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Cindy Wolff with Chico Junior High students Solomon Smith and Mariya Wolff, Cindy’s daughter

Growing Up Healthy

CSU, Chico is leading the way for North State children and their families to receive the nutritional and fitness guidance they need

Nancy Weinzinger was alarmed by the statistics in front of her. The Gridley Unified School District nurse couldn’t believe that there was such a large percentage of students with high blood pressure.

“We took 485 blood pressures—there were 48 students in the 6th, 7th, and 8th grade who were above the 95th percentile after the second test,” says Weinzinger (BS, Nursing, ’67). “We never used to think of blood pressure problems in young kids like this. Things are just so different now.”

The blood pressure tests were part of regularly scheduled screenings for children in grades K–8 in Gridley schools. Since 2001, Weinzinger has been checking the children’s height and weight and screening for acanthosis nigricans, a darkening of the skin that is an indicator for diabetes risk.

“This year, 50 percent of K–8 are above the 85th percentile in weight and/or have acanthosis nigricans,” reports Weinzinger. “The year before it was 44 percent.” A child between the 85th and 95th percentile in weight is considered at risk for overweight, and over the 95th percentile is considered overweight (the Centers for Disease Control and Prevention avoids using the word “obese” for children, preferring the word “overweight”).

These high percentages are not unique to Gridley schools. Obesity is the most common health problem facing children in the United States today, according to a 2001 Surgeon General’s Report, with about 30 percent of children found to be overweight in 2000. At the same time, fitness is declining, with less than one-third of children ages 6–17 meeting minimum fitness standards. There are nearly twice as many overweight children and nearly three times as many overweight adolescents as there were in 1980, and the numbers continue to rise.

To help combat this epidemic in Northern California, a network of agencies and school districts called the Sierra Cascade Nutrition and Activity Consortium (SCNAC, pronounced “snack”) has been created. It aims to promote a balanced diet and physical activity through a social marketing campaign and to implement prekindergarten to 12th-grade nutrition and physical activity programs, as well as parent, teacher, and family-based educational programs. The idea for the consortium was conceived in 2001, when Weinzinger and others contacted CSU, Chico nutrition and food sciences professor Cindy Wolff about the health problems among schoolchildren in their communities.

“One of the reasons this whole thing began was because of the phone calls I got from school nurses and teachers,” recalls Wolff. “I got a call from Ruth Sweet [BA, Sociology, ’70; Credential, ’72], a teacher at Hooker Oak Elementary School. She was looking for services for an overweight 9-year-old whose weight was impairing her social development, which was then impairing her academic performance. The girl’s parents were not English speaking, and Sweet didn’t know what to do, but obviously the child was developing some real issues. I met with the child and tried to find some assistance for her and her family, but I could find nothing.”

As a registered dietitian, Wolff says she could have met with the parents herself, but her Spanish was inadequate for the task. Then Wolff got a call from Weinzinger, concerned about the high rate of prediabetes and weight problems, and the lack of fitness in the children in her school district, asking for help with her annual screenings. School nurse Alma Hayes (BS, Health Science, ’97) from Durham also called asking for information and services to be provided to her school district. Wolff decided that she and some of her graduate students would research the problem of childhood overweight.

A quest for change

What started with some concerned calls and preliminary research has grown into a multimillion-dollar program involving 30 agencies, 13 North State school districts, and a variety of community partners. Wolff, director of SCNAC, has a passion for educating children and parents about proper nutrition and good fitness practices. This stems not only from her research into the areas of pediatric overweight and nutrition education for children, but also from a personal interest as a parent.

“My daughter was the same age as the girl who was brought to me; they were at the same school,” she notes. “I’m first and foremost a parent, and I see that my kids are living in a world that is a hostile environment when it comes to protecting health. Then, via my own and my graduate students’ research, and folks like the school nurses calling me up, I saw that this issue was huge.”

Wolff, nursing professor Irene Morgan (BS, Nursing, ’78), and student interns from the nursing and nutrition programs at CSU, Chico teamed up to do screenings, starting in Gridley.

“That school district is 50 percent Hispanic,” notes Wolff. “The overweight rate was higher among Hispanic students, but it was really high among Caucasian kids as well.”

Then the team was asked to do screenings in Thermalito schools by school nurse Sharon Wedin, who had been observing the increase in overweight students and was worried. The group of students they studied were about 35 percent Hmong, with about 2 percent Hispanic. The statistics were essentially the same. “The rates in Thermalito differed [from those in Gridley] by less than 1 percent,” says Wolff.

Wedin had asked all the students how much soda they drink, and only a couple out of 360 students said none, but the rest said a lot. “Each can contains 10 teaspoons of sugar,” says Wolff. “I spoke at Chico Rotary in August, and I brought with me the amount of sugar that the average teenager gets in sodas in one week. It’s a quart jar and a third of another quart jar. The equivalent amount of bread to equal the amount of carbohydrates they’re getting in the soda is four and a half loaves of bread.”

