In the broccoli bed the tall, gangly stalks are topped with yellow flowers. They have passed their tasty prime and are going to seed. A group of sixth-grade students are carefully pulling them out of the ground while other children follow with pitchforks, turning over the black topsoil.

“Hey, there’s a snail and a baby snail,” says one child.

“Oh, there’s a whole bunch of snails!” cries another. A few kids squeal and back away.

A boy holds up his gloved hand. “Ew, look! This one’s stickin’ to my finger!”

Nearby, the garden’s hens, Ella, Couscous, and Henrietta, are patrolling the vegetable and flower beds, looking for bugs. In one bed lettuce seedlings have put forth small green leaves. In another the tendrils of young pea plants are climbing up strings. A few tiny pods are already visible. The radish bed is full of bushy, vigorous-looking plants, and the leeks have sprouted skinny green stalks.

Over in the raspberry patch other sixth-graders are raking and weeding the paths between bunches of 2-foot-tall, healthy raspberry canes growing in raised beds.

“Make the path deeper than the raspberries,” a boy instructs his coworkers.

On a table set up near the garden wall, seven kids are making pizza to bake in a tall outdoor oven hand built of stone and brick. On a breadboard they roll out a ball of whole wheat dough into a big thin pie, then ease it onto a large wooden paddle called a peel and paint it with olive oil. Toppings, including fresh vegetables and herbs from the garden, are set out in bowls: sautéed chard and leeks, feta cheese, fresh rosemary, and cilantro. The garden teacher, Amanda Rieux, and assistant Lissa Duerr, an Americorps volunteer, are overseeing the pizza-making process.

“David, Manta, have you seen the cilantro growing in the garden?” Rieux asks. “I’ll show you where it is. Do you know what these are? These are leeks.”

“We don’t have to put chard on,” suggests one boy. “I don’t like chard.”

“I want some,” says another.

“You can decide as a group if you want chard,” says Duerr.

The students take an informal poll. Chard lovers predominate. They sprinkle some on.

One of the teachers arrived at school several hours ago to fire up the wood-burning oven. “Do you know how hot it gets?” asks Duerr. “’Round about 650 degrees!”

With Duerr’s help, David slides in the pizza. The kids wait impatiently, sniffing the aroma of fresh bread and savory vegetables that wafts through the cool spring air.

Out comes the pizza at last. They count 30 seconds to let it cool, then cut it into slices and dig in.

“Thank you, Lissa!” they murmur, between bites.

“You’re very welcome. How is it?”

“Great!”

For these sixth-grade students, it’s all part of an ordinary morning’s lessons in the Edible Schoolyard, an acre of urban garden behind Mar-

tin Luther King Middle School in Berkeley, California. Spectacularly situated on a hill overlooking San Francisco Bay, the garden took root from the dreams of a nationally famous local chef, Alice Waters, and a visionary public school principal, Neil Smith. In the years since its inception in 1995, the Edible Schoolyard Project has become considerably more than just a garden. Through the efforts of a dedicated staff of teachers and volunteers, and with the help of aggressive fundraising and community support, it has transformed the culture of a resource-poor junior high school by creating an extraordinary learning environment. The garden and its adjoining kitchen are unconventional classrooms where the middle school’s teachers integrate learning about biology, nutrition, horticulture, environmental education, cooking, and group cooperation into everyday lessons on diverse subjects, including math, science, social studies, art, drama, and English as a second language (ESL). More than 600 children spend 90 minutes of class time per week in the garden or kitchen. Sixth-, seventh-, and eighth-grade students grow, prepare, and eat their own fruits and vegetables, and kids who rarely sit down to family dinners at home get the chance to cook, set the table, and enjoy a meal together.

In the spacious, brightly painted kitchen, sixth-graders start their cooking lessons by making fruit salad, learning to use knives safely. While studying the origins of agriculture in Mesopotamia, they grow and grind grains—wheat, millet, barley, amaranth, quinoa, blue corn, flax—and bake flatbread with the flour they’ve made. By the time students reach seventh grade they’ve become skilled cooks. They eagerly compete on teams in the Iron Chef, a contest in which they are given a set of ingredients and must create a hot dish and a cold dish for a panel of adult judges in 45 minutes.

“It’s very fun in here,” says kitchen teacher Esther Cook. “It’s really important to me that they have fun—that they not think of cooking as a potential job, but as something people do every day for the people they love. We don’t out and out teach nutrition. If we can get kids to know what to eat and when, the nutrition piece is a big part of that. Parents say their kids are now interested in food. They know the vegetables, the greens, the taste of the different apples. A fair amount of what we do in the kitchen is just tasting.”

New school traditions have grown up around the kitchen and garden. At the beginning of each school year, children in the school’s ESL classes prepare a special dinner for their parents. During the week when children take state-required standardized tests, the staff and their student helpers produce a home-cooked breakfast daily for the entire school community. In spring the seventh-graders, whose time in the garden is ending, plant a crop of corn for the incoming sixth-grade class. The following fall the sixth-graders harvest the crop and feast on grilled corn. The lesson of that tradition, says garden teacher Kelsey Siegel, is that “you’re not going to necessarily always eat what you plant.”

On a bulletin board in the kitchen, teachers have pinned up a selection of “Edible Schoolyard Famous Quotes” uttered by kids while working in the garden or kitchen:

“I’ve never been full of vegetables before.”

“I’m thankful for photosynthesis and laughter.”

“Hey, look at the Golden Gate Bridge. It looks like a giant bra!”

