Child Obesity: A National Public Health Problem
As the child obesity epidemic rears its overweight head across the nation, affecting one in five children, camps can play a vital role in the rescue efforts by being a knowledgeable, safe support system. All sectors of camps can offer assistance to parents and children through nutritional support, educational programs, and leadership that promote good health and physical activity.
Research has shown that poor diet and lack of exercise are the leading causes of preventable adult death in the U.S. and are surpassed only by tobacco use. A study in the March New England Journal of Medicine found that as childhood obesity becomes increasingly prevalent, the current generation of children may "live less healthful and shorter lives than their parents" for the first time in United States history.
World experts have recognized that obesity "is a complex disease with genetic, metabolic, and behavioral determinants," (USDA Center for Nutrition Policy and Promotion), and camps can definitely be a part of the behavioral determinant sector of the solution. As the world is now acknowledging that obesity affects life expectancy, diabetes, high blood pressure, self-esteem, and many other crucial life issues, recognizing the public health problem and epidemic that it is can help correct the path our nation's children are on. Researchers from the University of Illinois in Chicago contend that if the current levels of childhood obesity remain "unchecked," obesity-related complications such as diabetes, cancer, and cardiovascular disease will result in today's children living "two to five years less than they otherwise would."
"Diabesity": Not a New Disease
"Diabesity," a phrase trademarked by Shape Up America founder and former Surgeon General C. Everett Koop, reveals a frightening connection between the dual problems of obesity and type 2 diabetes. This new catch-phrase is further presented in a "call to action" book, Diabesity: The Obesity-Diabetes Epidemic that Threatens Americans — and What We Must Do to Stop It, recently written by Dr. Francine Kaufman, past president of the American Diabetes Association and head of the Center for Diabetes, Endocrinology, and Metabolism at Childrens Hospital Los Angeles. In her impassioned portrayal of personal and clinical accounts surrounding the world of diabetes and obesity, Dr. Kaufman offers critical advice for our generation: "To stop the diabesity epidemic, the new normal must become not just an individual but a societal choice."
Childrens Hospital Los Angeles developed a practical program for kids and their families called KidsNFitness, where children play games that help them identify good food choices, encouraging them to watch less TV and become more physically active, which motivates parents to be good motivators and good examples. The program also included warm-up exercises and dances.
Dr. Kaufman, a longtime supporter of children and camp programs with her connection and dedication to Camp Chinook in Southern California, explains that "the new normal must be supported by our schools, our work places, our communities, our healthcare system, and our government."
One of the alarming statistics Dr. Kaufman's book details is that "the food industry spends approximately $25 billion a year on advertising . . . more than half is spent marketing to American children." One of the many ideas Dr. Kaufman poses to affect positive change is to use the mass media for education. Simply put, "we can create positive messages celebrating the new normal — a lifestyle that includes exercise and healthy eating and drinking."
How Did It Happen?
The effects of overeating and under-exercising are staggering, but camps have a role to play in addressing this public health problem and in encouraging healthy eating and active living among campers and staff. Statistics from the last seventy years show that society's adaptation to changing food systems have contributed greatly to where children are today with food issues. With scratch food being served to most kids at home prior to 1954 when frozen food was introduced, and then to microwaveable food in 1974 where children began to take control of their food selection, intake, and preparation, we can see the progression from parent-control to child-control over food (Symposium on Childhood Obesity 1998).
In 1994, statistics showed that take-out food had become 30 percent of food eaten by children. Foods that are purchased from restaurants and fast-food facilities more often have a higher caloric content than scratch food prepared at home, and portion sizes tend to be substantially larger. Add the problem of high-caloric food, parent-size portions, and child-chosen food products to decreased physical activity many children face, (due to many factors such as neighborhood safety, access to safe public play areas, walking versus driving to school, television, and physical education changes in schools), and it's no wonder that child obesity has taken a giant leap in getting the world's attention.
