Twenty-four million people in the United States have diabetes, and minority groups are hit hardest. According to the Centers for Disease Control and Prevention, 11.8 percent of blacks and 10.4 percent of Hispanics have been diagnosed with diabetes. What used to be called adult-onset diabetes is now simply referred to as type 2, as increasing numbers of children suffer from this illness. Although people develop both type 1 and type 2 diabetes for a number of complex reasons—some unrelated to personal choices—research indicates that lifestyle plays a role. Type 2 diabetes, particularly, appears to be associated with obesity.
An aura of hopelessness sometimes surrounds the public discourse about diabetes as it pertains to poor and minority communities. People won't change their habits, we say. Government won't change its policies, corporations will always focus on the bottom line, and this generation of children is doomed to a shorter life span than that of its parents.
Yet last December, I witnessed conversations that belied such cynicism. My 11th grade students from the South Bronx, leaning into a discussion circle, clutched their notes and searched through articles in which they had high-lighted relevant passages about the health crisis staring them in the face.
These students might not know the statistics about diabetes, but they know the reality. They have all encountered people whose lives include insulin shots, loss of vision, even amputations. When I ask, "How many of you know a close friend or family member with diabetes?" just about every hand in the room goes up. When I limit the question to family members, many hands stay up.
Debating Nutrition
My students' heated discussions centered on the story of Marvin Sweettooth, a fictitious13-year-old recently diagnosed with type 2 diabetes. Students debated the question of who, if anyone, was to blame for what had happened to Marvin and what his family, community, school, and government could do to help him and future generations of children.
- Round One: Who are we and how did we get here? In turn, each student—from Marvin to the fast food executive—explained his or her character's situation, history, and motivation. Students could ask one another clarifying questions, but this was not the round for accusations. This round was the easiest one for students who have a difficult time speaking up in class; they could write up comments in advance and didn't have to be nervous about classmates trying to "beat" them.
- Round Two: Who's to blame? This was the round for the avid debaters in the class. Students had to decide which person in Marvin's circle of influence was to blame for his situation—and plan arguments to defend themselves in case of attack.
- Round Three: How can we help Marvin? In this round, the people in Marvin's world had to collaborate, devising strategies that each could use to help Marvin and other children suffering from obesity and diabetes. The goal was to come up with a concrete plan to help restore Marvin's health.
- Round Four: How can we save Marvin's sisters? The final round of discussion was even more forward-thinking: What could each character do to help future generations of children avoid diabetes?
Over two spirited days, accusations, defenses, and possible solutions flew fast among my students and the characters they played. I made clear to students that when a person becomes diabetic, one can't always point to a clear cause or villain—and certainly we should never blame the person with the disease. But posing questions helped students think about the many people who might influence a person's health.
Mr. Makabuck, the fast food executive, admitted to caring about money but claimed that as soon as people started demanding healthier options, he would start offering them. Alexis Sweettooth, Marvin's mother, knew that Marvin should eat more nutritious food and exercise more. She asked for help from Ms. Getavote, a local politician, in creating safe places for neighborhood children to play. Mr. Cardio, Marvin's gym teacher, acknowledged that many students got little exercise in his class. He asked for more time in the week and a reduced student load ("You try to get 100 7th graders to break a sweat in a 45-minute gym class when half that time is taken up changing into gym clothes!") We also heard from advertising executive Ms. Sellafry, community organizer Mr. Knowurights, and Marvin himself.
The discussion drew out the best characteristics in each of my classes. In first period, a little more playfulness seeped into what was usually a very goal-oriented group of students. Even kids who usually let the five most ambitious students carry the class were vociferously defending their characters. In second period, the boys who normally showed up without notebook or pencil and aimed to sit through classes doing nothing instead tried to one-up one another with accusations, defenses, and logic. And in my class full of English language learners—who usually silently took notes—several students spoke more than they ever had before.
There were glitches, of course. Not everyone came prepared. A few were reluctant to speak in front of classmates and needed to be coaxed by fellow group members to take part in the discussion. Some had been absent throughout most of the preparation and were confused about their roles. But all students used substantial, nonfiction texts to support their arguments and challenge one another's ideas. And in each class, students groaned when the time came to end our discussion.
A Project That Hit Home
Perhaps my students were so engaged because they recognized themselves and their surroundings in Marvin's scenario. Bronx Leadership Academy II has the typical demographic profile of the South Bronx and other urban districts: 60 percent of our students are Hispanic, 38 percent are black, 12 percent are English language learners, and 20 percent have individualized education plans. The poverty rate is high enough that all students in the school receive free breakfast and lunch. The school educates many English language learners and students with disabilities.
No fresh vegetables can be found for sale within a several-block radius of our school. But "butter rolls" and bacon, egg, and cheese sandwiches are cheap at the bodega across the street. A cardboard container overflowing with French fries and chicken wings smothered in hot sauce, purchased at the Chinese restaurant two doors down, is the afternoon snack of choice.
Every year, I ask my students, "How many fast food restaurants did you pass on your way to school this morning?" I see furrowed brows, counting on fingers, and then students share: 6, 10, 18, 23 . . . .
"Twenty-three? Nah, you're beastin'! Where do you live?" they tease. But it's true. Then I ask, How much money do you spend on fast food each week? First come sheepish grins, then the confessions: $15, $20, $70 . . . .
