Princess Health and Clinton County coalition works to change the health lifestyle of its children, in an effort to change the local health culture. Princessiccia

Princess Health and Clinton County coalition works to change the health lifestyle of its children, in an effort to change the local health culture. Princessiccia

child obesity children children's health exercise health rankings nutrition school lunch school nurses schools youth

Gusty 08:38 Add Comment

By Melissa Patrick

Kentucky Health News

Public officials and local leaders in a small, rural county in Southern Kentucky that ranks near the bottom of in the County Health Rankings for the state have formed a coalition to improve the health of its community, with a focus on its children.

Clinton County (Wikipedia map)

Clinton County ranked 102nd out of 120 Kentucky counties in the 2016 County Health Rankings. �We recognize that. We saw that in our kids,� Lora Brewington, chief compliance officer of Cumberland Family Medical Center Inc., told Kentucky Educational Television in a report to be aired soon about the coalition.�And if we don�t change something now, we�re going to be going to the funeral home for kids a lot younger.�

So, with the help of the Foundation for a Healthy Kentucky, they formed the Clinton County Healthy Hometown Coalition to implement a multi-faceted public health program for the community's citizens, that focuses on its children.

�The coalition came together [according to] Aristotle�s thinking, that the whole is greater than the sum of its parts,� Brewington told KET. �We have a lot of great groups, that do a lot of great things, but if everyone is going for the same goal, and the resources are not combined, you�re not going to accomplish anything. And once we get everybody together and on the same page, by combining resources, we�ve been able to do some great things.�

Paula Little, assistant superintendent and supervisor of instruction for Clinton County schools, told KET that the coalition recognized most of the county's health issues stemmed from obesity, and decided to focus their efforts on the children in the community to change their culture.

"So we feel like if we can start young and start with our children and teach them healthy habits and healthy lifestyles that when they grow up they won't be faced with obesity and all of those chronic diseases that go with it," Little said.

Many of the coalition�s activities are school-based. Teachers have incorporated physical activity into the school day as well as during their morning routines and after-school day-care programs.

The coalition has worked with the schools to improve nutrition. Fruits and vegetables are now served every day with every meal. The schools also began offering supper to students during the school year and has since served over 6,400 meals. The program began last October.

Recognizing that an estimated 38 percent of Clinton County's children live in low-income families, the coalition launched a summer food program that delivers breakfast and lunch in a retrofitted school bus called the Bus Stop Caf� to areas in the county with high student populations.

The Healthy Hometown Coalition has also implemented school-based health clinics, which provides for the healthcare needs of students through a public-private partnership while they are at school. The clinics are run by the Cumberland Family Medical Center. In addition to providing clinical care, the clinics provide body mass index assessments and provide nutrition and obesity counseling.

�It�s about accessibility,� Brewington said. �It�s about the kid who has a cough and needs to see a doctor, but the parent can�t take off from work. ...It's about having healthcare right there where the child is the majority of the time."

Not mentioned in the KET report is that Clinton County schools implemented a comprehensive smoke-free policy last year that will go into effect in July. The policy will ban smoking on school property both during school hours and during school sponsored events, and also includes electronic cigarettes and all vapor products.

The coalition is working to change the culture of its community so that a healthy lifestyle becomes the norm, and not the exception.

�When you�re attempting to change a culture, and change the way people live, that�s a very long process,� Little said. �And it has to be something that�s consistent, that�s ongoing, and it has to be a message that children hear everywhere they go in the community.�

A full-time coordinator, April Speck, manages the various coalition programs and writes a weekly health column in the Clinton County News that often celebrates individual success stories. The coalition also sponsors community events, and has built a new playground.

�What makes me feel good about it is that I know there�s a real need here,� Speck told KET. �There�s a lot of kids who have childhood obesity... And just seeing them start to make changes in what they are doing, how much they are eating, their water intake, I know that we�re making an improvement.�

Princess Health and Slicing your way to an apple a day: Americans' apple consumption is on the rise because we're eating them in small pieces. Princessiccia

Princess Health and Slicing your way to an apple a day: Americans' apple consumption is on the rise because we're eating them in small pieces. Princessiccia

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Gusty 13:13 Add Comment

Photo from livestrong.com

By Danielle Ray
Kentucky Health News

Presentation is everything. Apple consumption is on the rise, and researchers at Cornell University think pre-sliced apples are the cause.

The 2013 Cornell study explored why so many whole apples served in school lunches ended up uneaten in the trash. Researchers found that eating whole apples can be difficult for young children with small mouths and for kids with missing teeth or braces. The study also noted that older girls find whole fruits messy and unattractive to eat.

The study found that consumption jumped by more than 60 percent when apples were served sliced. These findings back up U.S. Department of Agriculture statistical data about overall apple consumption. Data show that Americans ate more than 510 million pre-sliced apples in 2014, up from fewer than 150 a decade before.