In the universe of school gardens, Berkeley’s Edible Schoolyard Project is a bright star—large, luxuriant, generously staffed, and boasting a $400,000 annual budget raised chiefly from nonprofit organizations. Yet it serves a school with a diverse student population, including many children from poor families, and it grew out of the determined work of local community activists. In those respects it is far from unique. School gardens and greenhouses, student-run fruit and vegetable stands, and farm-to-school programs have taken shape in many localities around the country, funded by local jurisdictions, nonprofit organizations, and state and federal governments. There is evidence to support the idea that such projects can influence kids’ eating habits: for example, children who are involved in growing food in school gardens have been shown to increase their liking for certain vegetables. Such projects represent just one of the approaches being taken by school officials, activist groups, parents, and communities to change the way schools teach children about food and healthy eating.

Like chef Alice Waters, many people have come to believe that the food and drink children receive at school teaches them silent but powerful lessons, lessons that may leave a more lasting imprint on their

minds and bodies than what they hear from teachers in health or nutrition classes. As is true of the campaign to incorporate more movement and exercise into the school day, efforts to change the school menu take various forms but share an underlying philosophy: in order to teach children to make healthy lifestyle choices, the “hidden curriculum” about food and physical activity in schools must be consistent with the overt curriculum in the classroom. Right now, the hidden nutrition curriculum in many U.S. schools is all about fast food lunch choices, high-fat chips and snacks, bake sales that feature doughnuts and brownies, and a steady supply of soda and sugary drinks from vending machines. Although this kind of school menu may resemble the diet of many families in the United States, it is teaching or reinforcing unhealthy eating habits for our children.

Schools are mirrors of our society. As such, they often displease us and make us angry. Because schools take responsibility for children, parents, educators, and other concerned adults expect them to be the best possible environments: healthier, safer, more rational, more moral, and more compassionate than other settings. When schools turn out to have many of the same flaws that exist elsewhere in America, we are outraged, yet we’re looking at our own reflection.

But schools are also social laboratories. Throughout our country’s history they’ve been experimental settings where educators and reformers have tried to solve society’s problems. Public schools are the places where the majority of U.S. children over the age of 5 spend most of their waking hours. Reaching children at school is one of the most efficient ways of communicating directly with families. And because children are eager to learn and are open to new experiences and ideas, they can be effective agents of change within families. Tens of thousands of Americans probably have been motivated to quit smoking because a child or grandchild urged them to do so.

During the past few decades Americans have greatly expanded their expectations of what schools can and should provide. Schools in many places have assumed increasing responsibility for aspects of children’s lives that go beyond academics, including health care, psychological counseling, crime prevention, after-school care, and even child care for the infants and toddlers of high school students. More

recently the pendulum has begun to swing back toward a more academic focus. State and local jurisdictions and the federal government have moved to enforce academic standards by annual testing of students—and to penalize teachers and schools with scores that fall short. This trend has placed pressure on school systems to cut back on other priorities and to focus more exclusively on grooming students for standardized tests as official performance measures. Considering schools’ pivotal position in the lives of children and families, it’s not surprising that they’re being asked to become important players in the nation’s response to the childhood obesity epidemic.

Researchers, activists, and parents trying to combat the obesity epidemic through schools are using three major approaches. One is to improve and expand physical education programs or to find additional ways of incorporating physical activity into the school day. (Some of these efforts were discussed in Chapter 5.) A second strategy is to stop schools from selling foods and beverages high in calories and low in nutrients and to try to ensure that all the meals, snacks, and drinks available in schools are healthy. A third approach is to get schools to adopt curricula that teach the importance of a good diet and daily physical activity, curricula that also impart practical skills such as reading food labels and measuring portion sizes and that motivate students to try out and adopt new habits, such as eating more fruits and vegetables or reducing their weekly TV time.

It seems obvious that any serious and honest attempt to create a healthier school environment should incorporate all three approaches. If schools pay lip service in health classes to the importance of a proper diet yet sell sodas and junk food in vending machines, children learn the lesson that good nutrition is not an authentic priority. A similar message is transmitted if teachers extol the virtues of exercise but students rarely have P.E. or opportunities for vigorous play. Being consistent and avoiding hypocrisy are as critical to effective teaching as they are to effective parenting. Our schools must “walk the walk.”

The first lunch period is about to begin at Fairhill Elementary School, in north Philadelphia. Five students from the sixth, seventh, and eighth

grades have been hard at work since midmorning, carefully putting fresh grapes, strawberries, and pieces of pineapple and melon into plastic cups to make individual portions of fruit salad. Now four sixth-graders, chosen by their teachers to be this week’s sellers, are carrying cardboard cartons containing fruit salad cups, paper bags, and bananas to the big plastic “fruit stand” in a hallway outside the cafeteria. As they lug their boxes across a rain-washed courtyard, they pass a large red and white truck emblazoned with the familiar Coke logo, which is parked beside the school. A Coca-Cola deliveryman is inside the cafeteria, restocking the vending machines.

The children unpack their wares at the fruit stand and write the prices—$1.25 for a small salad cup, $2.00 for a large one—on a little blackboard. Each fruit salad comes with a banana and, this week, a free “veggie baby,” a small stuffed toy. Judith and Amanda will be delivering prepaid salads to teachers in their classrooms. Robin and Giuseppe will be selling salads at the stand. Being selected to make or sell fruit salads is a coveted privilege, bestowed on students who work hard and behave well. At Fairhill, which serves a low-income neighborhood whose residents are mostly Hispanic and African American, all the kids who work in the program during the year receive a share of any profits earned.

Dan Lewis, who supervises Fairhill’s student-run fruit stand each Wednesday, issues instructions to Robin and Giuseppe. “The customer is going to come up and say what kind of salad they want,” he tells them. “Place the salad on the counter. Give them a bag. Let them know they are getting a free veggie baby with their purchase. Only one of you should deal with the money.” Lewis works for the Food Trust, a Philadelphia-based nonprofit that has received nutrition education funding from the U.S. Department of Agriculture to operate school markets, farmers’ markets, and other programs designed to improve nutrition in low-income neighborhoods. Although the major goal of the fruit stand is to boost fruit and vegetable consumption among Fairhill’s students, the school’s food service staff would not allow it to be set up in the cafeteria. Lewis says they worried that it would take away business from the school lunch program, another federally funded program under which the USDA subsidizes the school for providing free or reduced-price meals for low-income children.

