Reading, writing and 100 percent juice


By Marian Uhlman
Reprinted with permission of the Philadelphia Inquirer Magazine

May 19, 2002 - Ruth Anderson realized she was going to have to lose weight, too.

It would do no good to rally her 510 students behind the quest for good nutrition while her own body was lumpy in spots that had been firm just 10 years before. Anderson, an educator for four decades, knew that the best lessons were taught by example.

Here she was, a first-year principal, regularly sending heartfelt advice to her children over the loudspeaker at Tanner G. Duckrey School in North Philadelphia. "It is nutrition time all the time," she'd say to the pupils, in pre-kindergarten through sixth grade. "Replace soda and candy with popcorn and juice." She'd become an unflagging nutrition booster, but was failing miserably to follow her own counsel.

If not for a nutrition task force's pledge to Duckrey, Anderson probably would have overlooked her appearance entirely that December day during a few precious uninterrupted minutes. She would have been worrying about how to raise test scores or get more parents reading to their kids. Or doing the payroll, since no one else could input it on the school's cranky computer system.

But the pledge had made her take a closer look at all nutrition-related issues, including her own.

At stake, if Duckrey lived up to the offer's terms - conducting as many as 1,500 hours of nutrition-related activities by summer - was as much as $10,000 for her school, where books, paper and lightbulbs are in short supply. "Anything to help the children" was her motto. If they'd eat better and learn what was good for them, she was for it. Too many mornings, she'd watch students snacking on candy and soda they'd bought at the yellow store across the street. Others got treats elsewhere or came to school on an empty stomach. And she was troubled by how many were overweight.

She'd seen a burst of enthusiasm when the school started trying in October to go after the pledge. She even got staff support when she banned candy at Duckrey, although it meant teachers could no longer hand it out as a reward. ("Candy was cheaper," said Michelle Rosbach, who now doles out pencils, pretzels, popcorn, stickers and grapes to her second graders.) But as Christmas break approached, Anderson was worried that nutrition was being pushed aside as teachers added report cards and parent conferences to their already frazzled workdays. Too much was at stake to give up.

Principal Anderson could thank a dead soft-drink contract for giving Duckrey a crack at the nutrition money.

In the spring of 2000, when she was still a senior teacher at another elementary school, leading nutrition experts in the region gathered at the Presbytery of Philadelphia offices at 2200 Locust St. Normally, these experts toil quietly at such places as the University of Pennsylvania, the American Cancer Society, the School District of Philadelphia, and the Greater Philadelphia Food Bank.

They had been galvanized, though, by Coca-Cola Bottling Co.'s recent attempt to strike a $43 million deal with the school district for exclusive rights to sell beverages in the city's cash-strapped schools.

They would have been happier if health concerns alone had scuttled the deal. But some school officials felt it was too meager. Who knew what would happen if a more lucrative contract was offered one day? As they talked at the Presbytery, the experts resolved to make a healthy foods agenda a district priority. Outfitted with a new name - the Comprehensive School Nutrition Policy Task Force - they set as a goal revolutionizing the way kids, parents, teachers, administrators and support staff in every Philadelphia school think about food.

They wanted to upgrade vending machines as well as cafeteria a la carte lines. They wanted nutrition injected into every subject ("favorite foods" as a writing topic; vegetable soup to spur a science talk about herbivores). And they hoped their agenda would spill into neighborhood stores and family grocery carts.

"We were trying to get people back in touch with what they know is right," said Sandy Sherman, the task force's leader and a nutrition educator at the Food Trust in Philadelphia, until recently the Farmers' Market Trust.

Such aspirations might seem outlandish in a world stuffed with Big Macs and Big Gulps. Timing is everything, of course. And kids' eating habits are suddenly a hot issue. They are guzzling more soda and eating more snacks. Their diets, along with inactivity, are being blamed for the nation's soaring number of overweight children.

