America is suffering from a nutrition crisis that is causing major decline in the health of the nation¡¯s children. Dependence on processed foods, corporate monopoly over the food industry, and government regulated-school lunches make food accessibility difficult for residents of low-income communities and poorly funded public schools. Past interventions, which have occurred mainly at the individual level, have proven ineffective. The CDC predicts that this generation of children will live shorter lives than their parents. New interventions focusing on the use of culinary arts as a tool for nutrition education are taking place at both school and community levels. These interventions are facilitated by parents, farmers, dieticians, and health organizations¡ªnot social workers. This article argues that social workers need to be at the forefront of the food advocacy movement in order to make changes to nutrition education curriculums, promote healthier cafeteria options, and alter the upward trend of childhood obesity and malnutrition in America.
The Center for Disease Control (CDC) (2008) predicts this generation of children will live shorter lives than their parents, largely due to complications related to poor nutrition. The CDC (2008) maintains that ¡°healthy eating and regular physical activity play a powerful role in preventing obesity and chronic diseases, including heart disease, cancer, and stroke¡ªthe three leading causes of death among adults aged eighteen years or older.¡± Powerful food lobbyists push policies through Congress that put the health of America¡¯s children at risk. For example, a recent bill passed by Congress said the tomato paste on pizza constitutes a vegetable serving on a school lunch tray (Nixon, 2011). To continue to receive funding for school meals, many school systems must follow this status quo way of feeding their students. Cafeteria funding regulations are so cumbersome, they often limit a school system¡¯s flexibility to serve nutritious foods that are sustainable, organic, or locally grown, and in turn introduce rigid feeding guidelines that promote and sustain poor nutrition education. When students receive processed school lunches that lack nutrient-dense foods and have been treated with chemicals and antibiotics, they can suffer from energy imbalance and increase their risk for cancer, heart disease, and obesity. Malnutrition can negatively affect overall health, cognitive development, and school performance. While childhood obesity has more than tripled in the past thirty years (CDC, 2008), physical health factors are not the only consequence. Children who are overweight or obese are more likely to experience social and psychological challenges such as bullying, decreased self-esteem, and depressive symptoms, while weight issues in adolescence have been linked to academic difficulties in high school and decreased college acceptance rates (Janssen, 2004).
Ann Cooper, Head of Nutrition for school districts in Berkeley, California, believes that ¡°school lunch is a social justice issue¡± (Cooper, 2007). The first part of this article will build on Cooper¡¯s claim by exploring the relevance of school nutrition to the field of social work, attempting to provide a window into what ¡°lunch time¡± is like for a child in the American public school system, and introducing information about lunchrooms at schools in France as a comparative model. The second part of this article will present and evaluate the social work components of existing school-centered ¡°Culinary Arts-Based Interventions,” and explore the role of the social worker in such interventions.
School Lunch in America
According to the CDC (2011), schools play a critical role in children¡¯s health by establishing a safe and supportive environment through policies and practices that support healthy behaviors. Examining several school lunch programs will provide a clear picture of the environment and behaviors U.S. schools are promoting. A social work intern at a large public elementary school in the Northwest Bronx observes the first grade cafeteria three days a week. Her observation reports describe an environment through which children are expected to eat in silence. Students are publicly disciplined by staff members via a megaphone as they are moved through an expedited procedure that involves standing in lines and sitting on crowded picnicstyle benches. The staff also enforces that children wear winter coats while they eat during winter months, in preparation for recess. First grade students in this cafeteria do not have access to drinking water, as staff members have defined the water fountains as off-limits. Enforcing a silent lunch period, crowding children onto benches, and creating an environment where children feel rushed and are not relaxed, directly contradicts the CDC¡¯s 2011School Health Guidelines (p.18). From an anti-oppressive perspective, the lunchroom experience described fosters a powerstruggle between students and staff. Forced to be submissive, speechless, and obedient, student socialization is not possible and the environment becomes cyclical: students recognize the familiarly oppressive situation as they enter the lunch room, which may cause them to feel powerless, which may increase tension and desire to fight back against oppression (Freire, 2000). Then students move to the playground, where they express their powerlessness through bullying, inappropriate language, and attentionseeking behaviors such as enuresis and tears. It is important to note that this observation focused on one environment and was perceived through an individual lens; Additional research provides a wide variety of sources detailing similarly limited lunch options, oppressive eating environments, and efforts for change.
