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					Helping Kids to Health

              The role of Iowa
               public schools
•   Iowa Dietetic Association
•   Iowa Dental Hygienists Association
•   Iowa School Food Service Association
•   Iowa Fit Kids Coalition
•   ISU Extension
Discussion Objectives

To understand and describe
 Three examples of health problems that
  can be prevented
 How the school environment impacts
  health and nutrition
 Policy changes that can impact health of
Children: A Valuable Resource
Invest in a Child’s Health

 To help his/her…
  Ability to learn
  Physical ability
  Appearance
  Social opportunities
  Success in school and future employment

      Health is key to a long and productive life!
Preventable & Interrelated
Health Problems
 Obesity
 Dental Caries
 Osteoporosis
 Psychosocial
Trends in Overweight
12.0%                                            NHANES
 6.0%                                            Girls
        1963-65 1971-74 1976-80 1988-91   1999
Overweight and Obesity
 Obesity has been related to changes in our
  lifestyle, including diet and physical activity
 Efforts to lose weight have proven
  unsuccessful for many adults.
 Obese children are 43.5 times more likely to
  have at least 3 cardiovascular risk factors.
  Nicklas, 2001
 As many as 45% of children newly diagnosed
  with diabetes have type 2 diabetes.
The Problem of Childhood

  Complex …but simple
  Cannot ignore that one cause is caloric
   intake that exceeds caloric expenditure.
  Experts recommend that we concentrate
   on preventing overweight.
No Simple Answer to the Obesity
Epidemic Food Glycemic
               Industry   Index     TV
       Candy                                     Decreased PE
                                                  in Schools
Soft Drinks                                          Density
 Pouring                                            Decreasing
Contracts                 Epidemic                   Physical
 Junk Food
Restaurants                                          Feeding
    Fast Food    Working                         Parenting
                  Mothers Poverty   Computers
Nicklas, TA, 2003
Genetic vs. Environmental
Obesity gene
 Children have higher risk of obesity when
  either one or both parents are obese.
 Obesity associated with genetic syndromes

What has changed? …
 “Gene pool” has not changed
 Environment: has changed
Dental Health
 Tooth decay is the most common chronic
  disease among children--5 times more
  common than asthma.
 An estimated 51 million school hours per
  year are lost due to dental related illness
 Children with chronic dental pain are
  unable to attend to school work. (Oral Health
  in America: A Report of the Surgeon General, 2000)
 Poor oral health tied to decreased school
  performance, poor social relationships and
  less success later in life
 Dental Health

 20% of low income children in Iowa have
  untreated decay in permanent teeth.
 68% of low income children have a history of
  decay compared to 52% of higher income
 56% of children participating in the IDPH
  dental sealant programs have a history of
What Dentists are Seeing

“Pre-fluoride” conditions of mouths
  Bone Health
 Bones are formed during childhood and
 Milk and dairy products are the best
  sources of calcium needed to form bones.
 Lack of calcium in adolescence could lead
  to bone health in later years.
 Weight bearing exercise is an important
  factor in bone formation and retention.
Bone Health
 Osteoporosis is “a pediatric disease with a
  geriatric outcome”
 Physically active girls who consume soft
  drinks have more bone fractures
  Wyshak, G, Arch Pediatr. Adolesc. Med, 2000; 154:610-613.

 Over 10 million men & women are estimated
  to have osteoporosis in 2002; another 33.6
  million have low bone mass and are at risk
  for osteoporosis.
    National Osteoporosis Foundation
Psychosocial Concerns of
Poor Health
 Lowered self esteem
 Body image disturbances
 Depression
 Poor academic performance
 Increased behavior problems
Why be Concerned?
 70 to 80% of overweight teens
  become overweight as adults.
 Poor diet/inactivity in adults causes
  300,000+ deaths annually.
 Osteoporosis decreases mobility and
  increases pain and has been reported
  in women.
What has Changed?
Physical Activity

 22% children did not participate in
  moderate or vigorous physical activity
 20% were not enrolled in physical
  education class
 86% did not attend physical education
  class daily
          (Youth Risk Behavior Survey, CDC, 2000)
Physical Activity
 Physically fit children perform better
  academically – California schools
 NASPE recommends 150 minutes/week
  of physical education
 Qualified teachers can ensure safety
  and teach appropriate activities that
  are enjoyable, develop motor skills and
  maintain health related fitness.
What has Changed?
Children’s Eating Habits
 Only 2% of kids meet all Food Guide
  Pyramid Recommendations
 16% do not meet any recommendations
 12% report skipping breakfast
 Only 11% eat a breakfast that contains
  three food groups and provides >25% of
  RDA for energy
Compared to
 84% of kids eat too much fat;
 91% eat too much saturated fat
 Only 15% get enough fruits
 Only 20% get enough vegetables
 Only 30% get enough milk
 Only 19% of girls aged 9 to 19 years of
 age meet calcium recommendations
Soft Drinks Cancel Out Milk

