It's lunchtime at H.O. Brittingham Elementary School in Milton; children rush through the line snatching items and putting them on plastic trays.

It's a familiar scene, but upon closer inspection, the items being put on the trays have changed.

Instead of heaping spoonfuls of mashed potatoes, white bread and chicken nuggets, students are choosing corn on the cob, diced fruit, apple wedges, carrot sticks, yogurt and sandwiches.

School have made health a priority, says H.O.Brittingham Elementary School Principal Dr. Cristy Greaves. The lunches include fresh fruits and vegetables through federal and state food programs, including a Farm to School initiative backed by the state that places locally farmed items in school cafeterias.

Still, despite state and schoolwide efforts in Cape Henlopen School District, the number of overweight and obese children refuses to budge.

A recent survey, which polled 3,000 households, found 40 percent of Delaware children, ages 2-17, were overweight or obese in 2011, a figure that has remained unchanged since the first survey in 2006, said Mary Kate Mouser, executive director of Nemours Health and Prevention Services.

“We know that healthy activities increased, and consumption of sugary beverages declined. There's something going on there that is good,” Mouser said.

Mouser pointed out some improvements – rates of overweight and obese African American males and white females decreased in recent surveys conducted from 2008 to 2011 – but overall children are not getting thinner.

Among white males, overweight and obesity rates increased from 2008 to 2011 from 34 percent in 2008 to 47 percent in 2011, and about half of all Hispanic children are obese or overweight.

Greaves said she is not surprised the numbers haven't improved.

“In our school, 80 percent of the kids are on free or reduced-cost lunches,” Greaves said, explaining that for many of the kids, the school lunch is the best meal they have all day.

When many of the students return home after school, they are told to stay inside and be quiet, so they turn to video games and television.

“There is a real safety concern out there for parents,” Greaves said. “When I was little we spent all day outside. Today you can't let your kids run around outside. And, with all the digital stuff out there, that's what kids want now, instead of a bike.”

Greaves said teachers and staff at H.O.B. have been trained by Nemours on ways to increase physical activity both inside and outside the school, including a Nemours program known as CATCH - Coordinated Approach To Child Health. When observing classrooms, one of the things Greaves looks for is how well each teacher does in getting students to jump and move during a lesson.

Greaves said students are participating in soccer clubs and playground groups, and last week a group of students in the Girls on the Run club finished a 5K in Wilmington, she said.

CATCH also focuses healthy eating, which is where cafeteria nutrition comes in, Greaves said.

“We are giving the children food experiences at school that they might not have at home,” she said. Students have enjoyed edamame, mushrooms and asparagus in the cafeteria.

“We hope they are learning what a healthy lifestyle looks like,” Greaves said. “In the future, maybe the numbers will change because of what schools are doing right now.”

Mouser agreed. “There's really no way of knowing what the numbers would look like if the emphasis hadn't been placed on healthy eating and exercise,” she said.

“It is our hope that others will use this data to inform their own research to help make good policy and changes occur,” Mouser said.

For more information, go to www.nemours.org.

Weight by the numbers

56 - percentage of overweight or obese Hispanic boys

43 - percentage of overweight or obese Hispanic girls

30 - percent of obese or overweight white girls

47 - percent of obese or overweight white males

34 - percent of overweight or obese African American males

44 - percent of overweight or obese African American females

More than half of all Delaware children consumed five or more servings of fruits and vegetables per day in 2011.

57 percent of Delaware’s children had fewer than two servings of sugary drinks per week.

More than half of Sussex County children are getting at least an hour of activity each day.