The Lunch Tray is a blog created by a mother concerned about her children¡¯s exposure to unhealthy foods in the Houston, Texas public school system. A member of the Houston School District¡¯s Food Services Parent Advisory Committee and her district¡¯s School Health Advisory Council, Bettina Siegel posts news about school food reform efforts, snapshots of what¡¯s going on in lunch rooms in her district (whichinclude photos and observation reports), food advocacy information, advice for parents creating bagged lunches, and news about lunch rooms all over the country. Her blog lists one week¡¯s menu for children in her district that includes: beef taco nachos, chicken fried steak with cream gravy, breaded chicken sandwiches, and pepperoni pizza. Siegel (2011) explains that school districts are able to manipulate these meals to meet nutrition guidelines by making them ¡°less bad¡±; for example, by providing baked instead of fried tortilla chips, using reduced fat cheese in nachos, and reducing portion sizes. Students are not made aware of these modifications, and do not know the difference between the beef taco nachos they receive at school and the ones they may purchase from a fast food restaurant. This leads to the deeper issue: What messages are these schools promoting? Siegel believes ¡°our schools are implicitly telling kids that it¡¯s perfectly OK to eat these sorts of ¡®carnival foods¡¯ every single day¡ªeven in an era in which one in three children are already overweight or obese¡ªand many of our students are doing just that.¡±
The documentary-turned-food movement Two Angry Moms (2007) began similarly when two mothers noticed room for change within their children¡¯s school lunchrooms. Amy Kalafa and Susan Rubin set out on a quest to learn how parents can get involved in changing school food. They partnered with chefs and school district leaders to create change. Their documentary details successes in one school district in Westchester, New York. The documentary aims to ¡°get moms angry¡± and to raise awareness to start conversations about school food and opportunities for change (Kalafa, 2007).
The struggles and successes of activists like these confirm the need for interventions in the area of school food reform. The type of environment in which students eat lunch and the food they consume can affect their physical, psychological, and social development. This is an issue that social workers should be at the forefront of, not only because access to nutritious food is a social justice issue, but also because one of the main motivations of social workers working with children is promoting healthy child development. Despite these goals, social workers are largely absent from these interventions, perhaps because food advocacy has not yet been incorporated into social work education curriculums. Instead of social workers, parents (mostly mothers), farmers, local district leaders, and independent organizations are advocating for change. One organization working toward change is Revolution Foods in San Francisco, California. Information provided on their website (2011) explains schools participating in Revolution Food¡¯s school lunch program have reported ¡°noticeable improvements in their students including higher attention levels in class, fewer disciplinary problems and an increased interest in healthy eating,¡± as well as improved academic performance. Revolution Foods programs include nutrition education, healthy meals, lesson plans that extend to teachers and families, and cooking demonstrations.
School Lunch in France
To gain information about a broad range of programs, it is useful to examine how other countries administer school lunch. The following descriptions of school lunchtime in France are presented not with the conclusion that France is doing it right, rather, that the comparative model illustrates different ways of doing things. Alternative models, such as this one, may inspire opportunities to learn. Research shows that U.S. schools use food as ¡°a product that has to be sold in quantity and quickly¡± and children have twenty minutes to eat from disposable tableware. French schools view food as part of the curriculum. They take time to create a ¡°civilized¡± atmosphere through which students socialize and enjoy their food, and in which food is used as a learning opportunity (I. Earner, personal communication, November 22, 2011). In French schools, the cafeteria is set up like a dining room. Children sit at tables with tablecloths, real napkins, silverware, and dishes. ¡°There is a whole process around food which is not only the eating of food but the role of food in your social life,¡± explains Ilze Earner, a professor at the Silberman School of Social Work at Hunter College. Earner has family connections in France and is passionate about the idea of using culinary arts as therapeutic exercise. She believes ¡°French lunch rooms create a very different atmosphere and relationship,¡± which makes children ¡°calmer, more polite, and reduces anxiety.¡±
Magazine articles and blogs echo Earner¡¯s reflections. In her TIME Magazine article ¡°School lunches in France: Nursery-School Gourmets¡± (2010), Vivian Walt details her three year- old son¡¯s lunchtime curriculum: ¡°no single meal is repeated over the thirty-two school days in the period, every meal includes an hors d¡¯oeuvre, salad, main course, cheese plate and dessert.¡± Students are encouraged to ¡°sit down and take [their] time.¡± Lunch menus are provided to parents months in advance (Walt, p. 1, 2010).
