Progress in Preventing Childhood Obesity How Do We Measure Up? (2007) / Chapter Skim
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Pages 280-325
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From page 280... ...
. Further, more attention needs to be paid to the provision of low-calorie and high-nutrient foods and beverages that contribute to a healthful diet and opportunities for physical activity in the child-care, after-school, and preschool environments regarding the.
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From page 281... ...
• Perform periodic assessments of each school's policies and practices related to nutrition, physical activity, and obesity prevention. Federal and state departments of education and health and professional organiza tions should • Develop, implement, and evaluate pilot programs to explore innovative ap proaches to both staffing and teaching about wellness, healthful choices, nutri tion, physical activity, and reducing sedentary behaviors.
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From page 282... ...
The obesity prevention effort in schools is an active area for change, and the committee recognizes that it can capture only a small proportion of the obesity prevention-, physical activity-, and nutrition-related policies and programs being implemented. This chapter focuses on assessing progress and ensuring that evaluations are conducted so that the most promising approaches can be identified and disseminated.
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From page 283... ...
OPPORTUNITIES AND CHALLENGES One of the greatest challenges for school-based obesity prevention efforts may also be an opportunity to rapidly advance progress. As noted above, because schools are primarily controlled and administered at the local level, there are challenges in disseminating effective prevention interventions and for schools to learn about what has been effective or ineffective in other schools or school districts.
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From page 284... ...
EXAMPLES OF PROGRESS IN PREVENTING CHILDHOOD OBESITY With the myriad of obesity prevention initiatives occurring across the nation, the committee can provide only selected examples of innovative practices. This section examines the progress toward meeting the recommendations presented in the Health in the Balance report (IOM, 2005)
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From page 285... ...
Of greatest relevance to childhood obesity prevention are the sets of questions about health education, physical education and activity, food service, and school policy and the school environment. School Health Profiles SHP is a biennial survey, which CDC has conducted since (SHP)
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From page 286... ...
. Future evaluations should examine the effect of these changes on students' cognitive, dietary, and physical activity behaviors, as well as health outcomes.
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Many states and cities are currently enacting legislation that focuses on multiple aspects of enhancing a healthy school environment. For example, in June 2005 South Carolina's legislature and governor approved legislation that focused on school nutrition, physical activity, and health education particularly in elementary schools (Box 7-2)
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items in the school cafeteria, in vending machines, in school stores, or in the classroom have been the focus of obesity prevention efforts in many localities (CSPI, 2006; Story et al., 2006)
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The Produce for Better Health Foundation, in conjunction with 5 a Day and Fresh from Florida, has compiled promo BOX 7-4 Key Considerations in Improving School Foods and Beverages from the Minneapolis Public Schools Food Service Presentation at the IOM Symposium on Schools • Ensure that Minneapolis Public School students have access to nutritious meals and ensure that nutritional and cultural needs of the diverse community are met. • Meet or exceed USDA standards for nutrition requirements, food safety, and food security (offering more fresh fruits and vegetables, more whole grains)
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From page 290... ...
. Additionally, innovative approaches to increase fruit and vegetable availability and consumption are being implemented by students, teachers, food service personnel, and the community through farm-to-school programs and school gardens (Graham and Zidenberg-Cherr, 2005; USDA, 2005)
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From page 291... ...
A major focus of recent obesity prevention analyses and efforts has been the competitive foods and beverages -- those foods and beverages offered at schools other than those available through the school meals programs (e.g., NSLP, SBP) often through school vending machines (Bachman et al., 2006; California Endowment, 2005; CSPI, 2006; Forshee et al., 2005; Westcott, 2005)
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From page 292... ...
• Has this school adopted a policy stating that, if food is served at student par ties, fruits or vegetables will be among the foods offered? • During the past 12 months, have the school food service staff worked on school food service or nutrition activities with health education staff from this school?
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However, physical activity is
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. Although, many changes in school policies and practices in improving the nutritional content of the foods and beverages offered to students are occurring, there appears to be less progress in making changes in physical education requirements, enforcing state standards where they do exist, or expanding intramural and other physical activity opportunities.
