Unhealthy Foods & Beverages Brought to School Outnumber Healthy Alternatives: Talking with Researcher Karen Coleman

Karen J. Coleman, PhD

Karen J. Coleman, PhD

In a recent report, the Institute of Medicine described schools as the “heart of health” and identified school-based interventions – policies that change food environments in schools – as one of the most promising ways to prevent childhood obesity. Inspired by these recommendations, Karen J. Coleman, PhD, a researcher from the Kaiser Permanente Southern California Department of Research & Evaluation, led the Healthy Options for Nutrition Environments in Schools (Healthy ONES) project. This program worked to change nutrition environments and policies at eight elementary and middle schools in Southern California over a three-year period. The project led to a study last year that found involving teachers, parents, and school staff to promote healthy school nutrition environments helped to reduce unhealthy foods and beverages in schools by 30 percent.

This week another study was published from this initiative in the journal Public Health Nutrition that reveals nearly 80 percent of all food and beverages brought to elementary and middle schools by students, parents, and teachers are unhealthy — including high-sugar snacks, beverages with added sugar, and chips or crackers. We caught up with Dr. Coleman to discuss the findings of her latest study and the importance of healthy foods and beverages in schools.

CTH Blog:
This is not your first time reporting on food options in schools. Tell us a bit about your work in this area.

Karen Coleman:
The Healthy ONES program was the result of a national research initiative from the U.S. Department of Agriculture concerning nutrition and policy. From 2007 to 2010 we studied a low-income school district in San Diego. We worked with schools in the district to remove unhealthy foods and beverages that were brought to campus for celebrations, fundraisers, and school meals. We also tried to encourage students to eat healthier food options, such as fruits and vegetables. We discovered that schools were throwing away perfectly good fruit after each lunch period, so we convinced cafeteria staff to serve the fruit as snacks for morning recess. We also worked with teachers in the school district to change their habits of using unhealthy foods and beverages as rewards. Now, instead of candy bars and soda, students are rewarded with stickers, pens, or certificates for quality time with the teacher. These are just a few examples of the types of things we have done to encourage healthier nutrition habits among schoolchildren.

CTH Blog:
What did you find in this latest study?

KC:
We set out to develop a system to monitor the junk food brought to eight school campuses in the Healthy ONES schools. We wanted this method to be as objective as possible since much of the research in this area was based on self-reporting, which is not always accurate. We observed and recorded the types of foods and beverages that students, parents, and teachers brought to school campuses over a period of one year before we started the Healthy ONES program and found that nearly 80 percent of all food and beverage items were unhealthy such as high-sugar snacks, baked goods, energy and snack bars, beverages with added sugar, and chips or crackers. We also found that only 14 percent of all items were healthy such as fruits, vegetables, and 100 percent water. This was the trend across all school environments observed including the playground, gym, classroom, and cafeteria. None of the schools studied had outside food vendors or vending machines on premises, so the only sources of this unhealthy food were students, parents, teachers, and other school staff.

CTH Blog:
Were you surprised by these findings?

KC:
Based on my experience I was not surprised by the lack of healthy nutrition options in schools, but I was surprised by the frequency in which children are exposed to junk food. I think that people greatly underestimate the amount of junk food present on school campuses and at special occasions, like end-of-the-month celebrations, birthday parties, and holiday festivities. There are also school-wide assemblies and fundraisers, parent and teacher nights, and many other events where organizers serve junk food. All of the unhealthy foods and beverages served at these events adds up over time. People often think about this as happening every once in a while but in reality, it happens a lot more often.

CTH Blog:
This study is unique in that it uses direct observation by non-school staff to report findings. Why is this important?

KC:
I think that if people really want to assess the environment or the impact of a policy accurately, objectively observing the outcomes is important. Studies that ask people about what is happening in their environment, especially when it comes to healthy behaviors, can sometimes be unreliable, because there may be pressure to report they are doing better than they actually are. Another issue with self-reporting is that staff are often limited to certain areas of the school, such as the classroom or cafeteria, and may not be able to tell us what is happening at school-wide events or fundraisers. As independent researchers, we were able to visit every environment within each school, at any time, and objectively assess the types of foods and beverages present in a methodical way. Conducting a study this way provides us with a better understanding of the extent of the problem.

CTH Blog:
Why focus healthy eating initiatives on the school environment?

KC:
The school environment is important because most kids spend the majority of their day there. We have the opportunity to control these settings and make them as healthy and safe for kids as possible. In addition, public schools have mandates to ensure the well-being and health of their students. The work we are doing here is intended to help school districts realize these goals.

CTH Blog:
What do you hope people take away from this study?

KC:
Up to now, the majority of the work done to change nutrition environments in school settings has focused on the quality of school meals or reducing unhealthy competitive foods sold or in vending machines on campuses. I really hope that as a result of this study, people are more aware that students, parents, teachers, and school staff are a major source of unhealthy items on campuses and that this problem is more prevalent than we think. Although regulating food and beverage items brought to school campuses is a time-intensive task, it engages and educates parents and staff about nutrition while improving what is available during the school day. These efforts may also influence what parents and children eat at home.

CTH Blog:
Tell us a little bit about the other work that Kaiser Permanente is doing in this area.

KC:
One way Kaiser Permanente is working with schools to improve overall health is through an initiative called Thriving Schools.  The program promotes workforce health and student-focused initiatives like improving school lunches and increasing opportunities for physical activity. Kaiser Permanente also recently worked with the San Diego Unified School District to develop a “Breakfast in the Classroom” program. As part of the program, the school sets aside 10 – 15 minutes at the beginning of each day to allow the students to eat their meals. The program also assigns students with various mealtime roles, such as retrieving food from the cafeteria, distributing placemats and food items for the class, and cleaning up.

 

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