Cookbook author Deborah Madison of Culinate.com is a food advocate and member of the International Exchange Forum on Children, Obesity, Food Choice, and the Environment in France¡¯s Loire Valley. In her report about the Forum¡¯s visit to lunchrooms in the region, she observed food was healthy and ¡°delicious.¡± Children ¡°weren¡¯t rushed¡±, students were given about two hours for lunch and recess, ¡°food was served on heated plates¡±, and lunchroom aids were ¡°lunch moms who were there simply there to be helpful¡± (Madison, p. 1, 2007).
The lunch descriptions from these various sources describe that in French schools, the emphasis is placed upon being respectful as well as culturally competent. Students recognize the foods they are given and are encouraged to try new and different flavors. In contrast, observation reports from the Bronx public school lunchroom noted many of the children do not eat food on their trays because they do not know what it is¡ªchildren have frowned or cried and made comments such as ¡°How do I eat this?¡± In a Hispanic neighborhood where children most often eat Latin-inspired cuisine, canned green beans and mozzarella sticks with ketchup are not a culturally informed menu option. Madison writes on her blog: ¡°Who gets to have these [healthy, delicious French] meals? All kids [in the French school], regardless of their parents¡¯ incomes.¡± What does the French system tell its children about their selfworth? Madison believes the message is ¡°We care about and love our children. They are us, after all, and we want them to eat well and be nourished¡± (Madison, p. 1, 2007). Might an American child wonder, ¡°The people who supposedly care about me are feeding me unhealthy foods that are rapidly, unpleasantly and inconsiderately presented. Do they really care about me?¡± Consider the budgetary allotment for each lunch program: According to the New York Coalition for Healthy School Food (2012), the U.S. spends 90 cents on each child¡¯s school lunch; France spends 7 euros, which equals approximately $9.50 (Cook, 2010).
Culinary Arts-Based Interventions
As food-related health issues rise within American Society, social workers must look toward foodrelated solutions. For the purposes of this article, the term ¡°culinary arts-based intervention¡± refers to supplemental programs social workers may use to promote and teach healthy eating through the lens of National Association of Social Workers (NASW) values and practices. Culinary arts-based interventions hold potential for nutrition education; skill and community building; healing within social groups and classrooms; therapeutic healing through increased focus and opportunity for creative expression; and overcoming oppressive barriers through interactive education. Children are a vulnerable population, and when empowered through the education system to provide concrete services for themselves¡ªsuch as preparing a meal¡ªthey can develop the skills and confidence that lower their risk of growing into vulnerable, at-risk adolescents. Each subsequent generation in American society is becoming increasingly distant from the source of its food. With education, children can be introduced to where food comes from, be provided with proper nourishment, and develop tools necessary to function in a society that purports living a healthy life is not a public right. Access to healthy foods should be a public right. Because it is not, social workers need to be at the forefront of the food movement fighting against this injustice. For example, social workers should be aware of the cultural incompetence promoted by American federal nutrition guidelines; specifically, studies have shown that a digestive condition called lactase nonpersistence, the loss of enzymes that digest the milk sugar lactose, is an issue for the majority of African-, Asian-, Hispanic-, and Native-American individuals (Bertron, 1999). Still, American food guidelines recommend diets include a dairy portion, and many schools continue to honor long-standing contracts with milk vendors.
