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December 1, 2009
Vol. 67
No. 4

Taking Charge of School Wellness

Poor nutrition and physical inactivity are threatening our students' futures. Will schools meet the challenge?

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While serving as U.S. surgeon general in 2001, I released The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity (Office of the Surgeon General, 2001). This report concluded that the sharp increase in the rate of overweight and obesity between 1980 and 2000 had touched all ethnic groups and threatened to become the leading cause of preventable death in the United States.
Because of schools' unique ability to open doors of opportunity for all youngsters, regardless of their their socioeconomic backgrounds or ethnicity, educators have an essential role to play in advancing student health and preventing childhood obesity. If we want all our children to have an equal chance to succeed in school and in life, our schools must not only promote academic achievement but also help students develop habits of healthy eating and physical activity.

An Unhealthy Start to the 21st Century

More than 30 percent of children ages 2–19 in the United States are overweight or obese (Ogden, Carroll, & Flegal, 2008).In the past three decades, this rate has doubled among U.S. preschool and adolescent children and tripled among 6- to 11-year-olds (Centers for Disease Control and Prevention, 2006).
Regardless of race and socioeconomic status, overweight children are more likely to become overweight adults (Whitaker, Wright, Pepe, Seidel, & Dietz, 1997). This is not a cosmetic issue, but a serious health threat. Overweight individuals are at increased risk of developing cardiovascular disease, diabetes, and certain cancers (Freedman, Mei, Srinivasan, Berenson, & Dietz, 2007).
Unfortunately, both adults and children increasingly overeat and eat the wrong foods. Trends contributing to obesity include more restaurant dining and the proliferation of microwaves and processed foods (Levi, Vinter, Richardson, St. Laurent, & Segal, 2009). According to the U.S. Department of Agriculture, few school-age children eat well, consuming the recommended daily amounts of fruits, vegetables, and whole grains as well as low-fat and nonfat dairy products to strengthen bones and build healthy bodies (Gleason & Suitor, 2001). Children and youth in poor communities—which often have limited or no access to fresh fruits and vegetables, along with other disparities—are especially vulnerable.
Equally disturbing is the fact that young people are not moving enough, at home or at school. The Centers for Disease Control and Prevention (Duke, Huhman, & Heitzler, 2003) found that about 62 percent of children ages 9–13 did not participate in any organized physical activity during their nonschool hours, and 23 percent did not engage in any free-time physical activity. Black and Hispanic children were significantly less likely than non-Hispanic white children to report involvement in organized activities, as were children with parents who had lower incomes and education levels. And few schools offer daily physical education throughout the academic year—only 4 percent of elementary schools, 8 percent of middle schools, and 2 percent of high schools (Lee, Burgeson, Fulton, & Spain, 2007).

Why Promote Physical Health in Schools?

A growing body of evidence shows that children who eat poorly or who engage in too little physical activity do not perform as well as they could academically (Action for Healthy Kids, 2004). Poor nutrition affects students' learning in a number of ways, depriving them of essential vitamins, minerals, fats, and proteins that are necessary for optimal cognitive function (Center on Hunger, Poverty, and Nutrition Policy, 1995).
Research also suggests the benefits of improving students' nutrition and physical activity. One body of research has examined the effects of giving students a healthy nutritional start to the day through school breakfast programs. Numerous studies have found that increased participation in school breakfast programs is associated with increases in test scores, daily attendance, and class participation, as well as reduced absenteeism and tardiness (Kleinman et al., 2002; National Governors Association, 2000).
A meta-analysis of about 200 studies found that regular physical activity can promote learning (Etnier et al., 1997). Data from one study showed that participation in a two-year, health-related physical education program significantly improved academic achievement (Sallis et al., 1999).
Only a handful of studies have examined the relationship between being overweight and learning. However, common sense tells us that overweight students face a number of barriers to school success. Being overweight can trigger or exacerbate a variety of chronic medical conditions—including asthma, type 2 diabetes, high blood pressure, depression and anxiety, and sleep apnea—that increase school absentee rates.
In addition to missing school, children who are overweight often face psychological and social problems that inhibit their academic performance. For example, one study found a strong association between being overweight in kindergarten and behavior problems such as anxiety, loneliness, low self-esteem, sadness, anger, excessive arguing, and fighting (National Institute for Health Care Management Foundation, 2004).

