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FORT WORTH, Texas - Fort Worth pediatrician John Menchaca worries.
He worries that meal deals and supersized sodas are stretching his young patients' waistlines, setting them up for heart disease and diabetes decades earlier than their parents. He worries that computers and video games keep too many children off the playground, pumping their wrists instead of their hearts.
But one of his biggest concerns - the one that makes his voice edge upward in frustration - is the chronic temptation posed by school vending machines. "I ask them,
What do you eat for lunch?'" Menchaca said. "And they say,Twinkies and a Coke.'
"Kids have a dollar or two in their pockets always, and they'll spend it, especially if it's lunch money."
For years, vending machines have been a mainstay in faculty lounges and school hallways - available for a late-afternoon soda or a lunchtime bag of chips. But study after study confirms that today's children are heavy and getting heavier. And so, a backlash has been brewing against vending machines and their high-fat, high-sugar contents.
This year, New York City took one of the most restrictive approaches, banning the sale of sodas and a wide range of sweets, from Twinkies to doughnuts to ice cream bars, in schools. The Los Angeles school system has voted to remove soda from its machines; Philadelphia officials plan a similar move.
In Texas state Sen. Eddie Lucio, D-Brownsville, hit significant opposition during the recent legislative session when he proposed eliminating the machines in elementary schools and restricting older students' access. By the time Senate Bill 474 passed, those provisions had been eliminated and the legislation simply called for the establishment of an interim committee to study school nutrition, said Lucio's press secretary, Doris Sanchez.
Opposition wasn't limited to vending companies, Sanchez said. "The superintendents and the school boards and the principals were calling opposing the bill," she said. "They said they would lose revenue - that was their only argument."
But in late July, the Texas Department of Agriculture weighed in, banning the sale of certain foods, including soda, to elementary school students during the school day. The policy, which went into effect Aug. 1, also prevents middle-school students from purchasing the foods during lunch.
But the list of excluded products is short - mainly hard candy, gum and soda, critics point out. Other junk food, including chips, cookies, chocolate bars and ice cream, could still be sold.
Some medical professionals want all junk food to be ejected from the machines.
"The (vending machine) companies and the school districts are making money off of this," said Dr. Donna Bacchi, a pediatrician at Texas Tech University Health Sciences Center in Lubbock. "There's going to have to be demand from families, parents in particular, not to have these things served."
Money has been a sore point. In January, Amarillo, Texas's school board voted to fill some of their soda machines with water and other nonsoda drinks, in response to concerns raised by local dentists. But canceling the remaining 11 years on the Coca-Cola contract would have cost the district $7 million, an official said at the meeting.
Any profits the machines generate go to benefit the students, school officials frequently stress. When the Arlington, Texas, school district negotiated a 10-year contract with Coca-Cola, ending in 2007, the company paid $3 million upfront for new school computers, said Cindy Powell, the district's executive director of finance. Plus, the machines generate commissions - on average, between $800 and $3,000-plus monthly for each high school - that can be used to improve student education and morale, Powell said.
"They will use this money perhaps to dress up a lobby of the campus," she said. "They may provide a pizza party for a class that had high attendance."
The new Agriculture Department policy does address a common criticism. The previous rules - developed by the Texas Education Agency when it had oversight of school nutrition - only barred the sale of soda and the other products from eating areas, including the cafeteria.
Nothing prevented students from buying sodas from a vending machine down the hall - even during lunchtime.
Rusty Kelley, executive director of the Texas Soft Drink Association, said his group supports the move to prevent elementary school students from consuming sodas during school hours. But restricting access at middle schools is a different matter, he said.
"At that point in time, students are getting old enough to make good decisions," he said.
School district officials often don't know what's being dispensed from the vending machines. That decision usually rests with each principal, they say.
"We do recommend to the principals that they put nutritional products in the machines," said Phyllis Propes, director of child nutrition services at the Fort Worth school district.
