Success from scratch

West Virginia is among the top five on just about every national chronic disease list. The state leads the nation in diabetes and obesity, according to the Gallup Healthways poll.

Surveys show that many West Virginians do not realize obesity is a leading cause of many chronic diseases. Many also feel those diseases are hereditary, and there is nothing a person can do to prevent them.

The state's children raise major red flags for the future. West Virginia University screens thousands of schoolchildren every year. In 2010-11, they found that 24 percent of fifth-graders have high blood pressure, 26 percent have high cholesterol, and 29 percent are obese. Eighteen percent of kindergartners and 23 percent of second-graders are obese.

There has been little public discussion of this problem. "The Shape We're In" project aims to stir up that discussion. Written and photographed by Annenberg fellow Kate Long, it will be divided into three parts in The Charleston Gazette, the state's largest newspaper:

• Children at risk
• Programs that work
• Communities making a difference

Some segments will be accompanied by West Virginia Public Radio pieces.

Part 1: "This is a public health emergency"

Part 2: A growing problem

Part 3: Putting the pieces together

Part 4: Health officials say W.Va. can reverse its chronic disease numbers

Part 5: W.Va. man: diabetes programs work

Part 6: "Get kids moving"

Part 7: Daily activity affordable, Department of Education says

Part 8: Wood researchers: Active kids do better academically

Part 9: Rocking the gym at 7:30 a.m.

Part 10: Nebraska school district lowers obesity rate

Part 11: What happened?

Part 12: 'Everyday heroes' saving own lives

Part 13: W.Va. ranks first in heart attack, diabetes, eight other categories

Part 14: Success from scratch

Part 15: Great Kanawha food fight

Part 16: Better focus

Part 17: W. Va. slammed with sugar

Part 18: Glenda and Jill vs. diabetes

Part 19: This is how bad diabetes can be

Part 20: Recognize diabetes before it's too late

Part 21: Logan hardest hit by diabetes

Part 22: Even if your relatives had diabetes, you don't have to

Part 23: Body and spirit

Part 24: American Diabetes Association is MIA in W.Va.

Part 25: Young people contending with diabetes

ALUM CREEK, W.Va. -- Kindergartners swarmed around the salad bar in the Midway Elementary cafeteria, so many, two adults had to help. The kids pointed at raw vegetable and fruit slices - peppers, cucumbers, cherry tomatoes, carrots, spinach, kiwi, oranges, apples.

"I want those orange things," one child said, pointing at a melon. The next loaded up on peppers and celery sticks.

At the tables, other kindergartners made inroads on the main dish, lasagna Florentine and Caesar salad, ignoring the salad bar.

"Either way, they eat good food," Principal Cheryl Workman said. "We give them choices."

She drifted around the cafeteria, smiling and chatting, looking for kids who weren't eating lasagna, encouraging them to try a bite. "A lot of kids eat a fast-food diet, and they're leery of food they're not familiar with. If we can get them to try it, lots of times, they like it."

Last summer, seven of West Virginia's poorest counties  - Lincoln, Mingo, McDowell, Clay, Gilmer, Fayette and Mason - agreed to try cooking lunch and breakfast with fresh ingredients all year, five days a week. They would offer meals free to all students who want to eat.

They are guinea pigs. State schools Superintendent Jorea Marple wants to spread healthy cooking statewide. Their challenge: Prove it can be done. Avoid fattening, processed, prepackaged food. Find things kids like, and stay within budget.

Marple is concerned about obese children at risk for future diabetes, children who come to school hungry, and the impact on children's schoolwork:

• One out of four West Virginia fifth-graders is obese, and one in four has high blood pressure, cholesterol or both, according to West Virginia University.
• One in five West Virginia homes sometimes runs out of food, according to a recent Food Research & Action Center study.
• Children who eat breakfast are less likely to be obese, studies show. They do better academically. They concentrate better and are less likely to overeat later.

