Childhood Obesity Proves Tenacious

Results from the three-year Pathways program aimed at reducing childhood obesity in American Indian communities led School researchers to two conclusions: The program improved children's diets and increased physical activity at school, and these successes weren't enough to reduce students' body fat.

The school-based program attacked the obesity problem from several angles, says Benjamin Caballero, a professor in International Health and chair of the Pathways steering committee. Classroom curricula emphasized healthy eating and physical activity, while the school cafeteria served more fruits and vegetables and provided reduced fat milk. Surveys showed that the amount of fat that children consumed during the school day fell from 33 to 27 percent. The program also scheduled physical exercise into the school day, with Native American games such as "Crows and Cranes" and "Chase the Lizard." (See "Healthy Traditions," Johns Hopkins Public Health, Spring 2000.)

"The question is then, why did it not have an effect on children's body weight and body composition?" says Caballero, MD, PhD. He notes several reasons. Pathways only changed children's diet for breakfast and lunch during the nine-month school year. "It's possible children eat differently outside of school and some might have compensated for whatever reduction in calorie intake," says Caballero, director of the School's Center for Human Nutrition.

While Pathways sponsored informational events for families, the goal was to make parents and siblings more amenable to healthy choices that a child learned in the program. "We focused on the piece of the problem at the school where children spend two-thirds of their day and consume 65 percent of their calories," Caballero says. Other studies are looking specifically at the family's role in the nutrition equation.

Another obstacle to reducing children's body fat was age-related: 7- to 10-year-olds are primed for gaining weight and fat. In addition, the program, which involved 21 intervention and 20 control schools in the western United States, wasn't helped by mainstream American advertising that relentlessly hawks fast food, sweets, and sodas to children. Pathways was designed in response to an epidemic of obesity among the nation's children, particularly on American Indian reservations. At one reservation, the rate of obesity in children quadrupled from 1976 to 1991, leaping from 9 percent to 38 percent.

With obesity now considered an early symptom of diabetes and other illnesses, communities must prevent it now or pay for a lifetime of health problems, according to Caballero. "Really there is no possibility to treat all the symptoms that emerge when 60 to 70 percent of people are obese," he says.

Caballero sees the Pathways results as the foundation for more research in reducing childhood obesity. Another project is already under way to collect data on 3- to 5-year-olds in the White Mountain Apache reservation. Ultimately, the plan is to introduce a program similar to Pathways for children at a younger age — before they become obese.

"I'm optimistic," Caballero says. "I think our experience from Pathways is there is a very strong commitment to change things from everybody, from tribal leaders, teachers, parents, and health administrators. They really want to change."