Few things rouse the emotions of American parents like childhood safety. There are safety standards for toys, zero-tolerance fighting policies in schools, V-chips for televisions, mandatory vaccinations against childhood diseases, and—let’s just say it’s a long list. But despite all these protections, today’s kids could be the first generation in American history to die younger than their parents. The culprit is not an aggressive pathogen or incurable disease; it’s fat.

As more evidence emerges that obesity in young people is even more dangerous than it is for adults—that childhood obesity can cause organ damage once thought to be impossible for anyone short of late middle age, safety-obsessed parents nationwide are beginning to sound a quiet, nervous chorus: “Ooops.”

We’ve entertained ourselves with stories about airlines putting in wider seats to accommodate our bottoms and the news that American cars lose an average of three miles per gallon in fuel efficiency because we’re heavier now than in 1970. Now we’re beginning to realize that our own bad habits—acquired when we left home and could eat whatever we wanted—are encouraging our kids to overeat from the time they can first say “more juice.”

Nowhere is the epidemic on display more vividly than in West Virginia. According to the Centers for Disease Control and Prevention, West Virginia is the most obese state in the nation. The U.S. obesity rate in 2000 was 20.1 percent; the average for West Virginia is rated “consistently higher” than the rest of the country at 23.2 percent. Although these rates include all 55 counties, the highest prevalence, at more than 25 percent, was found in the Eastern Panhandle and the southern and western reaches of the state.

Dr. Mark Cucuzzella, who practices at Harpers Ferry Family Medicine and is associate professor of family medicine in the WVU School of Medicine, says that changing the family diet overnight does not result in lasting change—a little more broccoli and a little less soda at home won’t curb the temptations confronting kids at every turn.

He was looking for a new approach. What he saw were mountains, two rivers, and places to roam. Harpers Ferry and Bolivar are located between the confluence of the Shenandoah and the Potomac rivers. There is Harpers Ferry National Historical Park, the Appalachian Trail, the Chesapeake & Ohio Canal. The area has endless opportunities for what Cucuzzella calls “natural outdoor play” that is immediate and completely free. What’s more, there were park rangers, staff and volunteers at the NPS AT office and the Appalachian Trail Conservancy, or ATC, which is headquartered in Harpers Ferry—in short, partners in the business of showing people a good time outdoors. A partnership was born to create an outdoor program called Tiger on the Trail, geared to school kids.

The National Park Service jumped in with both feet. Says Elizabeth Kerwin-Nisbet, both the Harpers Ferry NHP and the Park Service Design Center, also located in Harpers Ferry, grasped the scope. This was more than outdoor education, it could be the foundation of a broader community health program involving people of all ages and backgrounds. “Administrators and IT staff, anyone can lead a hike,” she said. And anyone in the community can get involved. Together, the partners recruited and trained volunteers to be hike leaders and share their love for the outdoors with kindergarten to twelfth graders at Harpers Ferry Middle School.

Having parks and doctors working together is no guarantee that students will ever take part in the program. “Without schools onboard,” said Cucuzzella, “the effort wouldn’t happen.” Enter Principal Joe Spurgas and teacher Assunda Wight. Spurgas, said Cucuzzella, has embraced the program in a way that’s becoming rare in the days of “teaching to the test” under No Child Left Behind. And Wight has become a hike leader, adapting her teaching to see the trail as her classroom.

“We want well-rounded students to leave our school, not just someone who scores well on standardized tests,” said Spurgas. “One of my goals with our kids is to see that being healthy throughout their lives is important to them.” School personnel encourage kids to try the salad bar and to try to stay active at home, but Tiger on the Trail integrates message, learning, and action seamlessly.

“They’re learning about all aspects of our community—it’s the historical, it’s Jefferson Rock, it’s Bolivar Heights where confederate soldiers lay in a trench,” he said. “They learn a lot while out on a healthy walk getting some fresh air.”

On its surface, the program is offering something basic: guided nature walks. But the hikes are designed to address educational objectives. One encourages kids to tabulate the health benefits being accrued during the hike; another focuses on identifying birds by song and sight—it’s field biology in disguise. The group will walk for awhile, take a break, and assess their surroundings. They might learn about the gold finches they see, or what’s happening in their bodies while huffing up a hill. None of the hikes is simply a march through trees. During their first year of operation, Tigers on the Trail hosted 700 students who collectively logged some 4,000 miles through the parks.

