Sights Set on Schools: Tackling the Obesity Dilemma Within the Education Setting

Justin Tang

564 0478

Gphy 403 Final Paper

Dr. Betsy Donald

April 22, 2010

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Introduction

The increasing prevalence of obesity in Europe and North America has become a cause

for much concern at the policy level. Primary and secondary schools and their lunch halls have

become sites of struggle in the battle to revitalize public health. The responses towards this

looming issue have varied from region to region. The UK government has responded at the

public level by reforming and regulating school lunches while bans on food items and unhealthy

ingredients have been the norm in the United States. This essay will compare and contrast the

respective food movements in Britain and North America and explore the role of culture and

economics on government policy towards food. Since efforts are occurring and intersecting at

various scales, the school has become a useful tool to understand public health through a

geographic lens. I will argue that government attention on the school setting is appropriate and

necessary, though further efforts are needed to counter the multi-dimensional crisis of obesity.

Rising obesity trend

Discussion and concern over obesity has grown intensely among medical professionals,

the media, and the public over the last decade as rates of obesity have steadily climbed

throughout the global north. In the United Kingdom, two-thirds of the population are overweight

or obese, a staggering 400% rise over the last quarter-decade (House of Commons, 2004). A

1999 study found 19% of 5-year olds were be overweight and 7% were obese (Morgan &

Sonnino, 2007). The 2002 Health Survey for England revealed that 21.8% of boys and 27.5% of

girls were overweight or obese; specifically 5.5% of boys and 7.2% of girls aged 2-15 were

obese (House of Commons, 2004). In the United States, the figures are equally dire: the 2007-

2008 National Health and Nutrition Examination Survey found that 16.9% of children and youth

aged 2-19 were obese (CDC, 2011). Rates for children aged 6-11 quadrupled between 1963 and
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2004 and tripled for those aged 12-19. One third of American children–approximately 9 million

children–were obese or at risk of becoming obese in 2006 (Fried & Simon, 2007).

Obesity: definition

Obesity and overweight are two commonly used terms that need to be clearly defined in

order to proceed with any analysis. Obesity, most simply, can result when an individual overeats

more than their relative energy needs. The UK Faculty of Public Health defines obesity as “an

excess of body fat frequently resulting in a significant impairment of health and longevity”

(House of Commons, 2004). The US government’s Centers for Disease Control and Prevention

simply states that obesity and overweight are labels for weight ranges that are greater than what

can be considered healthy for a given height. The BMI, which measures these two parameters,

has become prominent as the standard method around the world for determining body fatness.

For adults, a BMI of 25.0 to 29.9 is considered overweight while a BMI of 30 is considered

obese. The standards for children are different, however, since boys and girls have different

levels of appropriate body fat at different ages. For children under 19, overweight is indicated by

a BMI at or above the 85th percentile while obesity begins at or above the 95th percentile for

children of the same sex and age (CDC, 2011).

Childhood obesity has serious consequences from a long-term perspective. Whittaker et

al (1997, cited in CDC, 2011) found that 80% of obese 10-15 year olds were obese adults by the

time they were 25 years old. Being overweight before the age of eight was found to make adult

obesity significantly more likely (CDC, 2011). Ludwig and his colleagues (as cited in Fried and

Simon, 2007) suggested that one additional sugary beverage per day increased a child’s risk of

obesity by 60%. Furthermore, food choices and exposure to food marketing in childhood have

the potential to affect adult consumption patterns (Fried and Simon, 2007).
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These figures have become worrying from a public health point of view because of the

enormous social and financial costs associated with disease. Obesity costs £3.3-3.7 billion per

year in Britain and is responsible for around 30 000 premature deaths, putting a sizeable strain on

health services and possibly causing a reduction in life expectancy (Lake & Townshend, 2006).

Obesity significantly increases the chances of gallbladder disease, dyslipidemia, insulin

resistance, sleep apnea, and type 2 diabetes, even in children. The risk of coronary heart disease,

hypertension, osteoarthritis, and gout are moderately increased as well (House of Commons,

2004). In the United States, obesity is claimed to have reached epidemic levels (Millimet,

Tehernis, & Husain, 2009).

