family practice issues and general life events

Posts tagged ‘schools’

Obesity epidemic and school lunch standards

About 5 days ago, the USDA set guidelines for healthier school meals.  As a physician, I should get totally excited about that, but upon hearing the full story, I think my reaction is more of a what?  As the obesity epidemic reaches dramatic proportions, our children are not left out.  According to the American Academy of Children and Adolescent Psychiatry 16- 33% of children are obese.  This is a startling statistic but based on my patient population, I would estimate the number is closer to the 33% rather than the 16%.  But then again, I live in southeastern Oklahoma, and see a patient population of 45% Medicaid.  That is their primary insurance, it does not include those who qualify for Medicaid as a secondary insurance.  During medical school, I never imagined that I would be consulted by parents regarding their underweight child, only to determine he is the only one in the family that is on the growth chart and of a normal weight with respect to his height.  Or the number of children dragged in by their parents sure that their child has a thyroid problem, because it could not be that the only exercise the child gets is to get up off the couch to go to the bathroom between commercials, or that a large pizza is considered a serving size for them.  So I understand that obesity is a problem in our youth.  And I would applaud any efforts to help curb it, should those efforts actually make sense.

This is not an argument for whether I want to subsidize school lunches, food stamps or other government agencies.  These programs are in place, and for the moment, if we are to continue with them at least let their policies make sense.

Per the report found in Reuters  “The guidelines double the amounts of fruits and vegetables in school lunches and boost offerings of whole grain-rich foods. The new standards set maximums for calories and cut sodium and trans fat, a contributor to high cholesterol levels.”  And while I fully understand that, and the attempts to offer only fat-free or low-fat milk, and assure that proper portion sizes are given to children, I doubt that this is even possible to enforce much less implement.

My experience with cafeteria workers is that few if any realize what a proper serving size for an adult, much less a child.  I spend quite a bit counseling patients that serving sizes are roughly the size of their hand (since it is much easier to grasp and compare than carrying around a scale).  And currently, I have heard of schools allowing 2nd and 3rd servings to children.  With few exceptions there is not a child that ever needs a third tray of food.  (Those rare exceptions of underweight and active children this applies to the population that are not at that end of the spectrum)

Not to mention, the black market aspects that could foreseeable pop up.  Who is going to keep kids from bringing food from home?  I know it is being attempted in Chicago, but I remember sneaking brownies and gum into the classroom, where we weren’t allowed to eat as a child.  How are you going to determine if this is food from home, or from the cafeteria itself.

And the biggest reason that this will not work, the original proposal was blocked because potatoes were not initially allowed as a vegetable.  And pizza was also not allowed as a vegetable.  I like french fries and pizza as much as the next person, but let’s be real, health food they are not.  When the food manufacturers selling the food are allowed to dictate what constitutes health foods and what does not, there is a problem.  What child is going to pick an apple over french fries?  Will the school lunch still be able to meet the nutritional standards?  How precisely would those two be considered nutritional equivalents?

As a physician, I spend a lot of time talking to new diabetics and obese patients about their diets, and well pasta and potatoes appear to be the biggest contributors to the caloric intake.  It is what they learned from the USDA and their food pyramid.  The very same organization setting these standards.   The same organization which allowed the lobbyists to dictate the new standards.  And at what cost?

While I agree we have to start somewhere with educating the public and attempting to change the dietary habits of children before the suffer the health effects of obesity, including early onset Type 2 diabetes, hypertension, and high cholesterol, I don’t see this actually being effective.  Substituting whole wheat for white flour in pizza and spaghetti, while it looks like a wonderful idea on paper, may instead be thrown away in favor of other offering either by the school, or an entrepreneurial student.  And while I am in full support of the potential economic lesson this might lead to, it most likely will do little to help.  Nationwide standards have not helped to improve our education system, and without getting input from local officials and parents, I doubt that this will be much different.

Had change been truly desired in the school lunch program, input would have come from the parents, teachers, physicians, dietitians rather than the food industry who would have seen their potential profits cut.  The making of a pizza a vegetable merely because of its tomato paste (which is incorrect, since most use sauce which has a lesser concentration of tomatoes and tastes better) shows just what kind of answers we get from Washington.

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Do we overmedicate?

I saw a child the other day, a patient.  He was brought in for routine medication, one he didn’t want and didn’t feel he needed.  His parents weren’t sure either but the school was demanding it.  This actually is not too terribly uncommon.

The diagnosis of ADHD has become so used and diagnosed, it makes me question whether all the diagnosis are valid.  I try to do the right thing, I make sure all my newly diagnosed patients are formally tested, but over the last 6 months to a year, I have found that all of the tests are coming back positive.  That makes me question, am I only sending those that I already know have ADHD, or is something else going on?  In fact, some that I sent more for developmental delay came back positive as ADHD.  This was not the case two years ago, and I was using the same people to do the test.

Is the problem becoming overly epidemic or all some of the tools becoming misused to put more children on stimulants so rather than having to engage the children in their work they are merely medicated so that their job is easier.  What if the decreased concentration has more to do with the children being bored because of lack of stimulation, than to do with true ADHD?  I can calm any child down with Ritalin/Adderall and other stimulants, but to what cost?  And now the American Psychiatric Association is discussing with their DSM -10 changing the lower age limit down to 4.  How many of you had a calm 4 year old?

I have grave concerns for this trend.  I thought it was improving briefly and there are definitely times when medication is needed to help the child succeed in school and life, and even some adults sometimes need it.  But are we trading in our children’s health and well being for well ordered classrooms?

One of parents greatest complaints is that sometimes their children seem like zombies on their medication.  That child is overmedicated, but when we decrease the dosage a little, there seems to be complaints from the school.  I don’t know about you, but I went into a local school about 2 years ago, and was horrified by what I saw.  In the time before classes began there were more children on the wall in time out than there were sitting at the tables in the cafeteria.  This was before classes had started. And I saw one teacher send another student that way for merely asking another student for a pencil.  So my question is, whether the ADHD epidemic is true, or is it manufactured from our one size fits all education system.  Are we forgetting that 5 year olds need to be stimulated?  Maybe we need to sit down and look a little closer at where the problem is coming from.

As for me, I am stuck between a rock and a hard place.  What do I do for that child?  Is medicine the best choice?  Maybe, maybe not.  But him getting kicked out of school definitely isn’t.  So I write the prescription, and we discuss things to help him function better in school, and I will see him again, in the next room, or tomorrow.  Unfortunately in some cases, I don’t have the answers, only the questions.

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