Arkansas Gets Serious About Kids' Health

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Arkansas Gets Serious About Kids' Health
June 28, 2004
Rob Capriccioso

The candy and soda vending machines are gone from Arkansas' elementary schools. And, over the course of the 2003-2004 school year, state public health officials collected body-mass index measurements for every child in the public schools—becoming the first state in the nation to do so.

It's all part of an unprecedented effort to improve kids' health, spearheaded in part by Republican Governor Mike Huckabee, who has lost more than 100 pounds since being diagnosed with adult-onset diabetes in 2002. He has become a strong proponent of measures to improve public health in his state.

With support from Huckabee, in 2003 Arkansas lawmakers passed Act 1220, a statewide initiative with the sole purpose of improving kids' health.

A State in Need
The data from the first body-mass index screening is sobering: 38 percent of Arkansas' Caucasian public school students are overweight or at risk for being overweight. Among African-American students, the number is 43 percent. For Hispanic children, it's a whopping 47 percent.

Overall, Arkansas is the 47th healthiest state, with only Mississippi, Louisiana and Tennessee faring worse, the United Health Foundation reported in 2003. Arkansans have a risk for heart disease that is 12 percent above the national average. And, according to a 2004 state-by-state analysis from the National Women's Law Center and Oregon Health & Science University, Arkansas ranks 49th on women's health issues.

"Unfortunately, none of us can deny that Arkansas is one of the least healthy states in the country," Governor Huckabee commented in an official radio address earlier this year. "We eat too much. We exercise too little. Too many people smoke."

In March 2002, 100 leaders in the areas of healthcare, education, business, policy and media gathered for the first 'Arkansas Preventative, Nutritional and Physical Activity Summit' to identify strategies for addressing the statewide health epidemic.

Health educators took their concerns to legislators. Coincidentally, it was about that same time that Governor Huckabee was diagnosed with diabetes. Also in 2002, Arkansas' Democratic house speaker, Herschel Cleveland, had to undergo triple-bypass heart surgery.

When it came to funding Act 1220, the availability of state tobacco settlement money helped calm taxpayer concerns. Those dollars, in addition to grants from the Robert Wood Johnson Foundation and a donation from the American Diabetes Association, have covered costs relating to the BMI Initiative portion of the legislation thus far. Start-up costs in the past year have totaled approximately 1.4 million, or $3 per child.

Grasping BMI

The American Academy of Pediatrics recommends that every child have his or her BMI measured regularly as a screening tool for obesity. BMI is the ratio of weight in kilograms to the square of height in meters. It correlates well with more precise measures of body fat and can be derived from commonly available data—weight and height.

According to officials at the Arkansas Center for Health Improvement (ACHI), a Little Rock-based health policy research center, many parents are not aware of their child's BMI and do not routinely discuss weight issues with their child's physician. (ACHI was enlisted to develop and implement a standardized statewide BMI screenings by the Arkansas Child Health Advisory Committee, which was created by Act 1220.)

Arkansas health officials hope the mandatory annual BMI screening process will help parents tell if their children are overweight or obese, or in danger of becoming so. According to a recent Archives of Pediatrics and Adolescent Medicine study, parents of overweight children who received health and fitness reports ultimately made plans to change their child's diet and physical activity levels.

"School districts and communities working together can use this data to begin to implement either policy changes or programs that can help with this issue," explains Joy Rockenbach, Director of the BMI Initiative with ACHI.

ACHI officials worked closely with personnel at 11 pilot schools starting last summer to organize an assessment day, share information on accurately calculating BMI and to develop and create forms for recording height and weight data. They then took information gathered in the field and began a second round of BMI measurements at different schools.

At the same time, community health nurses trained hundreds of school nurses, coaches, teachers and others to take the measurements of the approximately 450,000 public school students in Arkansas. After a few months of testing, the full BMI plan rolled out in the middle of the 2003-2004 school year.