Obesity has proved to be a controversial subject altogether. Geographers such as Evans

have criticized the use of medical terminology for being overly linear. Proponents claim this

view promotes a notion of a body that is mechanical; a container that can be defined by health

status, counted and, mapped (Evans, 2006). This argument purports that this approach towards

obesity has led to the marking of morality and immorality upon bodies. For example, daily

reportage by the media and health professionals create assumptions that the obese are

irresponsible and blameworthy. These notions have impact on policy in the form of arguably

discriminatory responses that have been considered, such as the removal of a child from his

mother’s (who was obese) care, charging extra for National Health Service healthcare, banning

obese women from IVF therapy, and claiming that obese people are a detriment to the planet via

climate change (Colls & Evans, 2009). Evans suggests that more holistic understandings of

health have emerged that place experience, identity, and impairment as primary concerns (Evans,

2006). While criticisms regarding positivist approaches are valid, scientific understandings have

contributed to understanding obesity and weight in tangible forms. Government policy based on
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this knowledge appears to be the most effective method of ameliorating the health of citizens

while addressing issues of social justice and sustainable development (Morgan, 2006).

The school, targeted

The emergence of the school setting as a site of struggle for governments aiming to

reduce health deficits is not new but worth explanation. The amounts of time students spend

every day at school make this setting a logical target; it is estimated that a third of children’s

daily caloric intake occurs while at school (Schwart, Novak, & Fiore, 2009). The potential for

diet to play a role in education is also addressed. Poor diet may result in deficiencies in cognitive

development if children do not consume key nutrients during critical periods of growth (Belot &

James, 2010). With the risks of obesity beginning in childhood and converse benefits of early

intervention being high, the school has become an important mechanism in addressing health

inequalities. British Prime Minister Tony Blair stated that school meals were “central to the

nation’s future health” (Pike & Colquhoun, 2009).

Historical Background

United Kingdom: Welfare to Neoliberalism

The history of school food in the United Kingdom traces back to the welfare movements

of the 1800s. Inadequate diets among children became apparent with the advent of compulsory

education, when students were unable to learn. The Boer War showed another concrete effect of

poor diet, as the health of recruits negatively impacted the campaign (Pike & Colquhoun, 2009).

The Education Act of 1906 made it possible for local educators to provide free meals for children

of need and at cost to all other students. The Butler Act of 1944 solidified Britain’s commitment

to school meals by mandating that nutritious meals, including milk, should be provided for free

as a part of the education system. This “golden vision” for UK school food soon fell short, as
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free meals never became a reality and nutritional guidelines were never standardized (Morgan,

2006).

By the 1970s, the neoliberal movement had planted itself evenly across the UK, and

schools were no exception. Welfare policies had become increasingly unpopular and were often

criticized as state interference on the home and private life (Pike & Colquhoun, 2009). Changing

tastes among children, a result of broadening consumer culture, as well as the aim of reducing

public expenditure led to the demise of standard school lunches via privatization. The 1980

Education Act eroded the work done by the Butler Act, eliminating mandatory school lunches

(excluding children who were entitled), free milk, fixed pricing, and nutritional requirements.

Catering was opened to market forces with the 1988 Local Government Act, which forced school

boards to allow competition, resulting in a legacy of unskilled dining room workers and a

reduction in functional kitchen appliances. Furthermore, the notion that school meals should be

influential in students’ health was lost (Morgan, 2006).

United States: Federal programs and competition

The history of school food in the United States features similar themes as that of the

United Kingdom but with some significant differences. American schools are no strangers to

nationally sanctioned food programs. The National School Lunch Program (NLSP) was initiated

in 1946 to combat malnutrition caused by the Great Depression while the School Breakfast

Program (SBL) was initiated in 1975. Currently, some 30 million children depend on these two

programs every day. Nutritional standards were established under the 1995 School Meals

Initiative for Healthy Children, precluding schools that violated the requirements from federal

funding. The health benefits of the NSLP and SBL is debated by several authors, despite strict

guidelines from the School Meals Initiative restricting Recommended Dietary Allowances,
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percent-calories from fat, and calories per age. What is clear is that school meal programs do

have a significant impact on student diets and do provide adequate nutritional benefits for

children who might otherwise go hungry during the day (Millimet et al., 2009).

