Foster Children's Health


Need for betterment of children's health

Childhood obesity is considered the leading public health epidemic by the Oregon Public Health Institute (1), with approximately 31.9% of U.S. children and adolescents ranking in the 85th percentile or higher for body mass index (BMI) (2). This prevalence of obesity in the school-age population is cause for concern since obesity has been linked to serious chronic health conditions such as cardiovascular disease, cancer, diabetes, and high blood pressure, among others (3, 4, 5). Furthermore, youth with high BMI are more likely than their normal-weight peers to continue to be overweight or obese as adults, further increasing their risk for chronic disease (6).

One of the American Medical Association’s (2007) primary recommended strategies for obesity prevention and control is to increase consumption of fruits and vegetables (7). This recommendation is supported by studies reporting higher vegetable intake being associated with lower body mass index in elementary school girls (8), and surveys of healthy-weight middle school students reporting higher fruit and vegetable intake than students with higher weights (9). Fruit and veggie intake is critical not only for reducing the incidence of childhood obesity, but also for addressing the dietary deficiency of more than 90% of children ages 4-13 who do not meet the MyPyramid recommendations for the fruit and vegetable food groups (10, 11).

Two of the greatest challenges in increasing fruit and vegetable consumption among children are increasing their preference for and access to them; school gardens can address both. According to Heim, Stang, and Ireland, "5 - 10 exposures are often required to increase acceptance and intake of new foods" (12, 13). This highlights the importance of repeated opportunities for trying new vegetables and fruits in order to increase consumption of them and positively influence eating patterns and health. Free, fresh produce straight out of the school garden, promoted by teachers and peers, that can be sampled several times as the crops become ready for harvest at different times, could be one of the most far-reaching and powerful tools we have to encourage kids to adopt a fresher, healthier diet.

Supporting Publications:

(1) Lessons from the field: "Kelly GROW." Oregon Public Health Institute.
(2) Ogden, C.L., Carroll, M.D., & Flegal, K.M. (2008). High body mass index for age among US children and adolescents, 2003-2006. Journal of the American Medical Association, 299, 2401-2405.
(3) Hung, H.C., et al. (2004). Fruit and vegetable intake and risk of major chronic disease. Journal of the National Cancer Institute, 96, 1577-1584.
(4) Roberts, C. K., & Barnard, R. J. (2005). Effects of exercise and diet on chronic disease. Journal of Applied Physiology, 98, 3-30.
(5) Van Duyn, M. A., & Pivonka, E. (2000). Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: Selected literature. Journal of the American Dietetic Association, 100, 1511-1521.
(6) Guo, S.S., & Chumlea, W.C. (1999). Tracking of body mass index in children in relation to overweight in adulthood. American Journal of Clinical Nutrition, 70(suppl), S145-S148.
(7) American Medical Association. (2007). Expert committee recommendations on the assessment, prevention, and treatment of child and adolescent overweight and obesity. Retrieved from 
(8) Cullen, K.W., et al. (2004). Anthropometric, parental, and psychosocial correlates of dietary intake of African-American girls. Obesity Research and Clinical Practice, 12(suppl), S20-S31.
(9) Roseman, M.G., Yeung, W.K., & Nickelsen, J. (2007). Examination of weight status and dietary behaviors of middle school students in Kentucky. Journal of the American Dietetic Association, 107, 1139-1145.
(10) Guenther, P.M.,et al. (2006). Most Americans eat much less than recommended amounts of fruits and vegetables. Journal of the American Dietetic Association, 106, 1371-1379
(11) Bazzano, L.A. (2006). The high cost of not consuming fruits and vegetables. Journal of the American Dietetic Association, 106, 1364-1368.
(12) Sullivan, S.A., & Birch, L.L. (1994). Infant dietary experience and acceptance of solid foods. Pediatrics, 93, 271-277.
(13) Sullivan, S.A., & Birch, L.L. (1990). Pass the sugar, pass the salt: Experience dictates preference. Developmental Psychology, 26, 546-551.

