In the latest data from 2019, the U.S. Centers for Disease Control and Prevention reports that 16.6% of the state’s students in grades 9-12 were obese, just above the national average of 15.5%.

Neighboring states either fell slightly below or hovered above the national average, with North Carolina and Georgia having 15.4% and 18.3% of its ninth through 12th graders having a body mass index of 30 or more, respectively.

Body mass index is a formula of height and weight that Health care providers use to determine obesity.

The 2020 numbers weren’t much better in the percentage of children ages 2 to 4 who participated in the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program and who were also obese.

In the data from 2020, the CDC reports 13.1% of WIC program participants ages 2 to 4 in South Carolina were obese, compared to 12.9% and 14.1% in Georgia and North Carolina, respectively.

Dr. Christine San Giovanni is the medical director of Heart Health, the pediatric weight-management clinic at the Medical University of South Carolina, as well as the pediatric medical adviser for MUSC’s adolescent bariatric surgery program.

She said the state is slowly making progress in the battle against childhood obesity, but work remains.

“Over the past couple of years, it seems to be improving, although COVID probably set us back in making progress. In 2015, South Carolina ranked second in the country for childhood obesity, and currently we are ninth. So we’re slowly making progress but, obviously, we have a lot of work to still do,” she said.

In 2019-20, 20.1% of youth ages 10 to 17 were obese in South Carolina, according to the latest National Survey of Children’s Health as outlined in The State of Childhood Obesity. The study, conducted through the Robert Wood Johnson Foundation, gave the state a ranking of 9 among the nation’s 50 states and the District of Columbia.

The foundation is the nation’s largest philanthropy dedicated solely to health.

“The pandemic definitely contributed to a rise in obesity in children. The estimated proportion of 2- to 19-year-olds with obesity was 19.3% in the U.S. in August 2019. In August 2020, it was 22.4%. The monthly rate of increase in body mass index nearly doubled during the COVID-19 pandemic compared with a pre-pandemic period,” she said.

San Giovanni said the pandemic also worsened many factors that contribute to childhood obesity, including a lack of structured routines.

“So children were at home all day snacking and not being as physically active. Families were impacted by lower incomes and less access to healthy fresh foods and worsening mental health. The 6- to 11-year-olds experienced the largest increase in BMI change. Their pandemic rate was 2.5 times as high as the prepandemic rate,” the doctor said.

She said MUSC has implemented strategies to help put a dent in the childhood obesity numbers.

“Our pediatric weight-management program at MUSC, Heart Health, offers free fitness sessions for children and adolescents six days a week. We also organize an annual 5K walk/run,” San Giovanni said.

She continued, “We have already been using telehealth to have our pediatric weight-management program see children and adolescents throughout the state for weight-management counseling, but we are now trying to branch out to more community offices.

“In addition, the Boeing Center for Wellness partners with MUSC in implementing health checklists for schools to promote healthy behaviors for students, many of which target important contributors of childhood obesity.”

High blood pressure, high cholesterol, type 2 diabetes, fatty liver disease, sleep apnea and depression are among the various comorbidities for which obese children are monitored, she said.

San Giovanni said education must be coupled with compassion.

“Obesity is a chronic and progressive disease. We need to help those who have obesity. It’s usually something they will be managing their whole life. There is no cure. We also need to remove the stigma that comes with obesity,” she said.

“There should not be any shaming or bullying due to someone’s size. We know that this is a complicated disease and not just due to consuming too many calories and not exercising enough.

“Genetics can also play a role in obesity. Promoting good sleep is extremely important to release hormones that make us less hungry during the day. Children need nine to 12 hours of sleep each night and adolescents need eight to 10 hours each night,” she said, noting that socioeconomics play a large role in obesity.

“Children may not have access to fresh and healthy foods or may not have a safe place to exercise. Mental health is a big factor as well. We know that children who suffer from adverse childhood events as a child are more likely to have obesity, and this could be due to having depression, anxiety, or developing disordered eating,” San Giovanni said.

She continued, “Getting rid of stigma associated with obesity will help improve children’s mental health so that they can feel encouraged and supported in managing their weight. Everyone working together as a family to get healthy offers support and the idea that no matter what size we are, we all need to develop healthy habits to live our healthiest, happiest lives.”

