Full Potential Obesity :: Nationwide Children's Hospital

Obesity Trends

Over the past three school years, body mass index (BMI) screenings of kindergarten, third grade and fifth grade children in Columbus City Schools have revealed that an alarming percentage are overweight or obese.

  • a. BMI of 85-94% = overweight
  • b. BMI of 95% or above = obese
  • Source: All data provided by Columbus City Schools.

29 percent of kindergarteners, 38 percent of third graders and 47 percent of fifth graders were overweight or obese in 2009-2010.

Healthy Habits Become a Lifestyle When They’re Fun

Selena Rios was introduced to fitness training and nutrition concepts in an after school program, where the fun and friendly environment made the effort a blast.

Selena participated in a fitness and nutrition afterschool program at Lincoln Park Elementary School during third grade. Among her accomplishments over nine months were increasing the number of sit-ups she could do by 500 percent and boosting her aerobic capacity 36 percent. But if you ask Selena what she did in the program, she’ll tell you simply, “fun things.”

“What I liked best was playing games and meeting new friends,” says Selena. “We were a team and helped each other out.”

Selena’s mom, Reyna, has seen many positive changes in Selena since she began the program and started practicing what she learned at home. She says her daughter is happier, more content and much more active. “At home Selena will make up her  own activity plan,” Reyna explains. “Every Sunday we go out and she rides her bike or takes a walk.”

Selena is also making better nutritional decisions all on her own. Instead of eating three tortillas at dinner, she now chooses to eat one. And, Selena’s nutritional knowledge is wearing off on the family. Reyna has always encouraged her four children to eat fruits and vegetables because they are healthful. Now, they share their new nutritional wisdom with her: “Eat broccoli because it  doesn’t have any fat.” “Fish is good for your brain.” “Don’t eat pizza; it has too much fat.”

“I eat fruits and vegetables every day and play outside for 30 minutes.”

– Selena Rios

What We Know About Kids and Obesity Today

Over the past three decades in the United States, obesity in children and adolescents increased three- to six-fold, with the rate of increase dependent on age, gender and ethnicity.

We are beginning to realize the tremendous costs of obesity on the individual level and to the health care system now that the first wave of obese children has reached adulthood. Overweight children run a higher risk of having obesity-related conditions while they are still children. And,  they are more likely to grow up to be overweight or obese adults with serious health problems.

  • 1 in 3 kids in Franklin County is overweight, and 1 in 4 is obese.
  • 1 of every 3 kids will have type 2 diabetes in his or her lifetime.
  • Overweight kids are often teased and struggle to keep up with their friends.
  • Because of weight and health problems, kids today are expected to have a shorter life than their parents.

What It Will Take to Change the Numbers

Preventing pediatric obesity and helping children and adolescents who are overweight and obese lose weight are the most important health mandates of our time. To address them, we must fundamentally change how our society approaches eating and exercise. While genetics  also play a role in obesity, the obesity epidemic can be attributed generally to the abundance of  taste appealing, high calorie foods combined with the growth of a lifestyle in which physical activity is not essential.

Changing these factors requires intervention on many levels. Some of the most important  interventions we can undertake are within the school system, where children spend much of  their time and take in a large percentage of daily calories. We are making progress on the state and local level in improving fitness and nutrition in our schools. Following are some of the  initiatives and programs that are helping.

Fitness and Nutrition in Our Schools

Building the Foundation: Healthy Choices for Healthy Children Legislation

On June 18, 2010, legislation called “Healthy Choices for Healthy Children” was signed into law. The legislation will address childhood obesity using research-based solutions in the school  setting where it will have immediate impact. This legislation is a signifi cant step forward for Ohio, which:

  • Counts 1 in 3 children as overweight by the age of 8.
  • Ranks 13th in the nation for adult obesity and hypertension rates.

Healthy Choices for Healthy Children is designed to improve the nutritional value of foods in vending machines and a la carte cafeteria items offered during the regular and extended school day. The law also raises the bar for physical education standards, and it includes a pilot  program for providing 30 minutes of physical activity during every school day that schools can opt into.

