In N.D. as around the nation, poor children gain weight while wealthier peers shed pounds
When he started at Altru Hospital in Grand Forks 26 years ago, Chief Medical Executive Dr. Eric Lunn said obese children were very rare.
“In 1987, it just wasn’t a big deal in children,” he said. “Now, it’s not uncommon.”
Lunn sees children with weight problems often, even some younger than 10 who have developed Type II diabetes — once considered an adult disease. Individuals surveyed for Altru’s 2013 Community Health Assessment put childhood obesity at the top of health issues facing the city.
In North Dakota, more than one-third of 10 to 17 year olds were overweight or obese, according to the 2011-2012 National Survey of Children’s Health.
The childhood obesity trend, which saw rapid growth in the 1980s and 1990s, may be reaching a plateau as schools, government agencies and other groups continue to educate kids about healthy eating habits and regular exercise.
On the surface, the news is good, but further analysis by researchers found the outlook wasn’t as positive for every child.
Kids whose parents didn’t receive a bachelor’s degree or make enough to surpass the federal poverty line saw their rates increase from 1990 to 2010, according to national data from the National Health and Nutrition Examination Survey.
Their peers with parents holding at least a bachelor’s degree saw obesity rates sputter and decline during that time period
Youth weights in North Dakota seem to be following the national trend.
In households where the highest educational attainment of either parent was less than a high school diploma, more than half of children were overweight or obese.
That rate dipped to 34 percent for youth whose parents had more than a high school education.
The National Survey of Children’s Health only collected educational data in 2011, but its income data dating back to 2003 tells a similar tale.
About 54 percent of children whose household fell under the federal poverty line for its respective size were obese or overweight in 2011.
On the other end of the spectrum, only 28 percent children in a household with an income 400 percent or higher than the poverty line were obese or overweight.
When low-income families are facing a budget crunch, food is one of the first costs they cut, according to BriAnna Wanner, maternal and child health nutritionist for the North Dakota Department of Health.
Healthy, more expensive foods are traded for cheaper items high in sodium and sugar that have a longer shelf life.
While the percentage of children overweight or obese for all groups surveyed has grown since 2003, it was slower for children of higher socioeconomic status.
A decade ago, the combined overweight and obesity rate for children below the poverty line was 37 percent while their higher status peers posted a rate of 23 percent.
Food for thought
The solution to childhood obesity sounds simple, but eating healthier and getting more exercise may be easier said than done for children of low socioeconomic status.
Researchers with the National Academy of Sciences say income, the cost of fresh food, the number of fast food restaurants present and the distance from grocery stores play a role in how neighborhoods influence youth obesity rates.
In 2012, the U.S. Department of Agriculture estimated nearly 10 percent of Americans live in low-income areas more than one mile from a grocery store.
The most recent county-level data indicated in 2010 that the percentage was slightly higher in Grand Forks County at 11.3 percent.
When including the county’s entire population, the department considered nearly 30 percent of people as having low access to a grocery store — including about 4,500 children.
One look at a map of Grand Forks reveals several neighborhoods are not within the one-mile radius of at least one grocery store, especially in the city’s northwestern corner.
That area includes UND and its surrounding neighborhoods and is home to some of the lowest median incomes of any area in the city.
A new Walmart planned for the northwest and a Hugo’s grocery store proposed for the southeast corner of the city may reduce the number of people with limited access to fresh food.
Until those stores are in place, a fast food establishment falls closer to a home than the grocery store for many in the city.
Overall, Grand Forks County has less than two grocery stores but nearly eight fast food restaurants per 10,000 people. Like the grocery store, processed foods offered at fast food restaurants are usually cheaper than healthier offerings.
“When it comes to fast food, the healthy choice isn’t always the easy choice,” Wanner said.
Lack of exercise
Not eating right isn’t the only indication of the problem facing North Dakota’s low-income, overweight youth.
Local children’s activity levels followed a trend similar to weight status. The children’s health survey showed kids in households with more educated parents or higher household incomes exercised more frequently than those with less.
The cost associated with participating in activities such as school sports may prove to be too much for some households, according to Lunn.
Some organizations have created scholarships to ensure children of any income can participate in sports and other activities.
The Altru Family YMCA averages around $200,000 each year in financial assistance and scholarships that allow 2,500 to 3,000 children per year to participate in activities and use its fitness center, according CEO Deb Thomson.
“There are children that can’t afford to participate,” she said. “(Through financial assistance) we provide them with choices that are better than the alternative.”
If their parents work multiple jobs or go to school, that alternative may be spending time in front of a TV or computer screen.
With the assistance, low-income kids can participate in sports, swimming lessons, fitness classes, day camps and other activities.
Having a variety of offerings is beneficial, according to Lunn.
“If (children) don’t like a sport, you won’t get them to participate,” he added.
Local health experts agree education will continue to be necessary to prevent and treat weight problems in children of all income levels.
Grand Forks Public Schools has been taking steps to ensure students are learning about healthy choices and eating nutritious meals.
“It’s a balance of eating, exercise and lifestyle,” Child Nutrition Food Service Director Julie Tunseth said.
The district’s Fresh Fruits and Vegetables Program has brought fresh produce into classrooms three times a week for the past three years.
The program gives students a chance to try fruits and veggies their families may not buy or they avoid in the lunch line, according to Tunseth.
Besides the more usual fare, students also have had the opportunity to try things such as star fruit, jicama and tangelos.
The program is funded through a federal grant that gives preference to districts with a high numbers of students using reduced or free lunch programs. Almost 40 percent of Grand Forks students are eligible for free or reduced meals.
The district also has taken steps to integrate healthier food into its menu over the years.
The changes aren’t always noticed by students or heavily advertised though.
“Kids know they’re getting a hot dog,” Tunseth said. “They may not necessarily want to know it’s on a whole-grain bun or that the hot dog is low sodium and all-beef.”
Also gaining ground are local programs such as Altru’s Healthy n’ Fit Kids. The 12-week weight management class teaches children and their families about proper nutrition and exercise.
School programs and weight classes are a great start, according to Lunn. Getting the community to recognize childhood obesity as a problem is the next step.
“They say it takes a village to raise a child,” he said. “It’s going to take a village to work on this issue and make progress.”
More: To get a better picture of Grand Forks’ food and exercise environment for children — including the locations of grocery stores, fast food restaurants and parks — go to goo.gl/hAqM1n to see an interactive map. Read Jewett's blog post featuring fact and figures not included in this story.
Prevention and treatment
To prevent weight gain in children or help them lose weight, the American Academy of Pediatrics recommends these eating and exercise habits:
- Fruits and vegetables: Consume five or more servings each day.
- Sugar-sweetened drinks: Minimize as much as possible.
- Television viewing: Decrease screen time to two or less hours a day.
- Physical activity: Be active for an hour or more each day.
- Meals at home: Prepare them more often than eating out.
- Family dinner: Eat around a table at least five or six times a week.
- Breakfast: Eat it every day.
- Lifestyle changes: Involve the whole family.
- Food regulation: Let kids regulate their meals and avoid overly restrictive feeding behavior.