She said advocating for access to fresh, healthy food is particularly important in rural areas.

“Providing children with ideas of how to exercise even if they cannot be outside is important. There are many apps/YouTube videos they can do to get active. The emphasis should not be on weight, but instead on developing a healthier lifestyle.

“Eating more fruits and vegetables, increasing physical activity, drinking more water and less sugary drinks and getting a good night’s rest are just a few behaviors that children and families can work on together,” the doctor said.

R. Taylor Lee is the public health director for the Lowcountry Public Health Region of the S.C. Department of Health and Environmental Control, one of four public health regions across the state. Orangeburg, Bamberg and Calhoun counties are included in the Lowcountry Public Health Region.

He said obesity has been a problem not just in the state, but the entire Southeast Region, but there are programs DHEC has established to deal with the issue.

“We do have multiple programs through our Maternal Child Health Division that focus on childhood wellness. Specifically, our WIC program is a nutrition program that helps mothers and babies start off on a solid nutritional track,” Lee said.

“Through our WIC program, which is a very popular program, the farmers market vouchers have become more and more popular. That’s somewhat of a new concept. So it isn’t just go to the grocery store and get a certain amount of retail products, it is vouchers for use at farmers markets and specifically for fresh fruits and vegetables,” he said.

WIC need estimates are an estimate of the percentages of pregnant women, infants and children eligible for WIC and receiving WIC benefits. This is a useful measure of how well WIC reaches those who may benefit from the program, which includes services that help curb obesity.

The estimated percentage of need met among children in the tri-county area in 2022 included: Orangeburg County, 48%; Bamberg County, 63.2%; and Calhoun County, 47.1%.

Lee said there are small programs within DHEC’s Maternal Child Health Division that “interactively focus on mothers and newborn children and children with special health care needs.”

“They are always encompassing the well-being primarily of the child, to get them a solid launch pad, if you will, through nutrition, through health services and through parental support,” he said.

Lee said lifestyle is a factor which has contributed to the childhood obesity problem in the state.

“There are a lot of long-held dietary concerns that the South in general has that leads to obesity. A non-active lifestyle paired with a very rich diet in many aspects can just cause exactly what we have, and that is an obesity problem. That’s what several programs inside and outside of DHEC and campaigns try to focus on: active lifestyle, screenings for certain cancers and certain disease and, of course, nutrition across the board,” he said.

San Giovanni said, “Foods that are fried or cooked with a lot of butter are not going to help us in getting healthier, but I also don’t believe we need to eliminate these foods completely. I think eating unhealthy foods on special occasions and sparingly is a great idea, but on a daily basis we want to be choosing healthy foods to eat like fruits, vegetables, beans, nuts, baked meat and high-fiber foods like whole grains and whole wheat bread.”

Kate Gerweck is the manager of the SNAP-Ed Program at the state DHEC.

“SNAP-Ed is a federally funded grant program that’s considered the nutrition education arm of the SNAP program. SNAP is the Supplemental Nutrition Assistance Program,” she said.

Orangeburg, Bamberg and Calhoun counties are among the 22 counties included in DHEC’s SNAP-Ed service area.

“The goal of SNAP-Ed is to reach low-income individuals. So for the state of South Carolina to be eligible to receive SNAP benefits, you have to have an income that is 130% or lower of the federal poverty line,” Gerweck said.

She continued, “SNAP-Education provides nutrition education and obesity-prevention programs like physical activity programs by partnering with community organizations like counties, councils on aging, schools, whether it be elementary schools or daycares, Head Start centers and organizations such as libraries.”

DHEC delivers five different education programs, two of which are targeted toward children, including Tiny Taste.

“That is geared towards the 3- and 4-year-old age. This program aims to teach children about certain fruits and vegetables. We provide tastes. So children who may not have access, or whose parents may be unfamiliar with a certain vegetable or fruit, are provided with that exposure to those fruits and vegetables,” Gerweck said.

“We also provide their parents with educational newsletters and ways to prepare these foods so that we’re immersing them in ideally nutrition education, and also new exposures,” she said.

DHEC has another education program geared toward elementary-age children.