The term “competitive foods” has emerged to classify foods sold outside federal

programs such as the NLSP and the SBL. These include food sold from vending machines, snack

bars, tuck shops, and a la carte cafeterias (Delva, Malley, & Johnston, 2007). Foods include soft

drinks, sports drinks, snacks high in fat and salt content, and juices. A restriction exists on food

of minimal nutritional value (FMNV), such as soft drinks, chewing gum, and candies. FMNV

foods are not permitted to be sold in the food service areas during meals, however there is little

to prevent students from purchasing them from other locations and throughout the day. However,

many foods considered as junk foods are not classified as FMNV and can be purchased for

consumption in conjunction with food program meals (Dority, McGarvey, & Kennedy, 2010).

Competitive foods provide a telling story of the nature of food in American schools. The

role of private enterprise and corporations is much more prominent than in the United Kingdom.

The motivation for schools to sign contracts with providers of competitive foods is high since

these agreements allow administrators to combat underfunding and balance budgets (Delva et al.,

2007). Beverage exclusivity funds that guarantee “pouring rights” in exchanging for cash are

commonplace. The relationship between the consumers and providers of these goods is

significant: 83% of elementary schools, 97% of middle schools, and 99% of high schools sell

competitive foods and student access to purchasing is universal. As a result, corporations have a

vested interest in funneling their products into schools (Fried & Simon, 2007).
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Contemporary School-based Strategies: United Kingdom

The Ecological Era

The general concern over health and obesity has led to considerable reforms of British

school food programs. Morgan describes the new movement as the “tipping point” following a

rising tide of “moral panic” about obesity, especially among children. Popular TV personality

and chef Jamie Oliver’s “Jamie’s School Dinners” campaign, which focused on improving

nutritional standards in schools, also contributed to public awareness and outcry over what

children were being fed. Morgan is quick to suggest that Oliver’s movement is only one part of

the puzzle as rather than its instigator, suggesting that the climate at the time of the show’s airing

helped make it and further political movements garner attention (Morgan, 2006).

Morgan refers to the reemergence of public and policy interest regarding modern school

food as the “ecological era,” due to the interest in both human and environmental sustainability.

The movement began in Scotland, with a 2003 working paper entitled “Hungry for Success,” that

made three recommendations: school meals should be holistic, a continuation of education

within dining halls; provide high nutrient, high quality meals; and be considered a health service,

as opposed to commercial (Morgan, 2006). The corresponding 2006 English report, “Turning the

Tables,” made 35 recommendations and also considered environmental sustainability through

recommendations on food procurement. The holistic nature of this movement suggests that the

ecological era will affect more than parents and children, but also procurement managers and

food suppliers (Morgan & Sonnino, 2007).

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The Revival of Quality-based Procurement

Morgan and Sonnino argue that food procurement can be intrinsically linked to the

healthy diets for children. The authors compare UK school food procurement to methods

conducted in Italy, where a powerful food culture ensures that local, traditional, and organic

foods are sourced as part of a commitment to the citizen’s right to education and health. As a

result, Italian policies stand in contrast to British methods, especially since Italian contractors are

given the power to modify the services they deliver. Procurement managers are permitted to

discriminate by restricting public competition and favouring local producers in accordance with

the Italian view that the best value includes hygienic, nutritional, and educational aspects of food

(Morgan & Sonnino, 2007).

UK food procurement is unique in that local, regional, and fresh products are part of a

resurgence phase, following deteriorations in food quality due to the deregulation encouraged by

Conservative governments. These historical processes placed economic considerations first and

foremost, ignoring quality and value in favour of the lowest possible cost. Fresh foods were

exchanged for pre-prepared and processed food; kitchen appliances and culinary skilled staff

were no longer needed and removed. Today, procurement managers are learning to reconsider

quality and local ingredients and not simply cost in sourcing food. This change in tactic has

forced food service corporations to react. Canterbury Foods complained to school administrators

that it was unable to keep up with new demands, since it mostly produced “a lot of fatty foods

and salty foods.” This switch in focus has presented an opportunity for food companies that offer

healthy options to grow at a time when less health-conscious companies are struggling (Morgan

& Sonnino, 2007).