Gains and Gaps

A promising first step toward improving student health in the United States occurred in 2004, when Congress passed the Child Nutrition and WIC Reauthorization Act. This act required all schools with federally funded school meal programs to develop local wellness policies by the 2006 academic year.
Unfortunately, policies on the books do not necessarily translate into effective practices. Although the majority of U.S. schools have adopted polices to address poor nutrition and physical inactivity, many significant and serious gaps remain in local school wellness efforts. According to Action for Healthy Kids' 2008 report, Progress or Promises? What's Working For and Against Healthy Schools, many of these policies are weakly written and implemented. Most students still lack access to healthy, kid-appealing food choices.
Although schools have made progress in removing junk foods from the campus, they have been less successful in providing nutritious options that students will actually choose to eat, especially whole grains, low-fat and nonfat dairy, fruits, and vegetables. The report also found a lack of engagement with school wellness among school leaders, teachers, students, and parents.

Innovative Models Bridge Gaps

Although daunting hurdles and gaps persist, the good news is that many exciting and encouraging interventions are making a positive difference in schools across the United States. Here are just a few examples.

Success Stories from Michigan

In Michigan, health and education leaders collaborated on a Web site (http://mihealthtools.org/schoolsuccess) featuring real-world stories of local schools successfully building healthier environments. One of the more than 300 examples is the Walking and Pedometer Club at Burton Elementary and Middle School in Grand Rapids. Three days a week, approximately 150 students walk or run about a mile a day; students who log 15 miles or more receive a reward. Teachers and other staff members volunteer to monitor the program and record student progress. The school reports that since it has implemented the club, students are calmer in class and fewer students visit the health office.
The Web site contains many more examples of practical ways to advance school wellness, such as incorporating exercise breaks into classroom time, holding schoolwide physical activity events, implementing Farm-to-School programs to use local produce in school lunches, and involving families in healthy eating.

Students Taking Charge

Action for Healthy Kids has developed a program called Students Taking Charge, which motivates, educates, and empowers high school students to improve their personal health and to instigate wellness improvements in their school. Supported by a Web site (www.studentstakingcharge.org) and program volunteers, students develop and lead youth summits and peer-mentor training opportunities. As part of the Students Taking Charge video contest, students in 12 states created videos that were posted on YouTube showing why their schools are healthy places to learn.

Whole-System Change in Houston

In February 2009, Houston Independent School District in Texas held the Healthy Kids, Healthy Schools summit, launching a collaborative, whole-system change initiative with leadership support from more than 80 local, state, and national organizations (www.healthykidshealthyschools.org). The full community of stakeholders—business leaders, government officials, parents, health professionals, students, community leaders, school administrators and educators—have come together to create healthier schools in Houston.
Beginning in the 2009–10 school year, these volunteers are implementing a range of projects focused on improving nutrition and opportunities for physical activity. For example, one project team is working on increasing students' access to healthy, appealing foods. The plan includes introducing a new, healthy pizza product in school lunches, accompanied by promotions and nutrition education tie-ins, as well as expanding the district's Grab-n-Go Carts program to increase access to and consumption of kid-appealing fruits, vegetables, low-fat milk, and whole grain products. The carts project will be piloted in four school cafeterias with items attractively priced to encourage students to try healthier foods.
Another team is working on increasing community support and resources. Its plan includes a Healthy Food Zones initiative that encourages local businesses and stores around schools to offer healthy food options to students.