The team ended up studying 1,371 students ages 10 to 14 years in four Butte County school districts. Of those children, 47 percent were at or above the 85th percentile of their ideal weight, or body mass index (BMI), and 11 percent had elevated blood pressures. Fourteen percent, or one out of every seven students, was at risk for type 2 diabetes. The rates of overweight were above national rates for all school districts and all ethnicities. All of the schools included in the screenings were low-income schools. Once the data had been analyzed, letters went home to the parents explaining the screenings and the findings, along with a second letter for the parents to give to the child’s physician. Wolff also met with school officials to discuss the findings.

“In Gridley, they have a new superintendent,” says Wolff. “Nancy Weinzinger went with me to meet with him and show him that there is a problem in his school district. He called in every principal. Every school got on board.”

As a SCNAC school partner, Gridley Unified is getting input from teachers and the school board about the activities they will implement. “A lot of the activities that SCNAC told us about have already been done in Chico,” says Weinzinger. “We chose to start with some of the most popular activities, like the pedometer-based walking program for 4th to 8th graders.”

A healthy option

The studies had been conducted without funding, with Wolff and Morgan volunteering their time and students doing unpaid internships and graduate work. In order to provide education and services to the children and their families, Wolff began applying for grant money. One program in place since spring 2001, called OPT (Overweight Prevention and Treatment) for Fit Kids, was funded by Proposition 10 allocations to Butte County from taxes imposed on cigarettes and tobacco products. It targets children ages 0 to 5 from low-income families. It guides families through making changes in nutrition, activity levels, lifestyle, and attitudes that promote fitness and a healthy weight.

“We’ve had kids as young as 13 months old who are overweight,” says Wolff. “The doctors locally are stymied as to how to address the education needs of the parents, so we’re called in. We work with parents to modify the child’s lifestyle, and the family’s lifestyle to help protect that child.”

Along with nutrition counseling and educational materials for children who are overweight or have weight-related problems such as high cholesterol and diabetes, OPT offers a family-based weight control program called Lifelong Eating and Activity Patterns (LEAP). Families meet with a registered dietitian (or graduate student who has completed all clinical work) for two hours once a week for eight weeks.

“Our nutrition education and physical activity promotion classes have brought about some great results in families, who’ve turned around some of their habits,” says Shaunna Bass (BS, Nutrition and Food Science, ’04), a nutrition graduate student who has worked with LEAP for several years. “In one family with a little boy at home and a girl in school, the parents were promoting very different eating habits, with the dad bringing less healthy food choices into the house. Then, through the classes, the mom initiated tremendous changes.”

Bass relates how the mom cleaned out the cupboards, getting rid of all the junk food and exchanging it for healthier snacks, and involved her 8-year-old daughter in swimming and other sports. The dad joined in and stopped taking the daughter out as frequently to fast food and bringing candy and ice cream into the house. “They came back in and told us how much of a change it has made, and that it was the program that really was the door opener for them,” says Bass. “They had wanted to make changes but just didn’t know how.”

Kristen Gruneisen (BS, Dietetics and Food Administration, ’96; MS, Nutrition Education, ’99), who has worked for OPT for Fit Kids since 2002, says that they have seen children’s BMIs decrease through their participation in LEAP. “There are definitely positive outcomes as a result of their participation in the class,” says Gruneisen. “Even in those kids whose BMIs don’t decrease, often families will say it brought them closer through identification of common goals and family-based physical activities, and that the nutrition information is beneficial.”

Cultivating resources

In order to extend services to children older than 5, Wolff tapped into a state match grant program. The California Nutrition Network, which is funded by the U.S. Department of Agriculture Food Stamp program, provided a 50-percent match to the funds awarded to create SCNAC. The consortium has grown from serving one county to six, and eventually will include CSU, Chico’s entire 12-county service area. In February SCNAC received a big boost: it was awarded $5 million to expand activities across the North State over the next three years.

“There was so much interest in adopting OPT and requests for services by school districts,” says Wolff. “We were overwhelmed, so we needed to come up with other funding that would allow us to build staff and bring services to school districts, which are so cash strapped and under the gun to do well on the academic end that they just cannot address the health issues they are facing. By going to the California Nutrition Network and creating SCNAC, we were able to match the dollars we got from the county and provide services to children ages 6 to 18.”

SCNAC targets low-income families, providing both funding and training for rural communities to better meet the residents’ health-related needs. More than 200,000 residents from Butte, Yuba, Tehama, Siskiyou, Modoc, and Glenn counties participate in some form of SCNAC services. Wolff says that North State services supporting nutrition components are few and far between; many counties have no dietitians, and the public health departments are understaffed.

