Tuesday, March 30, 2010

Continuing the Conversation

As you can read under More Information For You, the Senate passed the resolution declaring September as "National Childhood Obesity Awareness Month." As I read through the release (and so much that is written about this issue), I find myself agreeing with many of the concepts and proposals. At the same time, I remain deeply concerned about the potential for further stigmatizing and harming the very children that everyone wants to help. I believe that we must ask ourselves whether any action or program is likely to make it easier or more difficult for children eat smart and be active.

School gardens and active recess - these are great ideas for all sorts of reasons! Biggest loser programs in schools or deeming photos of obese children - these are obviously bad news. It's all the possibilities along the spectrum that we must thoughtfully consider - so as to be both respectful and effective. [Note to Senators: Skip the exercise advice. Very few kids are eager to do that, but many of them love to P-L-A-Y (when they have adults role models and safe places to do it).]

Since I believe that the most respectful and ultimately effective programs focus on delicious nutrition and active play for children of all shapes, sizes, and weights, I plan to continue that conversation here and in other forums. Since I also believe that this discussion must include the prevention of bullying and eating problems, I plan to talk about those as well. Let's be honest: Any child who is teased about her or his weight isn't going to feel much like "exercising" or having a smart snack. They are much more likely to hide out on safe couch with a favorite "comfort food."

So, my first order of business (
in a tiny counter-revolution to Jamie Oliver) will be to explode some myths about school meals - and to feature School Meals That Rock. The conversation continues ...

Saturday, March 27, 2010

With Gratitude to ADA

On Friday, I receive a copy of a memo that made me proud to be a member of the American Dietetic Association. In response to my letter and the comments of many others, HOD Leadership Team issued a strong statement urging the Legislative and Public Policy Committee to take a more positive approach to addressing childhood obesity. Key sections are pasted below and the entire memo is included under pages to your right.

The HOD Leadership Team would like LPPC to consider mobilizing the Association to respond to this resolution and that ADA propose a more positive message to address childhood obesity. It was suggested that the month of September be recognized as Family Healthy Eating and Lifestyle month as a way to promote healthy family meals and family activity. Promotion of healthy habits such as meals and physical activity would be more a positive message with a focused outcome on changing the weight of children as a result of changes in eating and activity patterns. We are concerned that the unintended consequences of focusing on obesity awareness may result in children being stigmatized by others for their weight. We need to have a focus which does not create disrespect for others.

We strongly encourage you to take a stance on to this proposed resolution by taking a leadership role in collaboration with other organizations to promote a more positive message to Americans. We are aware that many ADA members are in support of Dayle Hayes comments and are looking for ADA to move the discussion to a more productive and beneficial outcome.

Please join me in thanking Ethan Bergman (bergmane@cwu.edu) and other HOD leaders for this strong and timely statement. You could also let Jeanne Blankenship (jbship@att.net) know that you support this course of action. Feel free to use any of the wording in my original letter to ADA leaders. I also know that the HOD leaders found the Rudd Center video about childhood obesity compelling, so I am embedding it here as well. You can share it folks who may not understand your concerns.

Friday, March 26, 2010

What to do - 5 of 5 - Promote Enjoyable Activity

When I wrote my original letter about the dangers of establishing a month to make children more aware of being fat, I knew that I wasn't alone. Many others, in a variety of health professions, have expressed similar concerns in different ways. Today, there is more evidence about how just how far the concerns have risen.

In the opinion section of today's New York Times, the Room for Debate section 'weighs in' on the topic with Better Ways to Help the Public Lose Weight. The distinguished commentators speak from different perspectives and different recommendations. There is, however, a common theme: There are many ways to approach public health concerns about weight more respectfully and more effectively. Check it out - and leave your own comment. Every voice counts!

This week, I have been offering answers to the question What can we do? Thus far, my suggestions have all been of the sedentary, sit-at-your-computer-and-let people-know-what-you-think-variety. For my final idea - promote enjoyable activity - I suggest that you get out of chair and go out into your community. So far, I've focused on thinking globally, this is all about acting locally.