Inside the spacious cafeteria, the walls echo with the laughter and chatter of hundreds of students eating lunch. Out here in the corridor, few children pass the fruit stand. Robin and Giuseppe make most of their sales to adults: a police officer, several teachers, a man visiting the principal’s office. Two cafeteria workers wearing aprons come by, eye the fruit salads, and promise that they’ll be back later. “Traffic is slower here. [Students] don’t walk by” on the way to the cafeteria, says Lewis. “We get a lot of chance sales—people picking up their kids, the UPS man. If there is any part that we could do better with, it would be to get more kids [buying].” Giuseppe unpacks his own lunch: a bag of chips and a large soda. Watching him, Lewis shakes his head ruefully. “There are some corner stores near every school that we [the Food Trust staff] work at,” he says. “They buy chips and soda on their way to school.”

Finally, business picks up. Jenny and Eduardo, two of the students who helped assemble the fruit salad cups show up with about a dozen other kids from the sixth, seventh, and eighth grades. A line forms. Robin enthusiastically hands out fruit salads and veggie babies while Giuseppe collects money. When lunch period is over Robin and Giuseppe tally the day’s sales: 31 large salads, 21 small ones. Judith and Amanda return from delivering their prepaid orders. They remove a pile of cash and their order list from a manila envelope and count the money.

“Only one quarter off,” Judith says. “We have $25.00 and it’s supposed to be $24.75.” A teacher had told her to keep the change. She smiles. “I’m so proud of myself!”

As the lunch scene at Fairhill illustrates, the nutritional environment in our nation’s schools is both complicated and inconsistent. The kinds of food and drink a public school offers depend on choices made by school officials, such as the principal and the food service manager, but also on policies set at the school district level and laws or regulations passed by the local, state, and federal government. The USDA has detailed rules specifying nutritional standards for the daily school lunch (and often breakfast) served in the cafeteria, meals that are subsidized in most schools by a national government program. But the federal government does not have authority to regulate any additional a la carte items sold in the school’s cafeteria, nor can it specify what kinds

of snacks or drinks may be sold in vending machines or in the student store. State and city governments often do regulate some of those items, though, and in recent years impassioned battles have erupted in many jurisdictions over whether laws should be passed to eliminate vending machines altogether or to prohibit them from dispensing sodas and certain other kinds of snacks and beverages.

Of course parents also influence what’s eaten at school, by making or buying children’s lunches and by bringing or sending in food for special occasions. In some communities they have also become players who influence their local schools’ lunch and snack menus. Clubs, teams, and organizations (such as Girl Scout troops) often sell snacks, sweets, or beverages to raise money. Teachers sometimes plan the menu for a special event, and some misguided ones use food in the classroom as a reward or incentive.

Most schools in the United States have no comprehensive nutrition policy specifying what kinds of food and drink are considered healthy or appropriate to be sold on their premises. The federal government does recommend that schools set such policies: in fact, detailed guidelines were published by the federal Centers for Disease Control and Prevention in 1996. Because few schools have accepted that challenge, the list of foods and beverages sold in most American middle and high schools is a hodgepodge. It typically includes dozens of calorie-dense snacks and drinks, foods that are often high in fat, sugar, and salt but low in vitamins and other nutrients. These items are sold to students not because they are nutritionally valuable but because they can make money for the school or its activities. Elementary school offerings tend to be somewhat healthier but still include high-fat cookies, crackers, and salty snacks.

The National School Lunch Program administered by the USDA has considerable influence on what children eat at school. Founded in 1946 with the laudable goal of fighting hunger, it has, ironically, become a target for reform by activists trying to reduce childhood obesity. The program provides free or reduced-price lunches on every school day to about 28 million children who qualify because their family’s income falls below a specified level. (In 2004 a child living in a family of four with an income below about $34,000 qualified for a

subsidized lunch; a child from a family of four with an income below about $24,000 qualified for a free lunch.) An almost equal number of children purchase the same cafeteria lunch at full price, typically between $1.25 and $2.50, depending on the school and the region.

The USDA sets nutritional requirements for school lunches, specifying their total calorie content, the maximum percentage of calories that should be derived from fat, and how much protein, calcium, iron, and vitamins A and C they should provide. It’s up to school food service directors to plan menus that meet those requirements. The USDA subsidizes participating schools’ lunch programs at a cost of more than $6 billion a year, paying the school food service a specified amount for each free or reduced-price meal served. Besides payments to schools, it also purchases certain foods from U.S. producers as a form of agricultural subsidy and provides them free to school food services, where they make up about 17 percent of the food served. Thus, the USDA’s requirements and its food subsidies to the school lunch program influence what school cafeterias serve to everyone.

Critics, including some nutritionists and dietitians, charge that the dual goals of the Department of Agriculture’s school lunch program—feeding children and subsidizing farmers—are often at odds with each other. For decades beef, pork, and dairy producers have successfully lobbied Agriculture Department officials to include large quantities of meat and dairy products among the foods that the program buys and donates to schools. Some details of the law governing the program even seem designed to put food producers’ interests ahead of nutritional concerns. Schools are required to offer whole milk as an alternative to lower-fat milks each year as long as more than 1 percent of students opted for whole milk during the preceding year—although whole milk is high in fat and not recommended for children over 2 years old. Since school food service directors operate on tight budgets and must strive to break even each year, the types of food they can get free from the federal government are a key factor in their decisions about what goes on the lunch menu. It is also cheaper, both for food services and for the government, to use frozen, canned, and processed foods in school lunches than to purchase fresh fruits and vegetables that might spoil and have to be discarded.

