Childhood Obesity: What Can Schools Do

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Childhood Obesity What Can Schools Do?

• Nutrition, Physical Activity and Academic Success

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Objectives

• Participants will be able to
• 1. Verbalize the impact of nutrition and physical
  activity on academic achievement.
• 2. Discuss several ways schools can provide an
  environment that is conducive to healthful eating
  behaviors and regular physical activity.
• 3. Help implement policies in their school
  district that address physical activity and
  nutrition.

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Utah AFHK Core Team Members

• Utah PTA
• Utah School Nutrition Association
• Utah Office of Education
• Utah Department of Health
• American Heart Association, Western States
  Affiliate
• Intermountain Pediatric Society
• Utah School Nurse Association
• Dairy Council of Utah/Nevada

• Utah School Boards Association
• Jordan District School Board
• Utah State School Board
• Utah Dietetic Association
• Primary Childrens Medical Center
• BYU Health Sciences-Physical Education
• University of Utah College of Health
• Utahns Against Hunger

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David Satcher, MD, PhD,United States Surgeon
General (1998-2001)

• In schools the focus needs to be on creating an
  environment that fosters lifelong habits of good
  nutrition and increased physical activity.

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Why a School-Based Initiative?
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Obese and Overweight Kids in Utah

• Fill 124 elementary schools - 2,067 classrooms

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Change The Conversation

• Its not just an obesity epidemic. Its an
  epidemic of physical inactivity and poor
  nutrition.
• Mark Fenton,
• UNC Pedestrian and Bicycle Center

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Potential Health Consequences

• Elevated Lipids and Cholesterol
• Hypertension
• Type II Diabetes
• Apnea
• Liver Abnormalities
• Orthopedic Problems
• Depression
• Poor Peer Interaction

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Economic Consequences of Obesity

• National costs attributed to overweight and
  obesity
• -9.1 of total US medical expenditures
• -78.5 billion dollars (1998)
• Approximately half of the costs were paid by
  Medicaid and Medicare
• Utahs portion of this cost was 393 million
  dollars
• -62 million paid by Medicare
• -71 million paid by Medicaid
• Finkelstein, EA, Fiebelkorn, IC, Wang, G.
  National medical spending attributable to
  overweight and obesity How much, and whos
  paying? Health Affairs 2003W3219226.
• Finkelstein, EA, Fiebelkorn, IC, Wang, G.
  State-level estimates of annual medical
  expenditures attributable to obesity. Obesity
  Research 200412(1)1824.

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Link Between Achievement and Good Health

• By reducing
• Absences
• Anxiety
• Apathy
• Depression
• Fatigue
• Infections
• Irritability

• By improving
• Academic success
• Attendance
• Behavior
• Energy levels
• Participation
• Test scores

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Link Between Achievement and Good Health

• Over 200 studies linking physical activity with
  cognitive functioning
• Studies link increased time in physical education
  with improved test scores in math, reading and
  writing
• Reduces anxiety and stress in teens
• Fitnessgram showed direct correlation with test
  scores
• Good health and nourishment enhance performance
  on cognitive testing
• Improved tests scores are a result of school
  breakfast program

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Cost of Poor Nutrition and Physical Activity

• Money associated with absenteeism
• Staff time and money
• Health care costs for staff
• ADA accommodations
• Money taken away from school meal programs

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School is Kids work and social world

• Need consistency between educational messages and
  real life messages in the school
• Growing commercial trends compete with healthy
  options

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Creating Change and Solutions
Community
School
Home
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Making ChangeCreating Policy
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Whats Happening in Utah?

• Gold Medal School Program
• Nutrition Policies in Wasatch, Tooele and Nebo
  Districts
• Legislative Resolution (HJR-11)
• Federal Child Nutrition Reauthorization Act-
  Wellness Policy
• Sample Policies
• Awareness Activities

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Shaping Utahs Future Utah Department of Health
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An Incentive Approach

• Promoting
• Physical Activity
• Healthy Nutrition
• Tobacco Free Lifestyle

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How Does GMS Work?

• Infrastructure
• Criteria
• School Recruitment
• Mentors
• Training
• Awards
• Cost

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GMS Infrastructure
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Criteria Developed

• Bronze
• Silver
• Gold
• Platinum

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Policy CriteriaExamples

• Each student gets at least 90 minutes of
  structured physical activity per week
• Food is not used as reward or punishment for
  students

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Environment CriteriaExamples

• Establish a
• Gold Medal
• Mile
• Provide competitive and non-competitive physical
  activity programs accessible to all students

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Reaches the Intended Audience

• Between 2001 and 2005
• 203 schools have participated in GMS and 114 of
  these schools have reached Gold level
• Over 103,000 students reached
• More than 2,700 teachers involved in a faculty
  wellness program
• More than 5 million Gold Medal Miles walked by
  students

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Changes Schools

• Between 2001 and 2005
• Almost 1,300 individual school policies or
  environmental supports have been implemented or
  strengthened to promote healthy choices

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Physical Activity Policy2001 and 2005
Percent of GMS with a Policy for 90 Minutes of
Structured Physical Activity Per Week

Percent
GMS with Physical Activity Policy by
Year
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Nutrition Policy/Supports2002-2004
Percent
Nutrition Policy and Supports by Year
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Wellness Policy

• Goals for Nutrition Physical Activity
• Nutrition Guidelines
• Involve parents, students, SFS, school board
  representative, school administrator, public

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2. Food as a reward is discouraged and shall be
used on a limited basis.
4. Seventy (70) percent of the contents of
vending machines accessible to students shall be
water, milk, 100 fruit juices, and items that
meet the nutritional standards established by the
Food Service Department.
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Elementary Schools

• No competitive foods during school meals.
• If schools have vending, they must contain only
  water, 100 fruit juice, non-fat or low-fat milk
  and fresh, dried or canned fruits and vegetables.

