Sunday, December 10, 2006

Monitoring Our Wellness? A Look into the Local Wellness Policy and the Basic Values of Adolescents - Tiffany Massood

Childhood obesity has reached epidemic proportions throughout the country. According to the Surgeon General, 13 % of six to eleven year olds and 14% of twelve to nineteen year olds are considered overweight. Type II diabetes, commonly called “adult onset diabetes”, has become a common morbidity in the youth of America (Surgeon General’s). Health professionals correlate this “obesity epidemic” to increased consumption of “junk food” and decreased participation in physical activity.

To combat this epidemic, the Richard B. Russell National School Lunch Act and Child Nutrition and WIC Reauthorization Act of 2004 requires all schools that receive aid from the National School Lunch Program implement a Local Wellness Policy as of the 2006-2007 school year. The Local Wellness Policy must address nutrition education, physical activity, school-based wellness, nutrition guidelines and a measure of implementation (Child Nutrition and WIC Reauthorization Act of 2004). Each school district receiving aid from the USDA/National School Lunch Program is required to construct a committee to develop these guidelines. Sample guidelines are provided via the internet and committees are encouraged to develop plans according to the sample guidelines. Committees are ultimately responsible for the implementation and monitoring of the policy guidelines (Healthy School).

The National School Lunch Program requires participating schools to abide by the follow regulations:
· Meals should not contain more than 30% of an individual’s calories from fat and less than 10% from saturated fat (National School Lunch Program).
· Average of at least 1/3 RDA for protein, iron, calcium and Vitamin A and C per week (National School Lunch Program).

School systems that participate in the National School Lunch Program are eligible to receive entitlement food (Food Distribution National Policy Memorandum). Entitlement foods are offered at a discount, thus decreasing food costs for the school system (Food Distribution National Policy Memorandum).

The implementation of the Local Wellness Policy was directed to decrease rates of overweight and obese children (Healthy School). The sample wellness policies were focused on limiting competitive foods sold during the lunch day as well as limiting food offered during social events on school property (Healthy School). Physical activity was limited to physical education classes taught during the school day for most students (Healthy School).

To more effectively implement the Local Wellness Policy, committees needed to evaluate Maslow’s Hierarchy of Needs and successfully integrate these principles into the development of guidelines focused on the prevention of obesity in children throughout America. According to Maslow, biological needs must be met to successfully meet other needs (Gerrig 389). Maslow determined that individual needs must be met in the following order: biological, safety, attachment, esteem and finally self-actualization (Gerrig 389).


The Food Distribution Program that allows school systems to receive entitlement foods was authorized by the U.S. Congress through several pieces of legislation.

The primary pieces of legislation which enabled the various commodities to be provided to schools, child care centers and the elderly are:
· Section 6 of the National School Lunch Act, which mandates a per-meal commodity assistance rate for schools participating in the National School Lunch Program
· Section 32 of the Agriculture Act of 1935, which authorized the purchase and distribution perishable commodities in order to remove surpluses and stabilized farm prices; and
· Section 416 of the Agricultural Act of 1949, which authorizes the purchase and distribution of commodities for the purpose of supporting farm pieces (Child Nutrition Programs)

“Massachusetts prorates each school system’s entitlements based on the same formula, the number of lunches served in the previous years times the entitlement rate”. (Child Nutrition Programs) Examples of entitlement foods are canned fruits in syrup, shortening, canned vegetables and heavily processed foods (USDA).

Entitlement foods are necessary to help sustain the food service director’s budget. In many cities and towns, food service departments within a school system are required to be self-supporting. Thus, to help decrease food costs, entitlement foods are staples on many of the menu items.

The National School Lunch Program offers lunches at free or reduced prices to ensure that every child receives a healthy, balanced meal. Students who are eligible to participate in the free or reduced lunch program have lower socio-economic status compared to their fellow peers. According to Drewnowski, et al, the “highest rates of obesity occur among population groups with the highest poverty rates and the least amount of education” (6). Individuals with increased socio-economic status have greater tendency to purchase higher quality meats, fruits, vegetables and grains compared to individuals with lower socio-economic status (Drewnowski 10).