About 13 percent of children and adolescents are now seriously overweight, according to government measures for weight and height. That's about the percentage at Duckrey, too. Extra pounds make these children vulnerable to major health problems, from heart disease to Type 2 diabetes.

"Left unabated, overweight and obesity may soon cause as much preventable disease and death as cigarette smoking," wrote outgoing U.S. Surgeon General David Satcher in December. More than 60 percent of American adults are overweight; almost 30 percent are obese.

But solutions are not as obvious as the problem. Satcher urged schools to think beyond phys-ed and health classes and to gear their entire environment toward healthy eating and physical activity - an exhortation that made the Philadelphia task force look prescient.

Schools elsewhere have taken steps toward healthier eating. Some set up salad bars. Others shunned exclusive soda contracts. But few have embarked on as comprehensive a program to promote general nutritional health as the one that sprang from the powwow at the Presbytery.

"Philadelphia is among the innovators," said Howell Wechsler, a specialist in nutrition and physical activity for the Division of Adolescent and School Health at the federal Centers for Disease Control and Prevention. "People are coming together with a systematic, long-term approach, not just being negative and trying to stop something from happening."

Nobody opposes good nutrition. There are simply so many countervailing forces.

Teachers motivate children to read with fast-food coupons. Parents bake cakes and cookies for fund-raisers. Principals throw pizza parties to honor students. And school cafeterias cater to kids' tastes rather than risk the loss of sales to the neighborhood competition.

Teachers and principals have little, if any, nutrition education. Most don't see it as part of their job. How can they inspire children to choose baked potatoes instead of french fries and to skip the sour cream?

"Money is a big barrier, and so is the lack of perceived importance of nutrition," said Simone French, an epidemiology professor at the University of Minnesota, who researches school-based interventions. "School administrators want kids to eat healthy, but it is not one of the things people spend time to develop and make policy on."

The Philadelphia task force realized it needed a gimmick. Something with more pizzazz than the Food Guide Pyramid. Where better to find inspiration than among the masters of marketing - McDonald's, Burger King, Pizza Hut? Prizes and rewards had lured millions of children to buy fast food. Perhaps prizes could get them to eat better.

The incentives would be aimed not only at children, but at the school staff, too. Teachers would be paid for taking two-hour nutrition classes, and they would also earn up to the $10,000 for school supplies that Anderson would come to covet.

It took about a year for task-force members to develop a pilot program, obtain federal grant money, and get the go-ahead from school district officials.

"Personally, I'd like to see no junk food in the schools," said Joan Nachmani, a task force member and coordinator of dietetic services for the district's food services division. "We can teach them in school to select healthier options, but the key is to have reinforcement outside the school in the home."

Four schools were chosen to be pilots - including Duckrey.

Principal Anderson has nothing against the brightly painted yellow corner store across Diamond Street from her industrial-looking brick school.

She just doesn't like to see her students leaving it with black plastic bags filled with candy, soft drinks and chips - especially when there's a free hot breakfast waiting in Duckrey's cafetorium, a spacious, multipurpose room with an auditorium stage separated from a kitchen by three rows of long, brown tables.

She'd been watching the morning routine since arriving at Duckrey in January 2001. Often, so many children gathered before school at the tiny store they couldn't all get in at once. (The shopkeeper declined comment for this article.) Anderson thought a sugar-laden breakfast made learning harder for children and established bad eating habits. So when a Food Trust staff member asked her in September what she first wanted to accomplish, it was a no-brainer. She wanted her students to eat the school breakfast, so they would get a nutritious start to the day.

Marjorie Scharf, a public health nutritionist who is one of two Food Trust staffers spearheading the project, had already started to market good nutrition at Duckrey and the three other pilot schools - South Philadelphia High School, William L. Sayre Middle School in West Philadelphia, and John Story Jenks, a kindergarten-through-eighth-grade school in Chestnut Hill.