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South Dakota will require 1/2 credit of P.E. or health for HS graduation starting 2006 FIGURE 7-1 State physical education (PE)
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, enforcement of state physical education standards and requirements is more difficult to monitor. A variety of perceived barriers to increasing physical activity opportunities were shared by stakeholders at the committee's symposium in Wichita, Kansas (Appendix F)
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. Further, national surveillance systems should include a more extensive focus on intramural and other physical activity programs so that progress can be tracked on the nature and extent of these efforts.
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In addition to a number of informal programs in individual schools and community centers, several research-based approaches are being evaluated. For example, the CATCH program -- which involves multiple modifications related to school food service, physical activity, and classroom curricula -- piloted a CATCH Kids Club as an after-school program for elementary school students.
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From page 299... ...
Although the infrastructure for after-school programs is limited nationwide, organizations such as the Afterschool Alliance and the National Network of Statewide Afterschool Networks are focused on obesity prevention in children and youth and are working to include nutrition and physical activity guidelines for after-school programs into school wellness policies (Afterschool Alliance, 2006)
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. Individual schools can track their progress in developing opportunities for physical activity through self-assessment tools such as the School Health Index.
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• Does this school offer opportunities for students to participate in intramural activities or physical activity clubs? • Does your school promote walking or biking to and from school?
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From page 302... ...
. Some indicators of progress in offering health education related to physical activity and nutrition are available by comparing the 2002 and 2004 results of the SHP survey, which found an increase across states in the percentage of schools that required health education courses included information on choosing a variety of fruits and vegetables daily (from 84.6 to 89.8 percent)
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The committee did not find a systematic assessment of obesity prevention efforts in school health services, which indicates a need for a comprehensive evaluation. SHPPS has a section devoted to school health services with relevant questions focused on school screening for height, weight, or BMI.
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Research and evaluations are needed to assess the ongoing trends in advertising and other commercial activities in schools and to examine whether changes in the school environment with regard to advertising can be linked to improved dietary and physical activity behaviors and health outcomes of children and youth.
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matched school and classroom-level data from the SHPPS 2000 with comparable questions in the SHI to examine the percentage of schools meeting the SHI recommendations in four areas: school health and safety policies and environment; health education; physical education and other physical activity programs; and nutrition services. The study found that most schools are addressing school health issues to some extent, but few schools are providing a comprehensive approach.
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From page 306... ...
Examples include the implementation of school wellness policies, policies regarding comprehensive school health programs, legislative or regulatory adoption or changes in school nutrition standards, and legislative or administrative changes in physical activity requirements. Changes in the school environment to promote more healthful behaviors are intermediate outcomes that denote increased opportunities for physical activity and healthful eating.
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needed to support additional physical activity opportunities. Crosscutting Factors FIGURE 7-2 Evaluating school efforts to increase extracurricular opportunities for children and youth to engage in regular physical activity.
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personnel. Crosscutting Factors FIGURE 7-3 Evaluating school efforts to increase the use of schools as community centers.
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• Changes in before- and after-school physical activity opportunities. • Meal participation rates for school breakfast and lunch.
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Although the committee could explore only a small subset of the ongoing efforts by states, localities, school districts, and schools in implementing and evaluating obesity prevention policies and interventions, it is apparent that throughout the country there are wide differences in the resources available, the level of evaluation activity, and the extent of commitment to improving the school environment to promote healthy lifestyles. Some schools have implemented extensive changes, with wellness policies in place and improvements occurring in the foods and beverages they offer, the relevant curricula that they present, and the opportunities for physical activity that they provide.
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From page 311... ...
Not only are political will and leadership needed to improve school nutrition and physical activity opportunities, but it is critically important that adequate and sustained funding be provided to reinforce these priorities so that attention to this issue does not result in unfunded mandates. Develop, Sustain, and Support Evaluation Capacity and Implementation Evaluation is vital to schools, school districts, localities, and states in determining if their initiatives are producing an impact and are effectively using the limited available resources.