"When I first heard we were going to do this, I thought it was going to be impossible," Workman said. "I worried about schedules and money and would the kids like it. But after we tweaked the schedule a couple of times, it's been great."

Early results

Since September, the number of children eating school breakfast in the seven counties has nearly doubled - from 42 percent to 75 percent.

The federal government reimburses by meal, so the counties received more than a million extra federal dollars to pay all or most of the extra expenses.

"The news is good, very good," said Rick Goff, director of the state Office of Child Nutrition. "This is a potential game-changer if it goes statewide."

In Lincoln County alone, the number of children eating school breakfast more than doubled in the first four months, from 40 percent in 2010 to 88 percent in 2011. Lunch-eaters jumped from 67 percent to 80 percent.

"West Virginia is to be congratulated," said James Harmon, regional nutrition director for the U.S. Department of Agriculture. "I'm not aware of another state that has taken the initiative to reach more children while improving the nutritional quality of school meals."

"Now that we know it works, we plan to offer cook-from-scratch training for cooks in every county next summer," Goff said.

"We have a lot of work to do. A few counties are cooking with fresh ingredients 95 to 100 percent of the time, others do it half the time, others are 25 percent or lower.

"We'll know the complete story [for the seven-county project] in a few months when we see if the tardies decreased, behavior problems diminished and absenteeism lowered. From what we hear, the answer will be yes."

The state Department of Education Research Division is evaluating the project, talking with parents, teachers, kids, looking at attendance and discipline records. Next fall, they will look at WESTEST scores.

The seven-county project stands in sharp contrast to Kanawha County. Last fall, Kanawha cooks were abruptly ordered at the start of school to cook from scratch, but given no extra training or explanation. Unhappy cooks packed school board meetings to complain. The county backed off.

There have been no such protests in demonstration counties. Their cooks got advance training. "We were all on board when school started," Miller said. "We had training, recipes, equipment." They talked about childhood obesity.

Isn't it easier just to open prepackaged lasagna and heat it in a microwave?

"Yes, that's easier, but this is better for the kids," Midway head cook Diana Adkins said.

Adkins has strong words for cooks who say scratch cooking forces them to make tasteless food. "There's no excuse for that. We can flavor food with all kinds of herbs, garlic, lemon and so forth. If you're a cook, you make it taste good."

She worries about kids eating junk food. In 2010, 30 percent of Lincoln fifth-graders had high blood pressure. Twenty seven percent were obese. Adkins knows they are at higher risk of diabetes and heart attacks.

Principal Workman credits several things for the boom in eaters:

"The children like the food because we have wonderful cooks."

• The kids get choices with the salad bar.
• When everybody eats free, more kids eat. "Nobody is identified as poor."
• More kids eat breakfast served later, at second period.
• The staff encourages students to try new foods, and the afternoon snack program familiarizes children with a variety of vegetables and fruits.

 "Kids are going home and saying, 'I tried this, and I tried that,'" Workman said. "I got a call from a mother who said her son came home and asked if they could have asparagus for dinner. She said, 'I never in the world would have thought he'd eat that.'"

Some children complain that servings are too small.

"We're not going to offer super-size portions," said Rick Goff, state Office of Child Nutrition director. "They can have all the seconds on salad they want. We want to help solve a problem, not contribute to it."

This is school food?

Soon after she became superintendent in spring 2010, Marple hit the road and started visiting schools. "She'd drop by my office to tell me about the chicken nuggets and corn dogs she'd seen kids eating," Goff said. 

"West Virginia leads the nation in obesity, diabetes and heart disease," Marple said. "Do we only fix these problems after they happen? Or do we also begin to fix things from the get-go?

"It's going to save money in the end if we feed all our children and encourage them to eat nutritious meals," she said. "Then maybe there won't be 30 percent of our fifth-graders who are obese. And maybe there won't be 25 percent who have high blood pressure and high cholesterol."

For years, as director of the Office of Child Nutrition, Goff has waged war on empty calories. He and his staff got junk food out of school vending machines, drove soda pop from the schools, and stiffened the state's nutritional standards.

