First Lady Michelle Obama unveiled her strategy for tackling the nation’s childhood obesity crisis.

Mrs. Obama’s initiative is called Let’s Move, and includes a website with tools and background on the initiative.

Her speech was informative and inspiring. One quote was particularly compelling.

“We can’t build the future for our youth, but we can build our youth for the future.” – Franklin D. Roosevelt

When FDR made his statement, our world was a different place, faced with scarcity, with little worry about environmental influences on our children’s health. Today, in our 21st century, we are building the future for our children, because everything we do now affects their future. I submit that when we address our various environmental issues we are in fact building the future for our children.

The impact of the environment on everyday living is a huge contributor to our present day childhood obesity crisis.

Take for example, food deserts, what I call an urban setting without access to healthy food. That deficit is access to nutrient rich food and will dictate the future for our children if not corrected. A school nutritional environment serving empty calories, sweetened meals, few vegetables and little to no natural fruits, contributes to underlying health conditions and a myriad of diseases lying in wait.

Evidence shows that environmental risk factors play a role in more than 80% of the diseases regularly reported by the World Health Organization. That future is certain and bleak, but as pointed out by Mrs. Obama in her speech, it is also preventable. Childhood obesity is something we as a nation can turn around.

In our present condition, building a healthy environment is a national outcome that may determine the future for the next generation.

Clearly, the importance of building our youth for the future is equally important.

lets move logo- childhood obesity prevention

The First Lady and her Let’s Move agenda asks us to look at the childhood obesity issue from a new perspective. She encourages us to “ask not what parents are doing wrong but what we as a nation can do to create a healthy environment which combats childhood obesity.”

Not only does her initiative reframe the conversation but it also shifts the burden/blame from individual or parent to the collective society consisting of schools, business, non-profits, health organizations, doctors, communities, states and the government. Her initiative, Let’s Move, requires a collaborative effort from all participants in order to “fix” the environment.

So where do we begin? Let’s start with a vision of what should be.

“Where people live, work, and play significantly impacts health. People thrive when they live in communities with parks and playgrounds, grocery stores selling nutritious food, and neighbors who know one another”, according to the Prevention Institute.

Schools would provide a great service if they instilled two concepts in all children.

Schools need to help students understand the benefits of healthy lifestyles and the relationship between calorie intake and energy expenditure to achieve energy balance at a healthy weight.
(IOM, 2005)

I think we can all agree that we deserve healthy environments where access to healthy foods is easy and affordable. Likewise, physical activity opportunities should be plentiful and integrated into our daily routine.

Creating this type of an environment (easy access to healthy foods and physical activity) is not a simple task. It requires a coordinated and comprehensive effort to re-engineer communities and educate citizens.

No one has a roadmap for exactly how to get there, so I will limit this coverage of the childhood obesity topic to the role of schools in solving the crisis.

In this article I explore some of what I call “schools’ false starts” in tackling the childhood obesity crisis and I conclude with the role schools can play in solving the problem.

False Starts

It’s nothing new to hear reports of conflicts between parents and school officials about how children should be educated. In the end, no one wins. But that’s exactly what has been happening with BMI (body mass index) testing in schools.

Student health, which historically has fallen into the parent domain of responsibilities, is seeing a shift in recent legislation due to the childhood obesity crisis. I begin with two topics causing a great deal of discomfort to schools, parents, and students alike.

Mandatory Testing of Student BMI

One of the most controversial childhood obesity interventions is BMI testing. Since 2003, a number of states have enacted legislation requiring schools to measure and report students’ BMI’s  to parents as a strategy for combating obesity. A few other states have required schools to test BMI without reporting the results to parents.

BMI is a measure of body fat based on height and weight. It is calculated by dividing weight (in kilograms) by height (in meters) squared. For children, appropriate BMI ranges change by age and gender.

These ranges are plotted on a standard growth curve to obtain a percentile ranking for each child. Children whose BMI is between the 85th and 94th percentile are considered to be at risk of being overweight. Children whose BMI is above the 95th percentile are considered overweight (The term obese is not generally used for children). National School Board Website.

In 2003, Arkansas – where 38 percent of children are overweight or at risk of becoming overweight – became the first state in the nation to make school weigh-ins a state law and mandated that parents be sent an annual report stating their child’s BMI. The reports also explained what the BMI means, the health effects associated with obesity, and ways to combat the problem.

