We are experiencing a startling epidemic of childhood obesity in Maine with 36 percent of kindergartners now overweight or obese. This unfortunate fact places Maine children among the most obese in the nation. Two-thirds of Maine adults are overweight or obese. Sixty percent of obese children already have at least one risk factor for current cardiovascular disease or diabetes.

This epidemic of obesity and its complications mean that for the first time in modern history our children may have a lower life expectancy than their parents. The major risk factors for this obesity epidemic are behavioral habits sewn throughout all of our population and culture such as poor nutrition and sedentary lifestyles. These high-risk behaviors are learned as children and reflect in part a lack of practical knowledge on the importance of healthy nutrition and physical activity lifestyle.

Children ages 5 to 18 years spend most of their time in school. It is logical, therefore, to develop scientific and practical policy for schools to be an environment for modeling and educating healthy behaviors as nutrition and physical activity. LD 796 is comprehensive school health legislation that would place Maine in the forefront of the states in responsibly addressing our frightening epidemic of childhood obesity. The bill has been developed by the State Commission to Study Public Health and by the Legislature’s Education and Cultural Affairs Committee to be sensitive to individual rights, to school health policy that does not have a heavy fiscal burden, and to the busy school day.

Commission members already have met with groups representing pediatricians, school nurses, nutritionists and school principals to work out amended language and

to achieve consensus.

The bill will direct the Department of Education to encourage nutritional education in public schools with outreach education to families; require calorie information on pre-packaged foods, adapt healthy standards and single-serving size limits for foods and beverages sold or distributed on school grounds during the school day, implement a pilot dairy vending machine program and implement the National Farm to School Program; re-establish a physical education consultant position within the Department of Education; and require schools to begin screening for body mass index (BMI) in 2007.

BMI is the easiest and best screening test for body overweight. It requires further evaluation by a health care provider to diagnose obesity. The BMI component of the Bill is critical for both public health and individual health reasons. If you don’t measure a problem in health you don’t know if you are fixing it or not. Health care provider records of height and weight do not assess the entire population of Maine children.

There is currently no ongoing statewide process to assess childhood obesity – whether it’s getting worse or better in each of our communities despite numerous new community and school programs addressing healthy lifestyles. School nurses already are encouraged to check height and weight, but they do not have access to methods to analyze the data at the state level. From my experience, they are begging for help with data analysis and reporting guidelines. School nurses are very interested in doing their part to help children and their parents suffering from the emotional and physical health problems of childhood obesity .

The key is to not stigmatize, to emphasize healthy weight and healthy lifestyles. There is a one-year planning and implementation phase to the BMI Assessment provision of the legislation. During this phase, the Department of Education shall work with the Bureau of Public Health and interested parties as parents, school nurses, and health care providers. The objectives of this careful planning phase will include adoption of rules and training for the measurements to be made accurately, sensitively, and confidentially, developing methods of analysis of grouped data by age, school district, and state; developing sensitive, positive parent reporting language; referring the student to the primary care provider for further medical evaluation and prevention; and providing link to growing local community physical activity and nutrition resources as the Healthy Maine Partnerships (healthymainewalks.org), Maine In Motion and Move and Improve.

Speaking of health care providers, we are doing our part to educate pediatricians and family physicians in the use of scientific, evidence-based guidelines on the prevention and medical evaluation and management of childhood obesity.

The Maine Chapter of the American Academy of Pediatrics along with the Maine Center for Public Health have been awarded grants this past year to develop the Maine Youth Overweight Collaborative. This collaborative works with 12 Maine pediatric and family practices to develop effective clinical guidelines for the evaluation, risk assessment, and prevention strategies to be shared with school nurses and other health care providers throughout Maine .

Stand up for our children and the future health of the Maine work force by writing your legislator to support LD 796.

Robert Holmberg M.D., MPH, is a pediatrician and a member of the Maine Commission to Study Public Health.