It's a known fact that each pound of fat represents approximately 3500 calories consumed. If any individual consumes more food than the body can burn, he or she will gain weight. It's also a known fact that 34 million people die each year from obesity-related causes including diabetes, heart disease, strokes, and cancer. The type 2 diabetes epidemic appears to be exploding all over the world, and experts predict that by the year 2010, 200 million people on the planet will have diabetes.
Although individuals "ought" to be responsible for their own choices in diet and exercise, most public health professionals now agree that numerous environmental and social factors are at play that influence eating and exercise behaviors. The responsibility goes outside the individual to include schools, families, advertisers, and government policies. Camp staff and camp programming can also have a role in addressing the diet and exercise problems. In many ways the old adage applies — if you're not part of the solution, you're part of the problem.
Based on information gathered over the last ten years, the USDA Food, Nutrition and Consumer Services has recommended formal changes to the Food Guide Pyramid (www.cnpp.usda.gov ). Newly released guidelines for 2005 (Dietary Guidelines for Americans 2005) encourage more fruits and vegetables while still keeping moderate amounts of sugar and fats. However, getting children to eat healthy foods is not always easy when they are used to eating high calorie, super-sized fast foods, sugar-laden snacks, and high-fat, salted junk foods.
Children (and adults) need nutritious food but they also need the education to learn how to adapt and adopt a healthy eating style. Children can learn to like foods that are good for them, not just the ones that taste sweet or salty. Children are capable of learning to eat whatever is given to them, and they also enjoy learning from older children. For example, children need help understanding what a serving is in a culture where everything is "super-sized." They may also need to understand the importance of drinking water rather than soda or fruit drinks often sold in the camp store. Researchers have shown that for every additional daily serving of a soft drink, a child's risk of becoming obese rises 60 percent.
The era of "walking uphill two miles to school every day" is long-gone for most kids, and with the availability of buses and carpools, most parents opt to take or have their kids taken to school. Children are often not allowed to play outside or walk to school for fear of abduction, foul play, bullying, drugs, violence, and other dangers. This discontinuance of activity is in itself not completely to blame for child obesity issues, but it does contribute. Dr. Rajen Anand, the executive director for the Center for Nutrition Policy and Promotion, proposed at the 1998 symposium that "The opportunities for safe physical activity represented by schools are those that we have to recapture in order to restore physical activity levels of our population."
Most people attest, further, that children spend too much time with inactive technology such as watching television, devoting as much as three to five hours a day to TV-related entertainment. Almost everyone is familiar with the Food Guide Pyramid, but not many people are as familiar with the Physical Activity Pyramid. According to the Council for Physical Education for Children, sixty minutes is the minimum amount of physical activity recommended for children. Ideally, children should engage in flexibility games and exercises as well as muscular fitness activities at least three times a week, have active aerobics, active sports and recreation activities be a part of each day's activities, and gather many of the sixty minutes of moderate and vigorous activities from lifestyle activities such as outside play, games, walking, and other physical activities. Camps can offer an optimal environment to encourage many types of physical activities, teach life-long active recreational pursuits, and establish opportunities to learn active lifestyle behaviors.
This concept of eating too much and moving around too little is actually one of the most observable and significant child obesity factors. There have been proven links between the amount of television watched and the higher level of obesity in children. This higher level and earlier onset of obesity in children has also shown a higher incidence of type 2 diabetes, which is a definable public health problem.
Many theorists try to blame much of the obesity problem in children today on genetics and the environment. It is quite obvious that environmental and cultural changes in the last fifty to one hundred years have significantly drawn attention and need away from physical activity, with television and computers, as well as general safety. Experts do admit that "genetics has a modest influence on obesity, by far the largest amount of variance in body weight is due to environment. Genetics permits a person to become obese, but environment determines if a person becomes obese (Symposium on Childhood Obesity 1998)." Many leading researchers and physicians agree that the heart of the matter is promoting and bringing back physical activity in schools. Physical activity was once deemed so important that the USDA Team on Nutrition included it as one of its eight principles. During the 1998 Symposium on Childhood Obesity, sponsored by the Center for Nutrition Policy and Promotion and the U.S. Department of Agriculture, Assistant Secretary for Health and Surgeon General Dr. David Satcher noted, "This is the most inactive generation of children and adolescents we have ever had in history."
