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Getting in Their Kitchen

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Contento and Koch

Contento and Koch

When fifth graders from P.S. 161 arrived at TC’s Earth Friends Room for a hands-on nutrition class this past fall, they found all the expected accoutrements: vegetables to slice, recipes to follow, rice simmering in a pot. More perplexing, on a table at the front of the room, was a plastic cup with a line drawn near the top and a hole poked in the bottom, flanked by a pitcher of purple water.

Kathleen Porter, a research and outreach coordinator, explained that the colored water represented “energy in” (food), while the cup with the hole represented “energy out”—the energy we use to keep our body functioning and for physical activity. She recruited two student volunteers to pour water into the cup while she plugged the hole with her finger.

“Sometimes I’m going to take my finger away, sometimes I’m going to keep my finger there,” she explained.

Porter told the students to imagine they had just done a strenuous activity; she pulled away her finger and the water level sank below the line. The students had to restore balance by pouring water to put “energy in.” Then she told them to imagine they’d just eaten a big Thanksgiving dinner and were now sitting around, stuffed to the gills. As the students poured in the water—representing turkey with all the trimmings—she plugged the hole in the cup, and the water rose above the line, spilling out on the table.

The point of the exercise was clear: Too much energy in from food, without matching energy out from body functioning and exercise, and one’s cup runneth over—and not in a healthy way. The students were learning the concept of energy balance.

Energy balance is central to Choice, Control & Change (C3), a curriculum developed by Isobel Contento, TC’s Mary Swartz Rose Professor of Nutrition Education, and Pamela Koch, Adjunct Associate Professor of Nutrition Education, together with Angela Calabrese Barton of Michigan State University. C3 uses science inquiry investigations to empower students to make positive changes in their diet and physical activity. It includes 19 detailed lessons that deal with the fat and sugar content of popular snacks and beverages, food and activity environments, diabetes education and other fundamental nutrition concepts.

Like the Earth Friends Room itself—which a century ago served as the cafeteria for what was then TC’s Horace Mann School—C3 continues a proud tradition of nutrition education at the College. “One hundred years ago, Mary Swartz Rose was doing nutrition with children here and making sure they gained enough weight to thrive,” Koch says.

Rose, who launched nutrition education as a discipline with TC colleague Henry Sherman, presided over the first of three major eras of TC leadership in the field. The second got underway during the mid-1970s, under Joan Dye Gussow, Contento’s predecessor and now Mary Swartz Rose Professor Emeritus.

“Joan was one of the first people to talk about eating locally and growing your own food,” Contento says. Her work inspired the creation of the Earth Friends Room, where children learn about “food choices that are good for them and good for the planet,” says Koch.

More recently, nutrition education at TC has taken on a new focus that reflects Contento’s core area of expertise: influencing the factors, both internal and external, that shape individual behaviors around food and fitness.

Seeking ways to disseminate, beyond the Earth Friends Room, the ideas that children were learning, Contento, Calabrese-Barton and Koch received funding in 1997 from the National Center for Research Resources to create Linking Food and the Environment (LiFE), a series of curriculum guides published by the National Gardening Association. Growing Food (2007) teaches children in grades four to six about food webs, agriculture and the ecological impact of food choices. The lessons are accompanied by a series of detailed botanical drawings, including one that demystifies the peanut plant. Farm to Table & Beyond (2008) encourages fifth and sixth graders to look critically at what happens to food during its journey to the consumer, including processing and packaging.

C3, developed with another five-year, $1.5 million grant from the same funder and published this past year, teaches students in grades six through eight about making lifestyle choices.

“Children at this age are starting to make their own decisions and their own food choices,” says Contento. “The focus is on developing autonomous motivation, so they will make healthy choices and feel proud of doing that. It’s not easy given the environment we live in. Stores in every neighborhood offer less healthy fare that is cheap, convenient and tasty. At the same time, children get three hours a week, on average, of ads for food. Of course, they don’t get three hours a week of nutrition education.”

C3 arms children with the motivation and skills needed to navigate this unhealthy environment. Kids calculate the amount of sugar in sweetened beverages and realize that the popular 20-ounce size has more sugar than is recommended for an entire day. Students use this kind of data to benchmark their own eating habits. They complete a “Bite and Write Food Log” to track their own energy balance. In subsequent lessons, they frame out plans for healthier eating and increased physical activity. Each lesson is paired with a “Calvin and Carol” reading, in which the two characters of the title learn to improve their energy balance so they can do the activities they love. Calvin and Carol are a big hit with the students, Koch says, and teachers often find ways to dramatize their dialogues.

Koch, Contento and Calabrese-Barton piloted the program in select schools and then evaluated its impact in ten classes at a single school. In 2009, together with research associate Heewon Lee, they followed up with a randomized, controlled study of the effectiveness of C3, conducted at five schools where the curriculum was taught and five that did not offer it. Involving 40 classes in all, the study measured self-reported changes in students’ knowledge, motivation and behavior.

“We looked at very targeted and specific behaviors that, taken together, would be enough to change kids’ energy balance,” Koch says. “Eating more fruits and vegetables, drinking fewer sweetened beverages and more water, eating packaged snacks less frequently and in smaller sizes, eating less frequently at fast food restaurants and choosing smaller sizes.” The study also measured changes in students’ “leisure screen time” and physical activity. “We particularly encouraged walking more and taking stairs whenever they could, because those were the things we felt they could have the most control over.”

The results of the study, published in the December 2010 issue of the Journal of the American Dietetic Association, were encouraging. Students in the schools where C3 was taught consumed significantly fewer sweetened beverages and packaged, processed snacks, cutting back on both frequency and portion sizes. They continued to dine at fast-food restaurants just as frequently, but ate substantially smaller sizes and ordered value or combo meals less often. Other reported behaviors proved more entrenched: for example, fruit, vegetable and water intake did not increase. But the students at the C3 schools said they chose the stairs more often and walked more frequently for exercise while spending less time watching TV and playing video games.

School districts across the country are now adapting C3 to meet their needs. In Jackson, Michigan, designating “a lead teacher” to champion C3 led to uptake of the curriculum for all 30 middle school classes. In Philadelphia, schools will incorporate C3 lessons throughout middle school.

Nevertheless, Contento warns that C3’s ultimate goal —improved eating and fitness behavior among students —will only happen if schools themselves practice what the curriculum preaches. She and Koch are beginning a new study, funded by the United States Department of Agriculture, designed to compare the impact of nutrition curricula along with that of instituting better food offerings and more frequent supervised exercise. Students will be weighed at the beginning and end of the study, and Koch and Contento will also calculate changes in Body Mass Index (weight corrected for height, which is a measure of obesity).

“We’ll really be able to see whether wellness policy can be an effective means of helping children eat better and maintain energy balance,” says Contento.

To help Contento and Koch develop their methodology for that study, most of the fifth graders who visited the Earth Friends Room from P.S. 161 this past fall agreed to be weighed and measured. Kathleen Porter gave another group pedometers and showed them how to measure the number of steps they take each day. A third group stirred the rice and vegetables. Then everyone sat down to lunch.


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