A Pound of Prevention
By Erin Peterson
Bertrand Weber remembers the moment in 2003 when he realized his district’s school lunch program needed to be overhauled. He had recently taken over as the director of Royal Cuisine, Hopkins’ food service, and was visiting one of the junior high schools during a hamburger-and-fries lunch day. The alternative entrée was pizza, and dozens of students were choosing a pizza-and-fries lunch, a meal Weber didn’t think had many redeeming nutritional characteristics.
His staff argued that it followed USDA guidelines: The crust was the grain, the cheese was the protein, and the fries were the vegetable. “That’s it,” he said. “This is baloney. We’re going to follow USDA guidelines, but we’re also going to follow my guidelines.” Weber knew the dismal statistics about skyrocketing childhood obesity, and school lunches like these weren’t helping matters.
Eighteen months later, Hopkins has a school lunch program that is admired around the state—and across the nation. Weber has decreased the amount of fatty, fried items on lunch menus, and schools offer sandwich bars, where students choose from a selection of healthful breads, meats, cheeses, and other toppings. At the elementary schools, kids may take as many servings of fresh fruits and vegetables as they want from a selection of about a dozen. At the high school, vending machines still dispense snacks, but instead of candy bars and chips, students choose among granola bars, dried fruit, and trail mix. Soda machines don’t contain Coke or Pepsi, they offer vitamin water. And pizza days—offered in some school districts as often as three days a week—have been reduced to twice a month.
Perhaps more surprising than the dramatic changes are the way that students have embraced them. When Weber started, the high school sold about 700 school lunches per day. Today, that number ranges between 1,200 and 1,400.
Innovative leaders like Weber aren’t easy to find in the world of school lunches, so when C. Ford Runge, director of the Center for International Food and Agricultural Policy and professor of applied economics and law at the University of Minnesota, heard about the program on a radio show, he contacted Weber. Runge wanted to find out how Weber had made such remarkable changes, and with the help of grants from the McKnight Foundation and Cargill, he hopes to find ways to replicate Hopkins’ success—and improve the eating habits of thousands of kids.
“The process is to monitor and evaluate the experience of the Hopkins schools and to compare their experience to other schools, like [city] and rural schools,” says Runge. “The endpoint is to develop a blueprint for changing school feeding programs based on this analysis, which can then be offered to schools elsewhere and around country as a template, should they wish to undertake similar types of reforms.”
Teaching kids how to eat well and make wise nutritional choices has the potential to be a significant step in the fight against obesity. For both kids and adults in America, it’s one of the most important public health issues today.
Anyone who has picked up a newspaper or watched television in the past few months has probably heard many of the mind-boggling statistics: Two-thirds of American adults are overweight. Thirty percent are obese. And the number of obese adults has crept up by an average of about a percentage point each year since 1980.
(The terms overweight and obese are determined by a person’s body mass index, or BMI, which can be calculated by dividing weight in pounds by height in inches squared, then multiplying the result by 703. If the result is higher than 25 and lower than 30, a person is overweight; 30 and higher is obese. A woman who is 5-foot-6 is considered overweight if she weighs 155 to 185 pounds and obese if she weighs 186 or more. For a BMI calculator, click here.)
All that extra weight has a cost: an increased likelihood of high blood pressure, high cholesterol, type-2 diabetes, stroke, gout, and some types of cancer. It’s a worrisome trend, and any number of get-rich-quick schemers have tried to profit off of people’s weight concerns by selling pills, herbs, and exercise equipment of dubious merit.
University of Minnesota researchers, however, are studying obesity and obesity prevention to find real solutions. In 2004, the University established the Obesity Prevention Center to provide leadership for multidisciplinary research, policy, and education that focuses on understanding and responding to obesity. The center is part of the Healthy Foods, Healthy Lives initiative, one of eight interdisciplinary academic initiatives at the University.
By learning how individuals make food choices, how schools and other institutions can influence how people eat, and how societal changes make retaining a healthy size tougher than ever, researchers are asking questions and finding answers that may help everyone lead better lives.
Exercise and obesity
Even avid athletes did a double take when the USDA recently released new guidelines recommending that adults exercise 60 minutes a day to prevent weight gain and 90 minutes a day to lose weight. For people who lead generally sedentary lives—and in the United States, that means well over half of the population—the idea of working out an hour or more every day can seem particularly daunting.
Katie Schmitz, assistant professor of epidemiology, has spent years trying to determine if there might be a middle ground. While doctors can advise their overweight and obese patients to increase their aerobic activity, it’s easier said than done. Schmitz challenges the assumption that aerobic activity is the best way for obese people to lose weight.
