James Carter, 14, flexes a bicep. A football player, he washes down his lunch with a swig of milk.
By Jill Wendholt Silva
The Kansas City Star
"Coach told us not to drink as much pop as we do," he says.
In the fall of 2001, administrators at Eisenhower Middle School in Kansas City, Kan., took a bold and unpopular step on the bumpy road to better nutrition: They unplugged the pop machine for a week.
The "Pop Out" was accompanied by a plug of another kind: The Midwest Dairy Council sponsored a flavored milk tasting during lunch and a "Milk Mustache" campaign featuring the school principal and Wizards soccerplayers with white froth riding above their upper lips.
"It was not a happy day when we pulled the plug," says assistant principal Marsha Cowan.
In the last 30 years milk drinking among preteens and teens has plummeted more than 40 percent as soda consumption has risen. Today the average teen-ager drinks more than 500 cans of soda a year. At 10 teaspoons of sugar a 12-ounce can, drink just one soda daily and that's a possible weight gain of 15 pounds a year.
Eleven percent of adolescents 12 to 19 are considered overweight, nearly triple the number 20 years ago. Another 14 percent are at risk of becoming overweight.
The power struggle between cola companies that offer lucrative contracts to cash-strapped school districts and milk producers desperate to turn the tide only hints at the tangled web of social factors responsible for an alarming increase in heavy teens. Fast-food culture, TV, video games, cutbacks in physical education at school and a rise in two-income households also share in the blame.
Health experts agree, regardless of who or what is responsible, the message is easy to understand, if sometimes hard to digest: Teen-agers need to get off the junk food and get more active.
Education, not carbonation, is the key to turning the obesity epidemic around.
Leaning tower of pizza
For most teens, the USDA Food Guide Pyramid might as well be a leaning tower of pizza. They eat double the amount of pizza and salty snacks and six times more cheeseburgers than teen-agers did 20 years ago.
Forty percent of teen-age boys' calories come from discretionary fats and sugar. Fast-food restaurants are the most frequent choice of outside food, and teens drink an average of 34 ounces of soft drinks a day. Green vegetables are nearly nonexistent in their diets.
Teen-age girls don't do much better. Two-thirds of teen-age girls drink 23 ounces of soda, and they average 85 percent or less of the recommended daily allowance for calcium, iron, magnesium, zinc and vitamin E.
The poor eating habits of teens are having a negative impact on their long-term health. Already one quarter of teens show signs of high cholesterol. Type 2 diabetes, once referred to as adult-onset diabetes, is rapidly rising. Health experts also fear a lack of calcium may lead to high rates of osteoporosis in the future.
Meanwhile, half of all teens are considered physically unfit, and many more have poor body image or suffer from eating disorders. Another serious long-term consequence is harder to measure but no less damaging: The stigma of being a fat teen-ager in a society where thin is in.
"We can't wait for people to get obese, then scramble to get our way out of it," says Robert Murray, associate professor of pediatrics at Ohio State University. "The problem exceeds our resources. No epidemic has ever been eradicated by curing one person at a time."
The cure is twofold: Teach parents how to feed children so they are at a reasonable weight when they start school, then help teens maintain their weight throughout high school.
"The No. 1 problem is convincing parents this is a problem.They have so many fears. ... (Poor) nutrition isn't even on the list of the top10 things they fear," Murray says.
Peer pressure in the cafeteria
In the 1940s, President Harry Truman authorized the National School Lunch Program as a result of nutrition deficiencies discovered in military recruits during World War II. Today the program feeds most public school students once a day - sometimes twice.
Eisenhower Middle School is typical of many urban schools throughout Kansas City: 65 percent of the predominately African-American student body qualify for free or reduced-price lunch.
The cafeteria also serves breakfast to 135 of its 700 low-income students who qualify. "We do have kids where this is the only place they might get a meal," assistant principal Cowan says.
Despite the added burden of supervising two meals a day for some students, Cowan says she would go so far as to support a "milk break" in the afternoon to help teens keep chugging on through the afternoon.
