SNACK ATTACK

As Child Obesity Surges,

One Town Finds Way to Slim

Somerville , Mass. , Goes

Beyond Schools to Push

Exercise, Good Eating

By TARA PARKER-POPE

May 10, 2007

SOMERVILLE, Mass. -- Most people think the battle against obesity

takes willpower. But the town of Somerville knows it takes the will

of an entire community.

Sparked by a desire to curb childhood obesity, this town of 78,000

has undergone a subtle yet dramatic transformation in the past five

years. Restaurants have switched to low-fat milk and smaller

portion sizes. The school district has nearly doubled the amount of

fresh fruit at lunch. The town, just outside Boston , has repainted

crosswalks to get more people walking to work or school.

POUND WISE

• What's New: The town of Somerville , Mass. , has made strides

against child obesity by getting the whole community involved.

• The Background: Many previous efforts focused solely on schools

failed to show results.

• What's Next: Project leader Christina Economos hopes to bring

her ideas to the Mississippi Delta and elsewhere.

The numbers suggest it works. During the 2003-04 school year,

Somerville schoolchildren gained less weight than children in two

nearby communities used as a control group, according to a report

published today in the medical journal Obesity. The difference was

statistically significant and translates into preventing about a pound

of excess weight gain among children who lean toward the heavy

side, the report says.

The Somerville study is believed to be the first controlled

experiment demonstrating the value of a communitywide effort. It's

only a small dent, but slowing the pace of weight gain among kids

is the key to conquering childhood obesity, says lead author

Christina Economos, an assistant professor at Tufts University . "It

could be the difference between graduating overweight and

graduating at a normal weight," she says. "We need to think about

how it plays out long term."

The Somerville program, designed primarily by Dr. Economos and

fellow researchers at the Tufts Friedman School of Nutrition, offers

a surprising blueprint. It didn't force schoolchildren to go on diets.

Instead, the goal was to change their environment with small and

inexpensive steps. Dr. Economos, a specialist in pediatric nutrition

and the mother of two school-age children, has long believed that

the battle against obesity can't be fought at the dinner table alone

but requires social and political changes.

[C E]

For inspiration, she turned to other successful social movements of

the past 40 years, analyzing tobacco control, seat-belt use and

breastfeeding. All were thorny public-health problems lacking a

quick fix, yet significant progress was made on each. In 2002, the

Centers for Disease Control and Prevention awarded Dr. Economos

a $1.5 million grant to find out whether the same social forces

could work in nutrition.

The goal of the researchers' Shape Up plan was to have Somerville

children burn more calories through exercise and take in fewer with

a healthier diet, for a total benefit of 125 calories a day.

What was missing from the program at first was a community

champion, someone like C. Everett Koop, the surgeon general who

railed against tobacco, or Ralph Nader in the battle over car safety.

"I knew we needed a sparkplug," says Dr. Economos.

She found it in Somerville Mayor Joseph Curtatone, a lawyer and

volunteer football coach at the local high school. Mr. Curtatone says

he had gained weight on the campaign trail and was hoping to shed

a few pounds when Dr. Economos walked into his office to talk

about her hopes for a community-based obesity intervention in

Somerville . "I bought into it right away because I could see the

potential," says Mr. Curtatone. He figured projects to encourage

exercise and good eating could make the city a better place to live

regardless of how the experiment turned out.

"We're here to improve the lives of everybody in the city," says the

mayor. "It's not about an individual getting a gym membership."

Project Faces Challenges

Shaping up Somerville wasn't going to be easy. Only 3% of the city's

4-square-mile territory is open space. Thousands of cars roar

through Somerville every day on their way to Boston , making streets

less than friendly for walkers and cyclists. Among the town's first-,

second- and third-graders, 44% were already overweight or

considered at risk of becoming overweight, based on their bodymass

index, according to Dr. Economos. That's above the national

figure of about 30%.

Though Somerville isn't among the more affluent Boston suburbs,

Mayor Curtatone quickly figured out that the type of changes Dr.

Economos envisioned didn't cost a lot of money. For instance, many

people couldn't find crosswalks because the paint had faded. The

city switched to a longer-lasting reflective paint. It redeployed

school crossing guards to areas where children were most likely to

walk to school, and the Tufts team gave parents maps of which

routes were staffed. The moves resulted in a 5% increase in the

number of children who walk to school, according to Jessica Collins,

a former Tufts project manager who now directs a Somerville

community-health program.

Separately, the Tufts researchers helped the city win a grant from

the Robert Wood Johnson Foundation for a bigger-ticket item, an

extension of a bike path that will eventually go all the way to

Boston . "This little experiment that came here is now tied to many

other decisions we have made," says Mr. Curtatone.

Many of the efforts didn't even focus on children. The Tufts

researchers held parent meetings in English, Portuguese, Haitian

Creole and Spanish to explain the goals of the Shape Up plan. Tufts

workers organized City Hall health fairs, a pedometer giveaway and

a community fun run that the mayor joined. As the spirit caught on,

the City Council came up with its own ideas: reimbursements on

gym membership for city employees and dozens of new bike racks

for schools and streets.

Twenty-one area restaurants received designation as Shape Up

partners in exchange for making small menu changes such as using

low-fat substitutes and offering smaller portions. Beth Ann Dahan,

co-owner of Soleil Café & Catering, says she was happy to

participate because it was good for business. "When Shape Up first

started, I remember people would tell me, 'We came here because

you were on the list,'" she says.

At the Somerville schools, food-service director Mary Jo McLarney

decided the best way to change the eating habits of the district's

5,625 schoolchildren wasn't to focus on calories, but to improve the

taste and quality of the food served in school. With help from the

Tufts team, she replaced some frozen foods with fresher choices

such as pizza made with fresh French bread. To boost fiber intake,

cafeteria workers put cheeseburgers on whole-grain rolls, mixed

whole-grain pancake batter and shelved french fries in favor of

baked-potato wedges with the skin left on.

