Wendy, an anguished high school freshman in Tucson, is 5 feet, 7 inches tall and weighs 180 pounds (which gives her a Body Mass Index of 28.18, substantially "overweight").
There is much more at stake than adolescent anguish about overweight. U.S. Surgeon General David Satcher has warned that obesity may soon overtake tobacco as the chief cause of preventable deaths in the United States. About 60 percent of adults in this country are overweight or obese, and the 1999 National Health and Nutrition Examination found 13 percent of children 6 to 11 years old to be overweight, 14 percent of adolescents 12 to 19. Some 300,000 Americans die every year from illnesses caused or worsened by obesity. Obesity can lead to death from heart disease, high blood pressure, type II diabetes and cancer.
Wendy was interviewed by Mimi Nichter, assistant professor of anthropology at the University of Arizona and author of Fat Talk: What Girls and Their Parents Say About Dieting (Harvard, 2000).
Nichter found that teen-agers are overwhelmed with temptations to eat fat food. Ironically, they also are bombarded with messages to be thin. "Despite intense pressures to be thin and media portrayals of an epidemic of dieting," Nichter wrote, "teen-aged girls live in a world saturated with junk food. The typical dietary choices offered in middle and high school lunchrooms are a variety of high-fat foods such as pizza and French fries, served together as a luncheon special. Ice cream and candy are readily available for dessert. How do girls deal with the opposition between ever-present junk food and the pervasive desire to be thin? One way the girls resolved this paradox was to reach for a candy bar and a Diet Coke, a combination that some jokingly referred to as a 'balanced diet.'
"Given the food dished out in schools, it is not hard to understand why the Centers for Disease Control continue to report increasing obesity among youth. The widespread availability of high-fat food in lunchrooms and in fast-food restaurants, coupled with a decrease in physical activity is one reason kids are getting fatter."
The growth in obesity is relatively recent. In 1962, 13 percent of the population was obese. By 1994, 35 percent of Americans were characterized as obese. In that same period, lifestyles underwent dramatic changes: there is more cheap, calorie-dense food available and people do not exercise as much as before. The United States has more than 215,000 fast-food restaurants, and nearly half of the country's food budget is for meals and snacks eaten away from home. More than half of all adult Americans get no regular physical activity and a quarter get none at all. Couch potatoes are common.
Where our children used to play outdoors, now they often can be found inside. Americans watch 1,539 hours of television, 51 hours of videos and play 21 hours of video games a year--an average of 4.5 hours a day spent in front of a TV screen.
SOME STATE LEGISLATURES ARE trying to reduce the growth of obesity among children by limiting the sale of candy, soft drinks and fatty snacks in schools. But the Arizona Legislature is not among them. Nearly all schools in Tucson have carbonated soft drink and snack vending machines. Some schools prohibit their use during lunch period and other times of the day.
Karen Blair, principal of Flowing Wells High School and a former physical education instructor, admits there is a problem of obesity in her school and was candid about the use of soda and snack-food vending machines. Coca-Cola has a contract with the school to provide soda vending machines. The company pays the school a commission. Blair described it as a "necessary nuisance" which supplies much-needed revenue. She says soda machine revenue helps pay for such things as those children who don't have the money for a field trip. "We don't leave him or her home. He or she pays a portion and we take [the rest] from the funds from the Coke machines." Her school also has a contract with Desert Oasis, a snack-food vendor with machines in many of Tucson's schools.
Catalina Foothills High School's principal, Wagner Van Black, said having an outside company, Sodexho Marriott, run the lunch program not only generates revenue for the school, it relieves it of personnel problems. "They clean the tables, take the trash out and provide the food for the students," he said. Van Black declined to discuss the effect of such food services on student diet.
But Nichter, the UA anthropologist, gives generally low marks to Tucson school cafeterias. So does a mother who personally knows the emotional pain of obesity. Danielle DeLacio, who has had a gastric bypass operation, packs a lunch for her 8-year-old son because, she says, most school meals "are between 30 and 50 percent fat."
