Health

Tipping The Scale

Health Advocates: Standing Pat Unacceptable In March Against Overweight Kids

by Barbara Shelly   |   Jan 4, 2018

Like every dieter, the Kansas City region has made its share of resolutions. We would, collectively, move more and consume less. We would cut down on barbecue and stock up on vegetables. Most significantly, we would halt the alarming increase in obesity among our children.

We formed commissions and task forces. Our leaders issued challenges — let’s log more steps, plant more gardens, ditch more pounds. Businesses and foundations stepped up with money for the cause.

Yet Kansas City has absorbed the lesson that every crash dieter learns quickly enough. There is no miracle weight-loss method. Not for an individual or a community. Slimming down — or preventing unhealthy weight gain from happening — requires long-term commitment and hard work.


About The Series

A decade ago, Kansas City Public Television aired a 10-part series, Generation XL, which examined “the obstacles and challenges facing schools in their battle against sedentary lifestyles and bad eating habits among children.”

Through Take Note, we are checking in with some of the local foot soldiers in this ongoing battle of bulge. This story, and the accompanying video, are the first installment of a three-part Web package running this month — Generation XL: A 10-Year Weigh-In — that takes us back to the cafeteria, back to the gymnasium, and beyond, to measure progress in addressing this critical health issue.

The series will wrap up with a panel discussion of experts, premiering at 7:30 p.m. on Jan. 25 on KCPT 19.1, hosted by KCPT’s Nick Haines.


“These types of changes take years and years of sustained policy work before they make a measurable difference in BMI,” said Michelle Dake, a youth advocacy educator for KC Healthy Kids.

BMI is body mass index — essentially a calculation of body fat. It’s the standard that most health professionals use to determine whether someone’s weight is healthy for their height, age and other factors. Researchers collect representative samples of BMI numbers to determine overweight and obesity rates for states, regions and the nation.

Skyrocketing increases in those rates prompted a call to arms a decade or so ago.

Ten years ago, public health officials didn’t hesitate to describe childhood obesity as a crisis. Nationwide, rates had doubled over 20 years. In part because of the health risks associated with carrying too much weight, teenagers for the first time in U.S. history were projected to live shorter lives than their parents.

Then and now, data from Missouri and Kansas mirrored the overall bad news.


Adults

  • In 2008, a little more than a quarter of adults in Kansas and Missouri met the requirements for clinical obesity. Since then, the figure has increased to nearly a third in both states, according to the latest “State of Obesity” report, issued annually by the Trust for America’s Health and the Robert Wood Johnson Foundation.
  • Nationwide, adult obesity rates have climbed steadily since 2011 and now are close to 38 percent. In Kansas, the rate climbed above 34 percent before falling to 31.2 percent in 2016. Missouri experienced a smaller drop.

Kids

  • Obesity rates among Missouri and Kansas toddlers ages 2 to 4 whose families participated in the federal WIC program dropped slightly from 2008 to 2014, flattening out at around 13 percent in both states.
  • Nearly a third of children between the ages of 10 to 17 in Missouri and Kansas are overweight or obese, ranking them 32nd and 25th, respectively, nationwide.

The obesity rate for children ages 2 to 19 nationwide has been consistent at about 17 percent over the last decade of research. But health workers take no comfort in that marker.

“Stabilization is great,” said Shelly Summar, manager for the Weighing In program at Children’s Mercy Hospital. “But keep in mind, the rates are still triple what they were 30 or 40 years ago.”

In November, research published in the New England Journal of Medicine warned that, if present trends hold up, 57 percent of today’s teenagers will be obese by the time they reach age 35.

That’s a dire forecast, given the toll of obesity on health care costs, productivity and quality of life. But area health and community leaders aren’t gearing up for a new round of crisis bulletins.

The relatively muted response has two primary causes.

First, people in the field have learned a lot about messaging over the past 10 years. Though increasingly recognized as a health issue, a diagnosis of excess weight carries a stigma that people are prone to deny or reject.

“Childhood obesity remains a subject that nobody likes to talk about,” said Ann Davis, founder of the pediatric obesity program at the University of Kansas Medical Center. “We have shifted our focus to talking about healthy lifestyles.”

And second, while the barrage of news conferences, bulletins, weight loss challenges and “obesity summits” of a decade ago has subsided, people in the Kansas City area never stopped working on the issue. Although gaps remain, funders, health groups, businesses and communities have made substantial progress in creating an infrastructure that promotes physical activity and healthy foods — the building blocks for the healthy lifestyle that is now the buzzword for obesity prevention.

