School Initiatives to Solve Childhood Obesity

By
Elizabeth Moore
Greg Israelstam
Jamal Mohamed
Team #8
Engineering 2367 / Section 29875
The Ohio State University

Prepared For
The Ohio Department of Education
25 S Front Street, Columbus, OH 43215

Abstract:

This proposal addresses the issue of obesity in the US, specifically childhood obesity and how it
can be solved in the state of Ohio. This proposal includes background information on obesity and
its significance. It then goes to describe in detail the context surrounding childhood obesity, its
causes, and its effects on both the individual and society in general. This proposal’s objective is
to persuade the Ohio Department of Education that a solution to childhood obesity is both
feasible and would save the state money in the long run. To this end, this proposal includes a
three-pronged approach to solving childhood obesity at the public school level by increasing
fresh produce in school lunches, incentivizing schools to spend more on physical education, and
establishing a more comprehensive health education course. The childhood obesity epidemic is a
problem that impacts all corners of society and preventative steps must be taken early in a child’s
life to reverse its harmful effects.

March 26, 2018

 Introduction
Background Information

Obesity is increasingly becoming a problem in the United States. The CDC defines obesity as
excessive body fat characterized by a Body Mass Index (BMI) of greater than 30. In 1990, only
15% of US adults were obese while today almost 36% of adults are considered obese and almost
70% are considered clinically overweight (“Obesity Prevention Source”, 2011). What is even
more disturbing is that youth and adolescent obesity has been increasing at an even greater rate.
The CDC defines children who are above or at the 85th percentile in the body mass index as
overweight while those who are above or at the 95th percentile as obese. The percentage of
teenagers and children who are obese has increased more than three times over the past few
decades. As figure 1 shows, in 1971, only 5% of youth between the ages of 2 and 19 were obese
and that number has increased to almost 15% in 2002 (Anderson, 2006).

Figure 1: Obesity Rates Over Time in the US (Anderson, 2006)

Significance
Obesity has a wide and noticeable impact on our communities and the individual. For US adults
aged less than 70, obesity is the is the second largest cause of death and is closely related to a
number of diseases and debilitating conditions including high blood pressure, heart disease,
asthma, sleep apnea, and many types of cancer. Obesity also negatively impacts our economy as
direct health costs associated with obesity and its related diseases strain the healthcare system
(“Obesity Prevention Source”, 2011). Indirect costs to the economy (related to missing days of
work, high employer insurance premiums, etc.) can be as high as $23 billion. Childhood obesity
is also intricately linked to adult obesity. Children who are obese are more likely than others to
become obese as adults (Anderson, 2006). Childhood obesity is also detrimental in and of itself.
Obese children tend to have lower academic performance than others and suffer from negative
emotional and physical health. They often carry these conditions into adulthood (Sahoo et. al.,
2015).

Recommendations

It is obvious from this discussion, then, that obesity is a growing crisis in the United States that
impacts everyone in some manner. However, obesity is also a preventable epidemic and our
public school system is the place where we can make lasting changes to reverse these trends. The
Ohio Department of Education can decrease the number of obese children significantly through a
three-step process. This process will consist of making the food available in school lunches
healthier, giving schools increased incentives to offer more time for physical activity in the
school day, and increasing the health education requirement for children in elementary and
middle schools. Unhealthy eating and a lack of physical activity are two of the main causes of
childhood obesity. These three initiatives will combat those causes to make a major improvement
towards the elimination of childhood obesity.

Current Situation
Context

Merriam-Webster dictionary classifies obesity as “a condition characterized by the excessive

accumulation and storage of fat in the body.” This definition may mislead people into
considering obesity as merely a
weight problem by downplaying
the severity of obesity and the
scope of its detrimental effects.
However, obesity is a serious
disease, and progress toward a
solution cannot be made until we
recognize it as such. Obesity
lowers the quality of life and is
associated with many debilitating
and life-threatening diseases. Type
2 Diabetes and Coronary Heart
Disease are two of the most well-
known and widespread diseases
resulting from obesity.
Figure 2: Overweight and Obesity Rates in Ohio (Adult Obesity in the US, n.d.)

