America's Obesity Crisis:Activists: The Obesity Warriors

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Nothing infuriates the obesity warriors more than dietary conditions in public schools. "We as a society have really abdicated responsibility for teaching kids how to eat right and how to have an active lifestyle," charges Ludwig, who wants to eliminate "junk food, fast food and soft drinks" from schools. "Students are a captive audience," he says. "Promoting their physical well-being should be part of the school's educational mission." The first step is getting rid of soft drinks, which "are basically candy," says Nestle. "Get 'em out of the schools." Tackling soft drinks alone could make a remarkable difference. Ludwig's research shows that for every additional daily serving of a soft drink, a child's risk of becoming obese rises 60%. The typical adolescent, he says, gets a whopping 10% to 15% of his or her daily calories from soft drinks. If those drinks were replaced by water, far fewer kids might become overweight.

Increasingly, school officials across the country are coming around to this point of view. Los Angeles, Philadelphia, San Francisco, Chicago, New York City and numerous smaller districts have taken steps to ban the sale of soft drinks during the school day (although New York has made the dubious decision to replace soda with sugary Snapple beverages). California and Texas have issued statewide bans on soft-drink sales in elementary and middle schools.

The next step, say Ludwig and Brownell, is to restrict the sale of potato chips, candy and other junk food in schools. Texas, Los Angeles and New York City are leading the way. After that, says Brownell, cafeteria menus should be revised to replace foods high in empty calories with more nutritious fare. Ludwig is eager to eliminate fast-food-type meals from school cafeterias, some of which sell food supplied by McDonald's, Pizza Hut, Burger King and other franchisers. On days when kids eat fast food, they consume an average of 187 more calories than on days without fast food, Ludwig and collaborators reported in a large study published in the January issue of Pediatrics. Since, on average, the American kid eats a fast-food meal 1 out of every 3 days, "this would account for an extra 6 pounds of weight gained a year," says Ludwig. "It's a poor return on investment to fund education by selling this kind of food to kids."

Besides reforms in the cafeteria, obesity experts would like to see changes in what kids learn about fitness and diet. Studies have shown that teaching kids to eat smarter, be more active and watch less TV can have lasting results. The largest school-based health-intervention study ever done was a mid-1990s trial, involving 5,000 children in four states, called CATCH (Child and Adolescent Trial for Cardiovascular Health). Aimed at preventing heart disease rather than obesity, it showed that improvements in the lunchroom, gym class and health instruction could change kids' eating habits and activity levels at school and at home. And the lessons stuck. A follow-up study three years later found that kids who had been through CATCH from third grade through fifth grade still had a healthier diet and were more physically active when they reached middle school than control-group kids.