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Notable Campaigns

Two campaigns are worth mentioning in a discussion of UK school meals. The 2004

“Eat-Well-Do-Well” campaign sought to provide nutritious meals to every primary school

student in the city of Kingston-upon-Hull at no cost. Breakfast, lunch, and a piece of fruit would

be included; additionally, the three-year long program would utilize guidelines more stringent

than national standards. Pike and Colquhoun (2009) argue that the Hull Campaign has the

capacity to reduce the “health gradient,” that is, to minimize the deficits in health as a result of

socioeconomic status. The authors argue that by universalizing food provision, multiple social

groups can be influenced, since the program removes structural barriers to nutritious food. The

“intermediate” classes, who are not eligible for free meal entitlement through state-run policies

may likely see significant benefits due to better nutrition and household income (Pike &

Colquhoun, 2009).

Jamie Oliver’s “Feed me Better” campaign bears mentioning as well. Oliver was able to

change school menus at various schools in Greenwich despite contractual agreements with

catering companies that are typically stringent and long-term. The new menus would replace

junk food and low-budget processed food with wholesome alternatives. Local council funding

was injected into schools as part of the experiment since new equipment had to be purchased and

kitchen staff had to be retrained and compensated for extra hours. Belot and James (2010)

examined the validity of one key reason for targeting food in schools: whether or not improved

meal programs provide positive learning and educational outcomes for students. The authors are

hesitant to solely attribute benefits to Oliver’s movement, due to numerous variables such as a

possible Hawthrone effect (subjects modify their behavior in response to being observed) and

non-random sample selection (Belot & James, 2010).

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Contemporary School-based Strategies: United States

Competing with “Competitive Foods”

The responses to the “moral fear” caused by reports of rising obesity rates have mostly

been seen as a movement against corporations responsible for the “competitive foods” that can

be easily accessed in schools throughout the country. An overarching view holds that schools

should carry the burden of responsibility in addressing obesity (Fried & Simon, 2007). This has

had a major impact in encouraging government regulation over food that is sold in schools.

Fried and Simon argue that progress has been minimal due to barriers. Congressional grants have

been employed to reduce junk food sales, yet are rendered useless due to political pressure.

Grants that download responsibility to school districts also fail due to financial pressures,

resulting in a return of junk food sales (Fried & Simon, 2007).

Efforts at the state and local level have been mostly unproductive. Between 2003 and

2005, 45 legislatures considered regulation over junk food and drinks for public schools with

questionable success, mostly due to inconsistent directives. The results have been referred to as

“nutritional chaos” by some authors. Language was often weak or inconsistent between

individual pieces of legislation (Fried & Simon, 2007).

The Child Nutritional Promotion and School Lunch Protection Act of 2007 sought to

establish national nutritional standards for competitive foods sold in schools. Although the bill

was introduced following more than ten federal efforts since 1966 to regulate the sale of

competitive foods in schools, it is arguably the most comprehensive. The act recommends that

the USDA update the definition of FMNV foods and allow new restrictions on the where these

items can be sold. Although the US Department of Agriculture cannot ban the sale of food or

drink during non-meal hours, this governing body can regulate nutritional standards for foods
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sold in schools. Making the definition of FMNV foods more stringent could bypass this barrier

and stop foods from entering schools (Fried & Simon, 2007).

NSLP and SBL: continuing or contradicting?

Despite efforts to combat competitive foods in the school environment, the School

Breakfast Program and National School Lunch Program remain as methods of addressing

inequalities in the diets of schoolchildren. Their abilities as obesity prevention programs have

been called to question by authors such as Millimet and his colleagues, who found that NSLP

contributed to rising obesity while the SBP participation did not. The authors found that the

health impacts of SBP were highly linked to selection processes and could therefore be used to

combat obesity by targeting select populations (Millimet et al., 2009).

Diverse Procurement

Procurement in the United States is a complicated topic, heavily influenced by

bureaucracy and corporations. As discussed above, American school food has been greatly

affected by commercialization, which favours cost and is opposed to nutrition and quality. The

effect of fast food must be considered when examining procurement since many students head

off campus during lunch hours. The number of students consuming these foods is unsurprising

when one considers the industry’s multi-billion dollar advertising campaigns and the strategic

placement of restaurants around schools (Morgan & Sonnino, 2008). School food authorities

procure foods from national distributors, which often feature limited and inflexible product

ranges. Procurement is also facilitated by the USDA’s Food and Nutrition Service, which

provides funding to states based on the number of students enrolled in school food programs.

