Extended Interview with Dr. Joe Thompson
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SUSAN DENTZER: Let’s talk about the key components of [Act 1220, a state-wide effort to combat childhood obesity].
DR. JOE THOMPSON: It’s really got several components, some of which are already in place and some of which are going into place now. The legislation eliminated all vending machines from all public elementary schools across the whole state so that parents no longer had to worry whether their lunch money was going to school and being put in a soft-drink machine, as opposed to the school cafeteria lunch box. It has required that schools disclose the pouring contracts, the actual legal arrangements between soft-drink or vending companies that they pay the schools for the right to have their machines in the schools.
SUSAN DENTZER: Why was that important?
DR. JOE THOMPSON: It’s important because parents who have kids that have weight problems need to know that the environment within which their child is going to school in has some risks. If the child passes a soft-drink machine or a candy machine, on the way to the cafeteria, it may be that they don’t get the healthy lunch that the parent or the school intended them to…
The other activity that’s now starting is to establish a Child Health Advisory Committee that is looking at statewide nutrition, physical activity, health education requirements to try and increase the awareness of nutrition and physical activity as contributors to childhood obesity that subsequently leads to adult obesity. And, finally, one of the more controversial areas has been the assessment of Body Mass Index for students in schools and the report to parents.
SUSAN DENTZER: Why was that deemed important?
DR. JOE THOMPSON: Well, I think it’s important because, for parents, if their children are overweight, they have a risk to their future health: diabetes, heart disease, and other conditions start early in life, national experts recommend that every child in every grade every year have their weight assessed using this new tool. A tool that uses not only weight but also height, and how old their child is and whether it’s a boy or a girl.
It’s called the Body Mass Index or BMI for short. And it conveys health risk information to parents. And now parents in the state are receiving the first kind of statewide roll-out of this health information to provide them with not only the BMI and what it means, but, also, things the family can do and places that they can turn to for help if their child does have a weight problem…
The Body Mass Index is a ratio of your weight divided by your height squared. It’s a mathematical ratio, but the Centers for Disease Control and Prevention have put out norms based upon previous years’ data of what a normal distribution of weight should be for a population of individuals.
Obviously, if you’re at the upper end of that norm, above the 95th percentile, of the BMI, then you do have a weight problem or very likely have a weight problem. Probably ought to say that differently.
If you’re over the 95th percentile, then it’s likely that you do have a weight problem and most people who have a BMI do need to look at both their nutritional intake and their physical activity. There are a few reasons that you could have a falsely positive BMI screening in that high range. If you are very, very muscular or were very tall and had almost no body fat, then you might be able — you might not have a BMI that was worrisome, but that was in that high range.
SUSAN DENTZER: The first of these (child health reports) has gone out (to parents). Let’s just talk about what you put on the sample health report.
DR. JOE THOMPSON: …[W]hat we have tried to do in the child health report is a very tailored message. It’s addressed directly to the parent. It talks about their child, what their child’s height and weight was the date that they were measured and in what school.
Then it provides the information about the Body Mass Index and whether their child is overweight; at risk of being overweight; normal weight; and we’re finding kids that are underweight, also.
So, it gives those four classifications. And then it has a tailored message depending on which of those four classifications the child falls into.
Finally, it provides parents with information that they, as a family, can do; things that they can do in the house, like limiting TV; or computer time; increasing physical activity; changing to low-calorie drinks from regular soft drinks and sugared juices.
And, finally, some resources for where the parents can turn to for assistance if their child is overweight and they need help.
SUSAN DENTZER: Let’s talk about the results that came out of Arkadelphia.
DR. JOE THOMPSON: Arkadelphia was our first school to give parents health reports…
And while, nationally, about 15 percent of boys and about 15 percent of girls are overweight or in that highest classification of BMIs, unfortunately, Arkadelphia had a much higher rate, 22 percent of boys and about 18 percent of girls had a BMI in that highest range.
SUSAN DENTZER: You have quite a range in Arkadelphia. Let’s talk about that.
DR. JOE THOMPSON: One of the things and we look forward to looking at other communities across the state and then looking at the state as a whole, to see if we can guide where we should intervene. Should it be in the earlier years or the later years. Arkadelphia, it looks like the middle-years, fifth and sixth grade, have real weight problems. In the top two classifications of being overweight or at risk of overweight, over half the boys and girls in either the fifth or the sixth grade are in those classifications. So they have a real weight problem in that fifth and sixth grade area.
