With childhood obesity still high in the United States, more schools are starting to build a culture of health and wellness.

When Mario Reyna talks about getting children more active and eating healthier, he often mentions the “culture” of wellness in the McAllen School District in Texas, just north of the border with Mexico.

Over the past few years McAllen has seen nutrition and physical activity programs grow stronger, as well as become more embedded in the schools’ daily activities.

This month, 18 McAllen schools earned the Alliance for a Healthier Generation National Healthy Schools Award, building on previous success.

“When we did well our first year, it helped us,” Reyna, health and physical education coordinator for the district, told Healthline. “Because it’s not only about doing well one year. You also don’t want to go backward. So then it becomes, “How are you going to sustain this?’”

More than 300 schools from 30 states were honored this year by the Alliance for a Healthier Generation for promoting healthy eating and physical activity.

Many of these schools struggle with high levels of poverty, lack of resources, and high staff turnover.

But in spite of these challenges, they still succeed in boosting students’ health.

“We’re in the inner cities and rural communities — primarily minority populations — and they’re able to get it done there,” Howell Wechsler, EdD, chief executive officer of the Alliance for a Healthier Generation, told Healthline.

So what’s behind these successes?

To earn the National Healthy Schools award, schools must perform well in several areas, including health education, physical activity, nutrition, and family and community involvement.

At Saint Louis Public Schools in Missouri — where all of its more than 26,000 students qualify for free or reduced lunch — students embraced healthier eating… even if they weren’t so sure about it in the beginning.

“Now we’re surprised when we see kids that constantly want salads or fresh fruits. That’s a change from where they were five years ago,” Leanne White, the district’s project director and supervisor for K-12 health and physical education, told Healthline.

Five of the district’s schools earned National Healthy Schools awards this year.

Healthy eating in the district, though, is not reserved just for the cafeterias.

Three of the district’s schools have garden programs, using a curriculum designed by Gateway Greening.

For students, the results of their hard work in the gardens are only a bite away.

“Produce is shared with the students and the families,” said White. “Anything left over is shared with the community.”

The district also replaced its aging water coolers with water bottle refilling stations “so the children have readily accessible water,” said White.

The schools learned the hard way not to let the younger kids fill up their bottles all the way. But this kind of trial and error is part of what makes these programs successful.

Project Healthy Schools, a community-university collaboration in Michigan, also emphasizes healthier eating, alongside exercising more and cutting back on screen time.

The main goal of the program is to decrease childhood obesity and, over the longer term, cardiovascular health risks.

Jean DuRussel-Weston, RN, MPH, CHES, program manager for Project Healthy Schools, said the program focuses on middle schools because not a lot of health interventions have targeted this age group.

In addition, “the kids are really at an age where they’re starting to make decisions by themselves,” including what to eat and how to stay active.

Project Healthy Schools provides schools with classroom lessons for all of its core areas.

The food-related ones focus on helping kids eat more fruits and vegetables, less sugary foods and beverages, and less fast food.

Program staff also encourage schools to make changes to the school environment so “kids have a chance to practice what they learned,” said DuRussel-Weston.

In the classroom, students build their own salads, including chopping the vegetables and making a healthier dressing. The program has also helped schools add salad bars to their cafeterias.

Other ways that schools can support healthier eating is by not selling candy for fundraisers, or by removing soda vending machines from the teachers’ lounge.

Support also comes from not using food as a reward or incentive in the classrooms — because healthy food is its own reward.

While schools across the nation have cut back on fried foods, hamburgers, and soft drinks, and increased access to fresh fruits and vegetables, many still struggle to get students more active.

“Physical activity has been a tough nut to crack. Partly because resources are needed. You need to have staff and facilities to provide opportunities for kids to be physically active,” said Wechsler. “The days when kids would just go outside and play on their own seem to have vanished.”

Saint Louis public schools try to make the most of the limited time during the school day.

“Once the children go through the door, we want the P.E. teacher to have them moving the whole time,” said White.

Gym class, though, is not the only time that kids move around.

“It’s about everybody working together,” said Reyna. “It’s not just me and my physical education teachers providing the physical activity.”

At McAllen schools, teachers get the students to do movement activities throughout the day, including about 10 minutes in the classroom before they take attendance in the morning.

Likewise, Saint Louis public schools have “brain breaks” in the classrooms to get kids moving.

Even minor policy changes can help children stay active, like not keeping kids inside for recess when they have misbehaved or didn’t finish their work in class.

Building a culture of wellness in schools is no small task, but programs like the Alliance for a Healthier Generation and Project Healthy Schools aim for long-term success.

“We’re asking them to commit for the lifetime of their school. We want this program to become an integral part of their school,” said DuRussel-Weston.

Wechsler calls his organization’s approach a “capacity-building model.”

A key part of both programs is identifying local leaders who will take ownership of the wellness effort. This could be a teacher or staff member who is passionate about health and wellness.

There is also ongoing support, professional development, and resources for teachers and staff.

To help schools focus their efforts, both programs assess a school’s wellness strengths and areas of need. Using this, schools develop an action plan to help them improve.

The support of these programs also comes at the right price, especially for resource-strapped schools.

“The beauty of the program is it’s free,” said Reyna, “because in my field — which is physical education — we’re not the ones that have the biggest budget in the school system. The big budgets go to the core [academic] subjects.”

Setting strong policies — which is part of both programs — from the start can help schools stay committed to their wellness efforts.

Like when a new principal arrives and wants to cut back on physical activity time to prep for standardized testing. Or teachers who try to keep kids inside for recess to do more math or reading.

“That is the biggest challenge on a daily basis. We have to be strong, have courage, and keep our minutes in physical education,” said Reyna.

Schools don’t exist in isolation, so no program can succeed without the support of the parents.

“The parents have responded very well because they know that our district is not only about the academic side,” said Reyna. “It’s also about everything else — emotional and social development, and physical and health development.”

To get parents involved, Project Healthy Schools has some wellness activities that kids can bring home, like going grocery shopping with their parents.

McAllen gets the community and city involved in its wellness efforts through the McAllen Kids Marathon, with students running the first mile of this 26-mile course.

Saint Louis Public Schools includes the community in other ways. The district worked out agreements so the community can use some of the schools’ outdoor facilities, like the gardens, playground areas, and walking trail.

For both McAllen and Saint Louis public schools, success depends on many hearts and minds.

“We really couldn’t have done this without the Alliance and some of our other community partners here in Saint Louis. It’s a collaborative effort,” said White. “We think that every child deserves a healthy school.”