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Competitive Foods- Secondary Schools

• The following beverages may be sold or served
  water, 100 fruit juice, non-fat and low-fat milk
• The following beverages may not be sold or
  served soft drinks, sports drinks, punches, teas
  and other beverages containing less than 100
  fruit juice.
• Fruits and vegetables should be offered for sale
  at any location on the school site where foods
  are sold (including fresh, cooked, dried, juice,
  or canned).

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Competitive Foods, cont.

• All snacks, sweets, or side dishes sold or served
  on school sites outside of the federal school
  meal programs shall meet all of the following
  standards have 30 or less of its total calories
  from fat, Have 10 or less of its total calories
  from saturated plus trans fat, have 35 or less
  of its weight from sugars, excluding sugars
  occurring naturally in fruits, vegetables, and
  dairy ingredients.

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Physical Education Policy Recommendations

• Elementary
• Implement the Physical Education Core Curriculum
  (Utah State Office of Education) in each
  elementary school.
• Aim for daily physical education instruction and
  activity for each elementary school child, with a
  goal of 150 minutes per week.
• Include at least two recess periods with active
  play each day.
• Restrict the use of recess as a reward or
  withholding recess as a punishment.
• Establish and promote safe routes for walking to
  and from school.
• Establish recess as an important time of day for
  children and teachers and not a time for
  remediation.
• Alter school schedules to allow for recess before
  lunch.

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Physical Education Policy Recommendations

• Secondary
• Implement the Physical Education Core Curriculum
  (Utah State Office of Education) in each
  secondary school.
• Prioritize instruction that emphasizes
  activities, knowledge and skills for life-long
  physical fitness.
• Include and promote intramural sports and fitness
  activities that emphasize involvement of all
  students in addition to formal athletic programs.
• Establish and promote safe routes for walking and
  biking to school.

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Nutrition Policy Recommendations

• Implement the Nutrition Core Curriculum (Utah
  State Office of Education) at each school.
• Limit food used for celebrations and rewards to
  less than once per month in each classroom.
• Achieve or exceed the federal standards for the
  school breakfast and lunch programs.
• Allow at least 10 minutes for breakfast and 20
  minutes for lunch (once a student is seated).
• Assure adequate facilities for each student to
  eat sitting down in the cafeteria.

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Nutrition Policy Recommendations

• No competitive foods sold during meal times.
• Establish guidelines for competitive food sales
  (vending, school stores, etc.) that promote
  healthy eating. See accompanying document
  Recommendations for Competitive Food Standards
  in Utah.
• Incorporate pricing that encourages the
  consumption of healthy foods in a la carte lines,
  vending and school stores.
• Include fruits, vegetables, salad bars, whole
  grain products and low-fat dairy and protein
  products while restricting the frequency of
  breaded and fried items as a la carte options in
  secondary schools.

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Wellness Policy Recommendations

• Establish a wellness committee at the school
  district level that includes school
  administrators, food service administrators,
  school board members, health and physical
  education teachers, other teachers, parents and
  students.
• Wellness committee to write, implement and
  evaluate physical activity and nutrition policies
  using accompanying materials in order to comply
  with the Child Nutrition Reauthorization Act
  which requires wellness policies to be in place
  in each district that receives school meal
  funding by Fall 2006.
• Encourage schools to use the Utah Gold Medal
  School Program (http//www.hearthighway.org),
  which provides guidelines, resources and
  incentives to schools that makes changes in
  physical activity and nutrition.

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Wellness Policy Recommendations

• Encourage schools to use the Healthier US
  program, which helps make healthy changes to
  school breakfast and lunch. www.fns.usda.gov/tn/He
  althierUS/index.htm)
• Restrict fund-raising activities that rely on the
  sales of unhealthy foods and encourage those that
  incorporate physical activity.
• Promote wellness recommendations to staff,
  teachers, administrators and parents so they can
  serve as role models for health.
• Include a yearly evaluation of the wellness
  policies, identifying implementation rates,
  results and plans for additional recommendations.
  

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What Kids Want

• I want to play like the other kids
• I want to be treated like the other kids
• I dont want to be fat

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What Can You Do?

• There is no limit to what we can achieve when
  we combine with the right people.
• Together we really can make a difference in the
  health of our nation's children.

Call to ActionDavid Satcher, MD, PhD
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Resources

• AFHK- Utah
• Competitive Food Standards
• Policy Guidelines
• Displays
• Listserv
• Fact Sheets
• Research backgrounders
• Presentations
• NASBE
• Sample Policies
• CDC
• School Health Index

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More Resources

• Institute of Medicine Report Preventing
  Childhood Obesity Health in the Balance, 2005
• American Heart Association Child Obesity Facts
  and Figures, 2005
• American School Nutrition Association, sample
  policies
• Hearthighway.org- UDOH links to school health
  information and Gold Medal Schools

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Contact Information

• Julie Metos, Utah-AFHK Chair
• julie.metos_at_hsc.utah.edu
• Sarah Rigby, Gold Medal Schools,
• Utah Department of Health
• srigby_at_utah.gov