Strategies

“We have learned a lot,” said Adriana Pecina, a program officer for the Health Care Foundation of Greater Kansas City, which continues to invest heavily in initiatives designed to combat childhood obesity. “I think one of the lessons is you can’t just provide healthy eating programs. You have to address the environment.” [The Health Care Foundation is a Take Note funder.]

To that end, and prompted by groups like BikeWalkKC, communities have added to their inventories of bike lanes and walking paths. Bus stops have been intentionally located near grocery stores. Safety features have been added for children walking and biking to school.

In December, Kansas City became the latest of several area cities to adopt a “complete streets ordinance,” resolving that future road projects give as much consideration to pedestrians, cyclists and transit users as to motorists. And while a recent audit sharply criticized Kansas City’s bike plan as inadequate for future needs, about 40 miles of city streets now have bike lanes.

Throughout the region, community gardens and urban farms have replaced vacant lots in aging neighborhoods. Farmers markets have opened throughout the region, with many vendors accepting benefits from the Supplemental Nutrition Assistance Program. Modern grocery stores have opened in several impoverished neighborhoods, and a refitted bus operated by Truman Medical Centers cruises low-income areas, stocked with in-season fruits and vegetables.

“In many ways I think Kansas City is ahead of the curve in having a diverse set of groups that are coming together for the long term,” said Gretchen Kunkel, president of KC Healthy Kids, which serves as a hub for many of the ongoing efforts. “We have a lot more capacity now than we did a decade ago.”

But this is a race in which one never gets to the finish line. A ZIP code map of Kansas City illustrates the challenges.

Residents who live in six ZIP codes along the Troost Avenue corridor have a life expectancy 13 years shorter than residents who live in more affluent areas of the city, just a few miles away. In Wyandotte County, life expectancy in some ZIP codes is 20 years shorter than in some ZIP codes of neighboring Johnson County.

“Policy at the municipal level often fails to recognize that certain parts of the area have more resources than others,” Pecina said.

School Role

Schools have always been seen as crucial players in any discussion about childhood obesity. They can contribute to the problem by offering candy as a reward for good behavior or by keeping children sedentary as they cram for high-stakes tests. Or they can help students eat well and become fit.

Over a 10-year time frame, the record is mixed and marked by fits and starts.

Policies at the federal level, mostly adopted during President Barack Obama’s administration, cracked down on the marketing of junk foods and sugary drinks from school cafeterias and vending machines. Prompted by former First Lady Michelle Obama and her campaign against childhood obesity, the U.S. Department of Agriculture set strict limits on the amounts of salt, sugar and fat that could go into dishes served in school cafeterias.

Former first lady Michelle Obama talks with Sam Kass, former White House Chef and Senior Policy Advisor for Nutrition at the Partnership for a Healthier American 2017 Healthier Future Summit in Washington, Friday, May 12, 2017. Obama appeared at an annual health conference sponsored by the nonprofit organization that sponsored her anti-childhood obesity initiative. (Pablo Martinez Monsivais | Flatland)

The cafeteria restrictions set off a backlash, both among critics of Obama’s policies and discerning student diners. Last spring, President Donald Trump’s agriculture secretary announced he’d be rolling back those standards, vowing to “make school meals great again.”

Beyond lunch hour, area schools have varied widely in their commitments to healthy eating and fit lifestyles.

A highly touted program 10 years ago was PE4Life. It brought a new focus on physical fitness into participating schools. Students climbed rock walls, danced with video game platforms and rode interactive stationary bikes. Instructors gauged their progress through the use of heart monitors.

The program was built around the concept that vigorous exercise makes students stronger in body, mind and spirit. And for awhile, educators said it worked. The principal of Woodland Elementary School in Kansas City told KCPT that disciplinary incidents dropped by nearly 60 percent after the program’s inaugural year. Students were healthier and happier, and the results showed in the classroom, he said.

The Health Care Foundation of Greater Kansas City in 2010 announced it would spend $400,000 to expand PE4Life to schools in six area districts. If early results were promising, the foundation would invest even more funding in the program, a news release said.

Lesson Learned

But that never happened. PE4Life turned out to be overly complicated, requiring expertise and staffing beyond the traditional gym class. Expensive equipment developed glitches and fell into disrepair. In 2013 Kansas City Public Schools converted Woodland Elementary into an early childhood learning center. Locally and nationally, PE4Life appears to be defunct.

At the Health Care Foundation, planners regard the collapse as an expensive lesson — sometimes simpler is better. “Schools have limited resources and limited capacity,” said Brenda Calvin. “I think they’re getting better at linking with community partners.”

Summar at Children’s Mercy Hospital, who coordinates a “healthy schools” working group, has found the same thing. To qualify for federal school meal funding, schools must have wellness plans in place. The best ones, Summar said, are often the simplest. “You want to have something you can measure,” she said. “Like 25 minutes of recess every day.”