What Can Camps Do?
Camps and their staffs can make sure that camp programs offer opportunities for healthy and active living for at least the time children are at camp. If children can begin to change some of their food and activity habits at camp, they might be able to transfer some of these behaviors when they return home.
What can camps do? For starters, camps can continue doing what they do best, which is focusing on the positive development of children. Camp is, after all, for kids. To continue in this support role is to come up with a plan and become the automatic response for parents and teachers who ask, "What safe, fun place can we send our kids?"
We offer a number of suggestions for camp organizations to address nutrition and physical activity in camp. Trying one or two of these suggestions may not solve the obesity problem, but they can lead to small steps toward positive change.
- Camps can help children learn to like foods that are good for them by presenting good choices in a fun, safe environment.
- Camps can provide older children and young adults as mentors for the children, to support positive, healthy behavior.
- Camps can teach children that physical exercise is fun and can be chosen over television and video games.
- Camp environments can become the safest activity-oriented learning center outside the school system by working in tandem with education and nutrition.
- Camp staff can become the new "super counselors," trained in intentional positive behavior modification programs designed to teach and support healthy eating and physical activity.
Dr. Kaufman's book on diabesity showcased a "super-simple" plan implemented by Blue Cross/Blue Shield of Massachusetts called "5-2-1 Jump Up and Go." This plan emphasizes eating five fruits and vegetables a day (5); reducing screen time to no more than two hours a day (2); and doing one hour of moderate-to-vigorous exercise a day (1). This simple plan can be easily adopted and implemented in the camp arena with completion punch cards for campers to hang around their necks, and incentive prizes to those who complete the daily program.
Food and Nutrition at Camp
Many camps look for innovative, fun, tasty ways to provide healthy choices and decision-making skills to their campers and staff. The following list includes some "tried-and-true" techniques found at camps that just might work at your camp:
- Teach children to alter food preferences by offering good choices.
- Serve only green leaf (or other dark green versus ice berg lettuce).
- Serve whole wheat bread items in place of white (i.e., hamburger buns).
- Serve all sauces, dressings, and gravies on the side.
- Make fresh vegetables and dips available in colorful arrays.
- Offer whole wheat or graham crackers instead of chips.
- Offer taste tests; expose children to new foods.
- Make kiwi the "fruit of the day activity" by providing each camper a half kiwi and a spoon. Show campers how real New Zealanders eat the fruit by scooping out the fruit from it's own "bowl."
- Serve slices of jicama and cookie cutters at the table for campers to make edible shapes.
- Provide frilly toothpicks for eating Gardenburger or other new item pieces.
- Offer a cabin or table contest, giving points for numbers of spinach leaves consumed.
- Provide a table of "Guess What It Is" taste-testing food items.
- Encourage eating breakfast.
- Studies show students perform better in school and at play.
- A healthy breakfast is a good deterrent for overeating lunch.
- Those who skip breakfast have more problems with weight control.
- Offer new exercise/activity programs.
- Offer a "new activity contest" where campers can suggest and teach a new activity.
- Offer dance programs.
- Offer ethnic dance/movement as an alternative activity.
- Offer line dancing or other group dance/workout classes.
- Promote a "5-a-Day Summer Club."
- Offer different colored fruits and vegetable pieces and toothpicks so campers can build a fruit animal shape or vegetable creation and then eat it.
- Provide cabin posters for tracking 5-a-day consumption.
- Have a competition program that offers points for healthy eating choices.
- Reduce "fast food" and junk food for snacks and side dishes (chips, cookies, candy, etc.).
- Replace chips at meals with soy crisps or camp-made potato products.
- Have a "make your own trail mix" snack activity session, providing healthy choices (dried banana or other fruit chips, nuts, raisins, Cheerios®, sunflower seeds, coconut flakes, toasted oatmeal or granola, carob chips).
- Send out parent newsletters that talk about new activities, foods, etc.