Despite the USDA guidelines specifying nutritional content, most school lunches contain a higher percentage of fat than the maximum specified by government requirements. Among schools surveyed during 1998–1999, school lunches averaged about 34 percent of calories from fat. Average fat content of school lunches had declined from 38 percent in the early 1990s but remained higher than the 30 percent maximum specified by the USDA’s requirements—and more than three-quarters of U.S. elementary and secondary schools had not succeeded in cutting enough fat to reach the 30 percent goal. In addition, the average elementary school lunch was providing about 10 percent more calories than what’s recommended by the USDA. Salt content in elementary and high school lunches was also much higher than the maximum level recommended. States are responsible for monitoring and enforcing their school districts’ adherence to the nutrition guidelines, but schools are not usually individually penalized for failing to meet the standards. It is extremely rare for a school to lose its eligibility to participate in the federal school lunch program.

In public schools I visited while researching this book, students told me the most frequent lunch entrees in their cafeterias included pizza, hamburgers with cheese, chicken nuggets, hot dogs, burritos, and macaroni and cheese. One overweight student at a District of Columbia high school said wistfully that she wished her school cafeteria would offer salad every day. “We had mashed potatoes three days in a row this week,” she complained.

One of the most disheartening aspects of the lunchtime fare provided at thousands of schools across the United States is that it often seems chosen to reinforce a taste for fast food and for foods high in fat and processed carbohydrates rather than to encourage healthier eating habits. School officials sometimes contend that they are forced to serve high-fat lunch entrees like cheeseburgers and hot dogs because that is the only kind of food students will eat. But researchers have found that many students do choose lower-fat alternatives, especially if they are first introduced to the lower-fat foods or if they and their parents are informed about the health benefits of reducing fat intake. Researcher Robert Whitaker found that about 30 percent of elementary school students spontaneously chose lower-fat menu items when

they were offered at lunch, and the figure rose to 36 percent after a letter went home informing parents of the low-fat lunch choices. In another study, students in some classrooms at an elementary school in upstate New York learned about the history and nutritional value of plant-based foods such as greens, black-eyed peas, and bulgur, as well as cooking and tasting such foods as part of their study of different cultures. Students in other classrooms, the control group, did not receive such lessons. When these foods were offered in the school cafeteria, students who had learned about them in class ate from 3 to 20 times more of them than did the students in the control group. “Kids like knowing about good foods that are good to eat,” says obesity prevention researcher Steven Gortmaker. “Kids are looking for stuff that is different and better.”

School officials in some health-conscious districts have successfully lowered the fat content in school lunches and breakfasts. For example, in Rocky Boy’s, Montana, tribal leaders on the Chippewa Cree reservation worked with a dietitian to revamp the school menu in an effort to combat high rates of obesity and diabetes among American Indian children there. Dietitian Tracy Burns got rid of premade pizzas and sugary cereals. She persuaded the school bakers to switch from white to whole wheat flour. She eliminated 2 percent milk as an option (instead offering only 1 percent), instituted a daily salad bar, and increased schools’ purchases of fresh fruits and vegetables. She asked school cooks to mix the higher-fat ground beef provided by the USDA subsidy with leaner ground beef or buffalo meat that the food service purchased locally. And students were no longer allowed seconds at meals except for fruits and vegetables.

The USDA has responded to concerns about the foods it provides to the national school lunch program by increasing the amount of fruits and vegetables it supplies to schools, although most are frozen or canned. The department does supply some fresh fruits and vegetables (about 21 percent of all fruits and vegetables it provides to schools), chiefly as part of a joint program with the Department of Defense, which trucks them to schools in 38 states. The USDA conducted a successful pilot program in several states that showed that offering children free fruits and vegetables as snacks significantly boosted their daily

intake from that food group and shifted their diet away from candy and high-fat snacks, but the future of such programs will depend on whether government funding is made available.

Even when the main school lunch offering of the day is healthy, many students still end up eating high-fat snacks, sweets, and soda for lunch because most schools offer such items as a la carte choices in the cafeteria, the school store, or vending machines. Schools throughout the United States opt to balance their budgets and fund activities by selling a bewildering variety of snacks and beverages, often in direct competition with the regular school lunch. Students may pick such items because they prefer them or because their lunch break is short and the line for the regular lunch is too long.

Although a federal law prohibits foods of “minimal nutritional value” from being offered in school cafeterias during mealtimes, the only items that fall into that category are soft drinks, gum, and certain candies. Many other foods—pizza slices, brownies, layer cake, French fries—supply enough nutrients to be legally sold as competitive items, even though they are high in sugar or fat. And federal law allows vending machines to dispense candy and soda throughout the school day, as long as the machines are not located in the food service area.

In a USDA-funded study of 2,300 school districts, more than 80 percent of middle schools and high schools sold a la carte items. Vivian Pilant, director of school food services for South Carolina, surveyed 20 middle schools in her state and found to her astonishment that they offered a total of 363 different snack and beverage items for sale—in many cases as alternatives to the regular lunch. The General Accounting Office’s 2003 study of the school lunch program reported that 94 percent of high schools and 84 percent of middle schools sell soft drinks or sugary fruit drinks, while about 80 percent of high schools and 60 percent of middle schools sell high-fat cookies, crackers, and salty snacks. Still, students often do have healthier alternatives: 90 percent of high schools also sell fruits and vegetables, and about half offer low-fat yogurt and low-fat cookies or pastries, according to another national study.

In Georgia’s Fayette County during 2003, the high school cafeteria’s a la carte line regularly sold 144 pounds of French fries each day—

amounting to 5 pounds of French fries per month for every student who bought food in the line! Defending the county school system’s decision to offer French fries and other high-fat a la carte items, school nutrition director Cheryl Calhoun told a reporter, “It wasn’t something I relished doing, but we had to for our financial survival, plain and simple.”