The USDA also provides $16.75 in “entitlement foods” per meal served under school food

programs. Additionally, surplus agricultural stocks are sometimes provided directly from the
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federal government and are donated or sourced from surplus commodities (Morgan & Sonnino,

2008).

Success and Limitations: United Kingdom

With the ecological movement still in relative infancy, it is difficult to tell if the revived

interest in healthy school meals will persist. Several factors pose major obstacles to the

perpetuation of the current school food reforms. Resources are a key concern: the £220 million

invested for three years will likely be insufficient to sustain an ambitious project that requires

expensive food ingredients, new kitchen infrastructure, and extra hours of labour. Inadequate

skill sets by kitchen staff, many whom are unfamiliar with healthy cooking techniques, will need

to be retrained. Farmers and producers must be included as well, in order to facilitate the supply

of local products that are both healthy and fresh (Morgan, 2006). Social participation is another

crucial factor that is needed and has already been problematic. The involvement of both children

and parents is needed; healthy eating campaigns require active participation in order for target

individuals to learn to appreciate food differently. Little input from students had been sought

with regards to their meals: one Sodexho survey (2002, as cited in Morgan & Sonnino, 2007)

found that only 27% of children in one school had been asked their views. As a result, children

were often been unable to provide their parents with adequate information about their school

meals.

The lack of parent and student involvement has resulted in a decline in students

participating in school meals. The Local Authorities Caterer’s Association found that

participation dropped by 10%, a figure equaling about 71 million meals. The change was

attributed to media hype and Jamie Oliver’s TV program, which had aired that same year

(Morgan, 2006). Conventional thought might suggest that packed lunches might be a healthier
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alternative to school food, which had been discredited as nutritionally deficient. Using

longitudinal data collected between 1999 and 2000, Rogers and her colleagues (2007) compared

packed lunches and school meals in order to determine whether nutritional benefits existed in

favour of either option. They concluded that neither packed lunches nor school meals met dietary

guidelines and were both lacking in fibre and key vitamins and minerals. However, packed

lunches exhibited higher levels of sugar and saturated fats, often exceeding the day’s

recommended intake while only providing half the recommended fruits and vegetables. This

combination should raise concern: diets low in potassium and high in sodium have been linked to

elevated blood pressure in children. School meals included worrying levels of processed and

fatty foods, yet still showed a lower atherogenic (increases the thickening of artery walls)

nutrient profiles than their home-packed counterparts (Rogers, Hebditch, Jones, & Emmett,

2007).

Success and Limitations: United States

Food bans have gained much attention from mainstream media and have been well

researched to determine benefits or costs. Schwartz, Novak, and Fiore (2009) posited the

hypotheses that context provides dietary incentive. That is, since children will eat what is readily

available, providing only healthy snacks that met nutritional standards (MNS foods) would

improve students’ diets. The authors found that students participating in the Connecticut Healthy

Snack Project increased consumption of MNS beverages (fruit juice and water), MNS salty

snacks (baked chips, popcorn, and crackers), and MNS sweet snacks (fruit, yoghurt, granola

bars, and popsicles). At the same time, students in the control group that had normal access to

junk foods consumed more of those foods, eating and drinking greater amounts of soda,

flavoured fruit drinks, and chips. Dority, McGarvey, and Kennedy (2010) found that schools that
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prohibit junk food sales during meals have fewer obese or overweight students. The study

suggests that schools that currently allowed junk food sales could reduce their number of

overweight or obese students by 18% by enforcing bans.

Concerns over the emotional and psychological effects of food restrictions on the

students were addressed as well. Schwartz and her colleagues examined the notion of dietary

restraint, which suggests that people are influenced by internal factors. This thesis has roots

based on studies investigating maternal diet restrictions among young girls. The authors suggest

that feelings of deprivation lead to strong desires for the prohibited items. The study also

considered whether compensatory eating, whereby students increase consumption of banned

foods at home, would occur. Neither was found to be valid. The authors suggest that food

restrictions ordained by a government body would not make students feel bad about their bodies

since equal treatment was being applied to all students. There was no evidence to suggest

compensatory increases occurred (Schwartz et al., 2009).