She'd hung a banner above the food line in the Duckrey cafetorium, distributed purple Food Pyramid folders to each child, and soon would hand out white plastic water bottles. Each bore the project's slogan - "Want Strength, Eat Healthy Food" - and a logo of an orange character with sunglasses and flexed biceps.

But the raffle tickets were what really got things going. During October, each time a child ate the school breakfast - such as French toast fingers, grits, sausage, cold cereal, juice and milk - he or she would earn a small blue ticket. It was a chance to win a new bicycle.

At times during the month, Anderson's clear, melodic voice would float over the school's loudspeaker system, coaxing: "The only way to get a chance to win the prize is if you come to the cafetorium to eat a healthy breakfast." Anderson, who has a lively sense of humor, later discovered that she'd been pushing the wrong button on her intercom and broadcasting her messages all the way down to 13th Street and Susquehanna Avenue.

More children started to turn out for breakfast, eager for the tickets. "Everyone thought they were going to win it," said third-grader Ashley Garnett. Some kids even searched the large trash cans desperately looking for lost tickets.

Anderson didn't stop there. She got nearby Temple University to send athletes to eat breakfast with her students. And she made up for the candy ban with a Temple-led pep rally - gymnasts, basketball players, cheerleaders, even the mascot Temple Owl - cheering: "Want Strength, Eat Healthy Food!" Not all the kids were impressed. Sixth-grader Tamika Austin, who later would become a school nutrition leader, said it was "corny."

By November, breakfast attendance averaged just over 300 children a day - 60 percent more than in September.

Now it was the staff's turn. After school one day, 19 people, including the Head Start teacher, the cafeteria manager and the computer science teacher, straggled into a first-floor meeting room. Scharf praised them for the project's strong launch, and then said, "I want to hear what you want to accomplish."

The teachers perked up. Get the parents involved, they said. See how a good breakfast makes kids feel the rest of the day.

"I'd like to see children exposed to a variety of food," said Beverly Mackaman.

"I want to broaden the word diet so it means things they like to eat," said Lisa Szybowski.

"We are not looking for nutrition to stand alone," Scharf said. She nudged them. Use food labels to hone math skills. Read stories with food themes. "The more you teach, the more money you have for resources."

But by Christmas, Duckrey teachers had recorded only 107 hours toward nutrition activities, garnering a mere $804.98 of the $10,000 pledge. Even the children's breakfast attendance had fallen, despite raffles in December for 25 jump ropes and indoor basketball hoops.

Anderson overdid it during the Christmas holiday. Chitlins. Ham hocks. And her favorite concoction of eggnog and rum-raisin ice cream splashed with milk. She indulged with purpose. One last hurrah, she thought, before taming her urges.

Her doctor had suggested a year earlier that she lose weight to control her high blood pressure. Her husband also had been on her case. Most of her life, Anderson had followed her mother's simple advice: Eat well, but avoid extra portions. However, a decade ago she had started to reach for food for comfort as she nursed her mother and sister during the final stage of chronic illnesses.

"I just blew up," said Anderson.

Her first year at Duckrey didn't help either. She'd gained 25 pounds, and was now carrying about 200 pounds on her 5-foot-4 1/2-inch frame. She'd seen other first-year principals put on weight because the job is so demanding.

She was inspired before Christmas by one student whom she'd heard had been asking for nutrition pointers. When she spotted the cheerful girl, she said, "I understand congratulations are in order."

The girl looked perplexed.

"I understand you lost four pounds," Anderson said.

The girl scrunched up her shoulders and put a hand over her broad grin.

"If you can lose four pounds, I can try, too," Anderson said.

The girl bounded back into the classroom, shouting, "Y'all, I lost four pounds." Anderson laughed.

The principal promised herself she'd start eating better and exercising more in the New Year.

After the holiday, the Duckrey program faced a major test. Throughout the fall, the thrust at all four pilot schools had been generating enthusiasm for the project. Now the task force members wanted to make a change in the beverages kids drink and make them conscious about their drink choices. A small alteration, but a tricky one.

