• Childhoow_obesity_150x150

    By Jeanette Andrade, PhD, RDH/LDN

    Childhood obesity remains a leading public health problem in the United States. According to a 2011–2012 report, 17% or 12.7 million children and adolescents aged 2–19 years are obese (Ogden, Carroll, Kit, & Flegal, 2014). (However the rate of obesity among 2–5 year olds has decreased from 13.9% in 2003–2004 to 8.4% in 2011–2012 (Ogden et al., 2014).) 

    Childhood obesity is not just a problem in the U.S., but around the world. In 2013, the World Health Organization (WHO) reported that globally 42 million children aged 0–5 years were overweight or obese and that the developing countries (e.g., Guatemala and South Africa) have 30% more children overweight or obese compared to developed countries (e.g., Norway and U.S.) (WHO, 2015). The risks associated with childhood obesity include a number of health complications, chronic diseases, and conditions such as type II diabetes and cardiovascular disease (Ogden et al., 2014; WHO, 2015). Thus, childhood obesity is not a problem of industrialized countries, but a matter of global concern.

    Many factors may contribute to the rate of childhood obesity, including socioeconomic status, parenteral education levels, race, and ethnicity (CDC, 2015; Cunningham, Kramer, & Narayan, 2014). Other factors that contribute to childhood obesity are the child’s eating and sedentary behaviors (Finch, 2010). Since the 1980s, children have been decreasing the amount of daily physical activity and overconsuming high fat and sugary foods while reducing their consumption of fresh fruits and vegetables (Mozaffarian, Hao, Rimm, Willett, Hu, 2011; Reidy, Deming, & Pares, 2014). The U.S. has attempted to combat the rise in obesity and lack of nutritious choices by implementing stricter guidelines on the USDA’s National School Breakfast and School Lunch Programs, as an estimated 31 million children in 2012 consumed lunch from school (Food and Nutrition Services, 2013). The current recommendations are for children to consume 25% of their total recommended calories and protein from breakfast and 33% of their total recommended calories and protein from lunch, less than 30% of their total calories from fat, and 50% of their calories from carbohydrates, of which 50% should come from whole grains (Institute of Medicine, 2008). 

    Other recommendations include provisions on specific amounts of food items based on food groups and on the child’s grade level. For example, for all grade levels, the fruit selections need to be fresh, frozen without added sugar, canned in juice/light syrup, or dried fruit, with no more than half the offerings in 100% juice form (Food and Nutrition Service, 2012). Additionally, for both breakfast and lunch, no more than 10% of total calories should come from saturated fats, and less than 600–740 mg of sodium should be present in these foods (Food and Nutrition Service, 2012). 

    Many industrialized and developed countries do have school lunch polices that meet standards based on food groups and plate methods (Bonsmann, Kardakis, Wollgast, Nelson, & Caldeira, 2014; Florencio, 2001). For example, Chile’s school lunch program must provide 800 calories and 15–20 g of protein regardless of the children’s age. In Peru, the program must provide 30% of total calories, 70% of total calories from protein, and 100% of daily iron (Florencio, 2001). In many countries within the European Union, school lunches must provide 65% of total daily calories, of which 59, 50, and 47% of these calories must come from fats, protein, and carbohydrates, respectively (Bonsmann et al., 2014). Like the U.S., European Union countries have standards on the types and amounts of food groups the school lunches serve to children such as frequency of serving fried foods and sweetened beverages (e.g., juices) (Bonsmann et al., 2014). 

    However, not all countries, especially developing countries with extreme poverty, have a school lunch policy in effect due to finances and lack of dietary diversity. Thus, in 2009, the UN World Food Programme provided school meals in 70 countries and the World Food Bank Group created a Global Food Crisis Response facility that was able to generate $1.2 billion to help these countries provide at least one school meal to children (Bundy, Burbano, Grosh, Gelli, Jukes, & Drake, 2009). Many of these countries have developed a school lunch policy to ensure that the meal provides at least 20% of their total calories and sufficient amounts of vitamins A, B12, zinc, and iron (Bundy et al., 2009).