Vending machines have become a seductive source of revenue for school districts. Machines dispensing soft drinks and fruit drinks are featured in the majority of U.S. schools—58 percent of elementary schools, 84 percent of middle schools, and 94 percent of high schools—and school vending machines are often stocked with cookies, candy, and salty snacks as well. Beginning in the early 1990s, soft drink manufacturers looking to expand sales began negotiating exclusivity agreements, known as pouring rights contracts, with many school districts. Under such contracts a district receives substantial payments in exchange for agreeing to stock school vending machines exclusively with a company’s products. About 10 percent of the nation’s school districts currently have such exclusivity contracts, according to the American Beverage Association (formerly the National Soft Drink Association). One Florida county school board agreed in 2000 to a five-year agreement with Pepsi-Cola worth $13.5 million.

Because so many schools now rely on a la carte and vending machine sales to pay operating costs and fund popular programs, obesity researchers have investigated whether substituting healthier foods and drinks would improve students’ diets while still allowing schools to hang on to these lucrative sources of revenue. The answer appears to be yes, if the price of the alternative food items is right. University of Minnesota researcher Simone A. French found that when prices for fresh fruit and baby carrots in a high school cafeteria were cut in half, sales of those items increased twofold to fourfold. In a similar study on high school vending machines, French and her research team found that if the prices of low-fat snacks were set at 50 percent below those of high-fat snacks, sales of the low-fat items doubled. Since total sales from each machine increased, the revenue from vending machines and the profits schools received were unaffected.

The sale of sodas and sugary juice drinks (often containing less

than 10 percent fruit juice) in school vending machines especially worries nutrition experts. Carbonated soft drinks have little or no nutritional value and are the biggest source of added sugars in the diet of American adolescents. In the past two decades soda consumption has doubled among children between the ages of 11 and 17. Kids’ daily intake of carbonated drink consumption rises sharply at around the age of 8, and by the time they are 13, U.S. children are drinking more carbonated soft drinks than milk, fruit juice, or fruit drinks. Two-thirds of American adolescent girls and three-quarters of adolescent boys drink soft drinks daily. Evidence indicates that this habit boosts children’s total daily calorie intake, apparently because the calories ingested in sodas and other sweetened beverages do not suppress appetite and reduce intake from other sources. In a study of Massachusetts schoolchildren, researchers found that the more sugar-sweetened drinks or soda kids drink each day, the greater their risk of becoming obese.

Armed with research findings like these, parents, pediatricians, nutrition experts, and community activists in many regions have been working to get schools to change their policies regarding what foods and beverages they sell. Measures regulating the foods and drinks that may be sold in school vending machines have been passed or are under consideration in cities and states around the nation. The country’s two largest school districts, New York City and Los Angeles, were among the first to act. Soda, candy, salty chips, and sweet snacks like cookies and doughnuts were banned from vending machines in New York City schools starting in September 2003. School authorities also issued new guidelines that reduced the amount of fat allowed in school lunches, prompting cafeterias to come up with low-fat recipes for cheese pizza, chicken fingers, and other entrees. In Los Angeles sodas were banned from vending machines during school hours beginning in January 2004, with a ban on sales of candy, fried chips, and other junk food taking effect later that year. Instead of sodas, school vending machines may dispense water, milk, sports drinks, and fruit-based drinks that contain at least 50 percent juice and no added sweeteners. Student response to the change in Los Angeles was mixed, with some schools reporting a drop in revenues from vending machines when sodas disappeared and others noting brisk sales of the alternative beverages.

In Philadelphia the political mood regarding soda sales in schools shifted radically within a period of less than six months. In August 2003 school district officials were considering an exclusivity contract with a soft drink company that offered $18 million in revenue over a 10-year period. By the following January, after widespread public criticism of the deal, they had retreated from the contract idea and had instead proposed a districtwide ban on school sales of soda and other sweetened beverages.

California has led the way at the state level. A 2001 law sought to ban the sale of soda, candy, and other energy-dense snacks during the school day in elementary schools and to limit soda sales in middle schools, but state budgetary constraints have so far prevented its implementation. Under a separate statewide soda ban enacted in 2003 and taking effect in July 2004, elementary schools can sell only water, milk, and drinks that are at least 50 percent fruit juice and have no added sweeteners. At middle and junior high schools, sodas may not be sold during regular school hours. Scientists are currently studying the soda ban’s impact on obesity rates in California schools.

Texas also recently issued a sweeping new statewide policy on school food, scheduled to be phased in over a five-year period. Under the new rules fried foods would be eliminated from school menus: even French “fries” would have to be baked. Food and drink portions would be downsized and second helpings would be prohibited. In addition, schools would no longer be permitted to sell foods that compete with the cafeteria’s official breakfast, lunch, and after-school snack offerings.

The soft drink industry and some school organizations have opposed laws regulating school vending machines, arguing that decisions about what to sell should be left up to local school officials and parents. The industry also contends that efforts to fight obesity should focus on providing kids with more opportunities for physical activity. “It’s about the couch, not the can,” reads an official statement from the American Beverage Association. “Policymakers should try to increase the quantity and quality of physical education, rather than isolating any one product as the cause of childhood obesity, which soft drinks clearly are not.”

But in a sign of the industry’s awareness of rising public concern about sodas in schools, the Coca-Cola Company recently revised its guidelines for school partnerships, promising that “carbonated soft drinks will not be made available to students in elementary schools during the school day” and that “a full array of juices, water, and other products will be made available wherever carbonated soft drinks are sold.” (Included in the “full array” to be offered to middle school and high school students will be Swerve, Coca-Cola’s new milk-based product.) The company also announced that it would no longer offer schools the large one-time payments that had been such a tempting feature of the exclusivity contracts for many districts.