The quandary that arose was this: What is nutritious? What balance of ingredients is sufficient?

Sandy Sherman, a Food Trust staffer, bumped up against these questions in mid-January at the Jenks school when she tried evaluating the lunch drinks of some first-grade boys.

The boy with 100 percent fruit juice obviously deserved a raffle ticket for healthy eating. "Water is good," she told another, giving him a ticket. The boy whose drink was only 10 percent fruit juice she had to turn down. Sorry, she said.

But as she moved from table to table through three lunch periods, she puzzled about the amount of juice a beverage should contain to be considered healthful. If 10 percent is not adequate, what about 20 percent?

Many sports drinks and iced teas contain less sugar and fewer calories than 100 percent juice, but they don't match its nutritional value. Fruit drinks often are fortified with vitamins. But their juice content typically is between 5 percent and 25 percent. Not as much juice - as juice.

Sherman was eager to take the crucial step of devising a policy for drinks sold a la carte and in vending machines at the four pilot schools. (The task force didn't focus on school meals because they already comply with federal nutrition standards.) But Sherman was perplexed. "Everyone," she said, "has a different idea of what healthy is."

She solicited input from other nutritionists and food service managers. After much debate, they settled on a simple standard for the school day, something that promoted nutrition and was easily understood: 100 percent juice was in. So were milk and plain water. Everything else was out. Now, the task force had to find juices kids were willing to buy. And then the schools had to stock them.

Easier said than done.

In late January, Duckrey's nine student nutrition ambassadors met for the first time. They sized up unfamiliar-looking mini-Cheddar cheese rice cakes heaped on a white plastic plate. None of them had ever tried the 70-calorie-per-serving treat, but in less than 10 minutes the plate was empty. It was a warm-up drill for their new job.

"Has anyone done a taste test before?" asked David Rice, a Food Trust staffer.

Craig Seawright, cocooned in two sweatshirts, raised his hand. "There was some nasty foods and some that weren't," said the sixth-grader. "We had to write down what we thought on a piece of paper."

Rice chuckled. In a few minutes, you'll be judging new juices for the school, he explained. "We are not going to tell you what they are," he said. "But there is nothing too nasty."

The first three students earnestly approached the taste-testing table. They circled, sampling five 100 percent juices in unmarked paper cups. Craig's cheeks puffed out like a chipmunk's as he rinsed his mouth with water between drinks. He tried hard not to smile. Or to reveal his favorites while the other kids took their turns.

The children formed a semicircle at the juice table to hear the results, wincing as they recalled the pineapple and nodding slight approval for the apple. The winner was the previously unheard-of kiwi-strawberry juice.

Scharf told the children it was their job to market it to other students.

"Can we bring it around?" Melissa Cosby, a fifth-grader, asked excitedly.

"We can put them in little cups on a tray," Craig suggested.

Scharf thought it was a first-rate idea, reinforcing one of the nutrition project's basic tenets: Kids are the best promoters for good nutrition.

Anderson hadn't planned for it to be a confessional.

She'd called the impromptu nutrition meeting merely to touch base with four of her top Duckrey lieutenants.

They'd almost finished when she fixed her attention intently on Scharf, who had joined the mid-February meeting. "I have high blood pressure," she blurted out. "I went for a checkup three weeks ago. My cholesterol is going off the wall. If I could stop this crazy eating. . . . "

The last six weeks had been a blur. Restoring heat to classrooms. Calling police to flush out drug dealers near the school. Prepping students for state tests. Battling the flu. And wondering about Duckrey's future - and her own - under the pending school reforms.

Anderson admitted she was "eating day and night."

"I'm supposed to be a role model," she wailed, referring to the nutrition program. Noticing the giggling and nodding heads, she laid into her lieutenants: "They are feeding you constantly around here."

