[Obesity Discussion]

“This is a treat,” she said. Her daughter had made honor roll, and this was the reward. “I don’t see why they should have to be out here away from everyone,” she continued. “What’s the harm in a treat now and then?”


Schools have internal cultures, and the ratio of enthusiasm to resistance varied from one to another. In some, the teachers used the materials and nutrition books Hollar sent; in others, they remained in boxes. In some, children actually stood up to move and stretch in the middle of a lesson; in others, the punishment for being noisy during gym class was sitting absolutely still on the floor. At Partin Settlement, there was usually a dish of candy for sale for some fund-raiser or another on the counter in the school office. At Kissimmee Charter, parents still sold Chick-fil-A biscuits (with gravy) in the parking lot every Wednesday to raise money for the Parent Teacher Organization. And once each marking period, honor-roll students are still given a coupon for a free hamburger, soda and small fries at McDonald’s — which is where the fourth grader’s mother got the idea of bringing in that lunch in the first place.

JoAnn Kandrac, who was the Kissimmee Charter principal during the last school year, is conflicted about the mixed messages. After all, she was the one who exiled fast food to the garden where the two girls were eating. But she has found tidy ways of rationalizing both. “You have to pick your battles,” she told me last winter. The biscuits “make quite a bit of money for the P.T.O., and they aren’t selling them to the children as much as to other parents who don’t have time for breakfast.”

As for the coupons, she says, sounding a lot like Chef Cooper defending pizza’s place on the menu: “I can’t pull everything away from the children. McDonald’s treats have been a tradition here forever. It’s naïve to think children don’t know about treats at a fast-food restaurant. Modern times call for modern methods. This is educating our children that they can make smart choices at places like McDonald’s.”


On a balmy day in January, the cafeteria was filled at 8:45 a.m. On the stage in front of the room, Michelle Lombardo, as energetic as any of the kindergartners in the front rows, was telling a story about characters known as the Organwise Guys, with names like Sir Rebrum and Hardy Heart. Lombardo, an independent consultant whose appearances are frequently financed by a grant from the Kellogg foundation, takes this act on the road throughout the country and was spending two days in Kissimmee. Soon she had the children chanting, “Low fat, high fiber, lots of water, exercise,” accompanied by moves that looked a lot like the Macarena. The floor was shaking so much that the LCD projector wobbled.

“This is a free radical,” she continued, clicking a drawing of an obvious bad guy onto the screen. “When you put a lot of fruits and vegetables in your body, they gang up on the bad guy and kick him out.” Then she introduced Peri Stolic, a smiling, animated bit of intestine. “She likes to be big and fluffy and filled with fruits and vegetables,” she said, “because she’s like a tube of toothpaste, and when she’s fluffy, it’s easier to squeeze the garbage out.”

During the trial year, it became clear that new food cannot simply appear on the lunch tray. Children must be taught about nutrition outside the lunchroom if they are to eat what is offered inside. That is why Lombardo and her Organwise characters began making regular visits to the HOPS schools and why Hollar circulated among tables introducing the Food of the Month.

In September it was broccoli. In October, sweet potatoes and apples. November, corn and cranberries. December meant tomatoes, and Almon asked the kitchen managers to order salsa, not realizing it was already part of the commodities stockpile. The managers, in turn, thought Almon’s request meant she did not approve of the fructose in the salsa that was already on hand and scrambled to purchase a different salsa. Almon, when she finally realized the confusion and read the labels, felt the commodity salsa would do, because fructose was the fifth ingredient, not one of the first four. But then she tasted the stuff, decided the commodity salsa was far too spicy for children and asked that it be cut with commodity canned tomatoes.

Small glitches and refinements continued into spring. The team and the district were still squabbling, for instance over the price of cheese, and Agatston was still paying the difference between the higher-fat version that the school would have purchased and the lower-fat version that the HOPS menu required. They were paying for other items, too (whole-wheat versions of standard refined-wheat products, for instance), but the cheese was particularly expensive and one of the primary reasons the HOPS reimbursement had jumped to $3,700 a month (from $2,500 during the trial year). Hollar had researched a method, known as “processing,” that she felt could reduce the costs of cheese. The term is somewhat misleading, because it is not the cheese that is being processed. It is the bookkeeping. The school gives its credit for its allotted amount of whole-milk cheese to a producer, in this case Land O’Lakes, which in turn ships the low-fat kind to Osceola. But a change of this magnitude requires approval, which by March Hollar had still not been able to get.

Also in the spring, Hollar decided not to send new materials to many of the teachers who had received the original educational packets — things like curriculum suggestions, posters for the students to color. Too many were never used, she learned, and when she sent a questionnaire to the staff asking why, she was told that “they did not have time, did not want to take on additional teaching requirements, needed to focus on insuring that their kids passed the mandated state tests,” she says.

