Healthy Schools Project Gets An 'A': Program Lowers Cardiovascular Risk Factors

"Anything we can do to fight childhood obesity in a culture where it is being fostered in so many ways is critical," says Kim Eagle, M.D., professor of internal medicine at the University of Michigan Medical School. In 2004, Eagle and local organizations in Ann Arbor, Mich., founded Project Healthy Schools, a program for sixth-grade students that's designed to increase physical activity and promote healthier food choices.

This week, U-M's Kimberly Lin, M.D., presented data at the prestigious American College of Cardiology conference indicating that the program has been successful in its first couple of years. Lin's presentation showed that program participants had a significant drop in diastolic blood pressure, total cholesterol, and LDL cholesterol levels. Additionally, there was a downward trend in systolic blood pressures and blood glucose levels among the students.

Initially just implemented in one middle school, the program was so well received that it has now expanded to five local middle schools. The program's success has been acknowledged by the Michigan Surgeon General, who has recognized all the middle schools in the district through the Healthy School Environment Recognition Program.

Measuring change

"We've had very positive feedback and we know we're changing some behaviors," says Jean DuRussel-Weston, U-M's MFit Community Health Initiatives program administrator and Project Healthy Schools manager. "In addition to self-reports, we're very proud of the fact that we have physical measurements indicating change as well."

In the presentation to the American College of Cardiology, Lin cited data from a study done using the measurements from the 2005-2006 academic year. The study aimed to both describe the prevalence of cardiovascular risk factors in the students and to determine the program's effect on those risk factors.

The researchers found that 40 percent of the 287 students assessed were considered "at-risk" for at least one of the six major risk factor categories, which included body mass index (BMI), systolic blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, and random glucose.

Prior to the intervention, 32 percent of the study participants were overweight (with a BMI above the 85th percentile for their height). A significant number of students were also identified as "at-risk" for systolic blood pressure (SBP) and total cholesterol levels. The researchers found that 8.7 percent had a SBP of at least 126 mmHg (which is the 90th percentile for an 11-year-old boy at the 95th percentile for height) and 9.6 percent had total cholesterol greater than 200mg/dl pre-intervention.

"The program allows us to identify students who are at risk," says Eagle. "We found that of the 40 percent of students at risk, 10 percent were a major concern. As a result, we contacted their parents and advised them to seek involvement with their child's physician or other provider."

After the program's completion, participants underwent another health screening. The researchers found a downward trend in systolic blood pressures and blood glucose levels-- and found that diastolic blood pressures and total cholesterol levels had dropped significantly. Of the students who were "at-risk" before the program, only 6.2 percent had an elevated SBP after the intervention (17 students, compared to 24) and 5.5 percent had high total cholesterol levels (12 students, compared to 21).

"We have shown that many sixth-grade students in Ann Arbor already show markers of risk for cardiovascular events. Project Healthy Schools is a portable program that can positively affect the cardiovascular risk factor profile of these students," concludes Lin.

Teaching healthy habits

Project Healthy Schools is a 12-week program that incorporates fun, interactive activities with educational information to teach students the basics of proper nutrition and exercise. "We're just trying to get kids excited about physical activity and healthy eating," says DuRussel-Weston.

The program begins in the fall with a kick-off assembly where U-M student athletes give motivational messages and do a group dance with the sixth-graders. Initial screenings and surveys measure a student's health, physical activity, and eating habits. The voluntary wellness screening includes height, weight, body mass index, blood pressure, and a three minute step test to measure heart rates. In addition, a full cholesterol test (known as a lipid panel) and random (non-fasting) glucose test are offered with parental consent.

Over the next few months, students participate in weekly activities designed to meet the project's five goals:

• Eat more fruits and vegetables
• Make better beverage choices, reducing high-sugar items
• Perform at least 150 minutes of exercise each week
• Eat less fast food and fatty food
• Spend less mindless time in front of the TV and computer

With their classes, students learn the updated food pyramid from the U.S. Department of Agriculture and how and why eating a "rainbow of color" of fruits and vegetables is the best way to get all the nutrients they need. They also learn portion control, how junk foods fit into a healthy diet, how to interpret food's nutrition facts panel and why limiting fat in the diet is important.

Students also learn about resting heart rates and the link between aerobic exercise and heart health. They learn how to calculate their target heart rate and the different activities they can do to achieve it.

Throughout the program period there are three interactive assemblies based on the Physical Education classes. Activities at these assemblies include exercises such as yoga, circuit-training, or dancing. In their classes, students also calculate the average time they spend in front of the TV or computer each day and identify other activities they could do instead.

To help motivate students, a friendly competition takes place between classrooms, with a monthly winner determined by an online "HealthyBlog." Students record their fruit, vegetable and healthy beverage consumption at lunch in addition to the number of minutes of exercise they do daily. Monthly team winners receive "active" gadgets such as Frisbees, foot bags and yo-yo's, and monthly individual winners receive Border's bookstore gift certificates. At the end of the year, the overall winning team receives an "active" field trip of their choice. Previous years' winners have chosen a softball game with healthy snacks, a swimming party and a rock climbing demonstration.

Reinforcing change

In addition to teaching students healthy habits, Project Healthy Schools aims to make the students' surroundings more health-conscious. Changes have been made in cafeteria selections and vending machine options. For example, vegetables and dip and a fruit salad bar have been added to the cafeteria, and items like the double-bacon cheeseburger and high fat meat pizza have been eliminated. In addition, the soda pop vending machines have been changed to offer water instead. "We owe it to our children for school to be an environment that promotes health," says Eagle.

Supporting the healthy habits outside of school is also important. "The change has to be reinforced at home or it's not going to last," DuRussel-Weston stresses. "Parents can talk to their kids about what they're learning in school. It's important that they are informed so that they know how to go out and buy food that fits in with the healthy behaviors being taught."

Project Healthy Schools keeps parents up-to-date through e-mail communication, the program's website, and WE CAN! (Ways to Enhance Children's Activity and Nutrition) which is a program of the National Institutes of Health designed to reach parents and children together through after-school activities.

Possible expansion

"This program is a long-term investment in the community and an investment in the future," says Dr. Eagle. "We hope that the Project Healthy Schools program not only impacts our students, but serves as a model to other school districts as well."

The current data suggests that the program has had an impact on its students, and other Michigan school districts have inquired about it. "Eventually, we hope to have a toolkit with all of our activities, props and educational materials so that the program will continue even when we can't be there. If districts were interested, it would be great if it spread all over the country," says DuRussel-Weston.

For now, Project Healthy Schools continues to change the way Ann Arbor students think about food and beverage choices and exercise. The program is a true community-university collaborative, and Eagle stresses that it would have been "simply impossible" to implement the program without the help of the community and private donors.

Project Healthy Schools (http://www.projecthealthyschools.org) has received funding or in kind support from the University of Michigan Health System, the Ann Arbor Area Community Foundation, the Community Foundation of Southeastern Michigan, Pfizer, Borders Inc., NuStep, Coca Cola Inc., the Thompson Foundation, Hands On Museum of Ann Arbor, U-M Mott Children's Hospital, U-M Cardiovascular Center, and private donors such as Randy Friedman, Robert and Ellen Thompson, and Dick and Norma Sarns.