The students have done more than hike. They’ve helped design the program. And with staff from the Design Center, the students created a trailhead map of the trails around Harpers Ferry. Kerwin-Nisbet sent the students out to gather trail-mileage data, take photographs, and write trail descriptions. Then a student intern at the Design Center did the layout. Their map was fabricated to official NPS standards and placed at The Point in Harpers Ferry’s lower town, creating a trailhead hub that thousands of people will use each year. “Their work is reaching everyone who visits The Point,” Kerwin-Nisbet said.


Will It Work?

Cucuzzella bucks a couple of trends. One is that doctors should be concerned only with providing medical treatment to kids who are already obese. For example, Tiger on the Trail involves all kids. It’s an intervention, not a treatment. And unlike the CDC, Cucuzzella doesn’t classify obesity as an illness. “Obesity is the most complex health problem that many of us have experienced; it is way beyond just disease. It involves family, culture, nutrition, environment, activity, and genes in ways we are just beginning to understand,” he said.
Thanks to a range of cultural shifts, like car-centered neighborhoods, over-packed lifestyles, fast food and frozen processed foods, and the cable television/internet revolution, parents are more sedentary, too. Kids are just doing what their parents do. “You see kids falling into the same patterns without realizing it,” says Cucuzzella.

The data concur. According to a 1999 CDC study, West Virginia’s youth are more lethargic than youth in any other state. Only 38 percent of high school students were enrolled in physical education classes; the national average was 56 percent. And fewer than half of West Virginia high school students participated in organized sports, well below the national average.

Everyone involved in Tiger on the Trail has an intuitive sense that it can help kids and adults. The big question is whether this type of intervention can have long-term health benefits. That’s what Carolyn Thomas wants to know. She is visiting assistant professor of health and physical education at Shepherd University. “We talk about how good all this stuff is for children, but there is a lack of data to confirm it,” she said.

Thomas conducted a modest “pre-pilot study” this year by surveying Tiger on the Trail kids before and after their first hikes. “We saw a definite shift in responses on the question of whether outdoor physical activity was fun,” she said, cautioning that the sample was small. And there was a clear shift in attitudes about whether outdoor activity was interesting—much more so after the hike than before.

Thomas also tracked the number of steps each kid took on their hikes. The average was between 3,000 and 5,000—halfway to the recommended 10,000 steps each day for adults. During the next school year, she’ll be able to enlarge the sampling because there will be more schools involved, thanks to a $10,000 grant from the National Park Service to pay for transportation. Thomas and her student researchers will gather more data to see if these “qualitative assessments” bear out what everyone hopes they will—that kids will be drawn to the outdoors and that they will stay active once they discover it. The health benefits will be a side effect.

“Kids look for things they can do with other kids,” Thomas said. “Hopefully, as they get older they’ll see hiking as something fun to do with their friends.”

Thomas sees community benefits beyond the health intervention behind Tiger on the Trail, too. “You’ve got a middle school, a family practice, national parks and community volunteers involved. This is really about community health,” she said. “This type of community integration is phenomenal. And it’s connecting kids where they live.”

It remains to be proven that outdoor education can be effective in curbing childhood obesity and overweight, but Cucuzzella is pretty sure what does not work: Having a family doctor council parents and kids about diet and exercise. The research confirms this. Cucuzzella searched the literature while writing a review last year on the topic. “At best, even the most intense multidisciplinary approaches may help a little, and only for the short term.” It’s about integration.

Cucuzzella practices what he preaches. If given the time, he will relax at lunchtime with a ten-mile run along the C&O Canal. Then again, he’s a marathon runner.

He isn’t looking to turn school kids into marathoners, he’s using what he knows to change a sedentary generation. In our modern “plugged in culture,” Cucuzzella offers a sensible antidote: “Kids just naturally playing, out digging in dirt.”

Despite all our advances in medical treatments and cures, we’re being plagued by preventable illnesses brought on by bad choices. And if things don’t change, they will get much, much worse.
Kids are not just small adults. Childhood obesity is a large predictor for shortened lifespan. Incidents of Type 2 diabetes—once unheard of among children, are rising. Cirrhosis of the liver also now afflicts young people in alarming numbers.

“I don’t think people realize the calamity we face,” said Cucuzzella. “It’s not just about what’s being offered at school lunches, it’s not just about changes in diet.” It’s a war on lifestyles that have us wasting away.