Carrots (Not Sticks) to Encourage a Healthy Weight

Carrots (Not Sticks) to Encourage a Healthy Weight
Steps we can take to help prevent childhood overweight and obesity . . .

According to the National Center for Health Statistics,¹ almost one-fifth of American children
aged 6 to 11 years are overweight— a proportion that has been increasing in recent years. Overweight children are more likely to become overweight adults, following a pathway toward such health complications as heart disease, diabetes, and sleep apnea.² As pediatricians, we are constantly looking for new ways to battle the obesity epidemic, and wonder what else we can do to slow the progression of the trend.

Foster and colleagues³ recently conducted a 2-year prospective study in which students in grades 4 through 6 from 10 different schools in the Philadelphia area were either exposed to a School Nutrition Policy Initiative (SNPI) or acted as controls. Following CDC guidelines, the SNPI included school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach.

In addition to traditional education about nutrition and physical activity, teachers in the intervention schools were shown how to encourage healthy lifestyles throughout the curriculum—such as using food labels to teach children about fractions. In the intervention schools, the foods sold and served were changed to reduce the amount of fat, sugar, and sodium. Only 100% juice, water, and low-fat milk were available as beverages.

Students who ate nutritious meals and snacks were given raffle tickets, with prizes that included items that could promote healthy lifestyle choices (such as bicycles and jump ropes). Families were contacted by nutrition educators and were encouraged to support diet and activity changes through a variety of methods (eg, eliminating unhealthy snacks at parent fundraisers and not giving sweets to teachers for holiday gifts).

At baseline, 1 year, and 2 years, the researchers obtained weight and height data and administered questionnaires about diet, activity, sedentary behaviors, and body image. Among children in the intervention group, significantly fewer became overweight than in the control group over the 2-year period (7.5% vs 14.9%, respectively). However, there was no difference in obesity incidence. After the study period, the prevalence of overweight had decreased in the intervention schools and increased in the control schools.

While no significant differences were found among the groups regarding remission of overweight, reported diet, or reported activity, the intervention group did spend less time doing sedentary activities than the control group. No difference was seen concerning body image or becoming underweight, which were considered potential negative effects of the intervention.

While the Foster study is limited by self-reporting for some outcome measures and by including only 10 schools, it does point out some frightening trends and suggests ways to mitigate them. Even in the intervention group, which was 50% less likely to become overweight than the control group, there was still a 7.5% increase in the incidence of overweight children. This increase—as well as the lack of response in the incidence of obesity and the absence of remission of overweight—show that the interventions made in the study are not perfect. However, they are a start.

How can we use these results to help fight overweight and obesity? We can encourage schools in our neighborhoods to stop providing and selling unhealthful foods, to have “bake sales” with nutritious snacks, and to increase education about nutrition and physical activity throughout the curriculum. In our day-to-day practice we can give stickers instead of lollipops after kids get their shots, we can encourage parents to set nutrition examples when helping kids with their homework or when shopping for food, and we can reward healthy lifestyles and growth parameters with coupons for nutritious food choices.

The overweight and obesity epidemic is overtaking us—let’s get creative about how to stop it in its tracks.