The legislation also requires body mass index (BMI) screenings when children first enter school  and in the 3rd, 5th and 9th grades. Parents will be notified confidentially about their child’s BMI  score and receive education about the health risks associated with a BMI indicating overweight  and obesity.

The purpose of BMI screening is to educate kids and parents about the value of making healthy  lifestyle choices. By knowing their child’s BMI, parents of an overweight or obese child can work  with the child’s doctor to intervene before he suffers long-term health problems. The screenings will be mandatory beginning in the 2011-2012 school year.

Lastly, the new law establishes a Healthy Choices for Healthy Children Council to monitor  progress, make recommendations and keep educators apprised of resources, best practices  and new developments in science and nutrition.

The bipartisan legislation was supported by the Healthy Choices for Healthy Children Coalition,  a group of state leaders in business, health care, education, child advocacy, fitness and nutrition co-led by Nationwide Children’s Hospital CEO Steve Allen, MD, and Cleveland Clinic CEO Toby  Cosgrove, MD, as co-chairs of the Ohio Business Roundtable Childhood Obesity Task Force.

With the new law providing for a healthy environment in the schools, the stage is set for  broad-based programming locally to help change our community’s culture to one that embraces a healthy, active lifestyle.

Columbus City Schools Wellness Initiative

Columbus City Schools has been conducting model fi tness and nutrition programs in advance  of the Healthy Choices for Healthy Children legislation – including being one of only a few school systems in the nation to measure BMI regularly. The district has developed an effective and  sustainable wellness initiative based on the Coordinated School Health Model to create the  healthiest school environment possible.

Incorporating the knowledge that students perform better when they are healthy, the wellness  initiative has launched a variety of programs and improvements, including:

  • BMI screenings for kindergarten, and third and fifth grade students.
  • Acanthosis Nigricans screening in collaboration with Nationwide Children’s Hospital’s Center for Healthy Weight and Nutrition. Acanthosis Nigricans is a darkening of the skin that is a marker for high levels of insulin in the blood that can help identify early metabolic changes associated with increased weight.
  • Water-only options in all student accessible vending machines.
  • Improved nutritional standards in the Food Service Department: beverages, other than water, are served in restricted serving sizes and include low fat milk and 100 percent juice only.
  • Fresh fruit/vegetable bars at all secondary schools.
  • Development of an enhanced health education curriculum.

Students spend 25 to 30 percent of their day and get 35 to 50 percent of their daily calories while at school.

Fitness and Nutrition Club (F.A.N. Club)

F.A.N. Club is a 30-week, afterschool fitness training program combined with a social cognition-based nutrition program for high risk and obese children. The program is a partnership between Nationwide Children’s Hospital, Columbus Public Schools and Mount Carmel College of Nursing.

F.A.N. Club was launched in June 2008 at Livingston Elementary School. During the 2009-2010  school year, a total of 98 children participated from Livingston, Lincoln Park and Avondale  Elementary Schools.

Among the participants, 35 took part in a pre- and post-program evaluation of fitness and BMI. As a group, these students:

  • Increased their aerobic endurance by 27 percent.
  • Increased their strength.
    • Average number of pushups increased 31 percent (an increase of an average of approximately 2 pushups per student).
    • Average number of curl-ups increased 41 percent (an increase of an average of approximately 4 curl-ups per student).
  • Students also increased their knowledge of nutrition and maintained their BMI.

A fourth school, Linden Elementary, also rolled out the F.A.N. Club at the beginning of the 2010-2011 school year. Plans for F.A.N. Club include expanding the program to serve 500 or more children each year at 20 Columbus City Schools locations.

2009-2010 School Year F.A.N. Club Results

  • Financial support for F.A.N. Club has been provided by Abbott Nutrition, CareSource Foundation, Cardinal Health Foundation and Medical Mutual of Ohio Charitable Fund.