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The connection between children's health and schools

Poor nutrition, lack of physical activity, obesity, and other health issues may negatively impact a child’s behavior at school and their academic performance. Although being overweight is not the direct cause of low academic performance, it can lead to health-related absenteeism (14) since obesity is linked to type 2 diabetes, sleep apnea, asthma, joint problems, and depression and anxiety (15,16,17). Being overweight can also cause social problems such as teasing, bullying, loneliness, and low self-esteem, negatively affecting a child’s performance in school (15,18). Studies have shown strong associations between obesity and poor school behavior and low achievement. Very obese youth are four times more likely than youth at a healthy weight to experience difficulty in functioning at school (15). Overweight children are more likely to receive abnormal behavioral reports and are twice as likely to be placed in special education and remedial classes than their peers that are not overweight (19,20).

Children, obese or otherwise, that do not receive proper nutrition are not able to work to their fullest potential. Poor nutrition interferes with cognitive function, impairing academic achievement (21). Nutrient deficiencies, namely iron, are linked to limited attention span, diminished ability to concentrate, irritability, and fatigue (22). Produce provided by the school garden, made available in the cafeteria and/ or during garden lessons, can be an excellent source of nutrients to optimize students’ cognitive function.

Federal regulations also mandate that schools promote their students’ health and wellness. All schools that participate in the National School Lunch Program are required by the Child Nutrition Reauthorization Act of 2004 to create and implement a school wellness policy (23). School gardens are a great complement to or central focus of such a program to foster student wellness and knowledge of healthy lifestyle habits.

Supporting Publications:

(14) Action for Healthy Kids. (2004). The learning connection: The value of improving nutrition and physical activity in our schools. Retrieved from:
(15) National Institute for Health Care Management Foundation. (2004). Obesity in young children: Impact and intervention. Research Brief. 
(16) Must, A, et al. (1999). The disease burden associated with overweight and obesity. Journal of the American Medical Association, 282(16), 1523-1529.
(17) U.S. Department of Health and Human Services, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity (Rockville, Md.: 2001).
(18) I. Janssen and others, "Associations between Overweight and Obesity with Bullying Behaviors in School-Aged Children," Pediatrics 113, no. 5 (2004): 1187-94.
(19) Schwimmer, J.B., Burwinkle, T. M., & Varni, J. W. (2003). Health-related quality of life of severely obese children and adolescents. Journal of the American Medical Association, 289(14), 1813-1819.
(20) Tershakovec, A.M., Weller, S.C., & Gallagher, P.R. (1994). Obesity, school performance and behavior of black, urban elementary school children. International Journal of Obesity & Related Metabolic Disorders, 18(5), 323-327.
(21) Story, M., Kaphingst, K.M., & French, S. (2006). Role of schools in obesity prevention. The Future of Children, 16(1), 109-142. Retrieved from: 
(22) Parker, L. (1989). The relationship between nutrition and learning: A school employee's guide to information and action. (Washington: National Education Association).
(23) Ratcliffe, M.M., et al. (2011). The effects of school garden experiences on middle school-aged students' knowledge, attitudes, and behaviors associated with vegetable consumption. Health Promotion Practice, 12- 36.

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Research reporting gardens as effective tool in dietary improvement

Perhaps the most investigated effect of school gardens is the ability to positively change students’ knowledge, preference, identification, and consumption of fruits and vegetables. Studies by Ratcliffe, et al. (24) and Parmer, et al. (25) found considerable improvement in recognition of a variety of fruits and vegetables, while McAleese & Rankin (26) and Morris, Briggs, and Zidenberg-Cherr (27) indicated a general increased knowledge of fruits and vegetables. As compared with a classroom-based nutrition education program, garden-based nutrition education has shown more effective in increasing children’s knowledge of and preference for and vegetables (24,25,28,29,30,31) Saunders, et al. (32) claim “school gardens can impact positively on primary students’ willingness to taste vegetables and their vegetable taste ratings”, which increases the likelihood of consumption.

Several studies have also measured actual consumption increases of fruit and vegetables among students that participate in a garden-based curriculum. McAleese and Rankin’s (26) experiment measuring fruit and vegetable consumption in sixth grade students participating in a school garden program found that fruit consumption increased by an average of 1.13 servings per day, and vegetable consumption increased by 1.44 servings per day. Compared to the initial average of 1.93 servings of fruit and vegetable servings consumed per day, at the end of the experiment, the sixth graders averaged 4.50 servings a day, almost reaching the MyPyramid recommendation of 5 servings a day (26). McAleese and Rankin also measured significant increases in intake of vitamin A, vitamin C, and fiber (26). All of these studies highlight the importance of hands-on, experiential learning when attempting to change children’s and adolescents’ dietary behavior, and showcase school gardens as a proven, effective method of health intervention.