“That provides nutrition education over the course of six weeks. Beginning this fall, due to SNAP-Ed’s goal to really provide physical activity as well as nutrition education, we are going to be implementing a new program that focuses on combining nutrition education with physical activity,” Gerweck said.

She continued, “We’re really excited to be able to broaden our reach within the communities that we serve and to be able to provide a broader educational component. The way that SNAP-Ed is attempting to target childhood obesity is through initiatives. We have a cooking program called Cooking Matters over a course of six weeks.”

Three Cooking Matters programs cater to adults, parents and childcare providers.

“Adults and parents are taught how to stretch their budget and to make appropriate food choices in terms of like recipe preparation, but also grocery shopping, which is especially important now given the rates of inflation and the cost-of-food rise that we’re seeing within the grocery stores,” Gerweck said.

“Our childcare provider classes are intended to be geared toward early education providers who might be running a Head Start program, or participate in the child and adult care food program, which is another subsidy of USDA that provides federal dollars to assist with food and meals,” she said.

Gerweck continued, “We teach them how to make healthy food choices, how to ensure they’re following the guidelines for the child and adult care food program because there are strict standards for what they have to serve in terms of meeting the servings of fruits and vegetables and whole grains and proteins.”

Gerweck said the agency relies upon partnerships to be able to spread awareness of its programming, which is all free of charge.

“We rely heavily on formed partnerships with organizations like councils on aging, boys and girls clubs. We have a partnership with the Catawba Tribe over in York County. … We know that obesity and food insecurity disproportionately impacts communities of color.

“So what we are really hoping to do is expand the awareness of our programs so that we cannot have to work so hard at trying to find partnerships, but have communities and organizations reach out to us,” she said.

Dr. LaShandra N. Morgan is manager of the Tri-County Health Network serving Orangeburg, Bamberg and Calhoun counties. The nonprofit formed to improve the health of residents in the tri-county region and has developed community needs assessments to help them target health challenges in the local area, including childhood obesity.

“In working with students over the past couple of years, we’ve been doing healthy backpacks, giving out healthy snacks in book bags and working with certain schools to kind of switch up. Some schools will give snacks, and they’re unhealthy snacks,” Morgan said.

“We’re working on our partnership with the school system in Calhoun County,” she said, but they have done the healthy snack initiative in Orangeburg and Bamberg counties.

“We actually did a fresh produce distribution in collaboration with the Calhoun County School District when they had their back-to-school jam on Aug. 13,” Morgan said.

The development of school and community gardens has been another successful initiative within the tri-county area.

Gardens already exist in the Bamberg County towns of Ehrhardt and Denmark, as well as at Orangeburg’s Samaritan House homeless shelter, South Carolina State University and the Regional Medical Center.

The TCHN is also the fiscal agent of Growing COB (Calhoun-Orangeburg-Bamberg), which has a mission to improve the health of the community through access to sustainable gardens, fresh food and education.

“We strategically place these gardens in areas of need. The one in Denmark is across the street from a multi-unit HUD facility. The community members have come and told us that they’re being more mindful of what they eat. They’re using herbs from the garden instead of using salt. That warmed my little public health heart,” Morgan said.

“All of these gardens are supported with funding from the Regional Medical Center and the Office of Rural Health,” she said.

Morgan said the TCHN is working with the MUSC Boeing Center for Children’s Wellness and the Orangeburg County School District to develop a health initiative within the schools.

“We’re strategizing right now. MUSC-Boeing has a children’s initiative, and I’ve been working with this group for years. They go to the different school districts, and they have a healthy checklist. So each school is competing to see who can be the healthiest school. They collect points by checking off different things off the check list,” Morgan said.

Gerweck said childhood obesity is a multifaceted problem that will take the community’s help.

“We cannot just say that we’re working at educating parents to choose healthier meals. Does that parent have adequate access to a grocery store that provides those foods? Do they have transportation to get there if they don’t have their own transportation? Is there public transportation available? So it takes a community to really make a large impact,” she said.

Gerweck said DHEC donates fresh produce from its own community demonstration garden.

“We’ve also had a hand in creating a garden at Harbison West Elementary over the past couple of years, and then an edible garden with the Newberry Child Development Center,” she said.