In gentle tones, Scharf backed her up. Looking at the smiling culprits, she said she understood they bring food because they care. "But," she said, "you have to stop." Change would be much easier, she explained, if they didn't supply so many temptations.

Duckrey's asphalt playground was a whir during recess on a gray, cool March day. Footraces. Pickup basketball. Double-Dutch. Tag. It was a rare child who stood still.

But recess was just 15 minutes a day. Down from a half-hour a few years ago, when the school had more supervisory staff. Physical education class was only 45 minutes a week - minus time to change clothes, listen to the teacher, and take turns during relays. After-school sports, which once included track and tennis, have dwindled to only a few offerings.

Getting enough exercise is hard for kids like Tamika Austin. She loves to jump rope, but can be sidelined by asthma. Her doctor recently told her she is at risk for developing Type 2 diabetes. Exercise and healthy eating can reduce that risk.

"When I exercise, because of my asthma, I start getting out of breath or real tired," said Tamika, a sixth-grader and a member of the student nutrition committee. "I like to do sports on my block. I jump rope and play wall ball. That's it, unless I go to the courts, once in a blue moon. Most of the time, my mom doesn't let me."

Avoiding sweets has also been tough for Tamika. She'd go to the neighborhood store several times a day with friends or on errands for her mother. "When I get something for the house, I want junk, too," Tamika said. "I don't know why. It is just tempting."

"It's hard for me, too," said Tamika's mother, Michelle Austin, who has been diagnosed with Type 2 diabetes. "Every time I go to the store, I want to buy a Pay Day. I know I am not supposed to eat it. . . . A lot of ways I had before diabetes, it is hard to change them."

However, she has observed subtle changes in her daughter since the advent of Duckrey's nutrition program. Tamika has been cutting down on snacks and starting to read food labels. On one recent shopping trip, Tamika surprised her mother by asking for 100 percent juice instead of soda.

Changing eating habits isn't for wimps. It's not orderly. It's not short-term. And if the goal is to prevent disease or obesity, it takes years to find out if the effort is making a difference.

"It is unrealistic to expect to shift the patterns of society sufficiently to have a trickle-down effect on weight levels in two or three years," said Shiriki Kumanyika, a Penn epidemiology professor and public health nutrition expert, who is advising the Philadelphia task force. ". . . It is like having a child and wanting the reward of him graduating from college when he is 2 years old."

"It took 30 or 40 years to get into this mess," said the CDC's Howell Wechsler. "You can't change attitudes and practices overnight."

By March, it was as though the pilot schools had reached base camp in their trek to the Mount Everest summit. That still was quite an accomplishment. Success in the nutrition arena is measured in modest steps.

At Duckrey, the second-grade teachers added diet-related words such as protein, dairy and grains to the spelling list. They practiced the math concepts of "greater than" and "less than" using suggested servings from the Food Guide Pyramid. A fourth-grade class made taproot soup to tie into a science chapter on plants.

Over at Jenks, parents limited unhealthy foods at fund-raisers and the principal penned nutrition tips daily on an office memo board. Students scripted healthy food promotions for South Philly High's in-house TV station. Most important, each pilot school spawned nutrition advocates like Alexzina Bryant, the food service manager at Sayre Middle School, who'd ask: "Where are we going with this? I am looking for change!"

Amid the many small steps was a notable one: Coca-Cola had agreed, at least on a trial basis, to stock glass-front vending machines with 100 percent Minute Maid juices and Dasani water at Sayre and South Philly High.

Since Coke's actions had inspired the nutrition project, events had now come full circle.

The Duckrey nutrition kids gathered in the cafetorium shortly before lunch. Juice already had been poured into scores of small paper cups.

Like a coach before the big game, Marjorie Scharf huddled with the children to explain the X's and O's of food sampling.

"You really got to believe in what you are selling," Scharf urged them on. "Say whatever you want to say, but say it like you mean it."

Pair off in teams. Hand out bookmarks you've designed with healthy juice slogans. Offer a juice sample to every Duckrey student. Tell them the new drinks will be sold after spring break.

