Until recently the halls of North High in Minneapolis were lined with vending machines where students could buy soda pop and other sugary drinks, as they can in most other high schools in the nation. But with rates of childhood obesity skyrocketing, the Minneapolis school district worried about pushing pop. The district needed a way to keep its lucrative vending contract with Coca-Cola while steering kids toward more healthful beverages.

Bryan Bass, North’s assistant principal, took the challenge. He stocked 12 of North’s 16 vending machines only with water, priced at 75 cents a bottle.

Three machines dispensed juice and sports drinks for $1. Only one sold soft drinks, at $1.25 per can. “We located the water machines strategically outside our buildings, so when you come out of a classroom what you see is a water machine,” says Bass. “We also decided to allow water in classrooms but not juice or pop.” The result? Profits from the vending machines nearly tripled, from $4,500 to $11,000 in two years. They’re now in their third year, and says Bass: “Water has become ‘cool.’ “

Price of health. North’s success demonstrates what many obesity experts and parents believe: Kids will learn to make healthful food and drink choices if they have access to them and are motivated to do so. “Price is a powerful motivator,” says Simone French of the University of Minnesota, an expert on school-based obesity prevention. She’s impressed with North’s efforts, but she says the problem is implementing these strategies throughout society. “Obesity is the biggest health issue facing kids, and we’ve got to do more.”

How to do more was outlined last week in the Institute of Medicine’s 460-page action plan, mandated by Congress, on “Preventing Childhood Obesity.” Chaired by Emory University’s Jeffrey Koplan, the plan is the first comprehensive look at childhood obesity and what government, industry, schools, communities, families, and medical professionals can do to reduce its impact. “I think this is similar in importance to the first Surgeon General’s Report on Smoking and Health in 1964,” Koplan says. That landmark document led to the health warning on cigarette packages and a ban on cigarette advertising on TV.

The health effects of childhood obesity are already becoming clear. Nationally, about 15 percent of kids over age 6 are thought to be obese, but some studies indicate the number may be closer to 40 percent. “Those kids are going to get diabetes much earlier,” says Minnesota’s French, also a member of the IOM panel that wrote the report. Already, 60 percent of obese 5-to-10-year-olds suffer one or more heart disease risk factors, such as high blood pressure or cholesterol, the IOM notes.

Pizza and fries. While no single factor produced this epidemic, many have contributed to it. Schools, for example, play a paramount role in teaching kids lifestyle choices. Yet more than 70 percent allow kids to buy high-fat, salty, and sugared foods during lunch, and some 20 percent offer brand-name fast food as part of the USDA-supported school lunch or sell it a la carte. Hamburgers, hot dogs, pizza, and french fries are standard school fare. Few schools provide salad bars, in part because USDA reimbursement covers only one vegetable per meal. And 50 percent of middle schools and 70 percent of high schools have contracts with soft-drink companies to market sodas on campus. By age 14, 32 percent of girls and 52 percent of boys drink three or more 8-ounce soft-drink servings daily. Few kids meet guidelines for fruits and vegetables, yet they are eating more calories than their parents did as kids-243 more for boys and 123 more for girls. They’re also moving less: Only 8 percent of elementary schools, 6.4 percent of junior highs, and 5.8 percent of high schools offer daily physical education.

The IOM developed a long list of recommendations. Key among them are that government and schools work together to establish healthful nutrition policies that apply to all food and beverages sold on campuses and that schools provide a minimum of 30 minutes of physical activity daily for every student.
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Kids have become a special target for food and beverage advertising. Indeed, $10 billion to $12 billion was spent on television ads, packaging, contests, toys, and prizes to reach them in 2002, resulting in over $27 billion in sales to youngsters. The IOM is “particularly concerned with ads that target kids under 8 years old because they are not able to differentiate factual information from advertising,” says Koplan. The panel recommended the industry voluntarily set standards that would essentially eliminate much of the advertising for breakfast cereals and snacks to young children. “What I would like to see is the food and beverage industry differentiate itself from tobacco and create a demand for healthful products,” adds Koplan.

North High School has proved it’s possible.