Some critics favor laws that would give the federal government the authority to regulate all foods and drinks sold on school campuses as well as expanded authority to regulate advertising of foods and beverages to children. “The odds are stacked against children and parents when it comes to school vending,” nutrition activist Margo Wootan of the nonprofit Center for Science in the Public Interest told a Senate subcommittee in March 2004. “When a parent sends their child to school with lunch money, they do not know if the child will buy a balanced school lunch or a candy bar and a Coke.” The expert panel that issued the 2005 IOM report Preventing Childhood Obesity: Health in the Balance agrees with that position, urging that all foods and beverages sold or served in schools should be required to meet government nutrition standards. It recommends that the USDA, with advice from an external scientific body, develop new regulations that would specify age-appropriate portion sizes, as well as limit such things as fat and sugar content, in order to establish consistent standards and provide a more healthful food environment for students.

While this policy debate is being played out at the national level, parents can be effective advocates for children locally by monitoring school lunch menus and urging the food service staff to provide healthy meals. They can find out what snacks and beverages are sold in the school store and vending machines. At PTA meetings, parents should raise the issue of foods and drinks sold at school. Some schools have established nutrition committees, composed of representatives from the faculty, administration, student body, food service staff, and par-

ents, to work on improving school fare. In approaching schools, parents would be wise to work with nutrition experts or dietitians in their communities, suggests Leslie A. Lytle, a professor of epidemiology at the University of Minnesota School of Public Health who has done extensive research on obesity prevention programs in schools. “I had a principal say, ‘Leslie, you’re going to be so happy! The Coke person came around for the vending machines, and I’m asking that they give us Gatorade instead,’” Lytle recalls. Replacing sodas with sweetened sports drinks or with flavored milk products in 16-ounce bottles will not necessarily reduce children’s excess calorie intake or help to prevent obesity. Snacks and drinks in schools should not be super-sized, since a package or bottle that contains two or three “portions” is likely to be consumed at one sitting. In deciding what foods and drinks should be available, consider the number of calories an item delivers as well as its content of sugar, fat, saturated fat, trans fats, salt, and nutritionally valuable components such as vitamins and minerals. In all schools, drinking water should be abundantly available, and students should be encouraged to drink water rather than sweetened beverages when thirsty.

Christine Holmes is a tall, powerfully built woman of color who moves like a dancer. Striding up and down her large open classroom, shaking back her long, curly black hair, she calls out questions to the 20 spell-bound seventh-grade students in her health class.

“Dauncy, how many calories equals a pound of fat?”

“Three thousand five hundred,” Dauncy says, promptly.

“Raise your hand if you eat just chips for lunch.”

Seven or eight hands slowly rise into the air. “Chips and juice,” says one boy defensively.

“How many grams of fat in that small French fries?”

Fourteen, someone ventures—a guess that’s probably a little on the high side.

“How many hours of TV did you watch on Saturday?”

“Seven,” admits Cherisse.

“What did you do for the rest?”

“Go out. Hang out with my friends and sister.”

Holmes asks how many people have brought in wrappers from their favorite snack foods. One student hands her the wrapping from a cookie bar. She reminds the others to bring in their snack wrappers the following day. “We’re going to figure out all the calories in a serving.” Then she moves on to discussing last night’s homework. “So, why exercise? I asked you to write a little something. Get it out.” Eagerly, the students volunteer to read aloud from their essays:

“You could have fun and you can forget about all of your worries.”

“To be more athletic.”

“To be less embarrassed to be in public.”

A shy girl softly reads an entire paragraph about self-confidence. Another girl mentions that exercise keeps your heart healthy. A boy says, “To be strong and to fit in your clothes.” Holmes gives everyone a chance to contribute before winding up the discussion: “Americans are overweight. We can stop this, but the only way it can happen is if we exercise.”

It’s a seamless transition to the next part of the class, a step aerobics session. Holmes asks the students to get up and move their backpacks out of the way. Each boy and girl positions a plastic step platform. Holmes turns on her boom box and puts on a CD of hip-hop music. She starts the students dancing, then marching in place. Soon they’re stepping on and off their platforms, moving left and right, punching the air.

“Five, six, seven, eight!” shouts Holmes, moving through the dance steps at the front of the room. “Singles! Doubles! Clap! High up!”

A lot of the kids are grinning now. They pump their arms in time to the music, lifting their knees higher in response to Holmes’s exhortations. Three girls are noticeably overweight. They look hot and winded, but like everyone else they keep going. Holmes teaches a dance sequence, then runs the students through the entire routine again. By now they’ve been doing aerobics for 25 minutes.

At last Holmes leads a slower set of cool-down exercises. “Come on! Don’t stop. Don’t stop.” After a few more minutes she asks them to sit on their platforms and find their pulses. The kids collapse onto the plastic benches, breathing hard and feeling for the artery on the side of

the neck. Holmes turns off most of the lights and asks the students to put their heads down and relax quietly for a minute or two. “Today was the first time we did the step routine,” she confides to a visitor. “They didn’t do too bad at all. I started them with kickboxing first, to invite them into movement. Anything that can get them moving, I’m for it.”

Trained to teach health and P.E., Christine Holmes serves as Mildred Avenue Middle School’s team leader for Planet Health, an obesity prevention curriculum for students in sixth through eighth grades that is being introduced in many schools in Boston and elsewhere. Mildred Avenue is a newly built middle school adjoining a community center in Mattapan, a low-income neighborhood southwest of downtown Boston. Designed by researchers and educators at the Harvard School of Public Health, Planet Health (mentioned in Chapter 5) integrates lessons on nutrition, physical activity, and reduction of TV time into school curricula in math, language arts, social studies, science, and physical education. It was studied during the late 1990s in a randomized trial involving 10 Boston-area schools, where it reduced children’s television viewing, increased fruit and vegetable consumption among girls, and reduced the prevalence of obesity among girls. (Among boys, obesity rates declined in both intervention and control schools; there was no significant difference found between those that received Planet Health and those that did not.) The city’s school system has received funding from the federal and state governments and from Blue Cross and Blue Shield of Massachusetts to expand Planet Health, as well as Eat Well & Keep Moving, an elementary school curriculum based on similar principles, into several dozen schools in the Boston area and elsewhere in the state.