Children of all weights, shapes, and sizes need adult role models to help them get into a daily pattern of enjoyable physical activity. Here are three simple ways to be an active role model at your local school (with many more to come in future posts):
  • Walk your children (or grandchildren) to school. Start a walking school bus so that neighborhood kids can join in the fun.
  • Organize a before or after school walking program on the playground (or indoors). Get the PTA/PTO on board and start with just a day or two a week. (To pick up the pace, let the kids choose some music.)
  • Volunteer to help with active recess. Schools need all the community volunteers they can get in today's budget landscape. Get kids having fun with old-fashioned or new-fangled games.

Thursday, March 25, 2010

What to do - 4 of 5 - Support Healthy, Hunger-Free Kids

School nutrition hit the news in a major way today. As Congress moves to reauthorize the USDA Child Nutrition Programs (school breakfast and lunch, childcare meals, WIC, etc.), the Healthy, Hunger-Free Kids Act was introduced in the Senate.

While many details remain to be worked out (including funding levels), it is very clear that there is plenty of backing for expanding and enhancing these critical programs that help all children be well-nourished and ready to succeed.

It's exciting to hear so much support for funding more nutrient-rich meals, for encouraging local foods in school cafeterias, and for promoting school gardens. I know from my work with schools districts across the country that when children have access to these options, they eat them up! And, while these programs are important for all kids - they are an essential lifeline for low-income, at-risk children.

School nutrition directors are eager to have the funding and the mandate to take even more actions for healthy kids in their schools. You can urge your Congressional representatives to champion these efforts as one important way to promote healthy weights for all children. For more details, read the Comments page posted here - or follow the progress of Reauthorization at FRAC (Food Research and Action Center).

Wednesday, March 24, 2010

What to do - 2 of 5 - Speak Out in Professional Groups

Every health and education group associated with children is talking about the issue of childhood obesity (C-O) right now. If you have concerns, let the leadership know. If you belong to the American Dietetic Association, send a message to ADA President Jessie Pavlinac at ADAPresident@eatright.org. (If you send a message, please share it as comment here - so that others may be inspired to do the same.)
That's all I did last week to express my concerns about National C-O Awareness Month. You can read Jessie's response under comments to my March 20th post (bottom of this page). I was very pleased with this assurance:
We will direct our Washington staff to raise these concerns on our behalf and encourage our elected leaders in the House and Senate to follow ADA’s example of delivering a positive message that will resonate and motivate rather than alienate those children who are at risk or suffering from the stigma of obesity.
By speaking out, I have realized how many ADA colleagues share similar concerns and learned about ways that they are taking action. National Nutrition Month seems the ideal time to reinforce positive, inclusive approaches to healthy habits for all children ... from the ground up.

Tuesday, March 23, 2010

What to do - 3 of 5 - Contact Congress About Obesity Awareness Month

The resolutions to designate September as National Childhood Obesity Awareness Month are currently in House and Senate Committees. Here are the details and links to bills on THOMAS:

House Resolution 996

  • Title: Expressing support for designation of September as National Childhood Obesity Awareness Month.
  • Sponsor: Rep. Marcia Fudge (Ohio-11)
  • Latest Major Action: 12/19/2009 Referred to House Committee on Energy and Commerce.

Senate Resolution 412

  • Title: A resolution designating September 2010 as "National Childhood Obesity Awareness Month".
  • Sponsor: Sen. Kirsten Gillibrand (NY)
  • Latest Major Action: 2/9/2010 Referred to Senate Committee on the Judiciary.

To learn more about each resolution, go to THOMAS and search on the bill number.

What to do:

Contact your Senator and Representative – and/or the sponsors – to express your opinion about the resolution.

  • Send the same comments that you made to the Federal Task Force – about the dangers and unintended consequences of focusing even greater attention on childhood obesity. (Need to find their contact information? Search for their website and use online feedback form.)

  • Explain that there are already PLENTY of observances for September (www.healthfinder.gov/nho/nho.asp#m9) and many of them could be used to promote healthy habits for all kids, including Fruits and Veggies-More Matters Month, Whole Grains Month, and my personal favorite Yoga Awareness Month.

