What might policymakers do if they were dead-set in reducing the number of fat kids?
Imagine civic, business, and foundation leaders so worried about the social and individual costs of health problems that overweight children would face as adults that they wanted schools to fight a war on fat. Imagine, further, that these policy elites, riding the current moral crusade against fat children, wanted to solve the problem now. Would they follow Singapore?
Since the early 1990s, Singapore had operated an obesity-reduction program called “Trim and Fit.” School officials identified overweight young students and compelled them to join a “health club.” In these “clubs,” teachers instructed chubby students to run, jump rope, and do other exercises. They received “calorie cash” coupons for school meals that would not exceed the number of calories stamped on the ticket. Lunches were monitored to reduce soft drinks, French fries, and fast foods. Teachers measured students’ height, weight, and body mass monthly. The government awarded cash to schools that found new ways for students to shed pounds.
According to government records, these “health clubs” and incentives reduced the proportion of overweight students from 14 percent in 1992 to 10 percent in 2003. Serious drawbacks arose, however. The head of physical education at the elite Singapore Chinese Girls’ Primary School said that “to keep them in the club for a long time is bad for their self-esteem because there’s a stigma tied to it.”
In 2007, the government ended the program even after substanial reductions in overweight children, because policymakers–spurred by parents and educators–concluded that the psychological costs to “club” students of being bullied and teased unrelentingly outweighed (yes, a bad pun) program gains.
Singaporean culture, centralized national authority, and a decided preference for social control nearly guarantee that this program would not fly in the U.S. So consider another possibility.
Imagine that President Obama recently signed the Leave No Pound Untouched Act, a variation of No Child Left Behind, to prevent increased incidence of diabetes, heart disease, stroke, and other crippling diseases associated with obesity. OK, it is a huge leap in imagining but humor me.
The Act gave government officials the authority to use the Physical Fitness Test (it does exist) as a lever to reduce fatness. Adequate yearly progress (AYP) standards would be set and, if met, schools would be identified as “fit and trim.” Those schools that failed to meet standards would be rated “unfit” and if those schools continued to fail, they would be closed. State, district, and school officials would make public all of the above information, particularly the poundage gap between trim and unfit schools.
In schools eager to meet standards, principals and teachers would identify those students close to their expected body mass index or just a few pounds overweight. These students would have the best chance to pass the Physical Fitness Test. Extra physical education sessions would be scheduled for them to practice body curls, push-ups, and pull-ups. All vending machines for candy, sugary sodas, and chips would be replaced with ones dispensing carrots, celery sticks, and sugarless candy. Low-calorie, tasty lunches would be served daily.
Even were this implausible scenario of a moral crusade and federal law to occur in the U.S., the spread of obesity among children would continue unabated since the causes of obesity are hardly located within schools between 8AM and 4 PM.
Consider other causes. The lack of concerted federal action since the 2001 Surgeon General’s Call to Action on obesity underscore the inherent conflicts between food industry profits and federally-led campaigns promoting healthy eating. Moreover, the hours children watch television, how little or how much money families have to spend on food, and a dozen other reasons anchored in personal, social class, and cultural norms encourage obesity. Schools, at best, are only a finger in a badly leaking dike.
Direct action focused on changing adult behavior similar to past and current anti-smoking campaigns is needed, not schoolhouse lessons and nutritious lunches. Muscular action from the Surgeon General’s office, anti-obesity groups lobbying for legislation to tax high-calorie soft drinks, and banning fast food industry ads targeted at minors are some measures that have a chance to stem the tide of fat spilling over the nation. Expecting schools to reduce obesity only repeats the dismal history of foisting national problems onto schools and substituting illusions for direct action.