Studies have shown that the two strongest correlates to fruit and vegetable consumption is taste preference and availability (Neumark-Sztainer 199). In developing the nutritional guidelines required by the Local Wellness Policy, the USDA needed to re-evaluate the foods offered on the entitlement list. By providing low quality food products, such as canned fruits, canned vegetables and processed meats, Maslow’s biological needs are not being addressed in this population (Gerrig 389).

According to Maslow’s Hierarchy of Needs, biological needs must be met in order to achieve “other” needs that influence overall wellness (Gerrig 389). Developing strict nutritional guidelines without improving the quality of food provided is prohibiting these children from receiving fresh fruits and vegetables, thus preventing their biological needs from being met. By providing fresh fruit and vegetables compared to canned products with high sodium content, these children will have the ability to enjoy a wholesome and nutritious meal. Socio-economic status should not determine accessibility to fresh fruits and vegetables.


Nutrition education is considered the gold standard in developing healthy food choices. Traditional nutrition education is taught through health education classes. The curriculum contains lessons surrounding the Food Guide Pyramid and Guidelines for Healthy Americans. Traditional nutrition education focuses on weight maintenance and healthier choices, thus presenting a message that to achieve overall wellness these types of foods needs to be consumed as this quantity. This information is factual; however the manner in which it is presented needs to be communicated using social and behavioral sciences principles.

While basic nutrition knowledge is essential and making healthy choices, it will not solve the obesity epidemic. According to Doak et al, “preventing overweight and obesity requires understanding and addressing the ‘obesogenic’ environment in which children live. Environmental factors take precedence in prevention efforts because they provide the most potential for the greatest impact” (Doak 112). Nutrition education curricula should be developed at the local level to address the environmental factors that impact each community. Addressing each individual community's “risk factors” will enable the nutritional message to have a greater impact on that particular community.

For example, by having children and adolescents participate in cooking classes that focus on a different ethnic food each week, students may be able to feel a connection with their ethnicity while learning to prepare foods in a healthier way. It will also allow these children to discover different types of food, thus increasing the variety in their diet.

A study was conducted by D’Arca et al, that looked at overweight and obesity intervention through printed media (Dock 124). The study found that “intervention[s] involving distributing well-produced printer materials was not effective whereas a similar dietary education program including audiovisuals and discussion….led to reductions in overweight and obesity prevalence” (Doak 124). Thus, presenting the material in a different light will enable children to absorb nutritional knowledge.

According to Maslow’s Hierarchy of Needs, individuals need to feel a sense of belonging or attachment (Gerrig 389). By taking the traditional nutrition education curriculum and applying it to the environment in which the children are accustomed, these children are more likely to feel a sense of belong and sense of inclusion. Cooking classes will allow the students to improve the nutritional quality of their accustomed foods while, indirectly teaching good nutrition.


Many of the sample Local Wellness Policies advocated physical activity through existing physical education classes. Children that are overweight and obese are excluded from many traditional physical activity lessons due to lack of physical endurance or lack of coordination. Thus, the correlation between physical activity and weight status could impact the child or adolescent’s connectivity towards his/her peers. The lack of belonging could negatively impact his/her self-esteem.

Traditional physical education curriculum lacks the basic social principles that are needed to combat the obesity epidemic. “Physical activity for young people can contribute to the enhancement of psychological and social well-being” (Daley et al 1). However, traditional physical education increases the lack of self-esteem in overweight and obese school aged children. “Overweight children have increased odds of experiencing poor health related quality of life, particularly in the domains of psychosocial health, self-esteem and physical functioning” (Daley et al 2). According to Daley et al, “overweight adolescents are more likely to be socially isolated than their normal weight counterparts” (Daley et al 2). Overweight and obese children are less likely to participate in traditional physical education classes due to a fear of “not being good enough”.

