Schools make no headway in fight against fat

Staff WriterJune 28, 2010 

  • Researchers at UNC-Chapel Hill targeted rural schools, where higher poverty and less access to health care tend to increase obesity and diabetes risks.

    East Lee Middle, Lee County

    Dunn Middle, Harnett County

    Nash Central Middle, Nash County

    Overhills Middle, Harnett County

    Joseph W. Parker Middle, Nash County

    Roseboro-Salemburg Middle, Sampson County

  • The HEALTHY study was a three-year project in 42 middle schools to determine whether changes in cafeteria food, physical education and classroom activities would increase weight loss among overweight students and lower risk factors for type 2 diabetes.

    Among the findings:

    The number of overweight and obese students, those in the top 15 percent on weight charts, had declined by 4 percent in both participating and comparison schools.

    The percentage of children with large waist sizes was lower in program schools than in comparison schools. A large waist size increases the risk of developing type 2 diabetes.

    Insulin levels were also lower in the program schools. A high insulin level is the first step to developing type 2 diabetes.

    The average body mass index for participating students fell more in program schools than in comparison schools.

    SOURCE: HEALTHY study, New England Journal of Medicine

Middle school students targeted with an intensive effort to reduce obesity did no better at losing weight than their peers in schools without special programs, researchers at UNC-Chapel Hill and elsewhere report.

The study, published in the New England Journal of Medicine, involved a three-year campaign at 42 schools around the country, including six in North Carolina. It was aimed primarily at cutting the proportion of middle school children who are overweight or obese.

At half the schools, lunchrooms offered healthier choices, physical education teachers focused on movement instead of sports, classes taught good nutrition and lifestyle choices, and hallway posters and morning announcements included health messages.

Yet children at those schools lost no more weight than did students at the remaining schools, where youngsters were simply measured but no interventions were provided. In both groups of schools, the number of overweight children declined 4 percent during the study.

"Stunned is a good word," said Joanne Harrell, a nursing professor at UNC-CH and lead investigator for the North Carolina portion of the study. "We really have no answer" why the results were so similar between both groups of schools.

The study did produce some encouraging results. Diet and exercise changes in the intervention schools were successful in reducing some risks for diabetes. But the weight-loss findings underscore the difficulties health leaders face in making significant inroads against obesity.

Carrying extra weight and failing to exercise are key contributors to diabetes, heart disease, cancers and other major health problems. In North Carolina, two-thirds of adults and one-third of children are overweight or obese.

Despite years of dire warnings from health leaders, however, those rates have not improved. The so-called HEALTHY study demonstrates how intractable the problem is.

"Doing a broad intervention like changing a school, as opposed to working with a single overweight child, has essentially never been shown to work," said Dr. John Buse, one of the study's researchers and director of the UNC Diabetes Care Center.

Buse said interventions at schools have limitations. Teaching healthy habits is just one of a school's many missions, so even with the kinds of special efforts provided through the HEALTHY study, time is limited. Money is also at a premium. Healthier foods tend to be more expensive and often less popular, so changing the cafeteria offerings taps the budget.

At Dunn Middle School in Harnett County, where students participated in the interventions, Principal Stan Williams was especially enthusiastic about the changes to physical education instruction. A former PE teacher and coach, he said the effort to get children moving with hula hoops and other apparatus made classes fun, even for students whoweren't athletes.

Those changes, Williams said, have been incorporated in all the school's physical education classes. But he acknowledged that problems with excess weight spill well beyond his campus.

"It's like a lot of things in education," Williams said. "We can control a lot of what they do at school, but if they go home and they're sedentary, they eat fried foods, that can sabotage the data."

Sheree Vodicka, communications manager for the state's Eat Smart, Move More campaign, said the key to tackling obesity lies beyond one institution and one approach. Her organization, using funding from the Centers for Disease Control and Prevention, provides small grants to foster communitywide efforts. She, too, lamented the complexity of the problem.

"It's going to take changes across all sectors of society in order for us to see the change we're looking for," Vodicka said.

sarah.avery@newsobserver.com or 919-829-4882

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