"Unfortunately," Scharf said, the juices "you liked most aren't available."

"You mean we can't have the kiwi-strawberry?" asked Craig Seawright.

"Arhhhh," sighed a chorus of children.

Task force members had anticipated many obstacles, but rounding up healthy food options just wasn't one of them. They were surprised by the limited selection of available 100 percent juices for the schools. Stymied, they scaled back their policy to permit drinks with as little as 25 percent juice. And vendors still don't have every item on hand. The demand needs to be there, said Joan Nachmani of the school district's food services.

Task force members also gulped at the size of most available bottles: 16 ounces or more. Such large portions are factors in weight gain. But what was the alternative? "You are always uncovering something, something that you didn't know about that can move the project along like a committed individual or discovering something that is really a barrier or a challenge," said Scharf, who had also encountered similar problems with snack food. "If we want to move forward, we have to move within the given system. . . .

"At least 25 percent juice is a major success from what many people were drinking and think is healthy."

The sampling went well at Duckrey despite some grabbing and spilling. The nutrition kids even chased down Anderson with a juice cup and bookmark. On the whole, Tamika Austin said, the kids liked the juices - apple, orange and cranberry-grape. "They wanted to come back for more."

Away from the schools, the task force is making progress toward Year Two. The school district has signed off again on the pilot, and will permit the task force to expand to five schools. Penn obesity researchers are planning tie-ins for a study. And the Pennsylvania Health Department wants to link one pilot school to a broad obesity prevention project that also would include the National Park Service and the City of Philadelphia.

In that role, Joseph W. Catharine Elementary School in Southwest Philadelphia is joining the group. Jenks will continue in a limited role because of funding changes. Sayre, South Philly High and Duckrey have accepted invitations for Year Two. (South Philly High's new beverage vending options, largely 100 percent juice and water, were so popular, said Sandy Sherman, that sales increased by about 460 percent in the first month compared with the same period a year ago.)

At Duckrey, the outside world is intruding yet again. The drug dealers threatened Anderson after spring break for advocating they move away from the school grounds' perimeter. And the cops were called in. But Anderson is pleased by the School Reform Commission's decision to have Temple University manage her school. Not just for the university's wide-ranging expertise in education, but also for its desire to focus on nutrition.

More and more ideas are spilling from the Duckrey staff as the year's end approaches. The counselor had more than a dozen kids interview senior citizens about their childhood diets. The art teacher coordinated a nutrition poster contest. One third grader's entry: "I'm superbread and I give energy to work and play." In the coming year, sixth-grade teacher Sandra Black plans more hands-on nutrition activities such as keeping food diaries so the kids will understand "what it looks like and feels like to eat healthy."

"Duckrey has certainly shown that it has all the essential elements to promote healthy eating," Sherman said.

In all, 20 staffers recorded almost 400 hours of nutrition education between January and March - about four times the number of hours from October to December. Steven Lomax, the school's congenial computer science teacher, tallied 100 hours. "It wasn't too hard," he said.

Despite the progress, by April the staff had generated only $4,200 of the $10,000 prize. Still, it is a start on the purchases the school hopes to make - an overhead projector, a large screen projector, microphone, videos, math textbooks and more - to further nutrition education.

"Things are really changing," Anderson marvels. "I never thought this would take off like this and be so enjoyable."

As for her personal goals, Anderson hasn't lost any weight. She started exercising several days a week, but has been inconsistent because of the relentless demands of her job.

She has seen a nutritionist. She even bought a $40 electronic food scale.

"Now it is my turn," she said, "to be part of healthy eating, good nutrition and weight loss, and a healthier body.

"I think I will be able to do it," she said. "I'm in the mode."

Contact Marian Uhlman at 215/854-2473 or muhlman@phillynews.com.

© 2005, Journalism Fellowships in Child and Family Policy, University of Maryland