The Shape Up grant from the CDC paid for refrigerated display

cases, food processors and fruit juicers to make serving fresh fruits

and vegetables easier for the kitchen staff. Dr. Economos persuaded

a Whole Foods store to donate about $35,000 in fresh produce.

Now children are allowed to eat as much fruit as they want. One day

the mayor joined schoolchildren in the cafeteria to make freshsqueezed

orange juice.

'A Balancing Act'

"It's a balancing act, because it doesn't serve any purpose for us to

produce meals nobody will eat,'' says Ms. McLarney. "It's about

giving them the most nutritious, highest-quality meal we're able to,

and it's probably more balanced than they're able to bring from

home."

In classrooms, teachers taught a nutrition and exercise curriculum

designed by Tufts. One part focused on a fruit or vegetable of the

month, and children took part in taste tests. During cucumber

month they munched on cucumbers and ranch dressing and dillpickle

spears. January was bean month. Beans are a healthy fiberrich

food, but they can be a tough sell with kids. Somerville children

sampled bean and cheese quesadillas, red beans and rice, hummus

and vegetarian chili, and voted on their favorites. (Quesadillas won,

hummus lost.)

[Mayor Joseph Curtatone (left) helps a child make fresh-squeezed

orange juice at a school in Somerville , Mass. ]

Mayor Joseph Curtatone (left) helps a child make fresh-squeezed

orange juice at a school in Somerville , Mass.

"The voting alone encourages kids to try the item," says Ms.

McLarney. "Kids wanted the chance to have their voice heard so they

would try a food just for the chance to put a little piece of paper in

a box."

Not every effort succeeded. The food-service department held a

contest seeking healthy recipes from parents, and the winner was a

salad that included chopped cucumbers, tomatoes, low-fat cheese

and beans. It tasted good to contest judges, but didn't draw eaters

when placed in large bowls in the cafeteria. The children still

grumble about the switch from french fries to potato wedges.

The school district even lost a little money for a while when it

eliminated chips, cookies, ice cream and sports drinks from the

snack foods sold at lunch. Given the choice of milk or juice (or

sherbet once a week), many kids opted to buy nothing. But then a

funny thing happened, says Ms. McLarney: Forced to go without a

fatty or sugar-rich snack, more children and teachers started

buying the healthy lunch food. The schools are selling twice as

much fruit in their lunchrooms as they did five years ago, she says.

"Everyone was unhappy,'' concedes Ms. McLarney. "But we just

decided it was in everybody's best interest. Kids have $1.80 in their

pocket and they're choosing between a sundae, Powerade and a bag

of chips or a salad or sandwich, what do you think they'll pick?"

Outside of the cafeteria, even art teachers got into the act by

encouraging children to paint fruits and vegetables. The Tufts team

created an after-school curriculum that included yoga, dance and

soccer.

Ruth Grossman, a sixth-grader at Benjamin G. Brown School , says

her teacher used to hand out candy bars as a reward for doing well.

Now, the teacher hands out passes that allow children to skip

homework or a test question. Ruth says she used to snack on

potato chips, but has switched mostly to fruit. She also started

taking a fitness class, and her mother took up rowing. "I learned

that eating the right foods helps you do things," says Ruth. "Eating

a good meal before a test helps you focus better and last longer."

Celia Taylor, a second-grade teacher at Arthur D. Healey Elementary

School, said she started taking yoga classes after teaching the

Shape Up curriculum. And the lessons prompted her to change

snack time in her classrooms. In the past, children brought

whatever snack they wanted. Now the class has a group snack,

brought in by parents and selected from a list of healthy options

like cheese and crackers or fruit.

Significant Difference

All the efforts translated into a modest but significant difference.

After eight months of the Shape Up program, researchers in May

and June 2004 measured the height and weight of 385 first-,

second- and third-graders in Somerville . They compared the results

with 793 children in two nearby towns that weren't part of the

Shape Up program. They took the children's body-mass index and

calculated a "z-score," a measure of how much they differed from

the typical child of their age and gender.

In the two control towns, the "z-score" barely budged, according to

the report in Obesity. In Somerville , the z-score fell, suggesting the

children were moving closer to a healthy weight. The average

Somerville second-grader gained about four pounds, while a similar

child at other schools gained about five pounds.

Earlier efforts to reduce childhood obesity usually focused solely on

the school day. While some have produced modest results, others

have failed to lead to measurable changes in body weight. A CDC

task force recently concluded that there's insufficient evidence to

determine what type of school-based interventions are effective

against childhood obesity.

Dr. Economos hopes Somerville 's changes will be sustainable

because they involve the entire community, not just the schools.

After the initial $1.5 million grant expired, the Tufts researchers

helped Somerville secure an additional $1.5 million in new grants to

keep up the effort. Today, a Department of Homeland Security grant

is providing fitness equipment at fire stations and chefs to train the

firefighters about nutrition and healthy meals. A doctor sponsors

the community fun run. The City Council is discussing whether to

give some workers bicycles instead of government-funded cars.

Now, Dr. Economos is working with the Save the Children

Foundation to adapt and test some of the Shape Up initiatives for

rural schoolchildren in the Mississippi Delta, Appalachia and

California 's Central Valley .

"A lot of people making a few small changes added up to this huge

thing," says Dr. Economos. "We couldn't go to the kids and say you

have to change your lifestyle. We had to change the environment

and the community spirit first."

Write to Tara Parker-Pope at tara.parker-pope@wsj.com