Then, as you get into the older grades, the boys in Arkadelphia have a real problem in high school. Over 25 percent of the boys are in the highest weight category, being overweight in the 12th grade. So those boys are going to graduate next year and 25 percent or one-in-four young adults in Arkadelphia are going to be classified as obese by CDC standards.
SUSAN DENTZER: Were you surprised?
DR. JOE THOMPSON: Unfortunately, we weren’t surprised, we were dismayed. We knew Arkansas has a higher health problem than many other states, which was part of the reason that the legislature and the governor took action. But I think anytime you have real information that provides real data, this now is going to provide Arkadelphia, as a community and as a school district and as individual schools, as well as the parents, real information that provides them something that they can track.
SUSAN DENTZER: What has been the reaction of schools (in Arkadelphia)? Were the schools themselves surprised about these numbers?
DR. JOE THOMPSON: …[S]chools have been incredibly receptive to the process. Now, we developed a protocol that attempted to minimize the burden on schools so that they didn’t have to calculate the BMIs; they didn’t have to prepare the reports; and they didn’t have to worry about whether the measurements were accurate or not. But they’ve been really receptive on having their kids assessed. And I think they’ve worked with their parent groups to make sure that the parents are aware of what this new information can mean.
And now we’re in the process of transmitting that information to parents and making sure that they have the support necessary so that they can take action to help the children have a healthier and more productive future.
SUSAN DENTZER: And what feedback do you have so far about how the parents have, in fact, reacted?
DR. JOE THOMPSON: I think we’ve got, overall, very positive feedback. There are concerns. What does this mean? You know, how much of an emergency is it if my child is overweight? Most of these kids did not become overweight overnight. They have, it’s slowly crept up. And I think some of the recommendations from the Academy of Pediatrics and others are going to be mechanisms that we reverse that trend over time, reducing the TV time, computer time, increasing physical activity, changing our diets.
SUSAN DENTZER: Specifically, with respect to how much more activity students should engage in in schools. What are likely to be the changes made there?
DR. JOE THOMPSON: Well, we’re already seeing some real innovation in some of our schools. It’s a balance between what a student takes in foodwise and what they burn in terms of physical activity-wise. Some of the schools are looking at changing where the school buses let off. So if the school bus lets off half a mile away from the front door of the school and the student rides in the morning and rides home in the evening, they’ve walked a mile, just from the school bus to the front door of the school and back. So some of those activities can be incorporated into school policies without changing the curriculum or costing any time during the school day when education is major priority if not the priority for schools with the students.
SUSAN DENTZER: Now, back to changes in physical activity that may have to take place. We were told that there was one school … essentially is requiring at the high-school level one semester of [physical education] for the entire high school? The entire term that a child is in high school. That’s almost nothing.
DR. JOE THOMPSON: Well, and I think what you’re alluding to is our environment within which we’re raising kids has changed. I mean, 20, 30 years ago, kids played outside; they had high levels of activity. And they burned a lot of calories. Now, frequently, kids, particularly teenagers, spend a lot of time in front of the television or the computer. They’re much more sedentary. The nutritional substances that they take in have far less nutritional value and far higher caloric content.
So, you’ve got really a combination of much poorer nutrition, much decreased physical activity and those two things together are contributing directly to our problems with obesity in adolescence and earlier in childhood.
SUSAN DENTZER: What about what kids are eating?
DR. JOE THOMPSON: Kids, you know, kids are kids. They’re going to eat what tastes good. And they’re also going to eat what’s marketed to them. And I think it doesn’t take much to turn on the television for the after-school programs and see what a majority of the commercials are.
Many of them are food items; many of them have little to no nutritional value and they’re packed with calories, frequently sugar and other substances.
So, I think one of the issues really is, trying to improve the nutritional education of parents and families and, also, students, so that they make better nutritional choices. You know, so that’s there’s not, I mean, as a practicing clinician, I’ve had a 10-year-old come in that drank a 2-liter soft drink every afternoon. Not diet drink, 2 liters full sugar and caffeine soft drink every afternoon between the time they got home from school and when their parents got home from work.
There’s not way they can burn that many calories off. They’re going to be an overweight kid. If they continue that health habit into adulthood, they’re going to have heart disease and they’re going to have major health care problems.
SUSAN DENTZER: So a lot of this is really a family issue as much as anything?
DR. JOE THOMPSON: I think it’s not an individual issue. There are some individual characteristics, but it’s a family; it’s an environmental issue; it’s a community issue.