Awareness of childhood and adolescent obesity crisis has increased efforts made at the individual and family level to combat food-related health issues. Obesity rates have been rising, and a new approach is beginning to form: community organizing against obesity. The interventions discussed in this paper acknowledge the role community and society plays in shaping childhood eating habits, and they are taking place at both school and community levels. It is important to note that social workers are not involved in many of these programs.
CookShop Classroom is a federally funded nutrition education and cooking program administered by the Food Bank of New York and facilitated by classroom teachers. Participating schools are provided a six-month curriculum, which includes eighteen lesson plans through which children use their five senses to grow plants, prepare, taste, and discuss healthy recipes. CookShop lessons may offer therapeutic benefits such as increased social health, increased interest in healthy foods, and overcoming oppression and self-confidence issues through interactive education; however, the secondary focus of this health education program is not psychosocial health, but academic improvement. Through using measurements, new vocabulary, and gathering scientific information, students may increase their academic performance (CookShop Classroom Curriculum, 2011). There is great potential for social workers to be a part of this intervention. By introducing guided discussions and cultural information into the curriculum, students could learn about each other¡¯s family traditions, be given information about the obesity crisis and come up with their own ways to address the problem, or learn about U.S. food policy and advocacy. Age-appropriate lessons could be conducted by school social workers to supplement these CookShop courses and to empower students to bring what they learn to their communities.
Another school-based intervention program is Nicci Cagan¡¯s From The Ground Up. Three years ago, Nicci Cagan was a ¡°lonely mom¡± living in Ulster County, NY, looking for a way to get involved in her son¡¯s school (N. Cagan, personal communication, November 20, 2011). Cagan noticed the lunch options at her son¡¯s school did not use local or organic ingredients. She decided to do something about it. Cagan offered to start a garden at the public elementary school with the Parent Teacher Association. ¡°My organization started out as a group of parents working together to make positive change,¡± Cagan explained. With only $250 and forty volunteers, From The Ground Up was born. ¡°We live in such an isolated world. Gardening brings you into the community and having your hands in the earth is healing¡± (N. Cagan, personal communication, November 20, 2011). Cagan went on to create a garden at her daughter¡¯s preschool, and within months, gardens were popping up everywhere. From the Ground Up advocates for farm-based education, and partners with other organizations like the Slow Food Movement, The Farm-Based Education Association and Chefs Consortium to bring cooking to classrooms. The organization received a local economies grant last year to put 30 percent local food into school cafeterias. They run food testing in classrooms every Tuesday across public schools in Ulster County, and host a Junior Iron Chef competition. Cagan is not a social worker, but what she is doing is social work. ¡°If a child comes to me and says ¡®I¡¯m so angry!¡¯ I¡¯ll say, ¡®come and pound this salt with me.¡¯ Kids need an outlet to express their feelings, and cooking can be that outlet. Having ownership over your own body is a powerful thing¡± (N. Cagan, personal communication, November 20, 2011). From The Ground Up is another example of a program where social workers could get involved running groups, individual sessions with children, and advocating for social justice at a community level by reforming school food.
A 2003 article in Reclaiming Children & Youth details a school centered culinary arts-based program geared toward community outreach. The Wallace Academy Community Kitchen in Nashville, Tennessee, was established with a dual mission: to offer job training for troubled teens and to provide food for low-income community members in Nashville (Long, 2003). In the first year the program distributed 10,271 meals to 16 community agencies. Centerstone Community Mental Health, the nation¡¯s largest not-for-profit provider of community-based behavioral healthcare, administers the program. It is run by chefs and teachers who promote values like trust, creativity, creation, experiential learning, independence, and self-confidence in the kitchen. This program¡¯s emphasis on community engagement as part of the therapeutic process makes it unique. ¡°The very idea of being directly involved with helping people is a thrill to our students¡.It teaches them community responsibility, as well as increases their empathy for others,¡± said Len Mitchell (2003), co-author of the article and program manager of culinary operations for Centerstone Community Mental Health. Although Centerstone is an organization that employs many social workers, chefs and classroom teachers are the facilitators in this Nashville Community Kitchen.