“It’s a critical program,” says Morgan. “Obesity, as the graduate students have found, is leading to increased high blood pressure among children, and there is increased soda consumption and decreased physical activity—all the wrong directions. So we can start reversing these habits through education, through limiting—eliminating, actually—soda consumption in the schools. We also have to somehow educate the families, because in the school settings, we can increase the kids’ physical activity, get the soda machines out of there, but at home they’re still going to consume sodas and sit around and watch TV or play video games if they don’t fully understand the health risks of that behavior.”

In addition, SCNAC has been named the lead agency for the Sierra Cascade Region’s California Children’s 5 a Day-Power Play! Campaign, having been awarded more than $400,000 by the California Nutrition Network for three years. Through the campaign, children ages 9–11 are encouraged to eat at least five servings of fruits or vegetables and to play actively for at least an hour a day.

“Part of this is a push from the state,” notes Wolff. “In 2001, I went to the California Nutrition Network and said, I looked through all of your funded programs, and I notice that you have $50 million coming to California, and only $350,000 of that is going north of Sacramento. And they said, we know we have a problem, can you help?”

To help the North State build infrastructure, Wolff is providing nutrition students with opportunities to work in their field while they are going to school, encouraging them to go through the graduate program and complete the post-grad internship, and then helping create a job for them back in their home county. Former Associated Students president Amber Johnsen (BS, Nutrition and Food Science, ’04) has done just that, and is currently a program manager in her hometown of Orland while she finishes her graduate studies.

Wolff’s spirit and enthusiasm are matched by the students, alums, and faculty working alongside her. The consortium currently employs 24 students, seven Chico alumni, and seven faculty from four departments on a part-time basis. Along with the nutrition and food sciences program and school of nursing, the health and community services and recreation departments are CSU, Chico partners. The SCNAC staff work very closely with the Office of Sponsored Programs and the Research Foundation in all administrative aspects. Each semester, 30 to 40 CSU, Chico students from eight different departments intern for SCNAC. In the past two years, 10 students have completed their graduate thesis research with SCNAC, and Wolff and her students have presented 14 papers at state and national conferences. Wolff splits her work time between teaching and directing SCNAC and the OPT for Fit Kids program.

“Cindy’s leadership is a big part of SCNAC’s success,” says Morgan. “She is a very dynamic person, and she brings people on board who each have a different kind of expertise to share. It’s not just an academic research program; this is a program to make a difference in children’s and families’ lives.”

For more information, call 530-898-5288 or go to the Web site at scnac.org.

Fun with Food and Fitness

How do you persuade a third grader to eat more vegetables? How do you peel a sixth grader away from his beloved X-Box? Parkview Elementary School in Chico, which has been a SCNAC partner for several years, gets kids excited about making healthy choices with fun activities.

SCNAC coordinator Carol Lams (BS, Dietetics and Food Administration, ’99) met with parents, teachers, and food supervisors from the school district and had them do a survey of different things that schools can do to promote nutritious choices and healthy lifestyles, says Parkview Principal Joann Parsley (BS, Agriculture, ’77; MS, Agriculture, ’84; Credential, ’78, ’88, ’01). “We talked about what we serve in the cafeteria and for snack recess, and how teachers and the cafeteria staff could promote healthy eating,” says Parsley.

For example, Lams provided the teachers with special pencils and stickers to reward students with rather than candy. She worked with cafeteria and district food service staff to implement healthier food options such as a portable salad bar, which was an instant hit with the kids.

The first Wednesday of every month, students are encouraged to walk or ride their bike to school. Lams organizes parents to come on the walk/ride to school days and hand out healthy snacks, such as bananas, and in January, she handed out water bottles with Parkview School imprinted on them. “Instead of bringing soda or juice boxes to school, we’re promoting that they drink water or milk,” says Parsley.

Lams also organized nutrition and fitness groups, such as a Hispanic mothers walking group and a nutrition action club for girls and boys with a particular interest in nutrition, with whom she met once a week to talk about healthy choices at places like McDonald’s. “She would bring in facts about how much fat is in different kinds of burgers and French fries, and suggest healthy alternatives,” says Parsley. “When school started this year, a couple of sixth-grade boys asked me when she was going to start her group again.”

This year, Lams started a mom/children’s group that she meets with on Tuesday afternoons to talk about healthy cooking. The mothers and the children talk about healthier ways to prepare their favorite foods. “Every time Carol sees something we’re doing that she thinks might not be the healthiest choice, she doesn’t say don’t do that; she says, I understand the sixth graders need to fundraise for environmental camp—here’s an idea, I will help support it if you can move from selling rootbeer floats to smoothies,” says Parsley. “Or, if you can, when you are selling pizza at open house, can you add a green salad? She helps to make the alternatives a reality.”