Likewise, overall apple consumption has grown by 13 percent percent since 2010, according to USDA data. Americans ate about 17.5 pounds per capita in 2013, the most in nearly a decade.

Why does simply slicing an apple matter? The difference between a whole apple and apple slices may seem silly or superficial, especially to an adult, but the inconvenience is a barrier nonetheless, David Just, a professor of behavioral economics at Cornell and one of the researchers behind the study, told Roberto Ferdman of The Washington Post.

"It sounds simplistic, but even the simplest forms of inconvenience affect consumption," Just said. "Sliced apples just make a lot more sense for kids."

The rise of mass-produced pre-sliced apples probably has a lot to do with the fast food industry. McDonald's added apple slices to its menu in 2004 in an effort to give parents healthier options. The company began automatically serving apple slices with Happy Meals in 2012, causing apple sales to skyrocket.

McDonald's has served more than 2 billion packages since first offering apple slices as a side, a representative for the company told the Post. In 2015 alone, the company served nearly 250 million packages of sliced apples, which amounts to more than 60 million apples, or about 10 percent of all fresh sliced apples sold in the United States, the Post noted.

The USDA, which oversees school lunch programs, can't be sure of how many schools offer pre-sliced apples versus whole apples, as local school districts make that decision. However, the agency does make recommendations and encourages schools make fruit appealing in presentation.

The problem with the pre-sliced apple trend? It may lessen food waste, but it increases plastic waste, which puts a strain on the environment. McDonald's apple slices, for example, are served in plastic wrappers. These wrappers are recyclable, yes, but two important differentials exist. First, "recyclable" does not mean it was made of recycled materials, only that it has the potential to be recycled. Second, just because consumers can recycle the wrappers does not mean they will.

Princess Health and House Republicans want to make it harder for schools to get free meals for all students; could affect more than 350 Ky. schools. Princessiccia

Princess Health and House Republicans want to make it harder for schools to get free meals for all students; could affect more than 350 Ky. schools. Princessiccia

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Gusty 10:38 Add Comment

Photo from npr.org

By Danielle Ray
Kentucky Health News

Kentucky school officials are concerned about a proposal by Republicans in the U.S. House that would make it harder for schools to offer free meals to all students using federal money.

The House is considering changes to the 2010 Hunger-Free Kids Act, now in its second year, which allows schools who serve a high-poverty population to offer free meals to every student.

Instead of collecting individual applications for free or reduced-price meals, the Community Eligibility Provision uses data that illustrates how many students in a given school may be "food-vulnerable": how many students live in households that receive government assistance, live in foster care, are homeless, and other similar criteria.

Under current CEP rules, schools with greater than 40 percent of students who qualify as food-vulnerable are eligible to offer free meals to all students. A bill approved May 18 by the House Education and Workforce Committee would raise the threshold to 60 percent, forcing schools between 40 and 59 percent range off the program.

"Proponents of community eligibility say it spares schools from paperwork and administrative burdens, and that it allows low-income children to eat free meals without the stigma or red tape of particpation in the free meal program, which is often a barrier for participation," Evie Blad reports for Education Week. "But Republicans on the committee said the provision is wasteful, potentially allowing children from higher-income families access to free meals."

The change could affect more than 350 Kentucky schools. Kentucky has 804 schools eligible to offer free meals under current CEP rules, according to the Center on Budget and Policy Priorities. Under the proposed bill, only 441 would qualify, according to the center.

More than 10,000 students at 17 public schools in Lexington alone would be affected, according to the Lexington Herald-Leader reported. More than 190,000 students statewide could be affected, the Herald-Leader said.

Nick Brake, superintendent of Owensboro schools, told Keith Lawrence of The Messenger-Inquirer that he is hopeful that his district will be spared cuts.

"I have been working with Congressman (Brett) Guthrie�s office on this issue," Brake said. "We are still looking at the overall numbers, but our district average is 63 percent, so it looks favorable that we will be able to continue to provide the benefit of this vital program in the future."

Muhlenberg County Supt. Randy McCarty told Lawrence he thought his district would still qualify. "Once a district goes CEP, it stays in place for four years," he said.

Hopkins County, which recently expanded its use of free meals to all public schools, faces uncertainty if the changes are passed.

"I have no idea if school districts will be grandfathered in, or how Congress will write everything, but I am afraid that if we don't jump on this now, we may not get this opportunity again," Michael Dodridge, food services director of Hopkins County schools, told Laura Buchanan of The Messenger in Madisonville. "I would hate to pass this up."

UPDATE, May 26: The Harlan Independent School Board voted to join the program, Joe Asher reports for the Harlan Daily Enterprise.

The proposed CEP changes are part of House Resolution 5003, the child nutrition reauthorization bill introduced by Indiana Republican Rep. Todd Rokita. For more information on the proposed changes, click here.