There is a growing body of evidence that links these diseases specifically to childhood obesity.
This is why it troubling that childhood obesity is on the rise. Over 42 million children under the
age of five were estimated to be overweight in 2010 (Sahoo, K., Sahoo, B., Choudhury, Sofi,
Kumar, & Bhadoria, 2015). As Figure 2 shows, in Ohio alone, about one-third of children ages
10-17 are obese or overweight. Children are also the ones most at risk of obesity complications
including, but not limited to, breathing problems, joint problems, high blood pressure and
cholesterol (increased risk for cardiovascular disease), liver disease, and social/psychological
issues. The list of complications obese children would face will only grow as they become adults
(Health Risks of Childhood Obesity, n.d.). Children not only suffer from the physical effects of
obesity, but also the psychological effects that negatively impact their academic performance as
well as their socio-emotional well-being. Studies have shown that overweight children are more
likely to be teased by peers, resulting in self-esteem issues that affect them for the rest of their
lives.The studies have also shown that obese children tend to have fewer friends, and thus live a
more sedentary lifestyle, which further leads to greater weight gain. Having fewer friends
decreases the number the opportunities available to these children to engage in physical activity
like playing games and sports. Obese children were four times more likely to admit having
problems at school as compared to their non-obese classmates (Sahoo, K., Sahoo, B.,
Choudhury, Sofi, Kumar, & Bhadoria, 2015). With the added stress and emotional difficulties
they face from their physical appearance, it is not surprising obese children have more trouble in
school than their healthy counterparts.

Causes

Research has found positive links between obesity and soft drinks, fast foods, lack of physical
activity, and television watching (Anderson & Butcher, 2006). According to the CDC, shorter
sleeping hours, poor metabolism, and genetics can all play a part. Lack of physical activity plays
a major role in the epidemic because of the overuse of electronics. Research has shown that the
prevalence of obesity increased by 2% for each additional hour of television watched. Snacking
on unhealthy foods (chips, candy, etc.) and drinking sugary beverages throughout the day are
also major factors in the increasing prevalence of childhood obesity that can be easily prevented
with increased education and awareness of food options in schools.

Effects

Childhood obesity does not just impact the life of the child; rather, it many different facets of
society. Parents of the child have to spend time and money to treat their child while healthcare
professionals spend precious resources and time treating complications associated with obesity.
Doctors also have a difficult time treating obesity as it is a newly-declared disease and people
generally don’t follow the health recommendations doctors advise. Treating these complications
also strains our economy and our healthcare system. Healthcare costs are 42 percent higher for
an obese adult than for a healthy adult, taxing the entire nation’s healthcare system (The
Healthcare Costs of Obesity, n.d.). The loss of productivity and missing days of work or school
due to obesity also negatively impacts our economy and these indirect costs can be as high as
$23 billion (Lobstein, 2004). The percentage of teenagers and children who are obese has
increased more than three times since 1971 (Anderson & Butcher, 2006). Around 75-80% of
these obese children will become obese adults (Lifshitz, 2008). Furthermore, insurance
companies including Aetna Foundation, UnitedHealthcare and Intermountain Healthcare have
been spending large amounts of money and time to fight childhood obesity. Aetna Foundation,
for example, has not only spent money hosting events to fundraise for the issue, but has also
awarded obesity-related grants of up to $150,000 per year (Storper, 2010). With insurance
companies spending so many resources on obesity, rates and premiums will go up for everyone
else. Resources should not be wasted on a disease that can be prevented if it is combated early
enough in a child’s life. Childhood obesity affects everyone in some way and thus it is key to
prevent childhood obesity early by making the necessary changes in public schools.

Proposed Solution
To tackle childhood obesity and prevent potential future health complications, proactive steps
need to be taken early on in an individual’s lifetime to instill healthy habits. Therefore, it is the
school systems’ and government’s responsibility to provide young students with more
meaningful opportunities for exercise and access to nutritious food. To accomplish this, a three-
pronged approach can be implemented to focus on nutritious dietary access, increased physical
activity and health education. Ultimately, the goal is to change the overall environment of health
in schools to give young children the tools and exposure to make healthy decisions and create a
long-term track record of consistent attention to health.

Dietary Access

In order to fully mitigate childhood obesity in a holistic manner, supervision and restrictions
need to be enforced in all areas of a child’s health. Although all-around diet should follow a
general guideline to promote healthy eating, schools have the ability to manage what a child eats
for lunch each school day. Therefore, by focusing more attention on providing healthier
academic lunch options, a child is exposed to the diversity of nutritious alternatives from a young
age.