Monday, March 22, 2010

What to do - 1 of 5 - Comment @ Regulations.gov

This week, through March 26th, we all have an unprecedented opportunity to shape the future of Federal efforts on children and weight. An inter-agency Task Force on Childhood Obesity is seeking your comments. (My first comment was change the name to something like Task Force on Healthy Futures for Children.)

The process is very easy: Go to www.regulations.gov/search/Regs/home.html#submitComment?R=0900006480abe53d and fill in the blanks. The comment box has room for 2000 characters and you can also upload documents. You can submit multiple comments.

If you want to know more about the Task Force and their specific questions, read the Federal register at www.regulations.gov/search/Regs/home.html#documentDetail?R=0900006480abe53d.

Speak from your heart - from your personal experience and your professional expertise. Tell them about your work and positive programs that you support. The Task Force's work is built on four pillars:

  1. Ensuring access to healthy, affordable food;
  2. Increasing physical activity in schools and communities;
  3. Providing healthier food in schools; and
  4. Empowering parents with information and tools to make good choices for themselves and their families.

Actually, I support all four pillars, but I do not want them wrapped in a negative, stigmatizing shroud of childhood obesity. I want these efforts to be about healthy habits and healthy environments for children of all sizes, shapes, and weights. No fat boot camps, no biggest loser contests, and no fat vests for educational purposes.

I believe that effective programs must focus on all the reasons for kids to eat well and be active - great taste, body energy, brain power, school success, sports strength, and old-fashioned fun!

Saturday, March 20, 2010

Concerns About National Childhood Obesity Awareness Month

Dear American Dietetic Association Leaders and Colleagues on the ADA-HOD Childhood Obesity Prevention Coalition:

I have become increasingly concerned about some efforts to address childhood obesity and ADA's participation in those efforts. This paragraph in the March 15th
On the Pulse has prompted me to put my thoughts into a cohesive form.
The House and Senate are considering resolutions that would recognize September as National Childhood Obesity Awareness Month. ADA is working with Congressional leaders on passing these resolutions and on how ADA members can participate in Childhood Obesity Awareness Month activities.
I am a passionate, long-time advocate for optimal childhood nutrition and for healthy school environments. My professional work and much of my personal life is dedicated to ensuring that all children are fit, healthy, and ready to succeed. However, the current drum beat of childhood obesity is often negative and narrowly focused. I believe that we need to reframe the discussion to be positive and inclusive. We need to move from a focus on childhood obesity to a discussion of the healthy habits that promote achievable, realistic, healthy weights for children (and adults) of all shapes and sizes.

Based on a growing body of evidence, I am seriously concerned that "obesity awareness" may have unintended consequences. If we look at such an event from the perspective of an overweight young person -- the individual it is designed to help -- it may cause significant harm. This Monday's New York Times featured a very thoughtful essay on
For Obese People, Prejudice in Plain Sight (www.nytimes.com/2010/03/16/health/16essa.html). The final paragraphs apply directly to the question of childhood obesity awareness activities:

Dr. Bacon tells the story of an overweight teenage girl whose high school was going through a “wellness campaign.” Hallways were plastered with posters saying “Prevent teenage obesity.” After the posters went up, the girl said, schoolmates began taunting her in the halls, pointing at the obese girl on the posters and saying, “Look at the fat chick.”

She said heavier students were now made to feel guilty about their lunch choices, but the thin ones could eat anything they wanted without comment — even if it was exactly what the fat kids were eating.

“Stigmatization gives the thinner kids permission to think there’s something wrong with the larger kids,” Dr. Bacon, the nutrition researcher, said. “And it doesn’t help them look at their own health habits. There’s got to be a way to do this more respectfully and more effectively.”

I am absolutely in favor of programs to encourage delicious Nutrition from the Ground Up and fun ways to make Let's Move be part of every family's weekend plans. However, I strongly believe that any efforts to address childhood obesity should not cause more problems, especially for young people who already vulnerable from being teased or bullied.

