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Illinois School Board Journal
July/August 2007
Barbara P. Klein is professor emeritus of food science and nutrition and co-director of Illinois Soy Foods Center and Vijaya Jain is director of community nutrition services, National Soybean Research Laboratory, both at the University of Illinois at Urbana-Champaign.
It's no secret that obesity is a critical health concern for adults and children nationwide. In a 2005 report from the Institute of Medicine, Childhood Obesity: Health in the Balance the major findings were:
The actual numbers are frightening: more than nine million children older than 6 are considered "obese." This represents a substantial change in prevalence of obesity since the 1970s. The percentage of elementary school children who are obese has tripled, and for high school students, the incidence has doubled. Even preschoolers are twice as likely to be overweight today.
In Illinois, 60 percent of adults are overweight or obese and 30 percent of low-income preschoolers are overweight. A significant proportion of these children will develop type 2 diabetes, as well as joint problems and cardiovascular disease, in their lifetime.
National health care costs related to overweight and obesity are estimated to be more than $100 billion per year. In Illinois, obesity-related health care costs are more than $3.5 billion.
Where to begin
So how do we combat this epidemic? It will not be an easy fix. Although federal, state and local governments can require better programs for nutrition, school foods, physical activity and health, concern must start in the family setting and extend to the schools.
But schools play a special role in helping children and parents learn about good health and nutrition practices, as well as increasing the opportunities for physical activity in and out of school hours.
What can schools do to specifically address the issue of obesity? Perhaps the easiest advice is for schools to promote the concept of energy balance. If we can increase the energy expenditure of children during and after school, it will counter some of the excess caloric intake.
In spite of Illinois' physical education requirements, few children approach the recommended minimum of 60 minutes of moderate to vigorous physical activity daily. Waivers of daily physical education are routinely requested for a variety of legitimate reasons, but the fact remains that one of the best ways to control weight gain is by maintaining an active lifestyle. Schools must find ways to incorporate physical activity into the classroom through a variety of short exercises.
Some of the easier ways to achieve this are including games and activities in the existing curriculum and upgrading physical education classes. While occasional physical activity fairs and events provide important information, they must be replaced by more daily activities whenever possible. Buffalo, New York, successfully introduced "The Walking School Bus" program, which enables children to walk safely to school, instead of riding in a bus or car.
Mandated health and wellness programs are present in Illinois schools, and include physical activity and nutritional components. Many districts are looking with a keener eye at what foods are available to students at school, both in the cafeteria and in the classroom as treats and rewards.
But when it comes to feeding elementary and high school students, there are many challenges.
More than 29 million children eat lunch in school, and receive free and reduced price meals every day through the National School Lunch Program (NSLP). At least 880,000 children in Illinois are eligible for free or reduced cost meals — 47 percent of our school children.
The NSLP provides balanced and nutritious meals to children of low-income families. This is particularly important because socioeconomic status is related to food insecurity and risk for obesity. Improving the nutritional profile of food served in schools should improve the health of the children most at risk for becoming overweight or obese.
The U.S. Department of Agriculture (USDA) sets the nutritional guidelines for the NSLP, but the specific foods and how they are prepared are up to the local school food programs. Schools receive reimbursement for meals and receive other entitlements, such as commodity foods and regulations are numerous. But even more challenging is the children's response to what appears on the lunch line.
Competitive foods, or foods of minimum nutritional value, have been banned from schools during regular breakfast and lunch periods in Illinois. However, audits of school lunches still reveal high fat, saturated fat and cholesterol on many menus.
Room for improvement
So what can schools do to improve?
The successful implementation of effective measures and policies in any organization must begin at the top. School boards, administrators and principals are the key groups who need to take ownership in dealing with the problem of childhood obesity. They can then successfully involve teachers, parents, students, food service providers and other groups to plan and implement suitable strategies to combat the problem of childhood obesity.
Banning the sale of junk foods and sodas and replacing them with healthier options such as 100 percent juices, low-fat milk, water and healthy snacks is one step. Another is to help parents recognize that educating children about eating right is part of their job, and they should encourage students to choose the right foods during the school lunch period. Educating children who bring a bag lunch about foods of minimum nutritional value might help them make better choices of what to bring.
Produce from local farmers, especially fruits and vegetables, should be included in school lunches and snacks. This serves a dual purpose: providing healthier options for children and supporting local farmers.
Many schools have improved the nutritional profile of the school lunch by including a salad bar. Studies show that when children are offered healthier options such as salads, fruits and whole grains, they will choose these healthy foods. The elimination of high-fat, high-sugar items and inclusion of healthier choices on a daily basis can help children learn how to select a wise diet.
Other school activities like gardens, trips to local food markets and grocery stores, and cooking classes have enabled children to understand the need for making better food choices and enjoy these items.