“It’s really hard for heavy people to do high-intensity activity because it’s relatively more difficult for them. It’s like putting on a 40-pound backpack to work out,” Schmitz says. “But what if we [asked them to do] resistance training first and made them stronger?” She conducted a pilot study on overweight women to see if twice-weekly strength training would have an effect on body composition—and if it would make them be more active overall. What Schmitz found was that the women stuck to the program and that the program did have an effect on body composition. With funding from the National Institutes of Health, she’s currently working on a study with more than 160 women to see if the results can be replicated.
Epidemiology professor Mark Pereira is tackling exercise from a dietary angle. He’s hypothesized that part of the reason working out may seem harder for some people has more to do with what they’re eating than how fit they are. Pereira recently received a four-year grant from the American Heart Association to study how different ratios of carbohydrates, protein, and fat in a diet affect the perceived difficulty of a treadmill workout.
“The diets we’ll feed [subjects] are designed to elicit very different effects on blood glucose, blood insulin, and the fats that are circulating in the blood,” says Pereira. “Exercise may feel different. It might seem more difficult. If we find a link between diet and exercise tolerance, that may be helpful as we’re designing weight-loss programs. We recommend exercise when [people are] obese. But if we have knowledge about certain dietary patterns that makes exercise feel easier, it might be synergistic. It could make it easier for people to stay in a program.”
Still, neither will be the magic bullet that many people crave. Robert Jeffery, a director of the Obesity Prevention Center and professor of epidemiology who has been studying obesity for decades, says that losing weight and staying thin require remarkable dedication. “Research on people who have been successful at losing weight and keeping it off has shown that they are pretty obsessive. They have to work really hard at it.”
Why diets fail
Pick a diet, any diet: If it’s the latest craze—completely cutting out simple carbohydrates or sugar or an entire category of food—a dieter will probably have trouble sustaining it.
Part of the reason is that it’s almost impossible to stick to weight-loss programs is that they so frequently make people miserable. “People have a hard time following [most diets],” says Pereira. “They get hungry, they report that they’re tired and cold, and the food gets boring,” he says. We’ll crave what we’re lacking and, eventually, break down and eat it.
On the flip side, eating foods that are high in sugar and fat—foods that contribute to obesity—trigger some of the same “reward” reactions in our brains that are triggered when we drink alcohol or take drugs. In other words, a doughnut someone eats makes him or her feel good in some of the same ways as a cocktail might.
For nearly three decades, Allen Levine (M.S. ’73, Ph.D. ’77), a professor in the department of food science and nutrition, has been studying neural pathways involved in feeding behavior. In one recent study funded by the National Institute of Drug Abuse and the Department of Veterans Affairs, Levine found that rats that drank a sucrose solution for just three weeks had major changes in the limbic area of the brain, a region that is associated with pleasure. The conclusions drawn from these studies have clear implications for humans as well.
“When people are exposed to a wide variety of palatable foods—salted nuts, chocolate cake, or M&Ms—they’ll be stimulated to continue to eat those foods based on neurochemicals,” Levine says. “Unless we have a means of stopping ourselves from eating those things, we’ll become obese.”
Drug companies such as Sanofi have heeded the results of studies like Levine’s to try to develop products that affect the reward system in the brain. While the Sanofi drug is still awaiting FDA approval, it could potentially help people curb their hunger—and lose weight.
Still, Levine cautions against thinking that pills are a cure-all. “We eat for such a variety of reasons that we’d have to have a [different] drug for eating when we’re stressed, or hungry, or bored,” he says. “After all, when you eat that piece of Thanksgiving pie, you’re not eating it because you’re hungry.”
Starting at the beginning
Runge’s work with the Hopkins school district is only one of several University projects happening at local schools to help kids lead healthier lives. It’s well documented that overweight kids are more likely to become overweight adults, so intervening early on to help kids develop healthy habits may be an effective way to help reduce obesity in the future.
Mary Story, a director of the Obesity Prevention Center and an epidemiology professor, has been involved in several projects at Minnesota schools designed to get kids thinking more consciously about choosing healthful foods and increasing physical activity.
For example, Story notes, African American girls are at high risk for gaining excess weight, so she developed an after-school program for them. Twice a week for two months, students met at several locations to learn about nutrition in fun ways and to play games that kept them physically active. More than 50 girls participated, and their parents joined them at a final session for a healthful dinner. “We don’t want to put children on diets,” says Story. “We want them to learn what’s healthy.”
Story has worked on a school-based program with third- to fifth-grade American Indians that sought to improve the food service offerings by increasing the number fruits and vegetables available at lunches. She also is working to increase the amount of physical activity for kindergartners at one school to an hour a day. “Data show that in the United States, children are only active about five minutes total in a physical education class,” says Story. “Our goal was to redirect P.E. classes so kids are active more of the time.”
