiting access to (and temptation by) unhealthy edible foodlike substances. Parents who would like to do this but fear a revolt at home might consider the following: When recent immigrants to America initially taste these products, they find them repulsive. Over time, however, they grow used to the excess salt, sugar and fat and their taste for healthier fare is lost. Fortunately, the reverse can happen when we switch to a real-food diet.

Parents can also role model healthy eating habits. From a young age, children learn basic lessons -- such as how and what to eat -- by copying their parents. Even teenagers are not immune to the effects of positive role modeling. So if your kids are used to seeing you stand at the counter eating a dinner of Chinese food out of a container, they will too.

Which brings me to a third suggestion for cultivating better eating habits in your children: sit down to family meals. Studies show that kids who eat meals with their families eat more fruits, vegetables and calcium-rich foods, and consume less soda and fewer fried foods. They are also less likely to be overweight. Even working parents who can’t always be home in time for dinner can do this by making breakfast the shared meal instead. If busy school and work schedules make this impossible, you might take time over the weekend to linger over a meal.

Of course, parents can and should continue to work with schools to improve the quality of lunch and to create a healthier food environment overall. In the past, the focus has been on eliminating unhealthy competitive foods such as soda, ice cream and candy bars. Let’s now turn our attention to finding healthy alternatives. One way to do this is by tapping students themselves for ideas. This could help to make the food more acceptable at all grade levels, as kids are more likely to eat food they have had a stake in preparing (or suggesting, in this case).
And if at first a new dish does not succeed, keep trying: research has shown that it can take more than a dozen exposures to a new food before it is accepted.

Judd is giving it the old college try in the Wayland schools. "We’re continuing to offer black bean salad, black beans and rice and making black beans available on the salad bar. It’s not very popular at the elementary level, but I still want to make it available, at least in small quantities."

To be sure, there have been success stories to note. In Wayland, pizza now comes on whole wheat dough and chicken patties are grilled instead of fried. High-school students can get homemade hummus and salad every day, and the menu often features dishes such as vegetarian chili. Judd said the demand for salad plates at the high school and middle school have increased significantly from years ago.

"Each year we strive to improve a little more," she said.

Would you like to share some feedback to this column or do you have a health and wellness question you’d like answered? We’d love to hear from you!
Please contact us:
In Wayland:
suzanne.rostler@greatmoves.com
In Weston:
bobbi.clarke@greatmoves.com

Wayland resident Suzanne Rostler is clinical director at Great Moves!, which provides pediatric and adolescent weight management services at its center in Newton, Massachusetts. She also serves as the senior dietitian in the Optimal Weight for Life program at Children’s Hospital Boston.

Weston resident Roberta Clarke is co-founder of Great Moves! and is also an associate professor, Health Sector Management Program and former Chair of the Department of Marketing at Boston University.

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what really causes weight gain?
THU JUN 05, 2008, 10:32 AM EDT

WESTON -

Living in a democracy where "all men are created equal," we have expectations that our bodies also are equal, and that how and what we eat should affect us each in the same way. If you read Gina Kolata’s book, "Rethinking Thin" (Farrar, Straus and Giroux, 2007), you realize this is not true. What causes some to gain weight results in no additional pounds for others.

Still, there is much that we know about weight gain. Most simply, we gain when we consume more calories than our bodies need. Yet, as evidenced by the myriad of diet options, a calorie may not just be a calorie.

A calorie from fat (e.g., bacon) operates differently in our body than a calorie from a refined carbohydrate (for example, sugar or white bread). This is why we have the Atkins Diet competing with the Ornish Diet as well as some less well-researched and highly questionable diets (the Grapefruit Diet, the Hollywood Cookie Diet). Each diet has different assumptions about the value of a calorie from specific foods. The studies cited in Kolata’s book add to the complexity by pointing out that each individual may respond differently to different types of calories.

Still, there are some basic causes of weight gain that are common to everyone. One is the amount eaten; if you eat more, you gain more, and it is clear that as a group, the American public is eating more.