Parent-teacher organizations also should be cautious about fund-raisers that feature high-fat/calorie-laden foods — this sends a mixed message to students about what is appropriate for nutritious eating.
Another step is to consider changing the composition of what students are fed.
Consider soy
Soybeans, a major crop in Illinois, have been grown and eaten in Asia for centuries, and their health benefits are well documented. While we recognize that no single food is going to provide magical nutritional benefits, we know that soy foods can fit into many recipes with the benefits of reducing fat calories, saturated fats and cholesterol.
For children with lactose intolerance or milk allergy, soy is a valuable alternative. About 3.5 percent of children are allergic to milk protein, and lactose intolerance occurs in an estimated 75 to 90 percent of African-Americans, Native-Americans and Asian-Americans. Soy allergy occurs in a much smaller percentage (about 1 percent) of the population of school children and adults.
Traditional soy foods, such as soymilk, tofu, tempeh, and miso are common ingredients in Chinese, Japanese and Korean recipes. But, these foods are hard to incorporate into a school lunch menu in the U.S.
Modern soy foods include soymilk, soy-based meat alternates, soy cheese and soy yogurt. These are alternative protein foods that can supplement or replace higher-fat meats and cheeses and are permitted by USDA.
Several recent studies have shown that soymilk or soy-enhanced foods are acceptable to preschool and elementary school children. The variety of available soy products — ranging from whole soybeans to soy flour to meat look-alikes to cheeses — can easily be incorporated into existing recipes.
"ISOY: A Better School Lunch" is a program launched by the Illinois Center for Soy Foods at the University of Illinois at Urbana-Champaign, and supported by the Illinois Soybean Association and Archer Daniels Midland of Decatur. Its objective is to introduce soy-enhanced foods into school lunch menus by replacing 100 percent meat entrees.
Two soy-enhanced products (spaghetti sauce and ravioli) were made with a half-and-half mixture of beef and textured soy. Two all-soy entrees, chili and chicken-like nuggets, were also tested. More than 1,000 students in four school districts in Illinois received these products as part of their usual lunch menu, and also got the whole meat alternative on a different day. The acceptability of soy-enhanced foods was measured by determining plate waste (how much children ate of a given entrée) in comparison with a non-soy product.
From a nutritional standpoint, the meat-soy blend entrées had 50 percent of the fat and saturated fat and cholesterol of the 100 percent beef alternative. Using all soy in a chili recipe reduced the fat content even more, and eliminated any cholesterol. The all-soy nuggets had half of the fat and no cholesterol compared to chicken nuggets. All-soy foods are always lower in fat and cholesterol than the non-soy alternatives.
But the big question is always: Will students eat this? When the percent eaten of the soy and non-soy products was measured, researchers at the Center found that the children ate essentially the same amount of each (Figure 1). Chicken nuggets, a familiar favorite for many children, were slightly preferred to the vegetarian alternative.
The ravioli, soy or non-soy, did not appeal to participants in the ISOY program because they were very different from the usual canned ravioli offered at most schools. So, although no difference was found in the amount eaten between the two versions served, the ravioli formulation needs some work!
What were the conclusions? Soy-enhanced foods and meat-based products were consumed in equivalent amounts for most products. School food service personnel were able to adapt the products to school standards. Using soy-enhanced beef (50/50 blend) decreased total fat, calories from fat, saturated fat and cholesterol. Using 100 percent re-hydrated textured soy in recipes will further decrease calories and fat components.
On the financial side, costs for meat-based recipes could be reduced by as much as one-third if soy meat substitutes were used for half of the meat ingredient.
Will adding soy to school lunch programs cure the obesity problem? While only one step in fighting childhood obesity, adding soy raises the consciousness of food service personnel to new foods and new ways to enhance the nutritional value of school foods. Educational programs are still needed throughout the school system, from children to parents to teachers to school boards.
The bottom line is that the obesity epidemic is real, and it has important implications for our children's health and well being.
If children are not healthy, they cannot learn well. If children are overweight or obese, it diminishes their ability to interact with others, participate in school activities and enjoy the school day. If children are not well nourished, their overall health, now and in the future, will suffer.
Resources
Institute of Medicine individual fact sheets are available at http://www.iom.edu/?id=22623, along with more extensive reports.
For examples of how to incorporate physical activity into the classroom, see http://www.take10.net.
For after-school programs, see http://www.actionforhealthykids.org/special_after.php.
A variety of resources are available from the Illinois Nutrition Education and Training Program (ILNET) at http://kidseatwell.org.
For ideas on farm-to-school programs, see http://www.farmtoschool.org/pubs.htm.
ISOY program information is available at http://www.soyfoodsillinois.uiuc.edu, including the recipes for the products used in the schools. Soy on the Menu: Recipes for Foodservice, a new cookbook designed for foodservice application, is available on CD from the same Web site, which also has cookbooks in the "Soy at Home" series available for purchase.