In recent years, obesity has seized the attention of the medical field and the media. Now our schools are starting to recognize the impact of obesity on mental health. The United States is known internationally for its larger plate sizes, big portions and supersized meals in restaurants. However, we are also witnessing the beginnings of a cultural shift that encourages body acceptance and pushing back from an ideal body type.
At the same time, it may also seem that our society has become obsessed with healthier food options. But do we really understand nutrition? When we see terms and phrases in grocery stores such as organic, humane, low carb, high protein, non-GMO, no artificial coloring/preservatives and natural, it can be overwhelming. Some of these terms can be misleading or confusing. Our society is overmarketed with food slang and undereducated on what food labels mean to nutrition.
School and mental health counselors should be asking themselves how physical health and body acceptance intersect with weight, body mass index (BMI) and mental health. What if a person is deemed to be at an unhealthy body weight but is genuinely OK with his or her body? Conversely, what if this person is not happy with his or her body yet is considered healthy? When it comes to these body issues in children, at what point do school counselors intervene? How do we begin to support childhood social and emotional concerns surrounding nutrition without shining a light on those children who might be in a fragile stage related to their body awareness and image? How do we teach families and school employees to use language that promotes positive body image?
Although most medical journals openly discuss pediatric obesity as a major public health concern, they continually fail to address how to effectively combat such issues. The same statement applies with counselors. We know that childhood weight is a concern, but are we doing enough within our schools? Brain studies show that nutrition plays a role in learning, concentration and mental health in general, so why is it so hard for us to connect the dots?
Let’s explore the disconnect between childhood obesity, nutrition and mental health, and how we, as counselors, can support child nutrition in school settings. Can making the connection between nutrition and social-emotional needs move counselors to collaborate more effectively with other professionals? Counselors should care about what we are feeding our youth during school hours because it impacts our profession directly.
There also needs to be an awareness among parents and caregivers that nutrition is important not only in the school but at home. One of the issues that school counselors face is that not all parents and caregivers are supportive. Even if they are supportive, they may not possess the means to buy healthier food for the home or to prepare meals consistently. Preparation takes time, and not all families have that time to devote. Socioeconomic status, family makeup and genetic issues can also contribute to childhood weight and nutrition levels. For instance, there may be a lack of food in the house because the family cannot afford it, or there may be foods that are high in unhealthy fats and sugar.
Education is key to awareness, but this is difficult when we as counselors are not advocating for changes in school nutrition. We need to educate ourselves and make a connection in our profession between nutrition and mental health.
What we know
Childhood obesity is not a new concern in the United States. Many articles have been published on the health concerns of children who are overweight or obese. Michelle Obama’s “Let’s Move!” campaign brought national attention to the issue. During an open discussion this past spring, the former first lady said, “You have to stop and think, why don’t you want our kids to have good food at school?” During her time as first lady, Obama also hosted the School Counselor of the Year national recognition ceremony at the White House. This begs the question: Why have counselors, and, specifically, professional school counselors, not taken action on this issue?
Unfortunately, if the first lady struggled to implement this agenda, it stands to reason that it might be equally difficult for school counselors to get a foot in the door. Because of the disconnect between counseling and nutrition, it might even seem odd to some people that school counselors should get involved at all. As mentioned earlier, however, there is actually a deep connection between the two. Researchers have shown that poor diet not only leads to physical health problems but also affects brain functioning. Brain studies have shown that what people eat affects not only the social-emotional realm but also academic performance.
In March 2017, Laurie Meyers wrote a cover story for Counseling Today titled “When brain meets body” that discussed the connection between physical and mental health. More specifically, it delved into how thoughts can cause changes in the regulation of cortisol, which can then affect our clients’ physical health. This physical heath-mental health connection is emphasized in the mental health community but not as often in the school community and hardly at all in the medical community.
Why this research matters to us
The World Health Organization’s obesity map shows that as a whole, more than 30 percent of the U.S. population is obese. The Centers for Disease Control and Prevention (CDC) reported that 35 percent or more of adults in Mississippi, Alabama, West Virginia, Louisiana and Arkansas were obese. The CDC also noted that there was no state in the country with an obesity percentage of less than 20 percent among adults.
Mississippi tends consistently to be near the top of the charts for adult and childhood obesity, which is what sparked our interest in pursuing research in this area (both authors are from Mississippi). One question we asked is why a state such as Mississippi, which is rich in farmland and has an abundance of crops and fresh produce, has a prevalence of obese children. Our state should have abundant nutritional food available for families, including for those of low socioeconomic status. Lack of education and what people can afford likely have some connection to obesity rates in Mississippi. Statistics show that education and salary levels are highest in those states with lower obesity percentages. Mississippi ranks last in education statistics among the 50 states.