Working Together

Poor nutrition and physical inactivity harm the well-being and academic performance of students. To ensure the brightest future possible for our children, more educators, policymakers, community leaders, businesses, and parents need to embrace and advocate for proactive school health programs. For suggestions on what you can do, see How Educators Can Promote Student Health (p. 40). By working together, we can ensure that every student enjoys a learning environment that not only supports academic achievement but also promotes lifelong habits of physical activity and proper nutrition.

Action for Healthy Kids. (2004). The learning connection: The value of improving nutrition and physical activity in our schools. Skokie, IL: Author. Available:www.actionforhealthykids.org/pdf/Learning%20Connection%20-%20Full%20Report%20011006.pdf

Action for Healthy Kids. (2008). Progress or promises? What's working for and against healthy schools. Skokie, IL: Author. Available: www.actionforhealthykids.org/special_exclusive.php

Center on Hunger, Poverty, and Nutrition Policy. (1995). The link between nutrition and cognitive development in children(Policy Statement). Medford, MA: Tufts University School of Nutrition.

Centers for Disease Control and Prevention, National Center for Health Statistics. (2006). Prevalence of overweight among children and adolescents: United States, 2003–2004. Available:www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_child_03.htm

Duke, J., Huhman, M., & Heitzler, C. (2003). Physical activity levels among children aged 9–13 years—United States, 2002. Journal of the American Medical Association, 290(10), 1308–1309.

Etnier J. L., Salazaw W., Landers D. M., Petruzzello S. J., Han M., & Nowell, P. (1997). The influence of physical fitness and exercise upon cognitive functioning: A meta-analysis. Journal of Sport and Exercise Physiology, 19(3), 249–277.

Freedman D. S., Mei, Z., Srinivasan, S. R., Berenson, G. S., & Dietz, W. H. (2007). Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study.Journal of Pediatrics, 150(1), 12–17, e2.

Gleason, P., & Suitor, C. (2001). Children's diets in the mid-1990s: Dietary intake and its relationship with school meal participation(CN-01-CD1). Alexandria, VA: U.S. Department of Agriculture.

Kleinman, R. E., Hall, S., Green, H., Korzec-Ramirez, D., Patton, K., Pagano, M. E., & Murphy, J. M. (2002). Diet, breakfast, and academic performance in children. Annals of Nutrition and Metabolism, 46(1), 24–30.

Lee, S. M., Burgeson, C. R., Fulton, J. E., & Spain, C. G. (2007). Physical education and physical activity: Results from the School Health Policies and Programs Study, 2006. Journal of School Health, 77(8), 435–463.

Levi, J., Vinter, S., Richardson, L., St. Laurent, R., & Segal, L. M. (2009). F as in fat: How obesity policies are failing America. Washington, DC: Trust for America's Health.

National Governors Association. (2000).Improving academic performance by meeting student health needs. Washington, DC: Author.

National Institute for Health Care Management Foundation. (2004). Obesity in young children: Impact and intervention(Research Brief). Washington, DC: Author.

Office of the Surgeon General. (2001). The surgeon general's call to action to prevent and decrease overweight and obesity. Rockville, MD: U.S. Department of Health and Human Services. Available: www.surgeongeneral.gov/topics/obesity

Ogden, C. L., Carroll, M. D., & Flegal, K. M. (2008). High body mass index for age among U.S. children and adolescents, 2003–2006. Journal of the American Medical Association, 299(20), 2401–2405.

Sallis J. F., McKenzie, T. L., Kolody, B., Lewis, M., Marshall, S., Rosengard, P. (1999). Effects of health-related physical education on academic achievement: Project SPARK. Research Quarterly for Exercise and Sport, 70(2), 127–134.

Whitaker R. C., Wright, J. A., Pepe, M. S., Seidel, K. D., & Dietz, W. H. (1997). Predicting obesity in young adulthood from childhood and parental obesity.New England Journal of Medicine, 37(13), 869–873.

End Notes

1 The Centers for Disease Control and Prevention defines overweight as having a body mass index at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex, and it defines obesity as a body mass index at or above the 95th percentile for children of the same age and sex.

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