Students from Frank Rushton Elementary School in Kansas City, Kansas, participate in the Walking Detective program. (Courtesy KC Healthy Kids)

And schools are learning that physical activity need not be limited to recess. Teachers are increasingly structuring classrooms to encourage movement and scheduling “brain breaks,” such as participatory dance videos, into their day.

Summar is part of a collaborative that developed a messaging tool called Fit-Tastic. It promotes five essential behaviors — vigorous physical activity, limited screen time, a calcium-rich diet, avoidance of sugary drinks, and consumption of fruits and vegetables — and comes with a wealth of tips and resources for helping schools and families attain those goals.

Wellness Policies

While all school districts in the Kansas City region have designed wellness policies, adherence and follow-through varies widely.

“I see some schools that are doing really well, and I see other schools where it’s not a focus at all,” said Davis of KU Medical Center, who collaborates with staffers at Children’s Mercy to operate Kansas City’s Center for Children’s Healthy Lifestyles & Nutrition.

Administrative changes, budget cuts and state accreditation pressures can derail a school’s best intentions for creative physical education and play times and healthy snacks. And all those factors are most likely to be brought to bear in schools serving low-income children — the group in greatest need of assistance with nutrition and exercise.

“I’ve never had a meeting with a principal or administrator who didn’t want to improve their students’ health,” said Dake at KC Healthy Kids. A former teacher, Dake consults with schools throughout the area. She also coordinates the “I am Here” program, which sponsors contests and a “youth summit” to engage students in the promotion of healthy lifestyles.

A glance at some of the award-winning “I am Here” entries during the past couple of years suggests that the region’s children are well suited to envision the healthy infrastructure that adults seek to create for them.

Fourth-graders at Stony Point North Elementary in Kansas City, Kansas, saw a rutted, swampy field beside their school and visualized a playground and grassy playing area; donors helped them pay for it. Sixth-graders at Prairie Elementary in the Shawnee Mission School District raised money to purchase stationary bikes for a “read and ride” program. Students at other schools recommended water bottle filling stations and school gardens.

Danger Ahead?

Small steps like that eventually cover a lot of distance, but health workers are forever wary of big setbacks.

Those could come from the federal level.

The tax bill recently passed by Congress, for instance, will likely mean less money for states and local communities to deal with problems. Disruptions in the Children’s Health Insurance Program or changes to the Affordable Care Act would spell trouble. The ACA requires insurers to cover obesity screenings and treatment as a preventative service. Health workers would like to see coverage extended to ongoing programs like Children’s Mercy’s “PHIT Kids” evening group, but they fear that political will might be moving in the wrong direction.<

As the recent report in the New England Journal of Medicine pointed out, obesity is a compounding problem. Obese and overweight adults are more likely to raise children who are above a healthy weight. Children who are obese have a higher probability of being obese as adults.

“The one thing we know better now is we have to start sooner,” said Dr. Brooke Sweeney at Children’s Mercy Hospital. “Rapid weight gain in infancy predicts obesity later.”

Pediatricians at Children’s Mercy clinics have started asking parents five questions related to eating and activity at every checkup or visit. Children who register too high on the body mass index are quickly channeled into treatment and classes — usually with their parents or guardians.

“Obesity is extremely treatment-resistant,” Sweeney said. She compared it to cancer — a condition with complications and rescissions that demands constant monitoring.

Fighting Fatigue

While physicians wrangle with the medical implications of an obesity epidemic that starts earlier in life and affects more children than ever before, others will work to sustain and expand the environmental efforts of the last decade or so.

Advocates worry about fatigue — on the part of funders, politicians, families and entire communities. Can an impoverished city like Kansas City, Kansas, sustain its “Healthy Communities Wyandotte” movement with a new mayor coming into office and new priorities? Will the current commitment to bike lanes in Kansas City give way to the fiscal advantages of streets built just for cars and trucks? Will gardens be replaced by gravel?

“I wish it was easier,” said Kunkel, at KCHealthyKids. “But this is an issue that is impacted at so many levels.”

After 10 years in the field, Kunkel remains optimistic. “You’re looking at groups coming together,” she said. “There’s awareness of the issue. There’s a lot of goodwill in Kansas City.”

Video Credit: Cody Boston

Take Note is made possible through the generous support of The Kauffman Foundation and The Health Care Foundation of Greater Kansas City.

Follow "Take Note: Our City. Our Schools. Our Future." as together we tell the stories that matter, the stories that make an impact. We want to know — what stories do you have for us, and what can we find out for you? Email us at contact@takenotekc.org, and follow the entire project at takenotekc.org.

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