opportunity to design these schools with facilities that can best accommodate after-school or community center programs.

As these programs are pursued, it is critical that the effects of changes in after-school programs and other after-school uses of school facilities (e.g., in the form of community centers) be evaluated. Innovations to encourage children and youth to participate in physical activities and learn about nutrition are particularly encouraged, because they have the potential to help prevent childhood overweight and obesity. Pilot results for after-school obesity prevention programs in low-income African-American communities are already showing promise in this regard (Beech et al., 2003; Robinson et al., 2003), though further research and evaluation is needed.


In most if not all states, schools are mandated to perform periodic academic testing to compare student performance against established standards. The committee recommends extending these assessments to include parameters related to healthful eating, physical activity, and other factors related to the risk for obesity.

Recognizing that the school environment is one of the many influences on a child’s dietary intake or energy expenditure, it is important to develop effective school-based programs. Thus, schools, school districts, state boards of education, and regional and national institutions have already begun to promote and implement innovative approaches for addressing the rising rates of obesity in children and youth and for promoting their health and fitness. Although these programs can be costly in terms of finances, personnel, and other resources, they have the potential to enhance the educational process.

Without systematic and widespread assessments of obesity-related behaviors and physical activity measures, however, there will be no way to identify which of the many possible strategies are potentially effective, much less the most cost-effective. Specific cause-and-effect inferences will not always be possible, but the availability of pertinent local data will enable schools, parents, school districts, states, policy makers, and researchers to identify some of the more promising approaches for further testing and development.

Many schools now use the School Health Index developed by CDC as a school self-assessment tool (CDC, 2004a). This measure incorporates physical and nutritional education components into evaluations as well as assesses other areas, particularly school health, counseling, health policies, health promotion, and family and community involvement. The committee encourages schools to use the School Health Index or similar school-specific

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