My students can all see that we have a problem with junk food. When we began our study, however, most of them did not link this problem to either their behaviors or their surroundings. How did we move from this basic understanding to a more critical analysis of the issues?
It took several years of trial and error before I got my students thinking and talking about how certain realities of urban neighborhoods and corporate policies might affect citizens' health. Our students' reading abilities span the entire spectrum, from the 2nd grade to 12th grade level. Many of our students will be the first in their families to attend college; many also make daily choices about spending time on academics versus taking advantage of other, more immediately enticing opportunities, some as benign as text messaging and some as threatening as hanging out with gangs.
As teachers who try to differentiate instruction for all these students' needs, my colleagues and I juggle many priorities without a wealth of experience; most of the school's teachers are in our first four years of teaching. We balance student motivation, state standards, and preparation for New York State's Regents exams. At the same time, we try to integrate literacy skills into all areas of the curriculum and teach students the professional and social skills they will need to navigate life in college and the work world. At times, the task feels overwhelming.
Assessment data have shown us that our students struggle with nonfiction reading. Experience has shown us that most come to class ill equipped for productive, academic discussion. And anyone who has taught teenagers knows that when they don't see the relevance of what we ask them to think about, they won't engage enough to sharpen their skills.
A Spur to Students' Thinking
With these realities in mind, I decided to push my students to think and discuss issues more critically as we moved into our annual unit on Fast Food Nation by Eric Schlosser (Houghton Mifflin, 2001). This book examines societal factors that have led to an exponential increase in fast food consumption and the effects of this increase on people's health.
I was no longer satisfied with the reading, writing, and reports about Fast Food Nation my students had done in the past. Although students were engaged in the topic, they weren't questioning what we as a society have done to create this dependence on unhealthy food and what we can do to improve matters. They weren't engaging with one another's work, taking new perspectives, defending their ideas, or challenging others' ideas.
Prior experience with Socratic seminars had prepared the students for this type of discussion. I thought they could handle it. So I created eight roles for the students (writing up a short back story for each character) and got them started researching. Students read articles about diabetes, the advertising industry, school lunch programs, and the history of fast food chains. Some groups read selections from Fast Food Nation or other books, others focused on news articles. Students knew which character they would be defending, so as they read they highlighted information that would help them justify their character's position and decide which other characters they might blame.
My coteachers and I tried to guide students to resources that would challenge and interest them, whether New York Times articles, health pamphlets geared toward teens, or passages from longer, more scholarly works. Students worked in heterogeneous groups, used reciprocal teaching techniques, and coached one another in literacy strategies. With this approach, many students read texts at reading levels higher than they could have worked through alone.
I expected every student to participate in the discussion, regardless of reading level, English language proficiency, or confidence. The eight characters sat in a "fishbowl"—a small circle of eight desks—while the rest of the class took notes from the outer circle of surrounding desks.
Discussion in each round reflected not only high levels of engagement, but also critical thinking, application of substantial research, and articulate discourse.
In the third and fourth rounds, students discussed actions their characters would take to protect the health of youth like Marvin—and themselves. Ms. Sellafry, the advertising executive, volunteered to use her marketing talents in a campaign to raise awareness about healthy eating. Ms. Getavote, the politician, promised to make community health a priority in her next campaign. She pledged to support clinics and community centers and to work with stores to make healthy food accessible. Marvin himself decided to mentor younger children, helping them learn from his experience.
Lasting Effects
At the end of the project, students' self-assessments showed that they were pleased. They believed they had made their points convincingly, responded to one another well, and maintained their characters' viewpoints.
I, too, was pleased. Students were probing issues more actively than in past years. They challenged their first, superficial answers and read more deeply. Teamwork was excellent; group members ensured that each of their classmates was prepared and confident going into a discussion round. The discussions themselves were a huge step forward: All students participated when they were in the fishbowl and listened carefully while in the outer circle.
Perhaps most important, the students were thinking about health issues that were relevant to their lives. They became involved in the discussions because they knew people like Marvin and his mother. They recognized his doctor and gym teacher; they knew firsthand the effects of decisions made by corporations and advertisers. Some began to consider, maybe for the first time, that as a society we should do more than tell people to take personal responsibility; we should enable people to take such responsibility. Students realized that governments and corporations also can—and should—act more responsibly and ethically.
I can think of ways to improve this unit. I'd like to ensure that students keep the larger questions in their minds even as they get heavily involved in their characters. I'd like to get them doing more independent research and create a real-world audience for their new knowledge; for example, students could create materials on diabetes for younger students.
But it was rewarding to see students make life changes. I noticed students bringing fruit salad and other healthy choices from the cafeteria during lunchtime study sessions. I heard about decisions to walk instead of take the bus. "Ms. O'Grady," Daniesha informed me proudly one day, "I've become a pescatarian—a seafood eater!"
Jonathan gave me the most faith that the seminar made a difference. One day he walked into my classroom holdingFast Food Nation. "I was standing on line at McDonald's," Jonathan told me. "And as I was waiting, I looked at the pictures on the menu board . . . then the cover of the book . . . then the pictures . . . and I walked out."
The conversation my class started about diabetes and societal choices clearly had an effect—and will continue.