One of the things that surprised her was the lack of knowledge—by both kids and their parents—about the caloric content of foods and how they related to physical activity. Knowing that a 20-ounce bottle of soda contained 250 calories seemed meaningless until putting it into context: It would take more than an hour of bicycling for a 100-pound child to burn off the calories in the beverage. Story says it points out the needs for further education in the area. “[We want kids] to learn the skills to make healthier choices at home and at restaurants,” she says.
Penny wise, pound foolish
It’s easy to think that eating habits are determined by individual choices alone, but the truth is more complicated. What people eat is influenced by everything from advertising to the amount of change in their pockets. This knowledge can be used to help individuals make healthier choices.
Simone French (Ph.D. ’90), a director of the Obesity Prevention Center and epidemiology professor, recently did a study to see if changing the price of snacks in vending machines at local high schools could encourage students to buy healthier foods—switching from high-fat chips, say, to low-fat pretzels.
Though some might suggest that swapping snacks just allows people to choose the lesser of two evils, French believes it’s a start. “The price reductions really did encourage high school students to select the lower-fat snacks,” she says. “The more you reduced the price, the more likely they would be to pick the targeted items. Even a reduction of a nickel or dime had an impact.” What’s more, evidence didn’t seem to suggest that students bought two bags of pretzels to make up for the single bag of chips that cost more—simply that students were choosing to eat more healthfully based primarily on the cost of the food they were buying.
Sometimes it doesn’t even take a price reduction to get kids to eat better. In a study funded by the Centers for Disease Control and the National Heart, Lung, and Blood Institute, French studied whether changes to cafeteria à la carte menus—the primary money-maker for many school lunch programs—could impel students to choose low-fat and healthful products. French found that just offering more healthful choices and fewer unhealthful ones was enough to get students to change their buying habits. “Most schools offer fruits and vegetables in the à la carte line, but they offer one or two selections and a hundred others that are chips and cookies,” says French. “If you increase the availability of healthful food choices, students will buy more of them.”
It may seem like a simple conclusion, but it’s one that many schools haven’t considered. Driven by a need to make profits on à la carte lines, food service directors often buy and offer the kinds of greasy, salty, and sugary foods that they know kids will buy.
The results from both studies may be applicable to more than just school cafeterias, but to anywhere meals and snacks are purchased, whether it’s an office building or a hospital.
Surprisingly, while a few pennies may be enough to make people change what they buy from a vending machine, far more significant amounts of cash won’t encourage them to meet their weight goals. In a study Jeffery conducted a few years ago, subjects were offered up to $1,000 a year to control their weight. Apparently, cash couldn’t compete with the couch and cookies. “We saw no effect whatsoever [on weight control] compared to no incentive at all,” he says.
On the other hand, being faced with the prospect of parting with some of their hard-earned cash is incentive enough to reevaluate their goals. When Jeffery asked study participants to sign a contract that had them handing over their own money and getting it back once they’d reached certain weight loss goals, the outlay turned out to have a small but positive effect.
Slow burn
For now, there is no easy solution that will solve the obesity problem—for individuals or for the nation. However, the studies and research conducted by University of Minnesota researchers are helping the public understand the roots of the problem as well as promising solutions.
The Obesity Prevention Center is bringing together some of the University’s—and the world’s—brightest minds to tackle the obesity epidemic from a variety of disciplines and viewpoints. Dozens of projects are being funded and researched. “It’s an exciting time for obesity prevention,” says French. “I’ve been encouraged by all the attention to the issue, because this isn’t something that’s going away.”
But, she says, “We don’t need to wait until we’ve got this nice edifice of research published in all the journals, because that’s going to be too late. We know what promising approaches are, so we need to get out there and take action now.”
Erin Peterson is a Minneapolis-based freelance writer.
 | | | |  | | At the Table | Many factors contribute to obesity and excessive weight gain, including biological, behavioral, and sociocultural issues. The University of Minnesota’s new Obesity Prevention Center likewise has numerous strategies and partners as it targets this epidemic.
Studies and initiatives include intervention focusing on individuals, community groups, health-care delivery systems, the environment, public education, and public policy advocacy.
University schools, colleges, and units that are members of the center include:
- Academic Health Center
- School of Public Health
- Division of Epidemiology and Community Health
- Department of Medicine
- College of Human Ecology
- Department of Food Science and Nutrition
- College of Agricultural, Food and Environmental Sciences
- Department of Agronomy and Plant Genetics
- School of Kinesiology
- School of Nursing
- Department of Family Practice and Community Health
- Department of Pediatrics
- Department of Psychiatry
- Department of Psychology
- College of Liberal Arts
Health-care organizations in the community that are members of the center:
- Minnesota Department of Health
- MDH Health Promotion and Chronic Disease Division
- HealthPartners Research Foundation
- Park Nicollet Institute
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