Legislation also has been introduced in Connecticut, Iowa, New Jersey, New York, Oregon, Texas, Georgia and Tennessee as of 2005 to require or encourage schools to measure students’ BMI”, says Amy Winterfeld, spokesperson for the National Conference of State Legislatures. Many more states have joined the BMI testing bandwagon since.

Some health advocates say BMI testing at school is the most logical place to begin to address the obesity crisis because schools already test vision and hearing, and a document from school has credibility. Perhaps most compelling is the argument that it is in school’s and society’s best interest to have healthy children.Kids eating fast food

The jury is still out however, on the value of BMI screenings in schools. According to the CDE Report entitled, “Body Mass Index Measurement in Schools.“Little is known about the outcomes of BMI measurement programs, including effects on weight-related knowledge, attitudes and behaviors of youth and their families. As a result, no consensus exists on the utility of BMI screening programs for young people.”

The U.S. Preventive Services Task Force concluded that insufficient evidence exists to recommend for or against BMI screening programs for youth in clinical settings as a means to prevent adverse health outcomes; however, the American Academy of Pediatrics (AAP) recommends that BMI should be calculated and plotted annually on all youth as part of normal health supervision within the child’s medical home. The Institute of Medicine recommends annual school-based screening.

California Fitness Test Legislation

California legislation (Senate Bills 78 and 601 passed in 2007), and took effect in 2009. It affected 500,000 ninth-graders across the state. For the first time, high school freshmen across the state of California were required to pass five of six fitness exams or face the possibility of repeating physical education classes until they passed or they graduated. Pass 5 of 6 fitness tests or repeat P.E. It caused quite a stir. Some parents saw the move as punitive and worried this would effect the elective course selection of college bound students. Schools for the most part were unhappy for purely economic reasons.

Where would the money come from to hire P.E. teachers in the already pinched budget? The author of the legislation, Senator Torlakson stated, “We want our students to be healthier. That’s the whole goal.” He further noted that educators have found a correlation between health and fitness and a student’s ability to learn well.

In 2009, statewide results indicate that roughly one in three students passed all of the California Physical Fitness tests. Only time will tell if this intervention has a positive effect on student health.

Common Ground

Few would disagree that schools can play a valuable role in addressing the childhood obesity crisis.

In fact, many obesity prevention efforts have primarily focused on the school environment because nearly all children, ages 5 years and older, spend a large part of their day in school for 9 to 10 months out of the year.

Schools are an important setting to enhance students’ dietary intake and physical activity opportunities and to provide relevant education and behavioral change programs.

In the next section we will explore some of the current school interventions which include physical education, recess, and nutrition.

Increasing Physical Education Opportunities

“School physical education programs offer the best opportunity to provide physical activity to all children and to teach them the skills and knowledge needed to establish and sustain an active lifestyle”, according to the National Council of State Legislatures.

Forty-nine states require physical education in schools, but the scope of the requirement varies greatly. The Surgeon General recommends children should engage in 60 minutes of moderate activity most days of the week, yet according to the SHPPS, 2006, only 3.8 percent of elementary schools provide daily physical education. The report also revealed that only 7.9% middle schools and 2.1% of high schools provided daily physical education.

The effect of No Child Left Behind on physical education programs (or lack of) is often the reason given for the reduction in PE minutes and programs. However, sacrificing physical education time for classroom time does not improve academic performance according to five controlled experimental studies in the U.S., Canada and Australia.

As an example: In 1999, researchers analyzed data from 759 fourth and fifth-graders in California and found that students’ scores on standardized achievement tests were not adversely affected by an intensive PE program that doubled or tripled PE time. On several test scores, students with enhanced PE performed better than students in control groups. Three other smaller studies conducted between 1970 – 2006 involving students from one or two schools also reported a positive correlation between physical activity and academic performance.

Physically active children tend to perform better academically. Fourteen studies including 58,000 students between 1967-2006 examined the link between physical activity and academic performance. Eleven studies found a positive association between physical activity and academic performance.

School Recess

Recess suffered the same fate as physical education in many cases as a result of the No Child Left Behind Legislation. Yet, like in the case of PE, research indicates that activity breaks can improve cognitive performance and classroom behavior.

Investigators in Georgia studied the effects of an activity break on classroom behavior in a sample of 43 fourth-grade students in 1998. Students without a break exhibited significantly less on-task behavior and were fidgeting more.

