Childhood Obesity: A look at Child Nutrition Education in schools and increasing Nutrition Education/MNT insurance referral hours for patients

By Grace Brinster, LWDI Intern

Educating children regularly about nutrition can help them make good food choices, inforce positive decision making skills, and effect behavior change – behaviors that might just stick with them well into adulthood. Also, establishing healthy eating choices at a young age can decrease the risk of future health complications and increase quality of life. However, according to the Center for Disease Control, (CDC) US students receive only eight hours of nutrition education each school year. (1) Let’s think. Where do kids spend most of their time? In school. Approximately 36 weeks (not including weekends) or 180 days to be exact. That’s almost half of an entire year, and only eight or so hours is spent on nutrition education. A CDC statistic states, “the percentage of schools providing required education about nutrition and dietary behaviors declined by 84.6%  to 74.1% between the years of 2000 and 2014.”(1)

Teachers have a lot on their plate, constantly. Therefore, and because it is not always a priority in the curriculum, nutrition education has been falling by the wayside for a long time. As healthcare professionals and teachers ourselves, we know the importance of any type of education. In fact, none of us would be here if we hadn’t chosen to educate ourselves in the fields we work or intern in. With that being said, why are we not providing our nation’s youth with the education they need to provide themselves with a healthy future? They don’t even have the chance, or choice, to step on the “rug of education” before it is pulled out from under them.

Adding to this, a drastic change in education has happened due to the Covid-19 pandemic, which forced schools to teach virtually. This means, at least for the past year, school aged kids may not have received any nutrition education at all, and have not been exposed to different eating behaviors or food choices. This bleeds into another question, what food habits are established in the home? Are the parents educated as well? So, to all dietitians, physicians, nurses, and other healthcare professionals, I ask you, what can we do to ensure nutrition education is increased in school systems, communities, and homes? Listed are some suggestions for what we can all do, regardless of your profession, to help bring awareness to this important need: 

  • Be more active in Public Policy and Advocacy – know what education programs assist in healthy school meals.
  • Write a letter to your State Senators asking for support in nutrition education programs.
  • Educate ourselves so we can educate others.
  •  Get active in your communities by:
    • Talk with or write letters to your State board of Education asking for support in nutrition education.
    • Research your community: Which schools need nutrition education the most?

Key facts 

  • Worldwide obesity has nearly tripled since 1975.
  • In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
  • 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
  • Most of the world’s population live in countries where overweight and obesity kills more people than underweight.
  • 39 million children under the age of 5 were overweight or obese in 2020.
  • Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
  • Obesity is preventable. 

Increasing MNT/Nutrition counseling services and referral hours


Some insurance companies cover nutrition services such as counseling services and/or medical nutrition therapy (MNT). Unfortunately, Medicare covers only 3 hours of MNT services for individuals who have been diagnosed with Diabetes, kidney related dialysis conditions such as End-Stage Renal disease, and some nutrition counseling for Obesity. (2) The hours can be extended if a physician determines a change in medical condition, diagnosis, or treatment. In order to see the referred patients, a dietitian must be enrolled as a Medicare provider. However, It is a lengthy process for dietitians to become contracted with insurance companies, and on top of that, requirements for coverage differ from state to state. (3,4) 

In addition to this, the client must have a physician’s referral in order to see the dietitian and that might only happen if their insurance includes nutrition services or MNT coverage. Otherwise, the individual would pay out of pocket. According to the National Conference of State Legislators (NCSL), the Affordable Care Act covers nutrition therapy for Obesity, Diabetes related diagnosis, and nutritional services in only twenty-three states. (5)

Although changes have been made in recent years to expand the number of people who can receive health insurance in general, there is still a chance clients will not be provided with enough MNT/nutrition education to improve their condition due to limited referral hours covered by insurance. Personally, I think increasing nutrition referral hours is a good place to start to help combat this issue. Improving access to specific medical care needs can only benefit an individual. Also, research shows those who are obese at a young age are more likely to be obese as adults – eventually leading to the need for nutrition counseling, education, or MNT later in life. This brings me to another point – weaving through the healthcare system can be complicated and often, patients don’t always get the one on one time that they need with a healthcare provider. Even if they do, the time spent is way too limited. 

This is the big, vague, picture of what’s happening in our healthcare system due to how insurance companies are set-up. In regards to childhood obesity, for the children, this process is probably confusing. Then, by the time they reach a nutritionist or dietitian who can educate them, they might only have less than an hour to talk about the problem because referral hours are limited or no coverage is applied to the session at all. Over many decades, the Obesity health crisis has been met with limited health insurance coverage, difficulty for providers to get covered in order to provide needs, and limited nutrition education in schools. How do we change this? 

Childhood Obesity: Is Nutrition Education enough? 


As we know, there is a lot of support advocating towards decreasing childhood obesity prevalence and occurrence. A few examples of this “support” are federal programs such as SNAP, WIC, the School lunch program, and research programs like the Childhood Obesity decline project and many more. However, data shows there still hasn’t been a huge decline in Obesity rates: 

Reference: Obesity Rates & Trend Data – The State of Childhood Obesity

Childhood Obesity can impact quality of health well into adulthood. It increases chances of stroke, cardiovascular disease, high cholesterol, and hyperlipidemia, all of which can lead to a diminished quality of life and death. Is nutrition education enough? If it becomes more pronounced in the curriculum, will we see a decline in childhood and adult obesity numbers in the next twenty years? We won’t know until the changes happen. 

Hence the need for a core curriculum in nutrition education and an increase in insurance coverage for nutrition services and MNT referral hours. Not providing enough nutrition education in schools and having a complicated health insurance system in order to access necessary medical care are problems contributing to this health crisis that need to change. 

References:

1.Nutrition Education in US Schools (cdc.gov)

2.Referral Requirements for Coverage for Nutrition Services (eatrightpro.org)

3.Medicare MNT (eatrightpro.org)

4.Guide to Insurance and Reimbursement – Today’s Dietitian Magazine (todaysdietitian.com)

5. Health Reform and Health Mandates for Obesity (ncsl.org)

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