Next Steps

While this report has focused on school initiatives, a wide variety of programs and initiatives to combat childhood obesity are being conducted throughout our community – from developing more safe urban green space to increasing access to healthy foods. Future success depends on expanding the reach of these programs, as well as evidence-based new programs, throughout Franklin County.

Another area of opportunity lies with local employers that provide health insurance for their employees. These employers are encouraged to offer plans that reimburse health providers for obesity-related services for dependent children, something many health care insurance plans fail to do.

Nationwide Children’s Hospital is one of the first Ohio employers to participate in the Alliance for a Healthier Generation’s childhood obesity health care initiative, a collaborative effort with national medical associations, leading insurers and employers to offer comprehensive health benefits to children for the prevention, assessment and treatment of childhood obesity. Nationwide Children’s will provide eligible children ages 3 to 18 with access to at least four follow-up visits with their primary care provider and four visits with a registered dietitian per year.

  • Note: Numbers include unique patients seen at Nationwide Children’s Hospital with a diagnosis of obesity or abnormal weight gain.
  • Source: Nationwide Children’s Hospital

Personal Story Update

Being Healthy and Fit is the New Normal for Danny Gwirtz

When Danny was featured in Full Potential 2008, we learned that he was motivated to lose weight so other kids wouldn’t make fun of him. Mission accomplished.

Danny was able to lose weight after enrolling in a weight program for children that taught him about healthy eating and fitness. Now 16, Danny has fully integrated health and fitness into his daily life. “It feels normal to eat healthy food and exercise,” says Danny. “I eat way more fruits and vegetables than I did before, and I eat breakfast every day.” Eating three meals a day keeps him from snacking.

During the summer months, Danny works on a landscaping crew for his dad, which helps him stay motivated and fit. “I get better sleep, because I’m tired from the work. I’m more awake and alert during the day, and less likely to be lazy and slogging around.”

Danny’s success in becoming healthy and fit has improved his self-esteem. He is confident he can steer his future in the right direction through the choices that he makes. He plans to attend college, which he will pay for by joining the National Guard.

Danny likes to cook and watches the Food Channel. He just might own a restaurant in the future.

“In my own restaurant, I would serve locally grown food and educate people not to eat too many unhealthy foods, like hamburgers.”

– Danny Gwirtz


For the Family

Eat a quality diet.
Follow the U.S. Dietary Guidelines. Incorporate five servings of fruits and vegetables per day, try to use whole grains when possible. Include low-fat (skim, 1 percent, or 2 percent) dairy products, and concentrate on low-fat protein sources (lean meats, fish, beans and nuts). Limit consumption of juice, soft drinks, fast food and fried foods. Being aware of correct portion size is  also helpful. Portion sizes vary with age; for adolescents and adults, one-half cup generally represents one serving of pasta or rice and 4 ounces (the size of the palm of your hand) represents a serving of meat or protein. Remember that the amount of calories—especially in sugars and fats—that can safely be consumed each day depends on the person’s activity level.

Be better consumers.
Learn to read a food label and look for products with less than 30 percent of calories coming from fats, and seek out food with high percentages of vitamins and minerals. Reading the nutrition information panel will help identify empty calories—those with high calories but no vitamins or minerals. Eliminating empty calories helps ensure that every food and drink contributes to a quality daily diet.

Processed foods tend to be less healthful and should be avoided. You can identify processed foods as those containing multiple ingredients that are diffi cult to pronounce and possibly unfamiliar to you. Healthful foods tend to contain ingredients that are known to you. Shopping more around the outside edges of the grocery store (fruits, vegetables, meat, freezer, dairy sections) and less in the inside aisles (packaged foods) will promote a more nutritionally balanced diet.

Two helpful websites: www.nutrition.gov and www.snackwise.org.

Eat together as a family.
Restart the tradition of a family dinner together without the TV.

Cut sweet drinks.
Substitute sweet drinks and juices with water or other drinks with no calories. Non-fat (skim) milk and water are preferred drinks.

Know your child’s body mass index (BMI).
The American Academy of Pediatrics recommends using BMI to screen for overweight children beginning at age 2 and through age 19. Discuss your child’s BMI with your family doctor.