My voice is just one of many who are concerned about the current course of action. Before you make any childhood obesity awareness plans, please watch this profound video (featuring young actors) made by the Rudd Center at Yale: www.youtube.com/watch?v=92rWQ-OIb1Y&feature=related. The Rudd Center's distinguished experts argue persuasively for a scientific and thoughtful examination of the effects of weight stigma and bias, especially when it comes to vulnerable youth like those portrayed in the video (www.yaleruddcenter.org/what_we_do.aspx?id=10).

Pasted below is an essay that Dr. Rebecca Puhl from the Rudd Center (who spoke at FNCE in 2009) posted last month on Medscape directly addressing the connection between weight and school performance. Please read it: The study she discusses and her conclusions may surprise you.

For me, the goal will remain what can we do to help young people of all weights, shapes, and sizes to be healthier, happier, and perform better academically? With all our expertise as the American Dietetic Association and as a profession, I know that we can find many ways to do this respectfully and effectively. ADAF's RD Coach program and the Healthy Schools Partnership are an excellent example of an effective, health-centered model.

Let's celebrate positive actions for all young people and their families this September. Personally, I could really get behind Kid's Eat Smart Month (perfect for back to school) or Family Food, Fun, and Fitness Month (lining up with Family Day: A Day to Eat Dinner with Your Children on September 27th).

Thanks for taking the time to thoughtfully consider these issues. Please feel free to contact me about them at any point. You may share this letter with anyone. I plan to share it widely with other ADA members, colleagues in school nutrition, and my Congressional representatives in urging them to vote NO on childhood obesity awareness month. Childhood obesity is much more than a current political buzz phrase; it involves the the emotional well-being, the physical health, and even the educational futures of millions of American children.



Dayle Hayes, MS, RD


Why are Obese Kids Performing Worse in School?
Rebecca Puhl, Feb 11, 2010
In the past few years, there have been increasing studies reporting that overweight and obese children have poorer school performance than their normal weight peers. While this may be true, these findings are often interpreted without consideration to the psychosocial factors that may play a mediating role, and have instead pointed to missed school days as a result of ill health associated with obesity, or even inferior cognitive abilities among obese youth. A few studies speculated that weight-based victimization could be an important variable to examine, but none had studied it.

As more of these studies appeared in journals, I became increasingly concerned about the potential take-home message that obese youth are cognitively inferior to normal weight youth. The stigma stemming from such findings could be considerable, and would be yet another harmful outcome in addition to the emotional and social consequences that obese children already face as a result of stigma.

But recently, a study was published in the International Journal of Pediatric Obesity (1), that examined the links between body weight of children and their academic performance. The authors conducted a random parental telephone survey of 1,071 public school students in Arkansas, and like other studies before it, found that overweight status was a significant predictor of poorer school performance. However, the authors also specifically assessed whether weight-based teasing predicted poorer school performance. They found that it did, with worse school performance among overweight children who were teased about their weight. This is the first published study I've seen that identifies weight-based teasing as a possible mediator in the relationship between children's body weight and their academic performance. And it makes so much sense.

Obese children aren't doing worse in school because they're not as smart as thinner students. They're doing worse in school because they face frequent (and often daily) victimization and harassment from peers because of their weight. (2) They are afraid to walk down the hallways because of negative remarks they receive from schoolmates. They are made fun of in physical education classes, mocked in the school cafeteria, and teased on the bus. Anecdotes from participants in our own studies also suggest that many students skip classes or miss days of school because of this torment. And we already know that overweight and obese youth who are victimized because of their weight have higher risk of depression, anxiety, low self-esteem, poor body image, and suicidal behaviors. (2) How could this not impact school performance?

My hope is that more studies like this will continue to surface, and that we can increase awareness among educators, health providers, and policy-makers that weight-based teasing and victimization is a widespread problem facing today's overweight youth, and that is has real consequences for their emotional well-being, their physical health, and even their educational futures.

1. Krukowski RA, Smith West D, Philyaw Perez Z, Bursac Z, Phillips MM, RAczynski JM. Overweight children, weight-based teasing and academic performance. Int J Pediatr Obes. 2009; 4(4): 274-280.

2. Puhl R, Latner J. Obesity, Stigma, and the Health of the Nation's Children. Psychological Bulletin, 2007; 133(4) 557-580.