Therefore, the first step in this proposed process is to ensure that children have continual access
to fresh fruits and vegetables to supplement lunch programs. This will allow students to freely
select fresh, healthy options that provide sufficient nutrients to promote a healthier dietary
lifestyle. To this end, it is suggested that the Ohio Department of Education provide funding and
support to the Salad Bars to Schools initiative.

This program was created as a complement to Michelle Obama’s “Let’s Move!” foundation, and
allows school districts to apply for grants to provide salad bars to all students through various
lunch programs. It is structured so that both private and public schools are able to apply for a
waiting-list where donors ultimately fund the initiative. Currently, this national program has
received funding from various sources such as Whole Foods, The Chef Ann Foundation, HBO
and the Indiana State Department of Health.

In order to encourage school districts and other early-childhood institutions to apply for this
program, there needs to be sufficient funding to efficiently implement these salad bars on a state-
wide scale. Thus, the Ohio Department of Education should take the initiative to donate the
necessary funding for Ohio schools to be able to apply for these grants and bypass the waiting-
list process. This will give administrators a more flexible approach to providing healthier dietary
options without the challenge of internal fundraising.

Physical Activity

Along with this proposed initiative to bring more fresh fruits and vegetables to a student’s
dietary structure, schools should complement the approach to healthy lifestyles by promoting
increased physical activity. This will provide an opportunity for children to exercise and
maintain a healthy balance between learning and staying active.

Therefore, the second prong in this proposed solution is to encourage schools to provide children
with more opportunities for structured physical activity throughout the school day. Increased
physical activity levels will directly address some of the underlying causes of childhood obesity
and allow children to establish a proactive lifestyle of physical health that is structured and
regulated. Thus, the Ohio Department of Education should implement a tax-based incentive to
allow schools to access better equipment for physical education and provide tax credits for
schools that exceed the standard requirements of physical activity levels.

According to research conducted by Dr. Barbara Von Tigerstrom, provincial and federal
governments in Canada currently provide various tax incentives to promote physical health, such
as personal income tax credits as well as sales tax credits. For the purposes of increasing health
standards in schools, however, the Ohio Department of Education should focus on providing
sales tax credits to schools who purchase equipment or facilities that promote physical activity.
According to Dr. Von Tigerstrom, “A sales tax exemption might be superior to an income tax–
based incentive… Unlike an income tax credit, a sales tax exemption generally provides an
immediate benefit and would reduce the up-front cost of a good or service, making it more useful
to lower-income groups” such as low-income schools or organizations (Tigerstrom, 2011). Such
tax credits would allow schools to be more financially able to purchase playgrounds and
recreational facilities for students.

Once this tax credit is available, however, schools need to be incentivized to promote increased
physical activity levels so that the tax credits can be beneficial and relevant to budgeting.
Therefore, the Ohio Department of Education should implement their Physical Activity Pilot
Program on a statewide level. Currently, the program incentivizes schools to exceed the
minimum 30 minutes of “rigorous” physical activity, by recognizing and awarding these schools
on state report cards. The Department of Education could support the incentive by recognizing
and awarding superior schools, such as those who rank in the top quartile of physical activity
levels, by providing increased tax credits and special ratings on state report cards. As a result,
school systems will be more inclined to provide increased levels of activity to their students, and
promote their value with updated infrastructure and equipment.

Health Education

Finally, a holistic environment of promoting a healthier lifestyle can be achieved by

incorporating a health education program into the standard curriculum. This will ideally give
children the tools to combat childhood obesity and provide an understanding of why these
healthier choices are so vital to one’s physical development.

The current state of health education regarding nutrition and physical activity in Ohio schools is
not prioritized on a statewide level. According to the Ohio Revised Code (ORC)3313.603,
“Requirements for high school graduation… include one-half unit of Health that… shall include
instruction in nutrition and the benefits of nutritious foods and physical activity for overall
health” (Ohio Department of Health, 2017).

Therefore, schools are only required to provide students with one semester of health education
that addresses physical, nutritional, mental, societal, and drug related health concerns. Since the
need for physical and nutritional health education is prevalent, and would complement the
previous two solutions, the Department of Education should implement a separate, more in-depth
health course related to obesity and physical education and mandate this program for Elementary
or Middle Schools. This will provide student with sufficient education to make informed choices
and understand the importance of maintaining a healthy lifestyle.