A Family Receives Its Results
Rennetta and Terrance Carter's two children, Emery and Nathan, were some of the first kids in the state to have their BMI's measured. The process is simple, painless and non-intrusive, something school officials stressed when introducing the program.

Emery, an athlete in 12th grade at Arkadelphia High School, wasn't too surprised that her BMI came back normal, but second-grader Nathan had a different reaction. "When I got the report, which came home in his backpack—I read it out loud," remembers his mom. "And he turned and looked at me, like 'What?'"

"If you look at him, he's not that much overweight, but it did trigger me into thinking that we need to change some eating habits in him," says Carter. "With him, he likes to eat out. I just think that we need to make better choices, especially when eating out..."

To date, over 90% of the state's 1,139 schools have returned their BMI assessments to ACHI.

Dumping Vending Machines
Act 1220 also eliminated food and beverage vending machines from public elementary schools. A 2000 survey by the Centers for Disease Control and Prevention found that 43 percent of elementary schools nationwide had a vending machine or a school store or snack bar where students could purchase food or beverages.

Some Arkansas health officials would also like to see vending machines removed from middle schools and high schools, noting that the percentage of overweight students tends to increase in fifth grade and remain elevated until tenth grade.

However, parents like Carter believe that action might be a little too extreme for older kids: "I don't think that they should ban it," she says. "I just really think that they should have more options there for the kids. I mean, have water and juice, but don't take the sodas out. Let them have a choice."

"But right now, it's like basically all sodas," she continues. "My daughter would choose water, but that's just her."

The Arkansas Child Health Advisory Committee recommended last month that access to vending machines in middle and high schools be limited to certain hours, and that any food sold in the machines be available only in the smallest possible portions. They also suggested that 50 percent of the beverages sold in schools be 100 percent fruit juice, low-fat or fat-free milk, and water. The Arkansas Board of Education hasn't yet decided whether to approve these recommendations.

Extension Service Awareness
Rockenbach believes that many of the health problems facing Arkansas families result from poor access to health care and health education. "I don't for a minute think that parents are not concerned," she says, "but there are so many other things about which to be concerned."

"If you've got the choice, when you're feeding your family on how far a dollar's going to go, you're going to be more likely to buy a food item that's going to help your child feel full and last a long time," she says from experience, having sometimes relied on macaroni and cheese to feed her now-grown sons. "And it may not be the healthiest choice you can make."

Rockenbach calls the Arkansas Cooperative Extension Service "one of the best kept secrets in the state." The service offers advice on how to read food labels, how to make wise food choices when working with a tight budget and how to use food stamps.

Dr. Rosemary Rodibaugh, a food and nutrition specialist with the program, says the service provides nutrition education in schools where 50 percent or more of the kids are eligible for free or reduced-priced lunch.

"We know that kids are talking about this information," she continues. "We have a lot of anecdotal data that tells us kids are asking their parents to buy more fruit, or they've tried broccoli and they actually want more!"

Continuing the Battle
In the past month, the Arkansas Child Health Advisory Committee has made many more recommendations to the state Board of Education, including:

* Requiring elementary schools to provide 150 minutes of physical education each week by 2010.

* Requiring middle schools and high schools to provide 225 minutes of physical education each week.

* Reducing the student-teacher ratio for physical education classes to 30-1.

* Establishing a Nutrition and Physical Activity Advisory Committee in each school district to assess the nutrition environment of the districts and plan improvements.

* Continuing education and additional certification requirements for nutrition specialists required in each district.

* Providing grade-appropriate nutrition education.

* Requiring the Arkansas Department of Education to hire nutrition and physical education specialists.

* Requiring at least one certified physical education teacher at each school by 2009-2010.

Governor Huckabee doesn't support all of these new recommendations, according to state officials. He feels that superintendents should control many of these kinds of issues locally.

While those debates begin, Carter remains focused on helping her son Nathan maintain a healthy weight. "We're going to have to pay more attention—when you hear about all the health problems we have here in Arkansas," she says. "We have to do something."

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