When leading preventive cardiologist Dr. Arthur Agatston and his Miami-based team began monitoring elementary students participating in an obesity-prevention program, their goal was simple. “We wanted to show that good food was good for kids,” Agatston says. “And that they would eat it.”
Agatston, who is also Everyday Health’s heart health expert, has long been a vocal advocate for healthier lifestyle choices. He writes and lectures extensively, and is probably best known for his South Beach Diet, which he originally devised as a way to help his cardiac and diabetes patients lose weight in order to prevent heart attacks and strokes. In 2004, he founded the Agatston Research Foundation, which now conducts and funds original research on diet, cardiac health, and disease prevention.
This particular project, called the Healthier Options for Public Schoolchildren, or HOPS program for short, was specifically designed to test the feasibility of introducing a holistic nutrition and healthy lifestyle management program at the elementary-school level in central Florida. As HOPS co-principal investigator, Agatston revealed the findings at the October 2008 meeting of the Obesity Society. In short, the two-year HOPS study found that kids who ate nutritionally sound, high-quality breakfasts, lunches, and snacks — instead of the typical cafeteria food — not only had lower blood pressure and were less likely to be overweight, they also scored significantly better on standardized tests, especially in mathematics.
Of particular interest to the researchers was the fact that the 1,197 students who participated all came from families with low incomes. “The research shows that we can make a qualitative difference in the lives of children through proven, effective, and easily replicated programs such as HOPS,” says Agatston, who recently partnered with the University of Pennsylvania on the Agatston Urban Nutrition Initiative, a multi-faceted health and wellness program serving depressed urban areas.
Teaching Kids Nutrition
Compiling this information wasn’t as simple as swapping white bread for whole wheat. Study organizers had to change what was being served in the school cafeteria and then they had to sell the kids themselves on why the healthy school lunches were better. The youngsters needed to actually prefer healthier fare to foods like french fries and chicken nuggets.
To help overcome the children’s initial skepticism over healthy school lunches, the team initiated a comprehensive educational program, complete with pep rallies where kids cheered for fiber and broccoli and appealing books that taught nutrition basics in a lighthearted way. “The educational piece was critical. We found that if you just put the food on the kids’ plates without any explanation, they simply won’t eat it,” says Agatston, an associate professor of medicine at the University of Miami Miller School of Medicine, whose interest in nutrition springs from the disastrous health effects of the typical American diet. “By purposefully integrating school meal provision with fun and effective nutrition education programming we have created an easy-to-replicate model.”
Wisely, the children were not put on diets, and the focus of the program was not on body weight. “We absolutely never used the word diet,” he says. “It was about nutrition and health. I feel very strongly that kids don’t have to be on diets. When they make good food choices and get more exercise, the weight will take care of itself.”
Agatston also doesn’t credit any one particular food for helping the children do better in school. Instead, he says, balanced blood-sugar levels from the healthier foods provided sustained energy that led to improved academic performance. “Just ask any teacher and she’ll tell you,” he says. “After the usual lunch, most students are on a sugar high that is followed by a crash.”
In fact, most children in America are overfed but undernourished, Agatston maintains. “Today’s kids are consuming an almost all-fast-food diet, full of trans fats, starches, and sugars, with literally no fiber or nutrients,” he explains. “Nutrients are found in the skin of fruits and vegetables, where the fiber is. And vitamins are found in whole grains. When you take the whole grain out of bread and you take the skin and the fiber out fruits, you’re left with just empty calories.”
And a multivitamin can’t make up for bad choices: “Ten years ago we thought that it could,” Agatston says, “but now we know there are thousands of micronutrients in foods like broccoli and asparagus. We have not figured out how to put those into a pill.”
Better Food in Schools
Agatston says he knew they had succeeded when children from the study went on to middle school and asked at the cafeteria where the HOPS choices were. “They realized they feel better and do better now,” he says. “And that they’re doing what’s good for them.”
In fact, getting children to embrace a healthier diet was the easier part of the equation. The real challenge was overcoming the skepticism and resistance of school officials and food vendors. Agatston’s team had to convince them that it was possible to offer cost-effective, nutritionally rich food. “The bureaucracy and logistics of it — not getting the kids to eat the food — was the bigger hurdle,” he says.
Today, Agatston and his fellow researchers hope that the success they’ve had with the HOPS program — and in particular with its effect on increased academic performance — will encourage school officials nationwide to reconsider what they’re serving in their cafeterias. And if they do, Agatston will be one step closer to reaching his goal of changing the way Americans eat for the better.