Further Considerations: Beyond and Between the Scope of Schools

While school food has been identified as a key target in tackling obesity, there are many

additional factors and confounds that contribute to decreased health and longevity. In their

analysis of the Hull, UK “Eat Well, Do Well” campaign, Pike and Colquhoun (2009) note that

their two comparison schools featured different levels of uptake despite near-identical meal

programs. The authors argue that spatiality–“the interrelationship between the subject and the

spatial”–can account for the difference. Cleveland School, which featured a dining hall with high

ceilings, natural light, and walls decorated with student art, had significantly higher rates of

participation than Crosby School. In comparison, Crosby had a standard dining hall that was

considered uninviting, with closed curtains and plastic chairs. The authors suggest that
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Cleveland’s welcoming dining hall encourages students to engage in positive interactions with

their peers, teachers, and school staff within that setting. Lunch hours at Cleveland are half an

hour longer than Crosby School lunch hours, where students finish their lunches quickly or leave

while still eating. Cleveland students experienced healthier school meal experiences because of

positive interpersonal interactions: for example, students increased fruit consumption after being

prompted by adults (Pike & Colquhoun, 2009).

Marketing provided by food corporations, located within schools or within close

proximity, has also been highly problematic. This issue has been felt in both the United States

and the United Kingdom and has been critiqued by the World Health Organization. The 2003

WHO Diet, Nutrition and the Prevention of Chronic Disease Report commented that marketing

efforts make healthy choices difficult for youth (Lake & Townshend, 2006). Advertisers have

been known for specifically marketing their goods towards children. The UK government places

no restrictions on children’s access to advertising, instead arguing that parents should decide the

amount of exposure their child should receive. Scandinavian countries, on the other hand, have

placed bans on advertising geared towards children (Gustafsson, 2002). Advertising may play a

more direct role in students’ future health as well. Exclusive agreements such as “pouring

contracts” encourage brand loyalty that can increase the consumption of unhealthy foods

throughout an individual’s life while encouraging consumerism. Policymakers must approach a

completely different strategy if marketing and commercial advertising do indeed play a

significant role in decreasing child health (Fried & Simon, 2007).

Public health officials have also identified falling activity levels as another area within

the school where obesity can be countered. Lake and Townshend (2009) take a geographically

influenced viewpoint by arguing that the built environment can link physical activity and
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reduced health. Factors such as high population density, areas of mixed zoning (featuring

residences and shops), and the availability of well-maintained paths, all encourage walking or

cycling. Suburbia, which has been derided for its lack of “walkability,” has been linked to

obesity in American and Australian studies. In one study, obesity rose from 30% to 60% between

a “walkable” region and a “low walkable” neighborhood (Saelens et al., 2003, as cited in Lake &

Townshend, 2006).

Conclusion

In both the United States and the United Kingdom, a tacit theme underlying the

movements and responses to obesity has emerged as one of convergence. With support from the

fearful public body and concerned school administrators, national governing bodies have moved

to clamp down on practices of unrestrained marketing and consumption of unhealthy foods

within the school system. As patterns of commercial marketing and consumerism become

increasingly parallel in nature, similarities in government strategies will likely continue to grow.

The efficacy of stringent school food policies has been demonstrated as an effective method of

promoting healthier students and countering childhood obesity. Though findings have shown this

angle of attack to be beneficial, the contributing factors to obesity are many and as a result, a

varied group of tactics should be employed.

The lack of agency of children in shaping their own diets and health consequences has

been one overarching failure among school meal programs. Despite their daily involvement in

the consumption of meals at school, children have been relegated to “end of line” decisions, only

being able to chose between the lunch hall offerings, packed lunches, or commercial options.

Governments may need to change their approach to the food industry, placing firm restrictions

on advertising and setting new nutritional standards.

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Through the current body of research, it is clear that schools are indeed a key facet with

which to understand and tackle childhood health issues. Whether schools should be the sole

gateway to solving the obesity dilemma or a part of a larger solution is yet to be determined.

Nonetheless, we as citizens, policymakers, educators, and parents have a responsibility to

encourage healthy lifestyles for children and youth. Tightening restrictions and establishing

rigorous standards surrounding food in schools has been shown to be beneficial with few

drawbacks. With such great costs and so much to lose, how can we afford not to?
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