The Q&A: Steven Kelder

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Steven Kelder, the co-director of the Michael & Susan Dell Center for Healthy Living at the University of Texas School of Public Health, has more than 20 years of experience in the design and evaluation of child and adolescent research, particularly in interventions directed toward youth, schools and parents. Kelder is one of the investigators for CATCH, a research-based program that guides schools, families and children in the process of being healthy, reaching more than one million Texas children.

Editor's note: This interview has been edited for length and clarity. It was conducted by visiting Russian journalist Olga Sorokina who came to the Tribune newsroom under the auspices of an International Center for Journalists exchange program.

Trib+Health: What are the main principles behind the organization of school meals in public schools in Texas?

Steven Kelder: If the school is designated as a school eligible for free and reduced lunch, that means that the federal government will reimburse the school for meals that low-income children receive. And, in Texas, almost about 80 percent of children qualified for free and reduced lunch. Sometimes it’s whole schools, whole districts that are governed by the types of foods that they can serve the kids under the U.S. Department of Agriculture regulations.

So one place to start is the regulations. Schools, however, that do not have the free and reduced lunch program, they may have to adhere to the state of Texas food regulations.

So the way to start thinking about school meals and food that are served at campuses is to first know what the regulations are. And the regulations require certain things about the amount of fat on average. So look at maybe a week's worth of meals, and each of those meals that are served, all have a carefully defined amount of calories, amount of fiber, amount of protiens, right down to the nitrite level.

That's one of the ways that the people who are in charge of food at schools need to think.

Trib+Health: What is the overall picture of the health of children in Texas?

Kelder: If you look at the whole United States in terms of rates of obesity and rates of diabetes, metabolic or obesogenic type of related syndromes, Texas ranks fairly high, as does most of the South. So we've got Texas, Louisiana, Georgia, Mississippi, Florida and states near the South.

One could say that Texas is in trouble in that sense, and we know that the other states can reduce the rate of these things. But we have failed to figure out how to do it in Texas. That might be due to that individual freedom argument, or it might be the way we set up our schools or it might be the way we create systems.

One of the things in Texas that is also pretty bad is the number of dollars per pupil, compared to the rest of the United States. ... Utah is the lowest per capita expenditure state, it's a little under $7,000 a year. Texas is closer to almost $9,000 a year. And some of the higher states, like New York and Wyoming, they are up to $18,000 a year.

That means we have very little margin for innovation and experimentation, and changing things in a state like Texas. You can't have a negative balance in the state, you just can't. So what you do is you lay off people, you cut corners, you become as efficient as possible, of course, and try your best to deliver a good service at a fair price. But things like health, education or food service get lower priority.

Trib+Health: Agriculture Commissioner Sid Miller recently said, “The problem we have is not serving healthy foods, but instead of having healthy children we have healthy trash cans.” As far as I understand this phrase, children don’t want to eat healthy food. So what can you say to parents? What to do to instill a food culture for the children?

Kelder: Well, it doesn't happen overnight. When you think about fat, salt and sugar, that's innate. It's what we are born with, the preference for these tastes and certain vegetables. I mean many fruits will meet these conditions because they have the sweetness and fructose naturally in them, but in the case of vegetables like broccoli or cauliflower or Brussels sprouts, you need to have a certain number of taste experiences.

We need to habituate kids to healthy food. Many studies have shown that children will habituate after about 20 trials. So what you can do with your kids is instead of saying ,"Eat the whole plate of broccoli!", say, "Just take one bite", and next time, "Take another bite." And then, over time, they'll become less averse to it, and they'll learn how to do it. So helping people eat better isn't solely the school's job. Parents do need to help. They need to help by serving their children healthier food. And we, as educators and policymakers, can make it a little easier rather than harder.

Many schools like here in Austin do things like every week they have taste testings instead of just serving lunch. Or they invite the local farmers to come and bring their best produce. There's been an explosion of schools that have rapidly accelerated implementing school gardens. So they turn eating into the science project. If you plant the seeds, and you care for them, that's part of the science class. Whatever the students produce, they are more likely to try. So that gives some taste to their broccoli.

But, as I said, Texas has a low rate of funding, who is going to pay for the garden? So we have a little problem in that way.

Trib+Health: What to do?

Kelder: We've done studies. A lot of American families, they don't eat together anymore. They just grab something out of the freezer and microwave it and take it into the bedroom and look at their computers. So that's not the healthiest pattern, let's say.

You can't eat well through packaged goods. A great deal of research will say that if you eat whole foods, which means that you have to spend a little time preparing the food, then you're better off nutritionally.

It's pretty easy to eat too much when you go and eat at McDonald's or eat fast food, which is all packaged food or highly processed foods. If you get a great deal of your food by eating out or by purchasing frozen dinners, then the likelihood is that you'll eat too many calories and eat the wrong combination of nutrients. You'll start down a path of doing things in a much less healthy way.

Parents need to learn how to cook again. We've lost cooking in many areas of the United States, because people at a little lower income level might have two jobs instead of one, so you're in that packaged food arrangement... You need to feed your children, but you're not there, and you buy things and put them into the fridge.

It's a conundrum that is not easily solved. There are local movements all over the country, where people eat organic, eat locally grown food and so on, but you have to achieve a certain income level to be able to fully participate in that. I won't say you have to be rich to eat healthy food. But certainly if you are poor, it is more challenging. In Texas, we have 25 percent of the people living in poverty.

Trib+Health: So, cook for yourself and eat together...

Kelder: Yes. And eat less processed foods.