Princess Health and Childhood obesity rates continue to rise nationally while Ky.'s rate has leveled off, but 1/3 of kids are still overweight or obese. Princessiccia

Princess Health and Childhood obesity rates continue to rise nationally while Ky.'s rate has leveled off, but 1/3 of kids are still overweight or obese. Princessiccia

childhood obesity farm to school nutrition obesity pediatrics physical activity research school lunch schools

Gusty 09:46 Add Comment

By Melissa Patrick
Kentucky Health News

Nationally, childhood obesity rates are not declining and severe obesity rates are still rising, especially among minority children. However, in Kentucky, child obesity rates have remained stable and the rates of obesity for minority children are not rising.

�Understanding the ongoing trends in obesity is important for public health and policymakers,� lead researcher Asheley Skinner, who is with the Duke Clinical Research Institute, said in a news release. �Our study suggests that more than 4.5 million children and adolescents in the U.S. have severe obesity."

The study, published in the journal Obesity, examined data from the National Health and Nutrition Examination Survey between 1999 and 2014 and found that 33.4 percent of children in the U.S. were overweight, meaning their body mass index (BMI) was above the 85th percentile for children their age. BMI levels estimate body fat based on height and weight.

In 2013-14, the study found that nearly 24 percent were obese, or above the 95th percentile, and that 2.4 percent were severely obese, or more than 140 percent of the 95th percentile.

The authors noted that the only statistical increase in child obesity since 2011 was found in those who were severely obese, which went up 2.1 percent, and this increase was most prevalent among African American and Latino children. The report also said that while there has been an increase in obesity in all age groups over the past 30 years, it "may be leveling off."

It could be that this "leveling off" effect is happening in Kentucky, where more than one-third of children are either overweight or obese.

The State of Obesity report found that 18 percent of Kentucky's high school students are obese, almost 20 percent of its 10- to 17- year olds are obese and 15.5 percent of its 2- to 4- year-olds from low-income families are obese. The report also shows that these rates have remained consistent for high school obesity since 2003, 10- to 17- year-olds since 2004 and the 2- to 4- year-olds since 2003.

The Kentucky Youth Risk Behavioral Survey also shows no overall statistical changes in obesity rates among  Kentucky's high-school students, including the state's African American high school students, whose rates range from from 15.5 percent obese in 2005 to 19.1 percent in 2013, or its Hispanic high school students, whose obesity rates were 15.5 percent in 2007 and 18.8 percent in 2013, the only two years with available data.

These reports did not break down the different levels of obesity.

Studies have shown that children with severe obesity are at an increased risk for heart disease, Type 2 Diabetes and even cancer when compared to children who are only considered overweight or mildly obese, says the release.

Skinner said it is time to expand local interventions and to find new treatment approaches.

"Addressing obesity in children is going to require a true population health approach, combining efforts at individual, healthcare, community and policy levels," she said in the release.

What is Kentucky doing about childhood obesity?

Kentucky's schools, as community partners in the battle against childhood obesity, are working to combat it through both nutrition and movement initiatives.

For example, most public Kentucky schools participate in the 2010 Healthy, Hunger-Free Kids Act that requires schools to provide healthier foods for their students; many schools participate in the Fresh Fruit and Vegetable Program, which provides a daily fruit or vegetable snacks to every student in participating schools; and more than 80 Kentucky school districts participate in the National Farm-to-School program.

Jamie Sparks, the school health and physical education director for the Kentucky Department of Education, said in an e-mail to Kentucky Health News that Kentucky schools are working to get students more active through several initiatives.

Sparks pointed out several successes, including school partnerships with the Alliance for a Healthier Generation initiative; a partnership with Humana Vitality called Students with Active Role Models, which encourages teachers and school staff to earn Vitality points by leading physical activity with their students; and partnerships with an online program called GoNoodle, which increases physical activity time in the classroom.

In addition, Sparks said, "Kentucky ranks second in the percentage of public schools enrolled with Let�s Move Active Schools. We have hosted 10 Physical Activity Leader trainings in the past three years."

But is that enough to make a difference?

Dr. Willian Dietz, author of an accompanying journal editorial, said there is a shortage of care-givers to treat obesity, noting that every primary care provider who takes care of children is likely to have about 50 pediatric patients with severe obesity in their practice. He also said that most of these providers aren't trained to treat childhood obesity, nor are they compensated appropriately, if at all, to treat it.

"We need more effective, cost-efficient and standardized approaches and services to manage children with the most severe obesity. This research emphasizes the urgency with which we must develop and validate a reimbursable standard of care for severe obesity in children and adolescents,"Elsie Taveras, spokesperson for The Obesity Society, said in the release.