        Gallons Consumed Per Year

                                  soft drinks
      1970   1980   1990   1997
Soft Drinks: The Facts

Who drinks soft drinks?
 50% of all Americans
 65% of adolescent girls
 74% of adolescent boys

  Borrud, et al., Community Nutrition Inst, 1997
Plaque   Acidity in the mouth after drinking a
         sweetened beverage
         single glucose


  5.0                       critical pH


          0      20       40    60      80   100   120
         Acidity after repeated exposures to
         a sweetened beverage

Plaque    First        Second    Third       Fourth
  pH      sip          sip       sip         sip



                            critical pH

  4.0      0      20      40    60      80   100      120
 Double Trouble: pH and Sugar Content

               Acidity (pH)   Sugar (tsp)
Water              7.00        0.0
Diet Coke          3.39        0.0
Mountain Dew       3.22       11.0
Diet Pepsi         3.05        0.0
Gatorade           2.95        3.3
Coke               2.53        9.3
Pepsi              2.49        9.8
Challenges for Change
 Public Health cannot compete with
  industry’s advertising budget
 Mandated changes are controversial
 Lifestyle changes are difficult for

   Aim for small improvements over time
Hope for Change
 Simple policies can promote health
 Activity promotion fits in well with fun
  school events
 Alternative fund raisers
 Children adapt to new ideas and
 School provides a venue for
  experiencing new tastes and activities
Why Change the School Health

Education is a process
  of planning and
  preparing for a
  successful future
Why Schools?

 Schools play a role in demonstrating to
 the parents and community the
 elements that lead to a successful and
 healthy lifestyle

 Children spend time in school
Roles for Schools
 Continue to provide nutritionally
  balanced meals to children
 Coordinate nutrition education with
  opportunities to eat healthy foods.
 Support nutrition education messages in the
  overall school environment.
 Provide tools for lifelong physical activity and
  healthy eating.
Nutrition            for
Schools in the 21st Century
 Budget constraints for schools and school
  meal programs
 Shortened meal times
 Weak regulations for physical activity and
  health in schools
 School meals must compete with offerings
  both on and off campus
 Foods sold in competition with the school
  lunch program for revenue are often of
  minimal nutritional value
Carbonated Soft Drink Sales
 • Source of revenue for schools
 • Competes with goals & revenue of
   school lunch
 • Conflicts with nutrition education
 • USDA regulations only limit placement
   & timing of vending machines
Carbonated Soft Drinks
in the School
 Potential to disrupt the classroom
 Sugar intake gives children a surge of
  energy followed by a drop of energy.
 More than 51 million school hours are
  lost each year to dental-related illness.
American Dental Association
Policy: 2000
         House of Delegates :

          oppose contracts that offer
           increased access of soft drinks
           to children and influence their
           consumption patterns.

          calls for continued monitoring
           of scientific facts and data on
           the oral health effects of soft
Taking a Position on Healthy
School Environments
 American Dietetic Association
 American Academy of Pediatrics
 Society for Nutrition Education
 Centers for Disease Control and
 Center for Food and Justice
 American School Food Service
• Create school meal advisory teams of students,
  parents and teachers to assist in selected menu
• Survey students on preferred foods.
• Educate students about serving sizes
• Employ economies of scale to increase revenue
• Ensure that food sale revenues for competitive
  foods are credited to the school food service
 Develop positive, healthy
  options for vending, school stores,
  cafeteria environment
 Ask soft drink companies to market
  healthier alternatives.
 Provide water, 100% juices, milk and
  soy drinks
 Require closed campuses during lunch
   Competitively price healthy foods
   Sell items that increase physical
    activity: pedometers, water bottles.
   Establish relationships with local food
   Participate in school gardening projects
• Ensure that adequate time and space is
  available for all children to eat
• Schedule recess before lunch
• Encourage teachers and staff to eat with
 Limit use of food and candy as a
 Encourage fund raising efforts
  associated with healthy lifestyles
 Provide daily recess
 Plan physical education that is inclusive
  of all students, including those with
 Fruit & Vegetable Pilot Project
    25 schools in Iowa
    Free fruits & vegetables provided
     throughout the day
    Children learned new foods; enjoyed them
    Decreased use of vending machines
    Positive influence on school environment
School Health Index
Changing the Scene
Fit Healthy & Ready to Learn
More Resources
Team Nutrition
Healthy Schools Summit
Alternative ways to raise money

 Schools can positively impact the health
  of students
 A number of options are available to
  implement school health programs.
 A number of tools are available to
  evaluate environments within schools
Thanks to the following persons who have
  provided expertise and visual support for this

Dr. Michael Kanellis, DDS, MS
Dr. Jonathan Shenkin, DDS, MPH
Linda Snetselaar, RD, PhD
Eva Tsalikian, MD

University of Iowa School of Dentistry, College of Public
  Health and College of Medicine
• Facilitators
  – Provide RD’s not yet enrolled on
    Professional Developmental Portfolio, CDR
    reporting form:
  – Please complete evaluation form (note
    page) & return
  – Send any additional comments

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