"I've been waiting for a long time for a superintendent to make meal preparation a priority," Goff said.

Last fall, Goff invited Marple to eat at three Cabell County schools where cooks prepare meals from fresh ingredients five days a week. "I wanted her to see schools where it's being done right," he said.

"After that visit, she asked me, 'What can we do to spread this statewide?' I didn't have to be asked twice."

They decided to do a trial run first in a few counties. Goff started recruiting. The seven counties volunteered.

By the end of December, the number of breakfasts served in the seven counties had skyrocketed from 43,600 a day to 74,900 a day. The lunch count rose to 75,597. In four months, the extra meals pulled in more than $1 million in additional federal funds, compared to 2010.

"Cooking from scratch costs less than processed food," Goff said, "so you save money on the food. Then you have the extra reimbursement."

The federal government reimburses $2.51 per lunch for a child who is eligible for free meals and $2.11 for a reduced-price meal. The county receives 28 cents for each paying child, even if the school serves the meal for free. A separate, lower reimbursement scale is set for breakfast.

"If you serve a lot more kids, you can break even on breakfast, with federal reimbursement, especially if a lot of kids qualify for free and reduced-price meals," Goff said.

"Even if you end up paying a little more overall, it's worth it, for what the kids learn in life skills," Goff said.

 "I think people would protest now if we tried to take it away."

Why is this working?

Goff's office doesn't order counties to quit serving prepackaged food.  "We wouldn't want to," he said. "For it to work, they have to buy in. But we can try to inspire them."

Last summer, his office arranged for cooks from the seven counties to train for two days with veteran Cabell County cooks, learning tricks of turning out scratch meals for hundreds of kids.

They seasoned raw chicken with oil/herb rub and steamed hundreds of bunches of broccoli.  They learned to use tools that puree or chop hundreds of vegetables. They baked hundreds of pizza bread rolls. They flavored with garlic and onion powder, lemon, ginger and herbs, to make food tasty. They learned how to make various salad dressings and homemade croutons.

"It's no easy thing, to cook for that many kids," said Kristi Blower, project coordinator. "It's one thing to make it taste good for your family, but another to cook for hundreds, with nutrition guidelines to follow."

"You learn to make different choices," she said: fresh marinated chicken chunks, for instance, vs. prepackaged, chemical-laced, breaded chicken nuggets.

The seven counties got necessary kitchen equipment and student-tested recipes. "When school started, we were ready to go," said Kay Maynard, Mingo County food services supervisor.

"We used to have a lot of kids trying to pay attention on an empty stomach," she said. "That's not so anymore."

Gilmer County

At Gilmer County high school, more than 80 percent of students are eating school lunch. "That's unheard of, nationally," Goff said.

In mid-March, Gilmer high schoolers rolled through the lunch line to pick up rotisserie chicken and roasted garlicky red potatoes. At the "Grab 'n' Go" station outside the kitchen, a few picked up pizza bread. Students wiped out the salad bar.

Last year in December, only 46 percent of all students ate breakfast. Now it's 87 percent.

"Last fall, a group of my teachers came to me and said, 'This is the best thing that's happened,'" Gilmer County High School Principal Nasia Butcher said. "They say they're seeing much better attention and focus, much better concentration since this started."

"We may not break even this first year," food services director Joe Frashure said. Fifty nine percent of Gilmer students qualify for free or reduced meals. "But this has been so good for the kids, we've pretty much decided that, if we have to pay a little more for it, it's well worth it."

"This obesity problem was created in a generation, and it's going to take a generation to solve it," Goff said.

Three non-demonstration counties have already started a universal free breakfast. Eight others eliminated the 40-cent "reduced price" charge.

The next step for West Virginia school food: four cooking-from-scratch trainings next summer, then regional trainings through the school year. "It looks like we're going to have more counties wanting to send cooks than we'll have room for," he said.