Each day, school food services across the nation are mandated to prepare nutritionally well-balanced meals with no more than 30 percent calories from fat. Studies show students who eat lunch in the school cafeteria get more milk and dairy, more vitamins and minerals and report higher fruit and vegetable consumption overall.
Cafeteria managers say the hardest part of feeding students is that they must compete with in-house, fast-food franchises, vending machines and school stores. USDA nutrition standards do not apply to a la carte items or vending machines.
A study by the Centers for Disease Control and Prevention found 43 percent of elementary schools, 74 percent of middle and junior high schools and 98 percent of senior high schools have vending machines or school stores that often compete with cafeteria offerings.
"I think you have to offer them the nutrition ... but it doesn't mean they eat it," says Barbara Johnson, kitchen manager at Eisenhower.
Some of the conflict is personal taste: Children weaned on highly processed foods tend to crave sugar and salt. But teens also worry about peer pressure.
Last fall, students passing through the Eisenhower lunch line were offered a 2-ounce portion of black beans. All it took was for one student to say the beans looked "nasty." The sampling stopped cold.
"They've got to fit in, even with how they eat," Johnson says.
Focus groups conducted by the U.S. Food and Drug Administration found that 12-year-olds could name food groups and understood that carbohydrates, protein, fat, vitamins and minerals are in food. But their knowledge did not necessarily carry over to their food choices.
According to one study participant, taste is the primary concern. "We hear 'Eat right. Don't do drugs.' It's getting boring, like a broken record, so we just tune it out."
Rapping about nutrition
"Supersize your play - not your meal."
"Big Gulp water . (Instead of pop.)"
"Dive into a pool. (Instead of a bag of chips.)"
"Tell your mom to take a hike - with you."
These are among the slogans that "Kid Power K.C.," sponsored by the Kansas City Metropolitan Health Council, is using to get the message across to "tweens" age 9 to 13.
The summer nutrition/fitness campaign kicks off this month. Participants gain free access to area YMCAs on designated days. They also can participate in recreational opportunities through the KCMO Parks and Recreation department.
The program is designed to encourage kids to make better lifestyle choices, says Shelly Summar, nutrition program coordinator at Children's Mercy hospitals.
But experts agree getting teens' attention can be tough.
A former investigative reporter turned dietitian, Barbara Storper has spent two decades trying to turn school kids on to good nutrition.
Using jugglers, skits and rap music, Storper uses her "Foodplay" theater group to encourage kids and teens to change eating habits - "one can of soda at a time."
One of her most attention-grabbing techniques is a "soak in the Coke experiment." Simply place an old tooth, chicken bone or iron nail in a glass of cola overnight. Then have students check out the corrosive damage 24 hours later.
Once Storper has their attention, she encourages students to respect their bodies by making better lifestyle choices, such as taking time to eat breakfast and eating more fruits and vegetables.
When the University of Rhode Island pre- and post-tested 1,200 fourth-graders in Rhode Island and Massachusetts, where Storper's troupe is based, 63 percent were able to put all food groups in the correct place on the pyramid in the post-test, up from 37 percent in the pre-test. Eighty-five percent knew a can of cola has 10 teaspoons of sugar, up from 21 percent before.
The students also self-reported changes in their eating behaviors. Eighty percent reported "eating more healthfully," 75 percent were eating more fruits and vegetables, 69 percent were drinking less soda and 68 percent were eating breakfast more often.
Turns out half of all teens choose to skip breakfast, a choice that can cost teens more than a little beauty rest. They also are more likely to miss out on an important group of nutrients for the rest of the day, including iron, zinc, vitamins A and B and calcium.
Studies linking breakfast and academic achievement seem to be a nonthreatening way to get nutrition dialogue going in the schools. Cowan says poor concentration, stomachaches and increased difficulty dealing with teachers and classmates are among the problems she's willing to attribute to students running on empty.
"A lot of the time in the morning they're not feeling good, and when I ask them if they had breakfast they say, 'I got up late,' " Cowan says. "I don't worry as much about the junk food, but the not eating at all is a problem."
Got flavored milk?
