Body Mass Index: A shift to healthful foods and changes in behavior make the difference

From the Union Leader
by Brenda Charpentier, Union Leader Correspondent

NORTHFIELD -- Getting rid of the soda machine was just a baby step when the staff of the Spaulding Youth Center, a residential educational center for kids with special needs, decided to battle childhood obesity.

For the past three years, Spaulding has collaborated with Greater Franklin Healthy Eating, Active Living (HEAL), the regional branch of a statewide coalition supporting healthy policies and environments in schools, communities and restaurants. Little by little, center staff have transformed the culture of their campus, so much so that they have become a model for what a committed community can accomplish, according to Liz Lawrence, a community specialist with the Caring Community Network of the Twin Rivers and HEAL coordinator.

"They are the leaders," she said.

The Greater Franklin HEAL works with several public school districts in the Lakes Region, including Newfound, Franklin and Winnisquam, with funding from a 3-year Foundation for Healthy Communities grant. Spaulding has the advantage of having control of meals and snacks as well as free time, since students live in cottages on the campus, so they can make changes quicker, Lawrence said.

That control and a host of policy shifts are getting tangible results. Body mass index is a way of gauging obesity. The body mass indices of many students are going down, said Evie Stacy, APRN, the center's consultant on child psychiatry and pediatric services. When a fellow staff member recently looked at the BMI of 14 students considered obese when they arrived at the center, they had shifted into the normal range.

"Some of our children have been able to express that they feel better about themselves," Stacy said.

The changes started with a couple of programs that HEAL helped Spaulding integrate into its existing outdoors-oriented wellness programs. One is called 5-2-1-0. It teaches kids to every day, eat 5 fruits or vegetables, limit screen time to 2 hours or less, play actively for at least 1 hour and drink 0 sugary drinks like soda and energy drinks. The kids keep track of how they do with those goals each day and earn rewards. Staff members were relieved to swap 5-2-1-0 with the old food pyramid, with its focus on serving sizes and food groups.

"That didn't work so well. I found the food pyramid was difficult for the students to relate to, and 5-2-1-0 is pretty basic," Stacy said.

HEAL also trained the staff to rev up traditional games like kickball. Instead of kids standing around waiting for the ball, they're taught to keep moving, by doing jumping jacks or jogging along the sidelines. The goal is for kids to stay in motion for at least 20 minutes to get a strong cardiovascular benefit. That effort is part of CATCH, or Coordinated Approach to Childhood Health. Spaulding kids take part in CATCH club and learn about nutrition and play outdoors games, all in a spirit of fun.

Staff members model healthy choices by never drinking soda in front of the kids or showing up on campus with a McDonald's bag. They've even swapped brownies for fruit cups at their staff meetings. The wellness committee promotes Zumba classes, health fairs and puts up motivational posters.

"The adults' behavior is critical," Lawrence said. "If you don't have the passion, you're not going to model it, and kids can tell. It comes across as hypocritical."

Gary Lavallee, residential program director, said the center hopes the staff's efforts will result in lower health insurance costs. "We're looking at claims over the past year," he said. We're hoping to make our payments go down."

Spaulding's cooks have revamped their menus.

"There's no white bread. All the dough is multi-grain," said Kay Romero, health services supervisor.

Dessert might be jello or lemon ice or watermelon. Drink choices are milk or water. Chicken nuggets come from chicken breast meat, oven roasted instead of fried. More vegetables and fruits are offered at every meal.

Hannaford stores used to donate baked goods to the center, but the staff has resolved to decline the offer. "It was really kind of them, but none of us could resist," Romero said.

The kids still do get treats. At Halloween, they enjoyed cider and oatmeal cookies. They can buy candy with their allowance but it's limited. Every Wednesday is ice cream night.

The fact that Spaulding's effort is so systemic is what makes it work, Lawrence said.

"Obesity prevention is working with behaviors. It's healthy choices, behavioral changes," she said. "It's making the healthy choice the easy choice in your environment."

For the kids, those choices can mean the difference between malnourished obesity and health. Stacy recalled one boy who arrived at the center about six months ago. He refused to eat anything but Hot Pockets (meat and cheese baked in a crust) and was obese on the BMI scale. He gradually learned to eat new, healthful foods and slowly lost the extra weight.

"He eats vegetables now," Stacy said. "His weight is healthy now."

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