- Print out a weekly summary or newsletter for campers to go home with featuring new activities and new food choices so parents can continue healthy choices at home.
- Post pictures and camp news on the camp Web site.
- Offer nonfat milk every time you serve milk.
- Offer sugar-free punch drinks (Crystal Light®, Bernard Foods®, etc.).
- Offer baked versus fried foods.
- Use food as an activity, not as a reward or punishment.
- Offer good foods in activities or events (watermelons for "dinosaur egg hunts," etc.).
- Offer healthy snacks (trail mix, dried fruit, fresh fruit, nuts, seeds, granola bars, yogurt, etc.).
- Offer salads, tacos, sandwiches, potatoes, and other display bars/food stations.
- Offer whole wheat, tomato, or other healthy, flavored tortillas with wraps or burritos.
- Educate your staff on nutrition and encourage them to be healthy role models.
- Teach moderation in consumption.
- Offer recreation with an intentional, safe, inclusive role.
- Incorporate nutrition education into activities.
- Encourage healthy lifestyles, not just the specific food angle.
- Don't serve just the foods that are popular; offer healthy foods for campers to experience and experiment.
- Offer contests for campers to propose new foods or reward ideas.
- Encourage parents to send non-food care packages.
- Offer desserts at camp that include fruit and healthy options.
- Fresh fruit with sugar-free whipped cream.
- Baked fruit with healthy toppings (apple crisp with half the fat and sugar in the topping).
- Cookies made with dried fruit or honey as sweetener.
- Use non-fat milk or cut sugar in half when making some desserts.
- Provide healthy options at the snack bar or camp store (juice rather than soda, granola bars instead of chocolate bars, nuts and seeds instead of candy, popcorn instead of chips).
- Educate children about healthy eating and knowing when to stop eating.
- Discuss food waste but cancel the "clean plate club."
- Demonstrate eating slowly and chewing completely.
- Discuss the twenty-minute rule for second helpings (teach the time travel sequence for the message to get from the stomach to the brain).
- Display the food guide pyramid in the dining hall and have a pyramid poster contest for each cabin.
Physical Activity at Camp
Most camp programs are synonymous with activity, but the truly successful camps challenge themselves every year by instituting new ideas and activities to draw in new campers and excite existing campers. While some traditions in program structures should remain, camp activity planners need to consider changes that result in healthier, active lifestyles. For example, most camps have a "rest hour" for the campers. Why not have an "active hour" when all campers are involved in some type of vigorous activity whether it is a soccer game or a walking club. It is crucial that campers are not standing still while others play. Campers often spend a good deal of time standing around, waiting for "their turn" or for something else to happen. A challenge to camp staff and campers could be to identify these times and design active alternatives. The following list of suggestions and questions are starting points for generating new ideas with physical activity:
- Emphasize physical activity each day, with an activity hour as well as a rest hour.
- Encourage campers to set goals to "walk across the state" in a steps/miles conversion program.
- Make physical fitness fun with contests and games.
- Look for and hire active role models at camp.
- Camp is a great place to try new sports and games — expose them to many activities. Since PE is not offered much in schools, many children do not get exposure to different activities.
- Get the campers involved in a community program, like a 4th of July race.
- Provide physical activity that doesn't require lots of equipment.
- Calculate how much time campers spend standing or sitting around waiting and create "waiting games" to counteract boredom and fidgeting.
- Encourage activity teams or "walking buddies" programs.
- Encourage self-monitoring so kids can see how active they are and set their own goals.
- Individualize intensity of each activity.
- Focus the end result and feedback on the process of doing your best and participating rather than on winning or being the best.
- Expose campers to a wide variety of new and traditional activities.
- The focus should always be on fun and gaining a healthier lifestyle.