    Compared to other countries, U.S. school lunches are fairly consistent as far as the calories and macronutrients are concerned. However, the food items placed on trays around the world are vastly different due to various factors such as culture, religion, and finances. A typical elementary school lunch in the U.S. may have four different choices and may be on a 21-day rotating menu cycle. For instance, a meal for one day would include a choice among these main dishes: chicken sandwich, hot dog, sunflower butter and jelly sandwich, or Italian salad with a breadstick. The sides may include a choice between 1 vegetable and 1 fruit such as carrots or cauliflower, banana or peaches. The drink choices may be between low-fat chocolate milk and 1% white milk (Urbana School District #116, 2015). 

    Whereas the standard school lunch meal in England, which is also on a rotating cycle menu, for one day may consist of breaded beef sticks, mashed potatoes, northern beans, wheat roll, peaches, and milk (England Public School District #2, 2015). In Honduras, there is no rotating menu cycle and the elementary school lunch meal consists of rice, beans, tortillas, and milk (Healthy School Meals, 2000). Note the author has reviewed the elementary school meal plans from public schools in these particular countries. High school lunch menus and private school lunch menus may provide different food items, but these schools should still adhere to the dietary guidelines established by each country.

    In conclusion, the fight against childhood obesity at home and abroad cannot be fought on school grounds only. Parents, the community, the government, and health professionals need to continue to educate and improve social structures to help fight the childhood obesity epidemic.

    Jeanette Andrade is a faculty member of Kaplan University. The views expressed in this article are solely those of the author and do not represent the view of Kaplan University. 

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  • References

    Cunningham, S.A., Kramer, M.A., & Narayan, K.M.V. (2014). Incidence of childhood obesity in the United States. The New England Journal of Medicine, 370, 403-411. doi: 10.1056/NEJMoa1309753.

    England Public School District #2. (2015). Elementary October Menu. Retrieved from http://images.pcmac.org/Uploads/EnglandPublicSD2/EnglandPublicSD2/Departments/DocumentsCategories/Documents/October%20EES%20Menu.pdf on September 30, 2015.

    Finch, C.E. (2010). Evolution of the human lifespan and diseases of aging: Roles of infection, inflammation, and nutrition. Proceedings of the National Academy of Science, 107 (suppl 1), 1718-1724.

    Florencio, C. (2001). Developments and variations in school-based feeding programs around the world. Nutrition Today, 36(1), 29-36.

    Food and Nutrition Services (2012). New Meal Pattern Requirements and Nutrition Standards: USDA’s National School Lunch and School Breakfast Programs. Retrieved from http://www.fns.usda.gov/sites/default/files/LAC_03-06-12_0.pdf on September 21, 2015. 

    Food and Nutrition Services (2013). National School Lunch Program. Retrieved from http://www.fns.usda.gov/sites/default/files/NSLPFactSheet.pdf on September 21, 2015. 

    Healthy Schools Programme. (2000). Honduras. Tegucigalpa, Honduras.

    IOM (Institute of Medicine) (2008). Nutrition Standards and Meal Requirements for

    National School Lunch and Breakfast Programs: Phase I. Proposed Approach for Recommending

    Revisions. Washington, DC: The National Academies Press.

    Mozaffarian, D., Hao, T., Rimm, E.B., Willett, W.C., Hu, F.B. (2011). Changes in diet and lifestyle and long-term weight gain in women and men. New England Journal of Medicine, 364, 2392-2404.

    Ogden, C.L., Carroll, M.D., Kit, B.K, & Flegal, K.M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814. doi:10.1001/jama.2014.732

     Reidy, K., Deming, D., & Pares, G. (2014). Dietary impact: Results of FITS in US and MING in China. Retrieved from https://www.nestlenutrition-institute.org/resources/library/Free/journalarticle/Dietary_Impact_Results_of_FITS_in_US_and_%20MING_in_China/Pages/Dietary_Impact_Results_of_FITS_in_US_and_MING_in_China.aspx on September 21, 2015.  

    Urbana School District #116 (2015). September Urbana Elementary Schools Menu. Retrieved from http://www.usd116.org/files/FoodService/foodmenus/Elementary-both-ENG.pdf on September 30, 2015. 

    World Health Organization (WHO) (2015). Commission on Ending Childhood Obesity. Retrieved from http://www.who.int/end-childhood-obesity/facts/en/ on September 21, 2015.

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