Stay away from fast food.
Eat fast food rarely. When you do, pick the restaurant and your food carefully. Look up the nutrition information (available at the counter) to know how many calories you’re eating. Stick to non-supersized portions. Downsize your selections using the junior menu. Add fruit or a baked potato rather than fries. Add vegetables and fruits at every opportunity. Avoid non-diet sodas and desserts. Share one meal with another family member.

For Schools

Measure and intervene.
Increase school-based BMI screening connected with the medical practices to form a seamless system of early identification and intervention.

Increase opportunities for physical activity.
Ensure daily recess is held in all elementary and middle schools. Implement Take 10! This program encourages taking two 10-minute breaks in the school day for moderate to vigorous activity in the classroom.

Ensure all food and drink choices are healthy.
School nutrition standards should be established for all non-USDA food in schools, including vended, a la carte, school store and fundraisers.

Advocate and provide learning opportunities.
Schools should incorporate healthy eating and physical activity behaviors into their lessons.  After-school programs will provide nutritious food choices and a safe environment for learning  and physical activity. Parents, school agencies and schools should advocate, support and implement programs that provide a healthier environment.

Columbus City Schools is making great progress in these areas. The Healthy Choices for Healthy Children legislation provides additional support throughout Ohio.

For Other Organizations

Healthy lifestyle behaviors start early.
Meals and snacks at childcare centers should comply with the USDA guidelines. Childcare providers need to be trained on best practices in nutrition and physical activity for the young child.

Faith-based organizations can reach out to families.
Faith-based organizations are a trusted source of support for families. They offer an excellent venue for screening, educational and health promotion programs.

Health care providers need to screen all children for obesity.
Along with screening children using body mass index, they should counsel families on strategies to prevent childhood obesity. Health care providers should receive training on evidenced-based obesity management guidelines. In addition, they must be involved in basic, translational and clinical research programs that advance our knowledge of causes, prevention and treatment of childhood obesity.

For Communities

Neighborhood groups are credible advocates.
Along with working toward safe sidewalks, parks and neighborhood physical activity programs, neighborhood groups can work in collaboration with stores and local farmers to increase availability of fresh fruits and vegetables.

The food industry can help improve food choices.
The food industry should offer a variety of healthy food options and provide information on nutrient quality, e.g., require restaurants to list calorie content of food items.

Employers must get in on the action.
Businesses should support employee activity through corporate steps challenges, Eco-bucks programs, walking and cycling clubs during lunch hour, and other programs that get people moving. Employers also can provide comprehensive health benefits for the prevention, assessment and treatment of childhood obesity.

For Society

Engage the media to increase awareness about obesity and co-morbid conditions.
Also, assist with health promotion messages on healthy lifestyle behaviors.

Implement a comprehensive community plan.
Community leaders, business leaders, hospitals, government and other stakeholders need a coalition to develop and implement a Columbus community plan to promote optimal nutrition and daily activities.

Support the recommendations of the Ohio Activity Plan.
This program of the Ohio Parks and Recreation Department will include communities working on creating a built environment that entices its citizens outside using parks, walkways, bike and roller-blade paths and skateboard parks. Building downtown grottos that showcase sculpture, fountains and park land to draw workers and visitors out onto the streets is also advocated.

Advocate for local, state and federal government policies.
Enact policies that create and improve resources for physical activity in schools, workplaces and neighborhoods. Advocate for legislation that supports reimbursement for obesity-related office visits; improve access to nutritious food choices for children who are affected by food insecurity; and promote diversification of healthy and culturally appropriate food options in the Women, Infants and Children (WIC) program.

Support legislation to improve the built environment in communities, such as safe sidewalks. There must be uniform access to green spaces, parks and recreation centers in all communities.

Note: Recommendations were developed by physicians at the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital and incorporate several recommendations from “Healthy & Fit: A Community Action Plan for Franklin County Children & Families,” by the Osteopathic Heritage Foundations and Children’s Hunger Alliance.

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