A Final Word About Social Support
Much of the physical activity literature suggests that social supports such as activity partners encourage adherence to exercise and activity behaviors. The other positive support option is to have role models. If young people see peers and adults they admire, like their staff or cabin-mates, engaged in enjoyable active pursuits, they may want to model a similar behavior. As is true with any relationship between an adult and a child, what a person does speaks far louder than their words. If counselors view being physically active as important, so will young people. If staff members have to drive a car or cart from place to place, then children may wonder why they should be physically active. If counselors don't eat in a healthy manner, it is hard to imagine that children will.
Most things are more fun when done with others whether it is being physically active or eating together. Small groups or partners or any combination being physically active could be a useful strategy to explore at camp. The focus should always be on fun and gaining a healthier lifestyle rather than on weight loss or conforming to a society-imposed ideal.
Camps can play a vital role in addressing the obesity epidemic. Children need to be given the opportunity to start and practice good nutritious habits, and camp is a great place to offer good food, great activities, positive environment, safe and secure location, and most of all, fun. Camps have an obligation to children and families by supporting all the good behaviors that families, schools, programs and institutes have initiated. The camp environment can continue to project safe and healthy fun with positive outcomes by being open to new ideas of adaptation to what our nation's children need to succeed in life. It takes a lot more than just a set of parents to raise children in our fast-paced culture, and camps are definitely part of the village that help the world raise children to be successful. What better place to reinforce these ideas and further give "kids a world of good."
Web Site Resources
- National Food Information Council 
- National Institutes of Diabetes and Digestive and Kidney Diseases 
- National Institutes of Health 
- American Academy of Family Physicians 
- American Obesity Association 
- National Agriculture Library 
- National Food and Nutrition Information Center 
- Mayo Clinic 
- USDA Center for Nutrition Policy and Promotion 
- American Dietetic Association 
- Shape Up America!  — educates the public on the importance of achieving and maintaining a healthy body weight through physical activity and healthy eating.
- Weight-control Information Network  — serves the public by providing information on obesity, weight control, and nutrition. It is a part of the National Institute of Health (NIH).
- Active Living Magazine  — features healthy lifestyles for today’s amputees (offers youth development information).
- Dietary Guidelines for Americans, 2005 
- Food Guide Pyramid 
- Young Children’s Food Pyramid 
- Presidents Council on Physical Fitness and Health 
- 1996 Surgeon General’s Report on Physical Activity and Health 
- American Council on Exercise  — promotes active, healthy lifestyles and their positive effects on the mind, body, and spirit.
- The Top Ten Fun Fitness Summer Activities for Kids 
- Be Active America!  — a national physical activity advocacy campaign.
- National Association for Health and Fitness  — a nonprofit organization dedicated to improving quality of life through the promotion of physical fitness, sports, and healthy lifestyles.
- Verb. It’s What You Do  — describes how to help children be more active; launched by CDC.
|Center for Nutrition Policy and Promotion. Food Guide Pyramid. www.cnpp.usda.gov  (Accessed July 2005).|
|Department of Health and Human Services and the Department of Agriculture. Dietary Guidelines for Americans, 2005. www.healthierus.gov/dietaryguidelines  (Accessed July 2005).|
|Goran, Michael, M.D. and Satcher, David, M.D. "Symposium on Childhood Obesity: Causes and Prevention, " October 1998.|
|Kaufman, F.R., M.D. (2005). Diabesity: The Obesity-Diabetes Epidemic that Threatens Americans — and What We Must Do to Stop It. NY: Bantam Dell.|
|Robert Wood Johnson Foundation. Obesity May Decrease Lifespan by Two to Five Years, Study Finds. www.rwjf.org/portfolios/features/digest.jsp?id=73201&iaid=138  (Accessed July 2005).|
Viki Kappel Spain is the food service director at Grizzly Creek Ranch in Portola, California, and has been cooking in the camp industry since 1985. She is the author of the book, Food Service Manual: Lessons in Group Food Service, published by the American Camp Association (ACA) and is a contributing writer of several published articles in the camp industry, including Camping Magazine and the Christian Camping International Journal. As an active member of ACA, she coordinates regional and local kitchen staff training conferences. E-mail: firstname.lastname@example.org  or www.campcookbooks.com .
M. Deborah Bialeschki, Ph.D., is