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From page 312... ...
The committee supports this effort to collect more extensive information on students' dietary and physical activity behaviors and hopes that this survey will be conducted by a number of states at the middle school and perhaps upper elementary school levels. Innovations in monitoring changes in the school foodservice environment also deserve additional emphasis.
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From page 313... ...
. An ongoing survey of physical activity levels and physical fitness -- spanning from children and youth, preschool through adolescence -- should be explored and should be conducted, either as a stand-alone survey or as a component of a current national surveillance system such as NHANES that has sustained long-term funding to track the progress of a representative sample of children and youth.
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Disseminate and Use Evaluation Results The added value of an emphasis on surveillance, monitoring, and evaluation is in the lessons learned and the evidence gained from assessments of whether specific interventions and policies have a positive impact on improving nutrition, increasing physical activity, and reducing childhood obesity. As discussed in Chapter 2, there is much to be learned from those efforts that are both effective and ineffective in achieving the desired intermediate and long-term outcomes.
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From page 315... ...
. In addition to bronze, silver, and gold awards, schools can work toward the platinum award, which in addition to other nutrition- and physical activity-related stipulations, requires the involvement of families and the community in health-related efforts; a policy of selling only food and beverage choices that contribute to healthful diets at school events, in vending machines, and at school stores; policies that ensure that meal periods are of the appropriate length or policies that schedule recess before lunch; and the implementation of a faculty wellness program (Utah Department of Health, 2006)
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From page 316... ...
Implementation Actions for Schools School boards, administrators, and staff should elevate the priority that is placed on creating and sustaining a healthy school environ ment and advance school policies and programs that support this priority. To accomplish this: • Relevant federal and state agencies and departments, local school districts, individual schools and preschools, and child care and after-school programs should prioritize opportunities for physical activity and expand the availability and access in schools to fruits, vegetables, and other low-calorie and high nutrient foods and beverages that contribute to healthful diets.
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From page 317... ...
Recommendation 3: Government, industry, communities, and schools should expand or develop relevant surveillance and monitoring systems and, as applicable, should engage in research to examine the impact of childhood obesity prevention policies, interventions, and actions on relevant outcomes, paying particular attention to the unique needs of diverse groups and high-risk populations. Additionally, parents and caregivers should monitor changes in their family's food, beverage, and physical activity choices and their progress toward healthier lifestyles.
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From page 318... ...
, state education departments, school dis tricts, and local schools should • Expand and fully use current surveillance systems related to children's dietary and physical activities, obesity-related health indicators, and relevant school policies and programs; • Implement a national survey focused on the physical activity behaviors of all children and youth; • Support research on means to improve the monitoring of diet and physical activity; • Establish mechanisms to link health, educational, economic, and sociological data sources across a variety of areas related to childhood obesity prevention; and • Expand and adapt self-assessment tools for schools, preschools, child-care, and after-school programs and evaluate their valid ity for predicting changes in children's levels of physical activ ity, dietary intakes, and weight. Recommendation 4: Government, industry, communities, schools, and families should foster information-sharing activities and disseminate evaluation and research findings through diverse communication chan nels and media to actively promote the use and scaling up of effective childhood obesity prevention policies and interventions.
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From page 319... ...
2006. Swimming upstream: Faculty and staff members from urban middle schools in low-income communities describe their experi ence implementing nutrition and physical activity initiatives.
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From page 320... ...
: Mini-Grants for Physical Activity and Nutrition Improvements. [Online]
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2004. Availability of school physical activity facilities to the public in four U.S.
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2004. Social desirability bias in self-reported dietary, physical activity and weight concerns measures in 8- to 10-year-old African-American girls: Results from the Girls Health Enrichment Multisite Studies (GEMS)
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2006. Physical Education and Physical Activity for Children.
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in-class physical activity program. J School Health 74(10)
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2005a. An after-school physical activity program for obesity prevention in children.
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