Healthy food consumption should not be dependent on social status. It should be affordable to all. However, many foods that are healthy and easy to prepare are also the most expensive. According to the website TalkPoverty.org, 20.8 percent of people in Mississippi live below the poverty line. Schools in this state, and in many of the other states identified as “obese and overweight,” may not be able to afford these healthier options in bulk.
This raises other questions. What can we do differently to secure healthier food access in our schools for reasonable prices? How do we partner with local farmers to provide more nutritious foods or to demand that our schools contract with better food providers? Healthy breakfasts, lunches and snacks during educational hours should not be contingent on whether a child has a homemade lunch or went through the cafeteria line.
The connection for Robika
Working as a school counselor in rural Mississippi, I noticed that a disconnect existed between the medical field’s information on physical health and the knowledge of mental health within the schools. I saw many children who would likely be classified as overweight or obese, and I saw a lot of students who were unhappy about their weight. I often consulted with the school nutritionist and nurse in these instances. With these particular students, I also noticed the prevalence of several issues that extended beyond academics to socioemotional problems, including bullying, self-esteem issues and anxiety. This observation sparked my curiosity about the possible connection among these different variables.
I wrote my dissertation about the connection between childhood obesity and personal, social and academic issues. Although I didn’t find a statistically significant connection (probably because of limitations in research), I did identify individual connections in my sample between self-esteem and interpersonal relationship satisfaction. This led my wanting to know more and wanting to continue this research and advocacy within the schools.
The problem was — and continues to be — that obesity is a difficult topic for schools to address. Obesity is a buzzword that is sometimes considered offensive. It was difficult getting parents and caregivers to agree to let me weigh their children.
As Rachael and I began collaborating on this topic, questions started forming: Why are school counselors not more involved? BMI doesn’t provide a fair reading of weight for different ethnicities, so why are we using it to define weight? What other way can we measure weight to incorporate multicultural, nutritional and genetic considerations? How can we fill in this gap among the medical, school nutrition and mental health worlds? Would school counselors be comfortable talking about this topic?
These questions continue to drive us as we move into more detailed research and advocate for school counselors and for our students.
The connection for Rachael
During my doctoral research classes, a professor said to me, “Rachael, bring in any research that sparks curiosity.” This simple statement opened a wormhole of personal curiosity, followed by fear and then drastic dietary changes. Becoming a good consumer of research resulted in me experiencing emotional ups and downs, especially when I decided to read more about Food and Drug Administration food protocol, particularly around animal products.
This launched my personal pursuit of knowledge surrounding nutrition. However, the real lightbulb moment took place when a direct correlation was drawn between some of my food intake and my autoimmune disease that I had been medicating for years. It was also around this time that Robika asked me to help collect data for her dissertation. Her research lit a fire in me to implore my friends, family members and students to care more about what they were putting into their bodies. Now, as the research advances, Robika and I hope that we can support counselors in K-12 settings in getting involved in school food purchases and menu planning.
What we can do about the knowledge gap
A lack of information exists concerning how school counselors can promote wellness and nutrition in terms of social and emotional health. Researchers for HealthCorps, an advocacy group that incorporates wellness education into schools, based their study on three domains: nutrition, physical activity and mental health. However, the term mental health was a misnomer because it did not encompass all aspects of mental health. Instead, it was essentially defined as mental resilience. In addition, no counselor was included on the study’s development team, which consisted of dietitians, nutritionists, integrative human physiologists and other health care professionals.
Through our own research, we believe that we are on the path to helping school counselors promote wellness, healthy weight and mental health through prevention and intervention methods with students and their families and within the school itself. Our long-term goal is to make connections between the brain, childhood weight and mental health, and then to use this information to help school counselors collaborate with school nutritionists and communities to create better lifestyle choices and, in turn, promote socioemotional wellness. We decided that we needed to start with school counselors themselves to get a better understanding of how comfortable they are talking about these issues, and especially childhood obesity. Again, the word obesity brings up a number of issues for many people.
We have received really wonderful feedback when presenting on this topic. Not a lot of counseling research has been done in this area. As a result, we have found that many counseling professionals are very interested and agree that it needs to be researched more thoroughly. Unfortunately, presenting this line of research to the schools has been difficult. Parents tend to keep their children from participating in research related to obesity and nutrition, and school boards, faculty members and school staff often have a difficult time with it too. Realizing that school counselors may not feel comfortable using the term childhood obesity, we have since changed this term to childhood weight. In this case, we can also talk about the opposite spectrum of obesity, which includes disorders such as anorexia nervosa and bulimia.
Another aspect of what we are attempting to do is to place these terms within the context of ethnicity, age and gender. In our initial research, we measured BMI because this was the only option for calculating obesity. However, we know that some ethnicities may be more susceptible to qualifying as overweight or obese even though they are of normal or healthy weight. Another example is that athletes who are larger and more muscular are not necessarily overweight or obese, but their muscle mass may tip the scales toward them being classified as overweight.
