South Dakota’s approach to the problem of overweight and obese children has been like that of a chronic dieter: lots of optimism and goals, with some action, but not enough to shrink the numbers on the scale.
Lightly funded, scattershot coverage of the state by public and private programs aimed at reducing the prevalence of overweight and obese children has helped some, but there has been no noticeable overall progress, according to several statistical analyses.
The state Department of Health grew concerned about childhood obesity 17 years ago and began collecting student height and weight measurements from dozens of schools. Back then, 32 percent of the children were considered overweight or obese.
When the latest annual figures were released this year, the proportion of overweight or obese children in the state once again registered 32 percent.
The intervening years saw little variance. There were only 2.5 percentage points of difference between the best year, 2011, when 31.3 percent of students were overweight or obese, and the worst year, 2006, when 33.8 percent were overweight or obese.
Many of the public and private officials involved in child-health issues describe the flat trend as a victory, albeit a minor one.
“I guess the way we see it is, we’ve been maintaining, so to speak, which we feel is a small success,” said Larissa Skjonsberg, director of the Nutrition and Physical Activity Program for the state Department of Health and a contributor to the annual School Height and Weight reports.
Nationwide, there has been more variance in the percentage of overweight and obese children, but not much more. Since 2000, the national rate has ranged from 28 to 34 percent annually.
Children are considered overweight if their body-mass index is between the 85th and 94th percentiles for their age and gender, and obese if their body-mass index is at or above the 95th percentile. Body-mass index is calculated by dividing weight in pounds by height in inches-squared, and then multiplying the result by 703.
Reach of government programs limited
To get the trend of overweight and obese children scaling downward, Skjonsberg recommended more funding to expand the reach of existing programs.
The federal Team Nutrition grant program, for example, funds a number of South Dakota projects in and out of schools, but the projects reach only a fraction of the state’s estimated 200,000 children.
The state has received $1.7 million in Team Nutrition grants since 2001. The state redistributes the money as sub-grants to various projects intended to encourage healthier eating and exercise habits among South Dakota children, but there is only enough sub-grant money to reach a few dozen schools or out-of-school programs per year.
The projects, with names including Smarter Lunchrooms, Harvest of the Month, and Farmers Grow MyPlate, help schools apply research-based lunchroom modifications that encourage healthier eating; educate children about healthy food and provide them with fruits and vegetables to sample; and take kids on farm field trips while teaching them about the MyPlate federal nutrition guidelines, which replaced the old pyramid-style guidelines.
A recent flyer for South Dakota’s Team Nutrition programs says there are about three dozen total sub-grants available. Karlys Wells, a Cooperative Extension associate at South Dakota State University who is involved in the subgrant process, said surveys show that the projects improve the attitudes and habits of participating children, but the number of participants is limited.
“We have some behavior changes, yes,” Wells said. “Not enough, but some.”
Nonprofit efforts also limited
Private entities have tried to augment the government efforts. One example is the national nonprofit Alliance for a Healthier Generation, which brought its Healthy Schools Program to South Dakota in 2012. The program has caused improvements in participating schools, but it works directly with only 20 of the state’s 150 school districts.
One of the participating schools is Knollwood Heights Elementary in Rapid City, where first-grade teacher Ashley Berg and second-grade teacher Meghan Barrows voluntarily shepherded the program. With help from the Alliance, a committee at the school has incorporated more fresh fruits and vegetables into school breakfasts and lunches, created extra recess time and started a Wellness Wednesday assembly.
The school also participates in Fuel Up To Play 60, a project of the National Dairy Council and the National Football League, which provides additional funding for efforts such as fruit and vegetable sampling, and encourages an active lifestyle with a goal of playing an hour per day.
Berg said many students at Knollwood learn bad eating and exercise habits at home, and statistics support her observation. The proportion of overweight and obese adults in South Dakota has remained between 60 and 70 percent every year since it first topped the 60 percent threshold in 2002.
"They don’t have a lot of opportunities to learn new things unless they’re introduced to it at school or through other programs,” Berg said. “So we’re trying to give them an introduction to it.”
Berg said it takes committed faculty members to get a wellness program up and running at a school, and she hopes more will take on the challenge.
Kari Senger, the Alliance’s Healthy Schools Program manager for South Dakota, said the number of schools she can work with is dictated by the Alliance’s funding. She said the Alliance tries to build up a “structure” at each school to address childhood obesity and health issues; after that structure is built, schools transition to website-only support, and other schools are recruited to receive direct support.
School food fight
The elephant in any room in which childhood obesity is discussed is school food. The number of U.S. children who eat breakfast at school has grown to nearly half the number who eat school lunch, making the government responsible for two out of three of many children’s daily meals during the school year.
Healthier school food standards adopted by Congress in 2010 were supposed to represent a bold new approach to childhood obesity, and while some say the standards are working and hold continued promise, others have attacked them for raising school food budgets, increasing food waste, leaving kids who refuse to eat the healthier food hungry, and leaving athletically active kids unfulfilled.
U.S. Rep. Kristi Noem, R-S.D., has been among the loudest critics and is supporting pending legislation to scale back some of the standards. She said the federal government is too involved in requiring what goes on students’ plates, and those requirements are driving up costs for school districts.
Easing the food requirements, Noem suggested, would free up resources that could be redirected to wellness education, which she thinks would be more effective at reducing childhood obesity.
“Programs that educate them on healthy lifestyles and nutritional values would be much more beneficial,” Noem said in an interview last week, “than passing down regulations for a school lunch program that just dictate what gets put on the plate and how much there can be of it.”
Goals repeatedly missed
As the debate over school food continues in Washington, and as public and private child-health programs continue to operate with limited funding, discouraging statistics about overweight and obese children continue to pile up.
Both national and state health officials have proposed goals focusing on the more severe condition of obesity, which can put children at higher risk of high blood pressure, diabetes and other problems including premature death. But rather than the goals influencing the trend, the trend has influenced the goals.
At the national level, the Department of Health and Human Service’s Healthy People 2010 initiative proposed a goal to reduce the national proportion of obese children to 5 percent. That goal was missed, and the Healthy People 2020 initiative has since changed the goal to 14.5 percent. The actual proportion of childhood obesity in the nation now stands at 17 percent, according to the most recent data.
The South Dakota Department of Health set a goal of reducing the proportion of obese children in the state to 15 percent by 2010. After that goal was missed, the department changed the goal to 14 percent and pushed the date back to 2020. The actual proportion of childhood obesity in the state now stands at 16 percent, having never gotten below 15.2 percent in 17 years of data collection.
As 2020 approaches, another potentially missed goal looms, and along with it some of the justification for continuing to label a flat trend a success.
“Obviously,” Skjonsberg said, “more needs to be done if we really want to see a drastic decrease.”