It should be noted that Dietz, who is the director of the Global Center for Prevention and Wellness at George Washington University, said in his editorial that other data shows obesity rates have declined in two- to five- year olds. He said that this doesn't mean this study is incorrect because different time frames were used. "It all depends on how you look at it," he said. He did, however, acknowledge that severe obesity is increasing among adolescents.

He said, �The authors� observation that severe obesity has increased is of great concern, especially because children with severe obesity become adults with severe obesity.�

Princess Health and Visiting chef at Harlan County High helps incorporate fresh, local foods and flavors into menus; 1 of 8 Ky. districts in program. Princessiccia

Princess Health and Visiting chef at Harlan County High helps incorporate fresh, local foods and flavors into menus; 1 of 8 Ky. districts in program. Princessiccia

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Gusty 11:41 Add Comment

image: foodtank.com

The "Chefs in Schools Collaborative" project, which helps school cooks learn how to incorporate fresh, local foods in their menus, is up and running at Harlan County High School, reports WYMT-TV.

"Fresh ingredients are always important to a cook," Judy Gurnee, visiting chef through March, told the Hazard station. "We like to work with the closest available products that we can get ... the finest quality."

Harlan County is one of eight Kentucky school districts in the program. Its cooks asked the visiting chef to help them better use spices on the local vegetables, so that students, whom they described as their "customers," would eat them.

"I'm for anything that's going to get the children to eat," Kitchen Manager Jan Hicks told WYMT. "That's what we are here for."

Making sure the kids eat their school lunch is especially important because for some, it is the only meal they get a day, WYMT reports.

"Our kids, one in four are homeless," Director of Food Service Jack Miniard said. "That means that they are living with a grandparent or they are living with some other family member ... so, this may be the only meal that they get a day."

The program is led by the Kentucky Department of Agriculture's Farm to School Program in partnership with the Community Farm Alliance and the National Farm to School Network. Participating school districts are in Boyle, Clark, Grayson, Oldham, Harlan, Martin, Morgan, and Pike counties.

Princess Health and Trimble County parents protest 'humiliating' treatment of students whose school lunchroom accounts are in the red.Princessiccia

Princess Health and Trimble County parents protest 'humiliating' treatment of students whose school lunchroom accounts are in the red.Princessiccia

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Parents in Trimble County are demanding that the county schools stop serving cheese sandwiches to students whose lunchroom accounts are in the red, Kayla Vanover of WAVE-TV in Louisville reports.

"Embarrassing, humiliating and 'flat out wrong' is how parents described the school's policy to take a student's lunch right off the lunch table and toss it because the child's parents had not replenished their account to cover the meal," Vanover reports.

On May 20, Lori Ritchie's daughter "sat down to eat, but her hot meal was thrown away and she was given a cheese sandwich with a side," Vanover reports. "Ritchie said she doesn't blame the workers, but she said the policy needed to be changed a long time ago. Wednesday, a special called public meeting with the school board allowed other parents and community members to voice their opinions on the current policy, in hopes an agreement could be made."

Doug Joyce, grandfather of a student, told the board, "It is bullying. We throw kids out of school or reprimand them for bulling, so why should we let grown-ups bully kids like that?" A board member, unidentified in Vanover's story, said "We don't want any child to be embarrassed or receive an alternative meal, so we are really going to beef up the communication."

Princess Health and Advocates of school nutrition standards use high-school chefs' competition to show that food can still taste good.Princessiccia

Princess Health and Advocates of school nutrition standards use high-school chefs' competition to show that food can still taste good.Princessiccia

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Gusty 18:07 Add Comment

The higher school-food standards required by the Child Nutrition Act expire this year, and Republicans are continuing their efforts to roll back some of them. Democrats and advocates of the standards used a student cooking event on Capitol Hill to generate support for the standards, apparently to counter arguments of some school nutrition directors that some of the healthier options are more difficult to prepare and serve.

In the final competition, the top nine high-school teams served their winning dishes to lawmakers. The dishes had to follow their cafeterias' budgets and the national standards: To win, students had to include products rich in whole grains, low in sodium and a half-cup of fruits and vegetables, Whitney Forman-Cook reports for Agri-Pulse, a Washington newsletter. She doesn't list any of the dishes, but they're listed with the winners on the "Cooking Up Change" website of the Healthy Schools Campaign.

Sen. Debbie Stabenow, D-Mich., hosted the event. She said that she and Senate Agriculture Committee Chariman Pat Roberts, R-Kan., who has vowed to roll back some of the standards, have been discussing the issue, and she would like to pass a bipartisan bill by Sept. 30, when the current law's authority ends. One standard Stabenow doesn't want to compromise on is the requirement for a half-cup of fruit and vegetables; Michigan is a big fruit and vegetable state.

Stabenow said the Department of Agriculture "is very willing to work with schools where there are issues" in meeting nutrition requirements. (Read more)