Moreover, officials privately grumble, schools can't be blamed for the bad health habits that children bring from home. Older high school students, for example, have lots of options of where to eat, including off campus.
"And they do get their lunches at fast-food restaurants, typically," Arlington school district spokeswoman Charlene Robertson said.
But other factors encourage students to raid the nearest vending machine, medical professionals say. Since schools often cram several lunch periods into a day, some students may eat long before the noon hour, leading to afternoon cravings. A long cafeteria line may encourage students to look elsewhere for food.
Plus, as they get older, eating in the cafeteria may not be cool.
Another problem is that too many students skip breakfast, encouraging them to reach for a pre-lunch snack, Menchaca said. And the sugar jolt of a candy bar or soda sets up a bad cycle, jump-starting the student's blood sugar, but only temporarily, he said.
"When it comes down, it stimulates more appetite. Then in the afternoon, they will look for another dosing - another fix, if you will."
When vending machines stock healthier snacks or drinks, they're prone to place them above or below eye level, said Bacchi, the Lubbock pediatrician. A couple of years ago, Bacchi and a Lubbock High School student met with the school's vending machine representative. Could he make water and other healthful products more visible?
"He was very resistant to moving them around because, he said, `These are the most popular items and we want to put them where they (the students) can see them,'" Bacchi said.
But if students look hard enough, it is usually possible to find some healthier alternatives.
Students with a craving for chips would be better off if they chose baked products, said Jennifer Raines, a clinical dietitian at Harris Methodist Fort Worth. Pretzels also aren't a bad alternative, although they are high in salt, she said.
When thirsty, milk and water are usually the best choice, doctors and nutritionists say. Milk - even flavored milk - provides the calcium that many students badly need.
Teen-agers have cut back on their milk consumption as they've started drinking more soda, according to a U.S. Department of Agriculture survey. In the mid-1970s, boys drank twice as much milk as soda and girls consumed 50 percent more. Twenty years later, both teen-age boys and girls drank twice as much soda.
Still, if obesity is the concern, other products are culpable, said Kelley, with the soft drink association.
"We have orange juice in vending machines," he said. "If you drink a bunch of orange juice, it will make you as obese as Coke."
But if given the option, would students subsist on water and raisins? Last year, the El Paso school system renegotiated its soda contract so that elementary and middle school students' access to vending machine beverages would be limited to milk, juice and other noncarbonated drinks. Some school officials worried about a drop in revenue, and so the soda companies committed to making up the difference, El Paso school spokesman Luis Villalobos said. As it turned out, there was only a slight drop in revenue, he said.
Don't underestimate us, says Sita Bushan, the Lubbock High School student who worked with Bacchi to change the vending machines.
While the soda company wouldn't stock the machines differently, it did agree to add two machines filled only with juice, water and other nonsoda drinks, Bushan said.
And it's those machines that sell out most often, she said.
"We never know that students won't make healthy choices unless we offer them," said Bushan, 17.
Several factors can encourage students to raid the nearest vending machine, medical professionals say.
-Schools may run several lunch periods in a day, with the earliest starting sometimes at 11 a.m. and the latest about 1 p.m. Rather than lose part of their 30-minute lunch standing in line, students may grab something from the nearest machine.
-Students who don't eat breakfast are more likely to develop midmorning cravings.
-Eating habits are developed at home. Parents should only offer healthy foods if they want their children to develop a taste for them.
Bringing an apple from home may be best, but when students do buy from a vending machine, nutritionists say they should look for the best choices.
-Chips: Baked chips are more healthful. Pretzels also are recommended - the drawback is they are high in salt.
-Drinks: Water and milk are generally the best option. Milk can provide badly needed calcium. Juice is nutritionally better than soda, but is high in calories.
-Snacks: If cookies are being sold, animal crackers and fruit-based cookies, like Fig Newtons, are more nutritious. Granola and energy bars will provide fiber, although they may be high in fat.
(c) 2003, Fort Worth Star-Telegram. Distributed by Knight Ridder/Tribune News Service.