Arkansas's got perhaps the skinniest governor and the fattest children in America. One wants to help the other — and their loss could be his gain. About 105 pounds ago, every Arkansan knows by now, Gov. Mike Huckabee got a diagnosis that turned his life around (and, some think, pointed him down a new political path). He learned he had adult-onset diabetes. On top of that, he had a bout with chest pains. With the help of Dr. Philip Kern and the Weight Loss Program at the University of Arkansas for Medical Sciences, Huckabee started to exercise and eat right, and the rest, like his girth, is history. Like reformed smokers who rail against cigarettes and wrongdoers who find Jesus, campaigner-par-excellence Huckabee stumbled on a new stump speech: Follow my lead, Arkansas. Lose weight, eat healthy, get moving and quit smoking. His cause caloric is earning him national media attention, from spots on National Public Radio to stories in USA Today. Time magazine and ABC News went so far this year as to declare him a "hero." In Arkansas he's mass communicating his message with two TV commercials airing on local networks. He's started the Healthy Arkansas Initiative, which so far is heavy on promotional materials prominently featuring the governor and light on substance. The health campaign, some speculate, could position Huckabee for national office, appointed or elected. No matter the secondary benefit to the governor's political future, health professionals are thrilled our high-(but no longer wide)-profile governor has taken up the cause to make a dent in the state's absymal health statistics — the most recent of which is that 38 percent of our school children are overweight or at risk of being so. Jean-Paul Francoeur, a member of the Governor's Council on Physical Fitness, likened Arkansas's health crisis to a train wreck waiting to happen. But now, he said, "We're putting on the brakes and skidding to a stop." Doctors and public health professionals had been working — with less fanfare — to apply the brakes long before Gov. Huckabee got on board. After seeing pediatric cases of so-called adult-onset diabetes — usually the result of years of dietary insult to insulin, which reduces blood sugar — skyrocket 800 percent from 1980 to 1995, Arkansas Children's Hospital decided to tackle the cause: obesity. It opened a clinic just for seriously overweight kids, and there ACH pediatricians are working with obese 2-year-olds, 12-year-olds who can't recover from hip injuries because of their weight, teens with sleep apnea and high blood pressure who tip the scales at 400 and 500 pounds. Against a backdrop of tobacco lawsuit settlement money rolling in at around $60 million a year, doctors and public health professionals — schooled in politics during the fight for how those dollars would be divvied up — began to lobby for legislation targeted specifically at children. Among their successes: A 2001 law to increase the amount of physical education and activity in public schools and, in 2003, Act 1220, the history-making, scale-shaking mandate to screen all public school children for their risk of obesity using the body mass index (BMI) screen. Getting less attention are smaller programs — like the Take 10 exercise and nutrition lessons being offered in the after-care programs of 10 Little Rock elementary schools. And parent-initiated drives that got schools to drop snack time in the early grades. And the Little Rockers Kids Marathon last year that got 800 children on their feet, running and walking. Pulaski Heights Middle School is sending its seventh- and eighth-graders to the gym an hour a month; at Forest Heights Middle School and others, kids work out to a 12-minute video at the close of every school day. Towns across Arkansas just divided up $750,000 in tobacco settlement money to build hiking and biking trails. The campus of the University of Arkansas for Medical Sciences bravely banned the ashtray. This fall, the Arkansas Center for Health Improvement mailed letters to the parents of 421,973 public school students informing them where their kids fell on the skinny-to-fat continuum. The screening revealed numbers so startling that ACHI Director Dr. Joe Thompson didn't believe them when they were first run and asked his staff to run the data again. What the numbers told him, he said to a grand rounds gathering at the state Health Department, was that "the epidemic of obesity is progressing more rapidly, and we are losing control." The reasons why are clear as a dinner bell: Fast food, cheap, ubiquitous and supersized. Streets too unsafe to allow unsupervised play and bike riding. Rules against backpacks that mean kids couldn't ride bikes to school even if they wanted to. Computer games, television, soft drink and candy machines everywhere you turn, including school. Our tendency to reward good behavior with bad food. While the Centers for Disease Control estimates that 15 percent of American children are "overweight," it's 21 percent in Arkansas. That's bad enough, but consider: "Overweight" is the highest category, describing children whose height-to-weight ratio falls in the index's 95th percentile or higher. These are the heaviest kids, and only their age keeps them from being called obese, a privilege that vanishes at age 18. So those kids whose BMI fell in the "at-risk for overweight" category — another 17 percent of Arkansas's children — are, frankly, overweight. Sixty percent are mostly of normal weight; another 2 percent of Arkansas students are underweight. The BMI letters suggest that parents whose children are at risk or are already overweight see a doctor. Doctors at UAMS and in private practice in Little Rock report that a small percentage of parents are bringing in the letters, but not as a primary reason for the visit. Being told their child is overweight doesn't go down well with some moms and dads, and the BMI screen has had its critics at the state Capitol from the start. While state Health Department nurses were lauded for doing a yeoman's job at training school nurses to administer the new test, there were glitches. At Central High School, the weigh-ins were not as private as procedure dictated — which might account for the fact that only half the kids showed up to be measured — and parents of embarrassed students complained. (One mother, however, told the Times that while her daughter came home from Central in tears the day of