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One in three children in the United States is overweight or obese. Significant numbers of those young people are grappling with health problems like heart disease, high blood pressure and diabetes.
Those conditions can be difficult for children to manage in any setting, but they can pose particular challenges for children during the school day.
Dr. Yolandra Hancock used to be an elementary school teacher, and it shows. She's patient, encouraging and has an endearing way of ending her sentences with "my love" and "my sweet."
Her patients include a 13-year-old who weighs 400 pounds; a child whose teeth are so rotted she can't bite into carrots; and many preteens who are diabetic. Today, Hancock is examining Derek Lyles, 13. He's 4 feet 11 inches and weighs 256 pounds.
"When we look at his body mass index, which is how well his weight and height balance out, his BMI today is 46.7," Hancock says. "For an adult male, we like to see a BMI of 30 or less."
Hancock is also troubled by dark patches of skin around Derek's neck.
"When little ones, especially around the back of the neck, have that sort of thick, almost velvety appearance to their neck, it means that their bodies are becoming less sensitive to insulin," she says.
Back-to-school checkups for patients like Derek mean lots of follow-up work for Hancock. Their belly fat pushes down on their bladders, so she'll have to write notes to principals, asking that her patients be allowed to go to the bathroom frequently. She must also draft requests to excuse children whose sleep apnea makes them appear drowsy in class, or whose joints hurt as they walk between classes.
Practical Challenges, For Kids And Schools
These accommodations also mean more work for schools, says Camille Wheeler, a nurse at Bell Multicultural High School in Washington, D.C.
"It's a lot. It really is," Wheeler says. "It takes a lot for the student, for the nurse, the parent and the school. Especially the school. Because the majority of the time the students are here, you know?"
Wheeler says it's not unusual for a child to arrive at school at 8 a.m. and depart at 6 p.m., depending on a family's aftercare arrangements.
"That's a large chunk of their time," she says.
On a recent afternoon, Wheeler is thumbing through stacks of paper, racing to process students' health information.
"I have a whole stack here of many, many health certificates, dental forms, health records," she says. "It's about well over 200 forms in here, and I'm getting them daily."
Many of the forms are related to obesity. Children with diabetes need midmorning snacks. Some are on special diets and some need medication. All this means time away from the classroom.
"It may not be in the forefront, like a broken bone for example, but it's there and it affects the students every day," says Shirley Schantz, nursing education director for the National Association of School Nurses.
Schantz says that nurses from across the country are increasingly calling her organization, asking for guidance on how to deal with childhood obesity in schools — even preschools.
"They see students that can't walk upstairs," she says. "They see students that are absent because they're overweight or obese, [who] don't want to go to physical education."
The physical aspects of living with obesity can be difficult enough for a child. But there's an emotional toll, as well. Bullying is a common problem for obese kids. Derek says other students often called him fat in middle school.
Taking A Toll On Learning
All these challenges can also affect learning. Dr. Hancock says there is evidence that children who are obese score less well on standardized tests and basic classroom tests.
"Some researchers believe that there may be something physiologically that's affecting the child's ability to learn," Bell says. "Others believe, because of self-esteem issues and bullying, it makes them less eager to attend school and participate in school activities."
Derek wants to lose weight so he can "walk fast like other kids." And he really wants to start playing football again this year.
"During training camp, I couldn't do most of the, like, exercise that other people was doing," Derek says. "I just couldn't do it."
For many obese children, even maintaining their weight when they're not in school is challenging. This summer, Derek could eat whenever he wanted, and the fridge was always stocked with food. At school, he says, he ate cereal or a muffin for breakfast. But over the summer, he often ate sausage and eggs. The pounds piled on.
Hancock hopes eating meals at school will help Derek get his weight under control. She embraces Derek as she says goodbye.
"All right, handsome, give me some hugs," Hancock says, embracing Derek. "I have faith you'll be able to make changes, because you've done this before."
As Hancock reminds her young patient, it's a brand new school year — an opportunity to start fresh.