“We’re approaching our new fiscal year. Our focus again this year is going to be on where else we can make an impact with starting community gardens. … We have educational curriculums that we can pair with gardening. … So these are geared toward children and adults. We’re excited for the possibilities,” Gerweck said.

She said any individual or group interested in learning more about and/or participating in any of DHEC’s SNAP-Ed programming can email [email protected].

Lee said, “(Collaboration) is absolutely 100% needed with not only other state agencies, but nonprofits, our faith community, all those partnerships as we like to refer to them. That’s the way to accomplish whatever goal that we’ve set.

“That’s communicating with other states as well. Other states share the same concerns, the same hurdles, the same funding, especially in the Southeast. I think we can learn a lot from each other locally, statewide and even regionally.”

Benjamin Miedema is the education associate for health and physical education at the state Department of Education.

He said PE is an integral part of the school’s public education system.

“How it looks in any given school or district is decided by that particular district, but what we do have within the code and the regulations is that PE is a part of all our public schools here. In K-5, it is actually required that 90 minutes a week of physical education is provided to students, in addition to an additional at least 60 minutes of physical activity,” Miedema said.

“That would be things like recess, movement breaks, walking classrooms, but that’s not things like … going from one class to another. That is not considered a part of that physical activity part,” he said.

PE is also a part of the defined instructional programs for middle school and incorporated at the high school level, as well.

“At the high school level, there is the one Carnegie unit that is required for graduation for physical education. Lastly, there is a requirement for physical fitness testing at the grades 5, 8 and at the high school,” Miedema said.

The SC FitnessGram project is a statewide effort to evaluate and ultimately improve health-related fitness among public school students in the state. The SCFitnessGram project involves the aggregation of health-related fitness data from public schools using a statewide FitnessGram software system.

Physical education teachers administer six FitnessGram test items to students enrolled in PE classes in grades 5, 8 and in the high school PE course required for graduation. Height and weight only is measured in grade 2.

The student physical fitness assessment tool provides a way to manage and report data at the school level to assist parents, teachers, schools and districts in providing fitness information that can strengthen fitness education, testing and improve student health and academic achievement.

“I actually serve on the advisory council for SC FitnessGram. Fitness testing is something that is a component of the requirements for our physical education courses. FitnessGram is one of those tests that’s an option. So many schools do choose to use the FitnessGram and, in that, it generates a lot of great data for them to see how their students are performing on those different components within personal fitness,” Miedema said.

“If they do stay within a school or a district that uses that same platform throughout the different grade points, it does give them some good longitudinal information to see how the student is performing. Has their fitness improved, stayed the same or gotten worse? It is a standardized measure that they can use across time like that,” he said.

He noted that physical activity and nutrition education go hand in hand.

“Within our academic standards for physical education, we do have some nutrition components within there. So they’re intertwined into the understanding of the need for nutrition. If you don’t bring enough calories in, you’re not going to be able to be active,” Miedema said. “So it’s obviously a connection there, and you need to be able to understand that.”

Miedema said the problem of childhood obesity is not new, but “we definitely want to see those numbers go the other direction.”

“When we look back at the requirements, the 150 minutes all together of 90 minutes PE and 60 minutes at least of physical activity, that’s not new. That’s legislation that’s been on the books for a while, with the intent to really look at these numbers to increase those activity minutes and opportunities and overall comprehension and understanding of what it is to be a mover,” Miedema said.

He continued, “It is not just physically doing the movement, but it is understanding concepts. We just actually got brand new standards last year in 2021, college and career ready standards for PE that highlight those areas that are most important for our students to learn to try to start to combat those numbers.

“The biggest changes to them was there was some movement of content, but overall it really was realigning them so that there was better articulation across the grade levels.”

Miedema said even when the pandemic forced shifts to virtual learning, teachers were able to use technology to ensure physical education was optimized for children in the different setting.

“This, just like all of our content areas, is an important thing for our state. … There have been teachers across this state that have produced some great, phenomenal resources that they used during that time and that they use still to this day for their online instruction for students that are choosing to be in that setting,” he said.

“They’re able to really expand and embrace that technology so that students can be more active even if they’re not in a live physical education setting.”