Maslow’s Principle of Esteem needs to be implemented in physical education curriculum (Gerrig 389). Individuals want to belong to a group, adolescents especially overweight and obese children have a strong desire to “fit in”. A decrease in belonging to a particular group or fitting in with other children leads to decreased self-esteem. Education professionals, along with health professionals, should collaborate to develop programs that decrease the negative stigma of physical fitness/education and allow all children and adolescents to participate regardless of their physical fitness level.

To begin to develop programs that increase self-esteem, the physical education curriculum should be developed on a local level compared to a state level. Each community and school district has very distinct needs; the curriculum should reflect those needs. Education professionals should request input from students and parents regarding the types of physical education curricula that would increase participation. According to Deforche et al, a “lack of autonomy can influence low self-efficacy” (413). By allowing student input on different physical education activities, their self-efficacy may increase and allow especially overweight and obese children to feel ownership in their own wellness.


Childhood obesity is at epidemic proportions throughout the country. The solution to this “epidemic” is multi-factorial and must account for the social and environmental factors that contribute to obesity in America.

Health policy professionals must take into account basic social science principles as Maslow’s Hierarchy of Needs to ensure that social and environmental factors are being addressed in the solution.

Obesity is caused by increased in caloric consumption and a decrease in physical activity; however just increasing physical activity and decreasing food consumption is an unrealistic solution to the problem. Health professionals must take into account the self-esteem issues surrounding overweight and obese children and adolescents, access to quality food, regardless of socio-economic status, and increase cultural competency within nutrition education.

According to Maslow’s Hierarchy of Needs, Self-Actualization occurs when an individual is “self-aware, self-accepting, socially responsive, creative, spontaneous, and open to novelty and challenge” (Gerrig, 389). When Maslow’s principles are implemented in Local Wellness Policies, so are the tools that enable children and adolescents to meet their self-actualization goals. By implementing programs that allow students to interact with educational and health professionals towards improving their own health status, students have the potential to meet their goals.

Failure to acknowledge these basic social sciences principles will lead to increased mortality and morbitity correlated to obesity, increased healthcare costs and decreased quality of life of many Americans.

Works Citied

Child Nutrition and WIC Reauthorization Act of 2004, Pub. L. no 108-265, Sec 204 (2004).

Child Nutrition Programs. 1 Oct. 2006 Department of Education

Daley, Amanda J., “Protocol for Sheffield Obesity Trial (SHOT): A randomized controlled trial of exercise therapy and mental health outcomes in obese and adolescents. BMC Public Health. (2005) 5:113.

Deforche, Benedicte, et. al, “Changes in physical activity and psychosocial determinants of physical activity in children and adolescents treated for obesity”. Patient Education and Counseling. (2004) 55; 407-415.

Doak, C. M. et al, “The Prevention of Overweight and Obesity in Children and Adolescents: A review of interventions and programmes.” Obesity (2006) 111-136.

Drewnowski, Adam and SE Spector, “Poverty and obesity: the role of energy density and energy costs.” Am J Clin Nutr (2004) 79; 6-16.

Food Distribution National Policy Memorandum. 1 Oct. 2006. USDA

Gerrig, Richard., Philip G. Zimbardo. Psychology and Life. 17th ed. Boston: Pearson, 2005.

Healthy School: The Local Process: How to Create and Implement a Local Wellness Policy. 17. Nov. 2005. USDA

National School Lunch Program. 1 Oct. 2006. USDA

Neumark-Sztainer, Dianne,, “Correlates of fruit and vegetable intake among adolescent Finding from Project EAT.” Preventive Medicine (2003) 37; 198-208.

Surgeon General’s Call to Action. 1 Oct. 2006. USDHSH.

USDA Food Available For School Year 2007. 18 Oct. 2006. USDA


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