Some days James Carter drinks a V-8 before football practice, but many of his classmates head for the cool, refreshing larger-than-lifesize bottle of Sprite blasting off the school's pop machine.
The Kansas City, Kan., school district has a "pouring rights" contract that gives a cola company exclusive rights to sell its products at the school. The school, in exchange, gets a percentage of the profit.
Despite the incentive, Eisenhower administrators continue to turn the pop machines off during lunch. That has meant the school has received less money for extracurricular activities such as field trips and other extras not covered by shrinking school budgets.
To encourage teens to drink less pop, school administrators placed plastic cups near the vending machines to encourage students to share with one another instead of drinking a full 20-ounce bottle. And assistant principal Cowan is willing to bet that many of her students might opt for milk if it were available in vending machines.
Midwest Dairy Council members are looking into ways to get single-serving, grab-and-go bottles of flavored milk into more school vending machines and at convenience stores.
"I think if you put a half-gallon (of milk) in front of every other kid, they'd drink it all," she says.
Why push milk?
Teen-agers need 1,300 milligrams of calcium a day, or the equivalent of four 8-ounce glasses of milk. Teen-age girls are the least likely to consume enough calcium, stunting their growth in adolescence and putting them at risk for osteoporosis as an adult.
Seventy-five percent of calcium consumed in the American diet comes from dairy products. While it is possible to get calcium from broccoli, leafy green vegetables, soy and fortified orange juice, the amount of food required is substantial.
Most dietitians agree low-fat milk is hard to beat for its nutrition value. It's also the most convenient and economical way for teens to get vitamin D, phosphorous and protein, which, in combination with calcium, helps build strong bones.
For teens who are lactose intolerant or vegetarian, hard cheeses and low-fat yogurt may be an option. Low-fat yogurt with active cultures contains lactase, a broken-down form of the sugar in milk. Milk with reduced lactose and calcium-fortified foods also are options.
Parents' call to action
Bob Oliver often winces at the food choices some of his students put on their plates at lunch.
"It's excruciating for me to watch them eat," says Oliver, a physical education teacher at Trailridge Middle School in Lenexa. "They know my eyebrow (goes up) when I see cookies the size of Frisbees."
While schools often receive blame for poor nutrition among teens, it's the hours of 3 to 7 p.m. when teens are actually at highest risk for inactivity and unsupervised snacking.
Unlike school-age children, teens typically have discretionary income of their own and hectic school schedules that allow them to forage for food, often without much supervision.
Today nearly half of all high school students watch more than two hours of TV a day. Kids with computer access spend additional time sitting in front of a screen, making the thumb the most exercised part of the body.
Parents remember days spent riding bikes and climbing trees. When there were no video games, no cable TV and fewer fast-food restaurants, only 5 percent to 10 percent of children were considered obese.
Health experts stress that while parents are not responsible for the epidemic, they need to exert more control over the home environment.
"I don't teach diets. I teach habits," says Keith-Thomas Ayoob, an associate professor of pediatrics at the Albert Einstein College of Medicine in New York.
"I'm a big fan of role modeling. Seventy percent of values are in place by the time a child is 6 years old. Ninety percent of values are in place by the time they are teens," Ayoob says. "Parents want the best for their children, but they're not always modeling that behavior."
When they do take the time to be good role models, results can be heartening.
Kyle Curry, a sophomore at Leavenworth High School, takes his diet cues from his mom, whom he describes as "health-conscious."
After he kept a weeklong meal diary for The Star, it was clear that he has learned a thing or two from her: He ate a fast-food meal just once and had only two 6-ounce servings of soft drinks during the week.
At 6-foot, 1-inch tall, he weighs 150 pounds and considers himself "pretty much in shape."
Kyle says he eats what he likes but tries to watch excess sugar, fat and excessive portion sizes. Instead of supersizing a Big Mac meal at McDonald's, he's more likely to go for the 99-cent menu's grilled chicken sandwich, or a fish fillet without tartar sauce.
"This is what I like to eat," he says. "But it's also going to be healthy for me."