Qualifications and Experience

We are a group comprised of passionate, well-educated individuals whose goal is to prevent and
reverse the complications of childhood obesity on a local and national scale. We have
experienced first-hand the nature of the current health system in schools and are witnesses to the
significant role that schools can have on a child’s overall development and long-term health.
With the increasing national concern surrounding the exponential growth of childhood obesity,
we decided to take initiative to research and develop a holistic approach to health in schools, so
as to mitigate and reduce the instances of childhood obesity.

As a team, we have completed hours of research on the current status of childhood obesity, how
it has changed in the past 30 years, and some potential reasons as to why more children are
obesity today than ever before. The research led us to shift our attention to schools and
government Departments who have a direct influence on children’s health. This opened an array
of potential fixes and highlighted the current programs that are being implemented around the
nation.

In analyzing these various programs, we have developed a three-pronged, wide-reaching

approach to alter the general health environment in schools. Keeping all stakeholders in mind,
our research led us to various solutions such as sales tax credits which would benefit children as
well as the schools investing in the children. Overall, our recent exposure to the nature of health
in schools, our passion for providing solutions to groups in need and our research and education
on the topic has allowed us to understand the situation in great depth and develop a systematic
solution to instill healthy habits and prevent obesity.

Budget

Program Cost Benefits

Salad Bars to Schools $2625 per school Reduced purchases of

processed food
 School Tax Credits $90 to $115 million $692 million

Health Education Course $30,500 $50,662

Figure 3: The Costs and Benefits of Adding Health Initiatives into Schools

The cost of increasing fresh produce in school lunches can be relatively low. In a case study
involving 28 elementary schools (Chef Ann Cooper, 2018) conducted by Salad Bars to Schools
found that the school salad bar cost per serving at elementary schools to be only $0.15.
Furthermore, the share of fresh produce in school food purchases shifted from 4% to 24% in the
first year of implementation. Schools balanced out this increase in fresh produce by reducing
their purchases of canned vegetables, French fries, and other manufactured, further reducing cost
of the program.

The cost of the school tax credits and health educational course, on the other hand, can be high.
Although it is difficult to measure how much the tax credits would cost directly in the United
States, the cost of Canada’s Children’s Fitness Credit (Tigerstrom, 2011) amounted to
approximately $90 million to $115 million each year in lost tax revenue and Wylie 1983
estimated that the cost of two semesters of a comprehensive health course to be $30,500.
However, these programs more than make up for their cost through long term savings in
healthcare. The Canadian tax credits, by some estimates, could lead to healthcare savings as high
as $692 million by 2029. Although this estimate is controversial and relied on optimistic
assumptions, it cannot be denied that these tax credits will lead to some reduction in health care
costs (Tigerstrom, 2011). The health education course will also lead to healthcare savings,
amounting to an estimated $50,622 (Wylie, 1983). Thus these programs should be implemented
in schools not only because they will likely have net positive costs as figure 3 shows, but also
because it is morally imperative that our children have the necessary diet, school equipment, and
knowledge to prepare them to live fuller and happier lives.

Conclusion
Some have argued that the childhood obesity epidemic has been exaggerated by the media;
however, this proposal has shown that there is a considerable amount of evidence to show that
the obesity epidemic is both real and has a substantial impact on both the individual and society
in general. A large body of evidence has shown that obesity increases the risk for many life-
threatening diseases including diabetes, hypertension, and heart disease (Jeffrey, 2008). Research
has also shown that the percentage of teenagers and children who are obese has increased more
than three times since 1971 (Anderson, 2006 and Jeffrey, 2008). Furthermore, direct costs to the
economy due to obesity and obesity-related diseases can be anywhere from 2-7% of a developed
country’s total healthcare costs. Indirect costs, related to the loss of productivity due to obesity,
can be as high as $23 billion (Lobstein, 2004). To solve this epidemic, we can tackle the problem
at the grade-school level by applying a three-pronged approach. The first solution is for the Ohio
Department of Education to support and fund the Salad Bars to Schools initiative that aims
increase the volume of fresh produce in school meals. The second solution is to provide a tax
incentive for schools to spend on students’ physical education. The last solution is for schools to
offer two semester-course that would focus on obesity and health-related topics. These solutions
will both help our children to make better decisions that will lead to fulfilling lives in the future,
but also provide healthcare savings long-term, making up for any costs incurred in the short-
term.

Thank you greatly for your time and attention with regards to this important topic. You may
reach our team via email at mohamed.331@buckeyemail.osu.edu.
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