In “The State Of Play”, a recess report released in February 2009, 8 out of 10 principals reported that recess has a positive impact on academic achievement. The same report cited that 96% and 97% of principals respectively reported that recess positively impacted social development and general well being.

More information on recess can be found at Peaceful Playgrounds’ Featured Article section of the website which includes a downloadable toolkit on the Right to Recess Campaign. Contents include Alternatives to withholding recess, organizational position statements, the impact of play and recess on social development, further research on fitness and academics, and research on the educational significance of recess.

Recess is also one of the few cost-neutral interventions, meaning there are not any additional costs associated with offering recess. The trade-off is in academic minutes versus physical activity minutes It requires only a schedule change.

Student Nutrition

The school food environment has a large impact on the dietary intake of children and adolescents because a substantial proportion of daily energy expenditure is consumed at school.

National data shows that foods eaten at school comprise 19 to 50 percent of students’ total daily energy intake (Gleason and Suitor, 2001).

For over a decade, state legislation has been aimed at restricting student access to high-calorie, nutrient-poor foods and beverages, labeled “competitive foods”.

Competitive foods refers to foods and beverages which are offered at school, other than meals and snacks served through the federally-reimbursed school lunch, breakfast and afterschool snack programs Many states eliminated “competitive foods” from campuses. Labeled the “The Junk Food War”, state legislatures and school districts joined forces to rid schools of vending machines unless soda was replaced with water or fruit juices and candy bars were replaced with health food alternatives.

According to the Food Research and Action Center (FRAC) only 2% of school-age children meet the Food Guide Pyramid recommendation for each food group. Research shows that access to competitive foods in school reduces the quality of students’ diets. While schools must meet federal nutrition standards, competitive foods are not required to meet the same standards currently. That could change with the reauthorization of the Child Nutrition Reauthorization Act sometime this spring.

Research also indicates that when a child’s nutritional needs are met, the child is more attentive in class, with better attendance and fewer behavior problems.

According to author, Dr. Levin, kids who play hard every day may be making their brains, as well as their bodies, stronger. Researchers have found that children who exercise on a regular basis have more neural activity in the frontal areas of their brains. This serves as evidence that children who are physically active may be better able to organize schoolwork, do class projects and learn mathematics.

Reversing the obesity epidemic requires a long-term, well-coordinated approach to reach young people where they live, learn, and play, and schools have an important role in that mission, as discussed in this article. Working with other public, voluntary, and private sector organizations, schools can play a critical role in reshaping social and physical environments children experience. The Let’s Move website provides information, tools, and practical strategies to help students and parents adopt healthy lifestyles for children.

Policy and Environmental Recommendations – Center for Disease Control

  1. Promote Healthy physical activities and schedule them into the school day, after school and before school.
    • Establish joint use agreements for recreational opportunities for student using city facilities and recreation departments using school facilities when available.
    • Ensure school children get the 30-60 minutes of physical activity each day at school between physical education, recess, after school programming or before school activities.
    • Institute Walk-to-School or Bike-to-School programs.
  2. Limit non-educational use of TV, videos, electronic games and computers.
  3. Schools offer and promote only healthy foods and beverages.
    • Improve nutritional quality of competitive foods and beverages.
    • Allow schools to purchase from local sources of foods like Farm to School Programs.
    • Provide free fresh food and vegetable snakes in schools.
    • Implement school policy prohibiting nutrient poor foods and replace with healthy snacks.

Child Obesity Resources for Schools

Let’s Move.

We cannot always build the future for our youth, but we can build our youth for the future. University of Penn, 1941 Unpublished speech. Franklin D. Roosevelt

Preventing disease through healthy environments: Towards an estimate of the environmental burden of disease. World Health Organization.

Promising Strategies for Creating Healthy Eating and Active Living Environments, Prevention institute 2008.

Nihiser AJ, Lee SM, Wechsler H, McKenna M, Odom E, Reinold C,Thompson D, Grummer-Strawn L. Body mass index measurement in schools. J Sch Health.

2007;77:651-671. Full  and executive summary.

California legislation (Senate Bills 78 and 601) [viii], 2007

Active Living Research Fall 2007 Research Brief Robert Wood Johnson Foundation.

Jarrett OS, Maxwell DM, Dickerson Impact of recess on classroom behavior Journal of Educational Research 1998.

The State of Play. Feb. 2010 Robert Wood Johnson Foundation.

National Standards for Foods in Schools. 2007 Food and Nutrition Board.

Make a difference at your school, Centers for Disease Control.