Un-super size me: Can city schools stem the obesity epidemic?

If Ivana Kadija ever hears Tony the Tiger telling kids his Frosted Flakes are "Grrrrreat!" she'll probably tell him to shut his furry trap. It's high-sugar food like that, says Kadija, chair of Charlottesville's School Health Advisory Board and a recently announced School Board Candidate, that's leading more local youths down the wide path to obesity and diabetes. Citing statistics that show a full one-third of city students are overweight by fourth grade, she wants the school system to make some not-so-sweet changes.

"We're in an obesity epidemic," says Kadija, a nutrition coach and mother of two elementary school aged daughters attending city schools, who unhappily recalls her first impression of the cafeterias.

"I noticed the free breakfast given out was some cereal or some sugary yogurt, animal crackers, and juice. I remember thinking, 'No, I think she'll eat breakfast at home.'"

Is sugar really Public Enemy #1 when it comes to healthy eating? That depends on whom you ask.

"Balance, variety and moderation with eating and physical activity are the keys to a healthy life," says Sandra Vazquez, head of the City School's nutrition program. "Sugar is not the bullet in the obesity problem, nor is removing it entirely the single solution."

So how much sugar is too much?

This year, City schools allow 30 percent of calories to come from sugar. That's less than the weight permitted by federal standards, but Kadija says it's still way too much. For instance, in a 100-calorie snack there can be nearly nine grams of sugar, the equivalent of more than two teaspoons.

Indeed, the heaps of added sugar can come as a shock. A slice of bread typically contains three grams– nearly a teaspoon. How about a container of low-fat Yoplait yogurt? With 14 grams (some from naturally occurring milk sugar), that's more than 3 teaspoons. Even the ground meat served in the school cafeteria contains added sugar, Kadija says.

In 2009, the American Heart Association released guidelines for adults suggesting an added sugar limit of just six teaspoons per day for women and nine for men.

"Why are children allowed to eat and drink so much more than that amount during the school day?" asks Kadija.

It's easy to see how school-day sugar can add up stunningly fast. Birthday parties with cupcakes can happen more than once a week (as much as 60g per frosted cupcake); french toast in syrup was sometimes served for lunch along with the daily choice of chocolate milk (at least 10g of added sugar for the milk alone). And don't forget ice cream on Fridays and the sweet treats– Tootsie Rolls and Jolly Ranchers– that some teachers routinely hand out to reward good behavior.

"It's clear that sugar is something we are absolutely addicted to," says Kadija, citing French research showing rats prefering intense sweetness even to cocaine.

"It makes you feel happy for a moment," she says, "but you crash 10 minutes later, and you're hungrier than you were in the first place."

That, she says, is no recipe for learning.

"Here we're putting this stuff in front of them all day long," she says, "and then they're imprisoned, supposed to sit in their chairs all day long."

Kadija's enthusiasm has won her support from high-profile members of the national food-writing community such  as Ed Bruske, a former Washington Post reporter who blogs as "The Slow Cook." Calling her a "dynamo," Bruske, in his April 5 post, also lauds the 200 person-strong turnout for the Charlottesville screening of the school food-bashing documentary, Lunch Line.

But those working on the front lines of Charlottesville City School's nutrition program say that while Kadija's singular focus on restricting sugar may be well received by some parents, it downplays the immense challenges of feeding several thousand kids, more than half of whom qualify for free and reduced cost meals.

"We have 95 cents to spend on food per meal," notes nutritionist Vazquez.

Anyone trying to find local or organic food can imagine that a dollar doesn't go very far in filling a plate. Meanwhile, federal law further complicates the picture with rules stipulating everything from the total calories to daily allocations of meat, protein, fruits, and vegetables. 

Buying in bulk directly from the United States Department of Agriculture offers low pricing on things like meat and eggs, but Vazquez credits school dietician Alicia Cost with constantly seeking ways to improve quality and increase local produce.

This past year, for instance, the school division used a grant to purchase 600 pounds of grass-fed local beef for a week's worth of meals, and the division sourced some fruits and vegetables from local growers through the Local Food Hub, a nonprofit that connects small farms to individuals and institutions.

Food Hub head Kate Collier calls Cost a "trailblazer at working through the system, making progress, really personally figuring out how it all works."

In September, in conjunction with the Virginia Department of Agriculture and Consumer Services, the Food Hub will award Cost and her boss Vazquez the Trailblazer Award for their efforts to incorporate local foods in school menus.

While Kadija applauds that effort, she says she remains stumped by what she sees as resistance to slashing sugar. Last year, she won what she thought was a small victory by convincing Clark Elementary School principal Gina Keller to limit chocolate milk at lunch to just once per week. Later in the year, to her chagrin, daily chocolate milk was back.

"The chocolate milk drinkers didn't start drinking the white milk," Kadija says, and "the assistant superintendant was concerned that kids weren't getting enough calcium."

Assistant superintendant James Henderson says the schools have removed other flavors of milk, but says if the chocolate variety is removed, many kids will instead choose juice.

Kadija is unmoved.

"There's no need for juice in schools either," she says. "They should be drinking water."

A UVA-trained endocrinologist board certified in internal medicine, Dr. Zachary Bush, agrees.