Portion sizes have increased dramatically as the cost of producing food has declined. Twenty years ago, a bagel was 3 inches in diameter and 140 calories. Today, it’s 6 inches and 350 calories. The cheeseburger of 20 years ago had 333 calories compared to today’s fast food cheeseburger’s 590 calories (see "http://hp2010.nhlbihin.net/portion" for more examples of portion increase).

While some would like to blame our genes for our heaviness, and there clearly is a genetic component to weight, genes cannot explain why we are so much heavier than we were 20 years ago. Our genes have not changed in 20 years, but the amount that we eat has.

So have the types of food that we eat. We – more correctly, our grandparents – used to eat foods that were less processed. Increasing amounts of what we eat today have unpronounceable ingredients.

According to Michael Pollan, author of "In Defense of Food" (Penguin Press, 2008), much of what we now eat today would not be recognizable by our great-grandmothers as food. Some in the nutrition community have suggested that if you can’t pronounce all the ingredients, you shouldn’t eat it.

Instead what we should be eating in far greater quantities are fruits, vegetables, grains and legumes (like beans). Not as attractive as Go-Gurt and Keebler Rice Krispies Treats Cereal Bars? Ask yourself how attractive you find obesity.

Of course, another contributor to weight gain is lack of exercise. Children used to walk to school; many now ride buses or are driven by loving parents. Children and parents both now spend enormous numbers of hours sitting in front of screens – TV, computers, video games, cell phones, and so on. Except for screens used for Dance Dance Revolution and Wii, this is largely immobile time; inert bodies use few calories.

Technology has made it easier for us to do the same work with less effort. We used to have to move around the kitchen to cook our food. Now, not only can we buy it pre-cooked, but we also don’t even have to get out of the car to purchase it. We can fill our bodies with food without ever moving anything more than the gas pedal.

Jay Leno on "The Tonight Show" has a regular routine that points out such changes such as not having to get up to change the channel on the TV because we have remotes, or not having to stand up to vacuum because the iRobot Roomba will do it for us.
The other part of the equation in weight gain, in addition to the calories we consume, are the calories we expend through our own physical effort. Less effort expended, fewer calories used.

Numbers of other causes of weight gain have been cited:

Not getting enough sleep appears linked to obesity.

Certain pharmaceuticals (antipsychotics, antidepressants, mood stabilizers, anticonvulsants, antidiabetics, antihypertensives, steroid hormones and contraceptives, for example) may increase weight.

Having a social network of overweight friends appears to alter one’s perception of what constitutes being heavy, a psychological construct called framing. If you have many friends who are overweight and you like them, then being overweight must be OK.

Certain studies have found the mix of bacteria in the guts of obese people differ from the mix in normal weight people, leading to the possibility that bacteria could contribute to overweight.

Endocrine disruptors (generally industrially produced substances that affect endocrine function) may cause weight gain.

Reduction in the variability in ambient temperature (that is, the fact that indoor heating and air conditioning systems keep our bodies at roughly the same temperature all the time) may offer us less opportunity to have to work to adjust our internal body thermostats to the outside temperatures; this adjustment process is thought to consume calories.

And there are more proposed causes, too many to cover here.

So what does this mean for those who would like to shed some weight? In the absence of that magic pill which would allow us to lose weight with no effort, a pill which realistically is years away, should it ever exist at all, the reality is what you have heard before – move a little more, eat a little less.

And if you follow Michael Pollan’s recommendations, you should "Eat food (that is relatively unprocessed). Not too much. Mostly plants."

Would you like to share some feedback to this column or do you have a health and wellness question you’d like answered? We’d love to hear from you!
Please contact us:
suzanne.rostler@greatmoves.com
bobbi.clarke@greatmoves.com

Weston resident Bobbi Clarke, co-founder of Great Moves!, is an associate professor in the Health Sector Management Program at Boston University. She is also the vice chair of the boards of the New England Organ Bank and the Academy for Educational Development.

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