CookShop, From The Ground Up, and Wallace Academy Community Kitchen operate in schools, yet there are also efforts to infuse culinary artsbased interventions with school-aged children in other environments as well. One example of this is Cooking Up Fun!, an integrated nutrition and youth development program designed by Cornell University¡¯s Division of Nutritional Sciences to help kids ages nine to fourteen acquire independent food skills (Thonney, 2011). Their website provides kid-tested lesson plans and resources for adults to start their own youth cooking clubs and facilitate culinary interventions in their setting of choice: school, after-school program, home, religious or community institution. The program promotes experiential learning by introducing adults as facilitators rather than educators. They challenge youth and engage them through decision-making practices to create their own learning process (Thonney, 2011). Unlike Cookshop, the goal of this program is not academically oriented. Rather, Cooking Up Fun! recognizes an opportunity for intellectual, psychological, emotional, and social development within the framework of a culinary intervention. Some of their student growth goals are to foster connectedness, a sense of social place, ability to navigate in multiple cultural contexts, commitment to civic engagement, conflict resolution skills, coherent and positive personal and social identity, decision-making and coping skills, and the motivation to achieve (Thonney, 2011). One program dietician said her workshops have inspired youth to develop goal-setting strategies, creative thinking skills, and self-efficacy (P. Redihan, personal communication, December 8, 2011). The lesson plans provided by Cooking Up Fun! could be used by social workers to supplement their group work practice particularly in after-school programs and community-based organizations, and in community organizing efforts by providing parents and teachers with the tools to facilitate similar interventions in order to prevent and overcome food-related issues such as diabetes, obesity, bullying, depression, and eating disorders in their communities.
The Role of Community Practice in Treating Obesity
A 2010 Health and Social Work article on the role of social workers in the obesity epidemic identified the need for social workers to shift focus from prevention and treatment at the micro level to a more macro level and include school and community-centered practices. Current youth obesity interventions focus mainly on the activity level and caloric intake of the individual (Lawrence, 2010). School systems put the onus on parents of overweight children by mailing home letters to inform them that their child is obese, ¡°rather than taking on the responsibility at the school level¡± (Lawrence, 2010, p.150). Programs identified in this article illustrate change happening at the grassroots level to address food-related problems with food-related solutions within a community context. According to Earner, ¡°Culinary arts-based interventions can build bridges between institutions¡ªschool and family, community and farm. Health is not something somebody can give you. You have to create it; you have to own it¡± (I. Earner, personal communication, November 22, 2011).
This is where culinary art and social work meet: at the point of creation. Acknowledging that America¡¯s childhood obesity epidemic is a collective crisis requires social workers to work toward overcoming oppressive barriers while creating new opportunities; Social workers can then facilitate personal and community efforts to create new individual and collective narratives around owning our health, our bodies, and our lives. This creates change at both individual and community levels. There are many points of entry for social work engagement in this area, a few of which have been suggested in this article. For example, social workers can incorporate new culinary arts-based interventions into school and community programs; Additionally, social workers can take on clinical roles within existing interventions in order to address psychosocialissues around eating and access to food. The CDC¡¯s ¡°Guidelines to Promote Healthy Eating and Physical Activity¡± (2011) suggests providing students with mental health services to address healthy eating can be beneficial. Professional development opportunities for health education and nutrition services, as well as partnering with families and community members in the development and implementation of healthy eating programs are just some of the solutions named. The CDC recommendations are relevant to social work because social workers are trained to address the client within context, the person-inenvironment, and in developing treatment plans for childhood obesity-related cases, it is essential to consider environmental context. Similarly, there is great potential for social workers in schools and community-based organizations to intervene in creative ways with the goal of reducing obesity while educating and nourishing a generation of children.
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About the Author
Meredith Marin holds a BA in Philosophy from NYU and is a first year Clinical Practice student at the Silberman School of Social Work at Hunter College. She interns with the Department of Education at a public elementary school in the Bronx, where she provides individual and group counseling for at-risk students and facilitates a 6th grade leadership development group. Meredith volunteers with Motivating Action through Community Health Outreach (MAChO), an organization addressing childhood obesity prevention and intervention in low-income communities.Meredith can be reached at firstname.lastname@example.org.