Supporting Publications:

(24) Ratcliffe, M. M., et al. (2011). The effects of school garden experiences on middle school-aged students' knowledge, attitudes, and behaviors associated with vegetable consumption. Health Promotion Practice, 12-36. 
(25) Parmer, S.M., et al. (2009). School gardens: An experiential learning approach for a nutrition education program to increase fruit and vegetable knowledge, preference, and consumption among second-grade students. Journal of Nutrition Education and Behavior, 41(3).
(26) McAleese, J.D. & Rankin, L.L. (2007). Garden-based nutrition education affects fruit and vegetable consumption in sixth grade adolescents. Journal of the American Dietetic Association, 107, 662-665.
(27) Morris, J., Briggs, M., & Zidenberg-Cherr, S. (2000). School-based gardens can teach kids healthier eating habits. California Agriculture, 54, 40-46. 
(28) Lineberger, S., & Zajicek, J. (2000). School gardens: Can a hands-on teaching tool affect students’ attitudes and behaviors regarding fruit and vegetables? HortTechnology10, 593-597.
(29) Morris, J., Neustadter, A., & Zidenberg-Cherr, S. (2001). First-graders gardeners more likely to taste vegetables. California Agriculture, 55, 43-46. 
(30) Graham, H., et al. (2005). Use of school gardens in academic instruction. Journal of Nutrition Education and Behavior, 37(3), 147-151.
(31) Morris, J., & Zidenberg, S. (2002). Garden-enhanced nutrition curriculum improves fourth-grade school children's knowledge of nutrition and preferences for some vegetables. Journal of the American Dietetic Association, 102(1), 91-93.
(32) Saunders, K., et al. (2010). Impact of school garden-enhanced nutrition education on primary students vegetable intake and preferences, knowledge, and quality of school life. Obesity Research and Clinical Practice, 4(1).

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Physical activity and other health benefits of school gardens

Increasing physical activity is another important method of mitigating childhood obesity and promoting healthy lifestyles in school-aged children. According to the National Association for Sport and Physical Education, only 8% of elementary schools fulfill the recommended 150 minutes of physical activity time per week, and only 6% of middle and high schools meet their recommended 225 minutes per week (33, 34). Gardening is a great complement to physical education to help children meet the recommended 60 minutes of daily physical activity (34). In addition to improving children’s health, physical activity during the school day has been shown to more than compensate for time not spent in other academic subjects (35) by enhancing cognitive performance, behavior in the classroom, and concentration scores in elementary school students (36).

School gardens can also significantly impact students’ mental and emotional health in a positive manner. The 2011 experiment by Van Den Berg and Custers was the first to provide evidence that gardening triggers relief of acute stress, decreasing cortisol and fully restoring positive mood (37). Gardening can also make students happier. A study from the journal Neuroscience found that contact with soil triggers the release of serotonin, boosting mood and decreasing anxiety, due to the beneficial soil bacterium Mycobacterium vaccae (38). This bacterium was also found to improve cognitive function (38), revealing yet another example of the connection between good health (in this case emotional) and superior academic performance. Even just sitting in the garden to work on assignments can improve mood and overall performance. A 2001 study by Kuo found that exposure to greenery and other plants increases productivity, reduces procrastination, and refreshes the ability to concentrate (39).

Supporting Publications:

(33) Burgeson, C.R., et al. (2001). Physical education and activity: Results from the school health policies and programs study 2000. Journal of School Health, 71(7), 279-293.
(34) DHHS and Department of Agriculture. (2005). National Association for Sport and Physical Education, Physical activity for children: A statement for guidelines children 5-12. Dietary Guidelines for Americans (2). 
(35) Taras, H. (2005). Physical activity and student performance at school. Journal of School Health,75(6), 214 - 218. 
(36) (2007). Physical education, physical activity, and academic performance. Active Living Research.
(37) Van Den Berg, A., & Custers, M.H.G. (2011). Gardening promotes neuroendocrine and affective restoration from stressJournal of Health Psychology, 16(1), 3-11.
(38) Lowry, C.A., et al. (2011). Identification of an immune-responsive mesolimbocortical serotonergic system: potential role in regulation of emotional behavior. Neuroscience146(2), 756-772.
(39) Kuo, F.E. (2001). Coping with poverty: Impacts of environment and attention in the inner city. Environment & Behavior, 33(1), 5-34.

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