If communities have sidewalks; if communities have places that people can go and play; a good sports program for young people. Then they’re going to actually be outside and doing more. If communities don’t have those things, they’re going to be kept inside by the parents to be safe. They’re going to have to do something, the TV’s there, the refrigerator’s there, and you’re going to have the combination of a sedentary lifestyle and poor nutritional intake.
SUSAN DENTZER: You’re a clinician and you know a lot about public health. And you certainly know enough to know that changing human behavior is a very, very difficult task. And if you’re getting 20 percent of people to change their behavior, that’s an enormous success. Are you up against just an insurmountable battle here to try to change behavior in the numbers of people who are going to have to live their lives differently to effectuate any change?
DR. JOE THOMPSON: This is going to be a Herculean undertaking to reverse the epidemic of child and adolescent obesity. And to address the problems that we’re having in our adult population, too. But we’ve got to start somewhere. And people learn their habits when they’re a child and when they’re an adolescent. They learn habits of physical education, nutritional habits, other habits that they learn as a child, that they see their parents modeling and that they may become parents themselves.
And the schools, through Act 1220, is a target to change the environment within which our children are being educated every day.
And then we hope that the vectors of information to parents and the changes that happen with respect to school boards and others who become more aware of what the influences are on the school and the children’s environment; that we’re able to change communities one at a time and mobilize them to address the problem.
SUSAN DENTZER: When all the state data (on childhood obesity) comes in, do you have any idea what it’s going to show?
DR. JOE THOMPSON: Yeah, I think it’s going to confirm a concern that we have, which is that many of our children are overweight, many of our adolescents are overweight and about to become overweight adults.
We hope that it is able to show us and I think it will be able to show us where we should intervene. It’s very probable that obesity doesn’t happen at the same time in rural areas and urban areas. It doesn’t happen at the same time for girls and boys. I think some of the data we’re seeing in Arkadelphia suggests that they have specific problems with specific sub-groups of kids. That this may guide interventions to be able to help those groups of kids and their parents in a much more targeted and much more effective way.
We’re excited. We’re going to have more information on childhood obesity and adolescence than most of the national agencies and many of the other states. And we think we’ll be able to inform the nation, as a whole, on the issues around childhood obesity and what we can do about that.
SUSAN DENTZER: Is Arkansas a model for other states in how to pursue strategies to combat this epidemic?
DR. JOE THOMPSON: We’re the first state that has a strategy, has a multifaceted, statewide strategy and it’s in place and it’s moving fairly well. I think it can serve as a model. I think we’ll learn from our experience and we hope to share with other states what went well and what didn’t.
I think there are some things that we’ve identified that we might do differently and I think there are some things that other states are doing that we may add to our portfolio. But I think we have demonstrated that a state can take action. It’s a broad-based, multifaceted approach. It engages the education and the clinical communities and I think you’ll see Arkansas making some of the first impact on this epidemic of any state in the nation.
SUSAN DENTZER: What are some of the things that you might consider adding [to Arkansas’ anti-childhood obesity programs]?
DR. JOE THOMPSON: I think the things that we might consider adding: The legislation doesn’t require any of the provider awareness or engagement. And we’re working actively now with both Arkansas chapter of the American Academy of Pediatrics and the American Academy of Family Physicians to try and engage those clinicians so that they’re fully aware of what the problems are around child and adolescent weight issues, so that they’re prepared to help the families.
And I think some of those things that we’re incorporating to make sure that every physician, every local health department, the school nurse knows how to help parents when they turn to them for help is an important component that we’re working to put in place.
SUSAN DENTZER: And what are some of the things that you’ve done that you now think you’ll do differently?
DR. JOE THOMPSON: I think some of the things that we’ve done — I don’t know that it’s that we’d do differently, but it’s the time line that we’re going to have to come up with. We’ve eliminated vending machines in elementary schools. And, actually the Child Health Advisory Committees discussing Board of Education recommendations on vending machines in middle school, junior high and high schools.
I think we need to move, you know, judiciously, we need to keep moving, but we need to look at are there alternative food offerings that could be placed in those vending machines, so that the schools maintain the revenue from them, but the students have a healthy option available to them.
So, I think those are some of the things that we’re working on, that we haven’t completely worked through the issues and I think over the next couple of three years as we work through those issues with school districts, we’ll be able to offer some guidance to other states and communities that are considering similar activities.