"The management of processed sugars in the liver increases inflammation," Bush explains, "which thus increases the epidemic diseases of America including diabetes, heart disease, and cancer."

As for milk, chocolate or white, Bush says it should all be removed from schools– and home refrigerators– because most of the population has some degree of lactose intolerance.

"We're not engineered for lactose," says Bush of the simple sugar that is the primary ingredient in milk and which, he says, "is capable of growing a calf 400 pounds in six months." Schools, he says, could meet calcium requirements by serving dark green vegetables like broccoli and spinach, and even adult women, often told to supplement calcium for bone density via dairy products, are misled.

"Calcium for bone density is an invented story by the dairy lobby," says Bush, who runs the holistic Revolution Health Center in Scottsville. "There has never been a study to show that an increase in calcium increases bone mineral density."

Bush says that sugar reduction serves to increase bone mineral density and eliminate damaging inflammation.

And while Bush would advocate a mostly vegan diet, heavy on vegetables and whole grains including brown rice and quinoa, Assistant Superintendant Henderson says change takes time, and the idea that kids accustomed to corn dogs and pizza would suddenly gulp down a niche seed like quinoa isn't realistic.

"We want the kids to eat it," he says, recalling several new menu items this past year that mostly ended up in the trash.

It's not so hard to get kids to try new foods, says Patrick Critzer, father of a seventh-grade student at the all-boys Field School in Crozet where Critzer is head chef, making from-scratch lunches five days a week– and serving only water to drink. The key, he says, is keeping things simple and kid-friendly.

"They're going to reject your food outright if you throw too much brown rice and sprouts at them," says Critzer. "You can sautée some broccoli with sesame and a little soy and have it on the side, and they'll come around and realize it's part of a meal."

The city schools are working on that, says Henderson, who notes that among the public system's recent nutritional achievements is the addition of new healthy choices including black bean and brown-rice tacos, which kids overwhelmingly approved after trying them last year. He hopes to see additional healthy choices.

"It's something we're passionate about," says Henderson, rejecting a focus on sugar.

"You can't get rid of one item and think it's going to solve it," says Henderson. "There are issues with salt, fat, and portions of food. We've got to be conscious of all of those things."

Henderson says the school division hopes to teach students to make good choices. That might mean that a box of whole-grain Cheerios sits next to a sweeter option at breakfast time.

Bush, however, says that's the kind of choice kids can do without; he cites a Stanford study discussed by famed author and neurologist Oliver Sacks (The Man Who Mistook his Wife for a Hat) on a recent NPR program that showed that individuals given a stressful mental task to perform were more likely to choose high-sugar snacks afterwards than their less-stressed study counterparts.

"We're setting a neurobiological trap for our children, and then giving them a food environment that dooms them to failure," he says. "Not only are they struggling on the SOL tests, they're also learning to fail in their food decisions."

The good news
In addition to increasing the proportion and local provenance of fruits and vegetables this coming year, Charlottesville recently signed on to Michelle Obama's Let's Move campaign, which sets nutrition and exercise goals for school systems with a goal of "eliminating childhood obesity in a generation."

Last year, gardens sprung up at most of the public schools, and this year, says Vazquez, students should be planting and harvesting even more.

Those gardens have inspired some families to plant their own at home, and one local father says he's seen his children's vegetable intake soar.

"If you have kids grow a garden, show them the food they produce, and have them cook the food, it will entice them to eat healthier," says Harold Folley, a father of five and longtime resident of Westhaven public housing who this past year moved to a private residence and, for the first time, planted a garden with four of his children, 18-year-old Semaje, 11-year-old Sadarius, 10-year-old Sabias, and 8-year-old Satatianna. Eating well at home, he says, helps his kids make healthy choices at school.

"My son liked how Walker [Upper Elementary] had options like salad," says Folley. "He raved about how they had chicken, how it was huge and delicious– he told his brother all about it."

Perhaps the key to improving the quality of school food is training kitchen staff to cook from scratch, something that's already happening in school kitchens around the country, as detailed in a recent New York Times article about Greeley, Colorado.

In that city of approximately 93,000, as in Charlottesville, well over half the student population is eligible for free or reduced-price lunch, and the school food budget is tight. Nonetheless, that school system sent all of its kitchen staff to a cooking-from-scratch boot camp run by a company called Cook for America.

According to Barbara Yager, co-chair of a taskforce called Community Action on Obesity: A Charlottesville Albemarle Taskforce, similar local training is a goal, as is upgrading kitchens so from-scratch cooking can occur. The trouble, as usual, is money.

"Schools," she says, "have a limited budget."

But while Yager agrees nutrition in schools must be improved, she says the obesity problem will never be solved until better choices are made at home.

"We all need to be working together and moving forward to do things that really matter," she says.

For Kadija, that would start with eliminating juice and candy rewards from teachers, holding once-a-month birthday parties in each class rather than individual celebrations, and seeking creative funding for higher-quality foods through donations and grants.

"We are saturated in sugar," says Kadija, "and I think the schools are a wonderful opportunity to demonstrate what a healthy meal can look like."

Correction: the name of the organization that connects local farmers to families and institutions is the Local Food Hub. –ed