Rolling back obesity

When CARE: Community Alliance for Research and Engagement was launched several years ago, one of its first tasks was to collect data on the health of New Haven’s residents, including the city’s children.

CARE knew problems existed, but still, the results were sobering.

Many students in the public schools, even those in early grades, already had pronounced weight problems that, left unchecked, would likely carry over into adulthood and result in a lifetime of chronic disease. Specifically, half of the local fifth- and sixth-grade students in the public schools were either overweight or obese. The rate for their peers nationwide is about one in three.

And the troubling statistics didn’t end there. The 2009 survey also revealed higher-than-average rates of hypertension, diabetes and asthma.

Local education officials note that children who are struggling with poor health generally don’t perform as well in school. They are tired more often and can’t sustain their attention for long periods of time. This health disparity, in turn, results in an educational disparity and, eventually, in an economic divide that some contend is growing ever wider. 

“These issues of childhood obesity are really so profound,” says Jeannette R. Ickovics, Ph.D., professor and director of the Social and Behavioral Sciences program and CARE’s director. “When changes of this magnitude take hold in the population it is clear that there can’t be just one cause, so there can’t be just one solution.”

A growing partnership

To address something as complex as childhood obesity, CARE has developed a range of in-school programs while it also conducts original research on health and academic performance. This partnership, in turn, is blurring the traditional town-gown boundaries and building the foundation for CARE’s long-term goal: a healthier New Haven.

Part of the solution is to make healthier food available and accessible in the schools and in the communities where the children live, and such changes are being made. But other measures are just as crucial, including programs that promote physical activity and other healthy lifestyle habits. CARE, meanwhile, is working to strengthen existing and emerging programs already initiated by New Haven’s District Wellness Committee.

“We’re pushing schoolwide campaigns,” explains Susan Peters, M.P.H. ’97, M.S.N. ’97, CARE’s senior program director for school initiatives and co-chair of the committee. “There have always been a lot of isolated and fragmented interventions. They have less impact without the synergy and coordination of the entire school and teaching staff.”

A cornerstone of this outreach is the Health Heroes program, which has already been implemented in several schools, with more expected to follow. The program can be tailored to address a health issue that is unique to a school and it can also be used to reinforce other social needs. One school, for example, has used a Health Heroes challenge to improve behaviors as part of its anti-bullying campaign, while other schools have used it to stress increasing physical activity and reducing the amount of time children spend immobile in front of televisions computers. Adults in the schools took notice. By popular demand, the program was expanded to include staff and families.

To date, more than 500 students, some 200 families and 60 staff members have completed at least one of the challenges posed by Health Heroes. For students who complete more than one, the possibility of a significant award, such as an iPod or bicycle, is offered.

While there is flexibility in the challenges offered by Health Heroes, they all share a common theme: developing healthier habits at a young age. Among the specific challenges students and others can accept are eating more fruits and vegetables, getting eight to 10 hours of sleep nightly, eating meals with family, drinking water instead of sugary beverages and engaging in at least 30 minutes of daily exercise.

Will Clark, chief operating officer for the New Haven Public Schools, says that CARE’s involvement in the schools has made measurable progress and that he looks forward to continued successes.

“CARE has become a valuable partner,” he says. “It offers that larger view and it brings additional expertise into the process of vetting, managing, monitoring and judging what everyone is doing, not just its own interventions.”

Indeed, CARE’s programs seek to build upon health-related efforts that were already part of the city’s school system. Such policies are required by federal law, and a 2008 ranking by the Yale Rudd Center for Food Policy & Obesity found that New Haven’s policies were the best in of all of Connecticut’s 166 public school districts.

“New Haven deserves a lot of credit. The district made the commitment to change its food environment,” says Marlene B. Schwartz, Ph.D. ’96, the Rudd Center’s deputy director. “Most importantly, New Haven removed all competitive foods, including a la carte items and vending machines. The only options are the school lunches that meet nutritional standards. But despite these huge changes, students in New Haven are still at extremely high risk for weight related health problems.”


Healthier schools/better students

Why does all of this matter? Beyond the future health of students as they grow into adulthood, a pilot study by CARE researchers indicates that health and academic performance are closely linked.

CARE and its partners have found that students with healthier personal practices (the top three being no television in their bedroom, less fast food in their diet and maintaining a healthy weight) are more likely to perform better on the Connecticut Mastery Test, a key indicator of whether students are achieving the academic benchmarks for their age and grade. The jump in test scores is most pronounced among children in the top one-third of students, that is those who have nine or more healthy practices among the 14 measured.  Those in the top one-third of students are 2.2 times more likely to achieve goal on reading, writing and mathematics compared to those in the lowest one-third of students.

To better understand the relationship between health and school performance, researchers are beginning to look closely at the implementation and effectiveness of the District Wellness Plan across the city’s public schools. With a $3 million grant from the National Institutes of Health, body mass index and behaviors associated with being overweight in a cohort of fifth-grade students across 12 schools will be measured over five years.

In addition, the research team will collect behavioral information and school-related outcomes, such as test scores, grades and absenteeism and truancy rates. Schools were randomized to receive an array of interventions: three schools will implement focused physical activity interventions, three will implement focused nutritional interventions, three will implement both nutrition and physical activity interventions, and three will be delayed intervention schools but will have the opportunity to implement district-level changes that naturally occur. The study is structured to differentiate between the classroom environment and the school and to highlight variations between the focused interventions. 

The findings will likely inform future decisions about how to promote health among schoolchildren and have implications for how New Haven spends its education dollars.

 “Ultimately it comes down to limited resources and what you can spend your money on—better computers, specialty teachers or better food in the cafeteria,” says Schwartz. “You have to have evidence that spending money in the cafeteria is going to pay off.”

Curtailing obesity, promoting better health and improving academic performance are ambitious—and interrelated—goals, Ickovics notes. And it will take years of sustained effort to change the status quo, but the investment is worthwhile if it stems the tide of poor health in the city and better positions young people to succeed in the classroom and to compete in college and beyond.

“The strong cumulative effect of factors may explain why we have failed up to now in public health,” says Ickovics. “It is changes in the classroom, the gym, the cafeteria, the playground, at home and in the community that suggest that more is better.”

This story originally appeared in the Yale School of Public Health magazine. Click here to read more stories from that issue.

Contact Michael Greenwood [email protected] 203-737-5151