Schools Challenged to Find New Ways

We saw that in 2011, Oregon had the lowest child obesity rate. By 2018, eight other states had better numbers. Those statistics change from year to year, and always there is some dialogue about the completeness and accuracy of the data.

Among those routine controversies, an occasional fresh idea turns up. Late in 2011, a paper was published by Amy McLain, a student at Pacific University. (After earning a master’s degree in Occupational Therapy, she went on to work for Kaiser Permanente and Billings Clinic, then gained more experience as a school occupational therapist in South Africa. Since 2013, she has been an Occupational Therapist at Ernest Heath-Advanced Care Hospital of Montana.)

The very interesting paper, “The effectiveness of occupational therapy in preventing childhood obesity in the school setting,” began of course with a comprehensive catalogue of all the reasons why childhood obesity must be ended. It went on to present a case for occupational therapy’s potential effectiveness as a front line preventer of childhood obesity.

The author recommends making much more extensive use of occupational therapists in the school environment, and enumerates the several areas of expertise that the OT is involved in: “[…] prevention and intervention techniques including diet and nutrition, exercise, behavior modification and lifestyle changes.” McLain wrote,

Although it is not written in the scope of OT practice to create prevention programs, specifically obesity in the school setting, OTs have the skills, imaginative tools, program development training, and holistic viewpoints of individuals to do so.

February of 2012 saw the publication of “Lunch Line Design Utilizing Constraints and Bottlenecks to Prevent Childhood Obesity,” which also espoused newish ideas. The uncredited writer mentions the Theory of Constraints. A constraint is a system’s weakest link. If it can be correctly identified and effectively modified, the fixing of this constraint can improve operations greatly, without extensive repair work on the larger system. This philosophical construct seems to be what the slang term “quick’n’dirty” was coined for.

A constraint is any factor that limits the organization from getting more of whatever it strives for, which is usually profit… Since the focus only needs to be on the constraints, implementing TOC can result in substantial improvement without tying up a great deal of resources, with results after three months of effort.

We are told that TOC is an on-going process, which only makes sense. When a system’s weakest link is modified, then, whatever used to be the second-weakest link will necessarily receive a promotion in rank, and become the new weakest link. There will always be something to work on.

What we are talking about here is a plan devised by a research cooperative called Smarter Lunchrooms. According to them, they are in the business of “helping students make smarter choices by subtly changing their behavior… One really interesting case study involves the wise implementation of a bottleneck.” A bottleneck is any complication or inconvenience that stands between the consumer and getting what s/he wants. By adding a contrived complication to a school lunch line the managers can prevent the consuming student from choosing the more fattening beverage.

The experiment looked at guiding the choice of regular skim milk versus chocolate milk and soda. So, this group partnered with a school to change the layout of the lunchroom and placed the chocolate milk and soda in an area where it was difficult to get to and only very few children could be there at any one time. At the same time, the school then placed the regular skim milk in an area where it was easily accessible.

Their findings: chocolate milk and soda sales went down and the sales of regular skim milk went up.

Your responses and feedback are welcome!

Source: “Obesity Rates for Youth Ages 10 to 17,”, October 2019
Source: “The effectiveness of occupational therapy in preventing childhood obesity in the school setting,”, 10/31/11
Source: “Lunch Line Design Utilizing Constraints and Bottlenecks to Prevent Childhood Obesity,”, 02/20/12
Image by Adrian Sampson/(CC BY 2.0)

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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