Unhealthy dietary influences are a great factor in the growth of childhood obesity. Portion sizes of food and soft drinks served at fast food restaurants are somewhat at fault for this epidemic. Portion sizes have greatly expanded; McDonald's French fries were originally sold in two-ounce portions. Today's "super size" fries are nearly seven ounces. Eight ounces was the original size of a vending machine Coke; this has expanded to twenty ounces (Mrdjenovic, Gordana, "Nutritional and energetic consequences of sweetened drink consuming in 6 – to 13 – year-old children," The Journal of Pediatrics, 2003, p. 605).

Soft drinks are the leading source of added sugar in children's diets. A 20 ounce serving of soda contains 17 teaspoons of sugar. As soft drink intake increases, milk intake subsequently decreases resulting in inadequate calcium and vitamin intake that may contribute to osteoporosis later in life. The caffeine in soft drinks can also interfere with sleep patterns, impacting school performance (Schwartz, Robert P., "Soft drinks taste good, but the calories count," The Journal of Pediatrics, 2003, p. 599).

Beverage companies blame the obesity epidemic in school children on the decline in physical activity. They are partly correct; however, it would take almost 40 minutes of moderate exercise to burn the calories from one 20 ounce soda (Schwartz, p. 599).

According to interviews I conducted with teachers, the majority of the milk sold in schools is either two percent or whole milk. The dietary guidelines for Americans recommend that school-age children have a diet low in total fat, saturated fat and cholesterol (cspinet.org). In a child's diet, milk is often the largest source of saturated fat.

For the prevention of future osteoporosis, it is important that children consume plenty of calcium since 95 percent of maximum bone density is attained by age 18. Children need the fat in whole milk for neural development, but only until age two. One percent and fat free milk provide the calcium children need for strong bones, but without the saturated fat that can contribute to obesity and heart disease later in life (cspinet.org).

One glass of whole milk has as much saturated fat as five strips of bacon. Two percent milk is not much better, being equal to about three strips of bacon. This is very important to note, because children drink up to three servings of milk per day combined between school and home. Switching to one percent milk or fat free milk is one of the easiest ways for children to get the calcium and vitamins they need while reducing their saturated fat intake and heart disease risk. Children who drink one cup of one percent milk instead of the same amount of two percent milk during the school day would cut almost 19 pounds of fat from their diet during their 13 years of school (cspinet.org).

Public schools are required by the National School Lunch Program to prepare meals that contain one third of the Recommended Dietary Allowance for protein and iron and no more than 30% of calories from fat. However, a USDA survey showed that a typical school meal still contains at least 35% of calories from fat (www.msnbc.com). Even worse, competitive foods and beverages are not part of the reimbursable Federal School Meals programs are not required to meet nutritional standards and are either sold as part of cafeteria food service (such as ice cream and pizza) or through other venues within schools such as vending machines and school stores.

Education about nutrition is a key component to the success of dietary changes and involving parents can only be beneficial to guarantee the success of the programs. Nutritional programs offer great potential for use within the public school system. There are several innovative programs that all have the possibility for successful implementation within schools.

The one percent or less school program was created by the Center for Science in the Public Interest (CSPI). A school-based nutrition-education campaign kit is available for purchase to promote the drinking of one percent or fat free milk in school and at home. When a school signs up for the program, they receive a kit tailored to their school's needs including signs to place in the cafeteria, directions for conducting taste tests, class activity lessons and flyers for parents. This program is appealing on several levels. It is designed to involve children in promoting healthy choices for themselves, their families and friends. It is also a very low cost to participating schools. The kit itself is only $65.00.

With the goal of finding out if children would choose healthy snacks over junk food, the United States Department of Agriculture (USDA) awarded grants totaling $6 million to schools through a Fruit and Vegetable Pilot Program (FVPP) for the 2002-2003 school year. The grants were used to provide each child in 107 elementary and middle schools with free fresh fruits and vegetables. The intent of the FVPP is to determine the feasibility and the success of such a program. The program has proven so far to be overwhelmingly successful and it is looking hopeful that this project will continue beyond the pilot (Buzby, Jean C., Guthrie, Joanne F., Kantor, Linda S. "Evaluation of the USDA fruit and vegetable pilot program," 2003, p. 1). The average cost of this program was $94 per student for the year (Buzby, p 12). Fresh fruits and vegetables were distributed to children through kiosks and free vending machines and some were served in classrooms as snacks. Over 90% of the participating schools provided nutritional education in conjunction with the program either by incorporating it in a lesson or as a health class. Some remarkable statistics emerged from the project. One school noted 25% fewer doughnuts sold at breakfast, one had a 50% decline in lunchtime dessert sales and a middle school noted candy sales dropped from an average of 850 pieces per week to 300 during the program (Buzby, p. 1).

There are simple changes schools can make to improve the healthy eating habits of their students. Breakfast at school is associated with increased math grades, fewer absences and improved classroom behavior (www.archpedi.ama-assn.org). According to the Food and Drug Administration (FDA) regulations, a cereal must contain 51% whole grain by weight to claim that "diets rich in whole-grain foods…may help reduce the risk of heart disease and certain cancers." Fiber is a major component of whole grain, so ensuring there are at least two grams of fiber per serving also serves as a good indication of adequate whole grains in the cereal. As easy way for schools to change the breakfast selections into a healthy option for children is to add fresh fruit and whole grain breads and cereals that meet the above criteria (Bistran, Bruce, M.D., Ph.D., Willett, Walter C., M.D., "Are you eating the right kind of breakfast cereal?" Harvard Health Letter, May 2003, p.2)

The fat content of school lunch programs needs to be lowered to a level in compliance with the Federal school meals program. Replacing unhealthy competitive foods, such as the ice cream sold at lunch, with healthy choices and eliminating vending machines that are accessible to the elementary school children would be a tremendous step in improving children's eating habits at school.