There was also the complication that state regulators at the Florida Education Department had questions about the program. A parent complained to that department that a child was being put on the South Beach Diet at school, leading to an audit of the school menus. The breakfast being served at the HOPS-intervention schools (and interestingly, at the control schools) was found to be under the state’s requirement of 554 calories. “It is almost impossible to get that many calories into a meal without too much fat and sugar,” Almon says. “The regs need to change, not the food.” The issue is still under discussion.

Despite the mixed results, the HOPS team is hopeful that real progress has been made and that the biggest fight — to make it a given that school lunch should be healthy — has been won. This is an increasingly common theme in conversations with healthy-lunch advocates throughout the country, who compare changing views of school lunch to public opinion on smoking. The same act has taken on different social meanings over the past few decades as the context around the act changes.

Cooper, too, is cautiously optimistic. “I think we are starting to see a movement,” she says. “We’re on the cusp of something.” The spate of obesity studies plus the diabetes data plus the new Congressional wellness plan requirements just might mean that a healthy school lunch will finally become the norm.

Lombardo ended her January program by asking the children to recite a pledge. “I do solemnly swear,” they repeated, “to be healthier, to eat low fat, to eat high fiber, to drink lots of water and get lots of exercise.”

Hollar added, under her breath, “And to stop bringing Lunchables to school.”


For a solid week last May, children lined up in the lobby of the Partin Settlement Elementary School, as they did at all the HOPS schools, waiting their turn to be weighed and measured. The youngest children stepped onto the scale happily and shared the number they saw with their classmates. The older children already knew that the number was loaded. They took off their shoes and their jewelry and excess clothing. They told their friends to stand away.

As they went from station to station, a tape measure was wrapped around their waists, they had their blood pressures taken, they were asked whether they played outside the day before or played video games after school, whether they brought their lunches or bought them.

Despite years of lunchroom changes at schools throughout the country, only now have advocates realized that they need to buckle down and get the facts. It just may not be enough to say, as Alice Waters does: “This is something right as rain. These kids like this; they are engaged in this. Why can’t every child have this? Anybody who sees it, gets it.”

It is not even enough to prove, as at the Ross School, that changing the menus means children eat better lunches. (Cooper’s menu doubled the consumption of fruits and vegetables compared with both the national average and control groups. And 80 percent of the parents changed the way they shopped, cooked or ate, thanks to the input from their children.)

What is needed — to persuade donors and school boards and government entities that better food is worth the cost — is hard proof that improving the lunchroom actually improves children’s health. “We have to measure, to document what we’re doing and evaluate its results,” says Carina Wong, executive director of the Chez Panisse Foundation, which, with financing from the Rodale Institute, is embarking on a three-year study of the health of children in the Berkeley programs. The Center for Ecoliteracy, together with the Children’s Hospital Oakland Research Institute, is studying them too, pricking their fingers and measuring their blood-sugar levels.

Agatston understands both the need for and the risk of measurement. There is always the chance that the results will not confirm what practitioners are certain is true. After all, studies have so far failed to make a definitive link. “We don’t have these children 24 hours a day,” says Caballero, who did some of the studies. “They go home, they go out with friends, they are off all summer and everything about the world — fast food, video games, television ads, everything — conspires to undo even the best things that happen in schools.”

Similarly, the data from the first year of HOPS was inconclusive. The program did reduce the fat served in the intervention schools by 20 percent, reduced saturated fat by 26 percent and increased fiber twofold. But after that first year, there was no sign that the “overweight” rate among the children had fallen.

Those results did not keep the Agatston team from proceeding with a second year of HOPS or from expanding the program at the start of the school year that began in Florida last week. HOPS is still in place in Kissimmee — but this year it is being run and paid for by the school district directly. Almon and Hollar are merely advisers. The cheese will be “processed” through the commodities program and Land O’Lakes. Two more schools will adopt the HOPS menu. Palmore has increased the price of lunch — to $1.75 from $1.50 in the elementary schools — and expects to cut some corners. Last year’s whole-wheat chicken nuggets, she says, were, at 41 cents a serving, simply too expensive, so the schools will instead serve a compromise like grilled chicken patties (about 34 cents). The Agatston team is also bringing HOPS to 9,000 more students in the Miami-Dade County School District and intends to expand beyond Florida next year.

Just this month, Hollar received an analysis of the data from the past school year that hints that HOPS is really working. The overweight rate in the HOPS schools in fact declined during the 2005-6 school year: specifically, 23 of the 486 children who had been characterized as overweight when school began were characterized as merely “at risk” or “normal” when school ended. In the control schools, by contrast, there was no decline and three children actually gained enough weight that they were added to the overweight category.

Hollar describes these results as “cautiously exciting” and warns that the sample size is small and that a true trend cannot be determined for at least five years. Agatston, in turn, says that even if the results had been otherwise, that would not have been a reason to abandon the program.

“If the data don’t show what we want to see,” he says, “we aren’t going to throw up our hands and say, ‘Let them eat what they want.’ All that will mean is that we aren’t doing this as well as we can, so we will have to find a way to do it better.”

Lisa Belkin, a contributing writer for the magazine, wrote about Meredith Vieira in last week’s issue.