As counselors, we have to be aware of the demographics of our communities. This is not a new concept of course, but we can start making little ripples to address a larger problem, especially in the schools. In some towns, nutritious foods are not available or affordable. High-calorie, high-fat foods are more readily available and come at lower prices. Once the cycle of eating high-calorie foods begins, it can be difficult to change it. Children who are taught about nutritious foods may mention this to their parents, but the parents may ignore the request because they cannot afford these foods or because the foods do not sound appetizing. Other parents may work multiple jobs and not have time to make meals for their families. Some families have to rely on their older children to make dinners.
Home life aside, however, schools need to work to have healthy options. Some schools will present the choice between a baked meal and a fried meal. Many students will opt for the fried meal. Although choices are important, we propose that children be presented with more healthy options. Countries around the world have lunches made from scratch that include vegetables, seafood, whole wheat breads, fruits (rather than sugary syrup) and nonprocessed meats and cheeses.
Children should also be educated about their food. This empowers them to make healthy choices based on their own knowledge. They can even be involved in planting vegetable gardens at school or preparing meals at home.
However, there seems to be no connection or collaboration between the different fields of research, even though there are several areas of knowledge that intersect.
We believe there are ways that these three knowledge bases can work together and help each other. The image on page 52 [of the print version of this article, bit.ly/1mVkdXK ] shows our proposed Integrative Collaboration Childhood Weight Model, which is where our research will go next. We want to bridge the gap and highlight what the features of each area are, as well as bring them together to create a richer research model.
Our hope is to first understand school counselors’ comfort level when discussing the issue of childhood weight. We also want an idea of their understanding of the connection between childhood weight and socioemotional and academic issues. We need to know what kinds of community, caregiver and school support school counselors receive. Do they already collaborate with the other faculty and staff in the school? If so, is this on a regular basis?
Future goals include creating prevention and intervention methods and materials that will address nutrition and socioemotional wellness in conjunction with other staff in the school district. Working as a team is more likely to result in better overall outcomes. Healthier children can mean healthier adults. So, let’s be willing to talk about the connection between food and mental health.
Potential interventions, prevention methods
Given that not a lot of research has been conducted in this area, school counselors are somewhat at a loss for potential interventions for childhood obesity. Children who are overweight or obese may come to the school counselor for issues such as self-esteem, a lack of confidence or bullying (either being the target of bullying or engaging in bullying themselves). However, we cannot assume that their weight is the reason for these issues unless the child mentions it as a cause. School counselors cannot target children who are overweight or obese for individual counseling.
Although interventions can be put into place by the school counselor for the specific issues mentioned (self-esteem, confidence, bullying), we believe that prevention methods may have the most impact for all children when it comes to childhood weight. Classroom guidance lessons focused on nutrition, wellness and self-care can be part of the comprehensive school counseling program. We also want to again emphasize the potential impact of collaborating with other school staff such as school nurses, school nutritionists and physical education teachers. Providing wellness interventions for both physical wellness and mental wellness is also likely to have a greater impact on students. Teaching these methods of self-care not only helps the whole child but also gives students the tools to continue healthy living and wellness practices across the life span.
An activity that might serve a dual purpose is horticulture therapy, in which children create sustainable gardens while also working with the earth as a form of healing. Children can learn how to grow vegetables and fruits and better understand their nutritional value even as they also grow their personal and social skills. Some children may even want to grow their own gardens at home.
Parent/caregiver involvement has been shown time and time again to be related to the success of the child. School counselors and nutritionists could present workshops for parents and caregivers focused on how they can make nutritious meals for their kids and even with their kids. Information on meals and snacks that are inexpensive but also better for the family can also be shared. Teaching parents about the value of nutrition and mental health should also be emphasized. Another area of emphasis might be teaching parents and caregivers how to engage in positive body language. Parents and caregivers are models for their children, and if they speak negatively about their bodies, then their children are likely to copy that negative self-talk.
Knowledge Share articles are developed from sessions presented at American Counseling Association conferences
Robika Modak Mylroie is a distance clinical professor in the Department of Counseling and Special Populations at Lamar University. Her experience consists of working in the clinical setting before becoming a school counselor. Her current research includes childhood weight, trauma and animal-assisted therapy. Contact her at firstname.lastname@example.org.
Rachael Ammons Whitaker is the program director for the clinical mental health and school counseling programs at the University of Houston. She worked as a behavioral therapist, behavioral interventionist supervisor and school counselor before pursuing counselor education at the university level. Her current research includes understanding and advocating for intersex children and the impact of childhood weight. Contact her at email@example.com.
Letters to the editor: firstname.lastname@example.org
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.