Proving that any school curriculum can actually reduce obesity rates has been a difficult task; Planet Health is one of the few to have shown a measurable impact. Harvard’s Steven Gortmaker, who led the team that designed it, believes that its effectiveness stems from its simplicity. Planet Health’s goal is to impart four basic messages: Be physically active every day. Watch no more than two hours of TV per day. Eat 5 servings of fruits and vegetables every day. Eat fat in moderation.

A research trial is a blunt instrument: it cannot detect all of the effects of changing an educational program. When a school’s faculty

and staff enthusiastically adopt the principles of a program like Planet Health, there is a more subtle ripple effect on the school community that does not show up in scientific measurements. It manifests itself in unexpected ways. Teachers stop ordering Chinese food for lunch, instead bringing fruit and taking power walks. The guidance counselor drops in to join the aerobics session in Holmes’s classroom. The culture of the school starts to change.

This has happened at Mildred Avenue Middle School. Shirley Allen, the principal, moved from a job as principal of another Boston middle school to assume command of the newly built school in September 2003. She brought with her Holmes and several other teachers who had been teaching Planet Health for a year and had been sensitized to the growing concerns about the nutritional value of the foods sold in school cafeterias and vending machines. “For 30 years in this system, I’ve always had an issue with the food,” says Allen, a soft-spoken but forceful woman. “It’s kind of odd for me to see a school food system selling foods like potato chips and snacks. A lot of children eat the junk and won’t eat the lunch…. I have an issue with somebody making money off kids anyway.”

A few days before school opened in September, Allen walked into her sparkling new middle school and found a vending machine full of snacks installed in the cafeteria. Outraged, she called a food services official in Boston’s school system to protest. A nutritionist assured her that some of the snacks in the machine were healthy. “To me it was so ludicrous,” Allen recalls. “I said, ‘I don’t want it…. Take the machine out.’” The next day the snacks had been removed; a week later workmen wheeled away the machine.

This victory emboldened Allen to make other changes. She asked her cafeteria manager to stop selling potato chips and to offer more fresh fruit. She serves water now instead of ginger ale or cider at school council meetings. She has Holmes collaborate with dance and P.E. teachers to put on a quarterly “Fitness Friday” event, an entire day of dance, aerobics, kickboxing, swimming, and other physical activities in which students and many teachers participate. At meetings with other Boston-area principals, she told her colleagues about her success in getting rid of the vending machine. “In the school as a whole, we are

more aware [of nutrition],” Allen says. “When there’s food in the building for adults, normally you would have a lot of sodas, but pretty much now you just see plain water.”

Teachers and administrators at some other Boston-area schools using the new curricula report a similar cultural shift. At Channing Elementary in Hyde Park, another low-income Boston neighborhood, most teachers have received training in the Eat Well & Keep Moving curriculum. Besides lessons in nutrition, they are incorporating aerobics, jump rope, nature walks, and other exercise into their teaching. Classroom-based physical activity is especially important for children at Channing because the century-old school building has no gym or cafeteria, and there is no physical education program. The only place to play is a small paved playground that doubles as a parking area. Principal Deborah Dancy has obtained federal and state funding for a free “healthy breakfast” program at the school and has recruited parents to take turns sending in carrots and celery sticks as snacks for their children’s grades. The school nurse compiles a regular newsletter for parents with nutrition tips.

Obesity, diabetes, and high blood pressure are common problems in Hyde Park, including among faculty and staff at Channing. “Quite a few of our teachers have started eating more nutritiously, and they are losing weight,” says Dancy. “They have more energy.” Equally important, from the principal’s viewpoint, are the gains Channing students posted during the 2003–2004 academic year on citywide standardized tests. Dancy says Channing showed the greatest improvement of any school in its local cluster in students’ average scores for math and language arts. She credits the Eat Well & Keep Moving curriculum with building her students’ mental endurance. “It’s not enough just to have the skills,” she says. “They have to have the stamina to get through the test.”

Even the best designed and most lavishly funded school programs cannot, by themselves, vanquish the obesity epidemic or ensure that children will be healthy. After years of trying, Leslie Lytle has learned this. The University of Minnesota epidemiologist was a member of the re-

search team that led the CATCH study mentioned in Chapter 5. Conducted among third- through fifth-graders at 96 schools in four states, the three-year trial represented the most exhaustive school-based effort ever undertaken to improve children’s habits regarding diet and physical activity. Reducing obesity was not the primary goal of CATCH; its purpose was to improve children’s risk profile for heart disease, particularly their blood cholesterol level. However, the project’s outcome measures also included children’s BMI, body fat, blood pressure, health knowledge, and eating and activity patterns.

CATCH featured a classroom-based health curriculum that taught children about healthy eating, physical activity, and tobacco use. It had a state-of-the-art physical education program designed to increase the time kids spent doing moderate or vigorous activity. And it revamped the school menu to reduce the fat content of lunch offerings. Fifty-six elementary schools were randomly assigned to receive the CATCH intervention; 40 schools served as the control group for comparison.

CATCH succeeded in changing both children’s knowledge and their behavior. Children in the intervention schools demonstrated a lasting increase in their knowledge about healthy food choices, and their eating habits actually improved. Compared with students in control schools, CATCH participants lowered their average daily fat intake and spent more time each day being physically active. But these favorable changes were not reflected in the health measurements that determined the trial’s scientific outcome. Children in the CATCH program did not show a significant drop in cholesterol or blood pressure, nor did they have lower obesity rates than children in the control schools when the project ended.