Nichter believes that the system actually works against a student who wants to eat more healthfully in a school cafeteria. "In contrast to the widespread availability of candy, salads are rare and costly commodities in the cafeteria," she wrote in her book. "Several girls complained that they would like to eat better at school but that the healthier foods like salads were more expensive than the high-fat foods like pizza and French fries. As one girl explained, 'Everything is fries here. They should try and push a little more nutrition, but they don't. I mean, like before going to buy your fries and stuff, I think they should have, like a No Smoking sign that warns you that it's dangerous. They should have what fries can do and how much fat they have and stuff. I mean, it probably won't stop very many people here, but it might make them take a second look at it ... Well, I don't know. I mean, all the bad food tastes good, and all the good food can be like so nasty. Food that's good for you costs more too.'"
Robert Abalos, the food service director for Catalina, said only 15 to 20 students purchase salads for lunch (there are about 1,350 students at the school). A tour through the lunch areas reveals meals of hot dogs and chips, chicken patties, hamburgers, pizza pockets, super pretzels with cream cheese and regular pizza. Abalos said the cafeteria periodically offers spaghetti with meat and tomato sauce.
The school shuts down soft drink and candy vending machines during the lunch hour and students cannot purchase sodas in the cafeteria, said Larry McKee, the school's principal. Milk, Gatorade or juices were available. Outside of lunch hours, the vending machines are operating. McKee estimates they generate about $25,000 a year in revenue to be used for events such as school dances.
NICHTER LAMENTS THE takeover of school cafeterias by fast-food companies. "It is not just soda machines that have worked their way into schools through corporate promises of revenue and other much other much needed resources to financially strapped administrators," she wrote. "Between 1991 and 1996, the percentage of public schools participating in the sale of brand-name fast foods increased dramatically, from about 2 percent to 13 percent. Burgers, fries and pizza from popular chains have become increasingly available in the school cafeteria."
There are huge profits for soft-drink bottlers in the school-age market. Soft drink consumption has tripled for teen-age boys and doubled for girls in the last 20 years, CBS News' 60 Minutes reported earlier this year, and American children now consume twice as much soda as milk.
A spokesman for Coca-Cola explained that the company's community relations program provides scoreboards, marching band uniforms and other such amenities for schools, in addition to the revenue schools derive from Coke vending machines. Coca-Cola has vending machines in nearly all the high schools in the Tucson area. Mary Dunkel, marketing director of Pepsi-Cola, said her company has a contract only with the Sunnyside School District. She said the schools in that district operate the soda vending machines and set the prices to be charged for the soft drinks. They pay a wholesale price to Pepsi.
Nichter believes carbonated soda consumption is out of control among high-school girls. "We find that more than 40 percent of the girls in our study were drinking two glasses of milk a week or less! Low calcium consumption was confirmed on the girls' diet records. In sharp contrast to their low milk consumption, one-third of girls were drinking soda two to three times a day or more, while another 20 percent reported drinking soda once a day!"
Consumption of soft drinks keeps climbing, as does the size of the drinks. In the late 1960s, Coca-Cola offered a 6.5-ounce bottle with fewer than 100 calories. Later, machines dispensed 12-ounce can with 140 calories. Today, 20-ounce portions are more the norm.
"The trend among youth toward soda consumption over milk has been documented nationwide," wrote Nichter. "Conservative estimates have children and teens guzzling more than 64 gallons of soda per year (much of which is caffeinated), an amount that has tripled for teens since 1978. The average 13-to-18-year-old female soda drinker consumes more than two cans a day, and 10 percent of females consume five or more cans a day. Soda is the main beverage of youth and provides many young people with 20 to 40 percent of their daily calories.... Of particular concern to women, the replacement of milk with soda may herald increasing rates of osteoporosis in future years."