the screening, she was inspired to lose weight.) A mother of two who is also a teacher in the Little Rock School District said she was annoyed at the time and energy that went into a report that she said told her nothing she didn't know already. She said the schools ought to pitch the pizza and cookies from the lunchroom and concentrate on more important matters: "I've got kids in my class who can't see the board," she said. "It takes them six months to get the results of their vision tests." She believes the BMI report is "falling on deaf ears and was a waste of money." A mother in Beebe went to the Fox affiliate newscast and several newspapers to decry the BMI test. She said her 5-foot-2, 115-pound daughter began to cry when she opened the BMI report and saw she'd been categorized as at risk of being overweight. "She's got a Janet Jackson abs and Madonna arms," the mother told the Times. "She can't pinch an eighth of an inch. She was devastated." It is a small failing of the BMI screen it may not accurately discern fat from muscle; athletes and other muscular children may produce a height-to-weight ratio that puts them in an overweight category. But, as the ACHI letter to parents noted, the BMI is only a screen, not a diagnosis. The Beebe mother, who like others talked to the Times under the condition that her name be kept out of the paper, also criticized the BMI screening as a violation of her child's privacy rights under federal health privacy rules, since it is information shared with an outside agency without parental consent. (ACHI does not agree with that position.) She's told the principal of her daughter's school that he must have her consent before her daughter is summoned for her BMI screen again this fall, when all students are again supposed to be measured. (While Act 1220 requires districts to administer the screen, students may decline to take it, an ACHI decision that's not been well publicized.) There were administrative problems as well. Some schools declined to participate — in fact, none of the six high schools in the Pulaski County School District took part. There was no money to mail the BMI letters out until summer, when the American Diabetes Association stepped up to the plate. Schools are now receiving boxes of returned letters that never reached parents who've moved or gave inaccurate address information to the district. For good measure, this writer, as a mother whose child is not skin and bones, will throw in her own reaction to the BMI letter: No, it wasn't news. But it turned up the heat on her long-time frustration with the way schools throw food at kids. Why did her elementary school serve kids soda pop and candy on test days? Why on earth do the tickets to middle school athletic events double as coupons for an order of "biggie fries" with the purchase of a hamburger and a drink? Why would any school celebrate its ACTAAP test scores with a pizza party — after lunch? That reaction — mild fury — is what those who orchestrated the BMI screening are banking on. "If just one or two parents in every school district will get passionate," pediatrician and BMI advocate Dr. Gary Wheeler said, they could have "a huge influence on policy." Pressure from parents on schools to help them keep their kids healthy with better food and more opportunities for exercise should work far better than mandates from the district down. ACHI director Joe Thompson acknowledged his office had received a fair amount of negative reaction to the BMI screens, including a registered letter with $8 worth of stamps on it from a mother who said she believed children were being faulted when other factors were involved. "When are we going to do something about the vending machines in schools?" she asked. Act 1220 did halt soft drink sales in all elementary schools, making Arkansas a leader in what is becoming a trend nationally. But when is a school district like, for example, Forrest City's, going to give up $100,000 a year for 10 years by dropping its soda contract for junior and high schools? Only when they have to, and they don't yet. When the state is struggling to find money to improve on our subpar public education, schools are going to value their soda and candy machine contracts above nutrition. Act 1220 requires that schools now track and make public the value of the contracts. The last year the Little Rock School District looked at the contracts its schools had negotiated was 1999, when seven-year contracts were estimated to bring in $1.5 million in cash and gifts-in-kind to its schools. It called off negotiations on new contracts this fall, anticipating the state Board of Education might take the advice of the advisory panel formed under Act 1220 to restrict the sale and availability of soft drinks at school. Arlo Kahn is a family practice doctor at UAMS who is frustrated at the number of patients he sees with obesity-related diseases. "They've got high cholesterol, hypertension and diabetes, they're off to dialysis." He puts the cost of obesity-related diseases at $1.17 billion a year (about the same as tobacco) in health care and lost productivity. Kahn, who won a federal grant to explore ways to integrate nutrition education into the medical school curriculum, said the situation will be worse for the next generation of doctors. They'll be treating today's obese teens who'll need dialysis in their 30s. What's it going to take stop the train and back it up? Kahn says nothing less than cultural upheaval, from changes in federal policy to city planning to curricula that teach the youngest children about nutrition. If Great Britain can discuss taxing fast food chains to fund obesity programs and sports facilities, why can't the United States? Or require them to post the caloric content of their meals? Why not a tax on sugar-filled carbonated beverages to fund research? Or tax incentives to serve healthier foods? Cities could require bike lanes and sidewalks and real mass transit, make sure parks and sports facilities are safe. Schools can rethink things — make their buses park a block from school, incorporate exercise into the school day, post the calorie and sodium content of the day's cafeteria meal, use food labels to teach reading. "The whole culture has to shift," pediatrician Wheeler said. "We're very lucky that we have a governor and a [health department] director who care."
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