Why didn’t CATCH reduce children’s risk of being overweight? The answer isn’t known. Lytle suggests it is still possible that the program did lower the risk, but not soon enough to be apparent when its effects were assessed. Perhaps the benefits will appear later in the participants’ lives. Researchers recontacted CATCH participants in the eighth grade, several years after the trial ended, and found that they were still reporting lower fat intake and more physical activity than children in the control group. “They had learned something and it had stuck with them,” states Lytle. She is currently restudying CATCH students who are now in twelfth grade, including measuring their BMIs.

CATCH’s failure to make a measurable impact on obesity risk may also reflect aspects of the curriculum design. For example, it did not try to persuade children to cut back on how much time they spent watching television, a strategy that has since proved effective in Planet Health and some other school interventions. And although it taught students about healthy food choices, it did not teach them about calories or portion sizes. Obesity prevention researchers are increasingly convinced that those topics need to be included in nutrition education for kids. “Eating a more healthful diet does not necessarily mean you’re going to change the energy balance between energy intake and energy output,” Lytle notes. “There’s the assumption that you’ll be eating fewer calories, and that if you’re more physically active, you will end up with a weight reduction. I think that’s faulty. If we want to study what gets kids to lose weight, we need to design studies that will focus on the energy balance piece of it.”

CATCH was school centered. It did not include a major effort to involve families or to change what children did after school or at home. “While we could positively affect the school piece, kids’ total calorie intake and energy expenditure is over a 24-hour period,” Lytle points out. “The family is a huge piece of this. We’re really struggling about how to get families engaged in all health promotions with kids.” CATCH was also an enormous project: it included more than 5,000 children in different regions of the country. How effectively the program was implemented varied, Lytle says, depending on the leadership and enthusiasm at individual schools. The same would undoubtedly be true of any new program a school system adopted.

After years of doing research in schools, “I can walk into a new school and almost within an hour say, ‘This school, if there’s a randomized intervention, will be dynamite,’ or ‘This school will be hard,’” Lytle states. “You can feel it…. Schools where there’s more cohesion, felt support, and all those kinds of things tend to adopt and institutionalize health programs much more aggressively than schools that are disconnected and struggling.” Leadership, a sense of purpose, clear educational principles, passionate and energetic teachers, adequate space and resources, involvement by parents and by the local community—the same qualities a school needs to effectively teach reading and math are what it needs to teach children how to be healthy.

Sometimes the best way to find an educational strategy that works is to start small. In 2001, when Meg Campbell started Codman Academy, a tiny public charter school in Boston’s Dorchester neighborhood, she drew on all the lessons she had learned as a teacher, poet, community organizer, health care researcher, mother of two daughters, and former “chubby kid.” Campbell believes that a central flaw in American education is that schools concentrate on nurturing children’s minds but fail to nurture their bodies. She had helped start Expeditionary Learning Outward Bound, a school reform project focused on active learning, and had been following the research findings on childhood obesity and physical activity. When she was planning her charter school, Campbell says, she was “immersed in the healthy mind/healthy body connection.” She decided she wanted to found a school where walking was built into the daily routine. She took a map of Dorchester, placed the point of her compass on the new school’s headquarters (located in the community health center at Codman Square), and drew a circle with a 1-mile radius. “I figured a mile was about the most that kids would walk” at one time, she says. She arranged her students’ schedule so that they had to walk to classes and activities scattered around the neighborhood, up to a mile apart: a tennis center, a gym, various classroom settings.

In its third year of operation, Codman Academy is a tough college preparatory school with approximately 80 students in grades 9 through 11. Most are African American children from poor families. They walk an average of 6 miles per week in addition to attending regular physical education classes (including required tennis). “If you do not like walking, this might not be the right school for you,” wrote ninth-grader Marquis Benjamin in a letter to new students. “When I first came here, I did not like to walk a lot but then one of my teachers said that I would have to learn to like it…. Now it does not really bother me as much.” Walking has become part of the school culture. Campbell tells her students that, just like Codman’s strict academic standards, the walking is preparing them for higher education: “It’s like college. In college, you walk everywhere.”

“I have some kids who are really clinically obese,” she says. “They’ll break into a sweat walking.” Many of the school’s approximately 80

students have lost weight since they enrolled at Codman, including one girl who has lost 50 pounds. “No one has gained weight at our school,” Campbell says proudly. She puts nutrition lessons in the curriculum, puts scales in the bathrooms, and makes sure lunch offerings are healthy. In contracts with food vendors she specifies that she will accept no French fries, no sausage, no high-fat items. “Many people in education say, ‘I have no control over lunch.’ They say, ‘Kids don’t like lettuce.’ I say, ‘Well, they don’t usually walk in saying, ‘Please, can I have algebra?’ either.”

Codman students attend classes from 9 a.m. to 5 p.m. Mondays through Fridays and from 9 a.m. to noon on Saturdays. Campbell can’t prevent her teenage students from going to the McDonald’s across the street and buying lunch or snacks, but she forbids them to bring the food onto school premises. She tells them, “You know how I feel about it. It’s like cigarettes. If you want to clog your arteries, do it on your own time.” She doesn’t buy the argument that fighting obesity is outside the realm of public schools’ responsibility. She believes that children want to be healthy, want to eat right, and feel empowered by knowing how to take care of their bodies.

“We have an epidemic, and the biggest contributor to the epidemic as far as I can see is public schools—both in terms of the poor food that they give and the lack of exercise,” she says. “It’s nothing to do with personal choice, because the kids are captive, at least for nine months of the year. This is a public health problem that we can solve.”

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