To an alarming extent, schools have also become conduits for corporate advertising and image-building. Many American high schools start the day with televised news and educational programs that often are endorsements for food products. Tucson schools often advertise their connection to major food and beverage corporations on their marquees. Back East, Hershey's even developed and disseminated free curricula to middle schools, "teaching about the place of chocolate in a balanced diet!"
Many adolescents seem to know little or nothing about nutrition. According to a Gallup Poll in 2000, teen-agers talked a healthful diet, but acted differently. The survey of 375 teenagers found that they said they selected a diet they thought was good for them. But potato or corn chips, cookies, candies, ice cream and other sweets led the list of preferred snack foods. Only 10 percent named fruit as their favorite snack food.
How can students learn about nutrition, in order to be careful about their choice of foods? In general, schools neglect nutrition. "In [the Tucson] high schools in which I worked," wrote Nichter, "health education was required as a one-semester course. During the four years of high school, a student was exposed to a maximum of five class periods on nutrition. There was considerable latitude as to what was included in these classes, and some health education teachers chose to include only one or two lessons on nutrition. ... [T]he content of these nutrition classes tended to be general, with a focus on food groups or the food pyramid. What was not addressed were the multitudes of questions that young people had about foods that they typically consumed. These questions involved not just health but beauty work and practices that girls engaged in for the sake of weight management. Considering the lack of information on how to make healthful food choices, coupled with the over-accessibility of high-fat foods and soda in the lunchroom and in vending machines, was it realistic to expect teens to eat healthfully?"
THE TUSD COMPREHENSIVE health education resource teacher, Kathy Carroll, disputes that view. "Every teacher--K through 12--is mandated to teach about nutrition standards. What is a nutritious meal? High-school teachers explain eating disorders, the relationship between excesses and deficiencies in nutrients and their impact on the body."
Weight control, of course is not solely dependent on what adolescents eat. Once upon a time, schools conducted abundant physical education. Today, in many parts of the country, PE is an endangered species. TUSD has what appear to be better than average standards for students' physical education: in elementary grades one through five, children are required to have PE 15 to 30 minutes three to five times a week. In middle grades six through eight, they are required to complete two years of PE amounting to 40 minutes every day. High school requirements are not specific, but students are expected to complete two years of PE. Sunnyside schools have no PE specialists at the elementary level, but have intramural sports. The district has intramural sports in middle school, along with PE classes. Flowing Wells does not require PE in its system, although it does require health education. Marana High School, however, requires a year of PE five days a week. After fulfilling that requirement, students have the option not to take PE.
"The trend nationally is to transition to an 'exercise club' atmosphere more than a sports activity atmosphere," Carroll said. "Students can know what their heart rate supposed to be. 'How do I know when I am fit and what does activity have to do with that?' Not 'Can I play badminton, tennis or football?' We are looking at fitness and measuring fitness and then 'What activities do you like and enjoy? You don't have to become a jock. We're concern about keeping kids--non-athletes--active."
However, Nichter is critical of Tucson's PE efforts. "You get these kids who may not have had PE in elementary school or in middle school, hardly," she said. "And then they set these incredible standards, these high standards for what you should be able to do. They'll say something like, 'You should be able to complete the mile in'--they'll set a number that is very unrealistic. Even when they give time for kids to work up to it, you have to recognize that people who have lived a sedentary lifestyle, when they are like suddenly 14 or 15 years old, it's going to be difficult for them even in the course of a few weeks in a semester to get up to that. [Furthermore] PE periods are really short."
Dr. Barry Shapiro, who specializes in treating obese children, told 60 Minutes, "A child who is obese at age 6 has a 50 percent chance of being an obese adult. A teen-ager who is obese has a 70 to 80 percent chance of being an obese adult."
Among the recent trends in fast-foods is the "super-size" portion. But we're not just super-sizing our colas--we're super-sizing our children, possibly for the rest of their lives.