Childhood obesity

Are we doing all that we can to reverse the trend?

03/30/2013  |  MARK E. BENDEN CPE, PhD

Childhood obesity, once a growing concern in the early 1980s, has transformed into a major epidemic over the past 30 years, with a prevalence rate of over 32 percent in children age two to 19 years — overweight and obese body mass index (BMI) categories combined as of 2010. Studies have shown that before a child reaches the age of six, the risk for obesity originates within the child’s home, as parental BMI and other non school related factors such as race and socioeconomic status, serve as the major indicators for potential child obesity. 

After age six, the patterns of obesity are more readily seen in a shift of focus from the child’s internal home environment to their external environment, such as school and social activities. This is especially seen as the child’s status of obesity in middle childhood and early adolescence becomes the greatest predictors of obesity in later adolescence.

At that point in their development, school leadership has an opportunity to make a difference through education, school environment, physical activity and nutrition. These interventions are crucial as children typically spend less and less time in their homes as they age. We know from epidemiological studies that obese children who grow into obese adults also have more severe health risks than individuals with adult onset obesity; indicating that “starting early” at a young age on the track to obesity is ultimately more detrimental than late-life adulthood obesity. In addition, obese children at age 13 have greater than a 70 percent chance of being obese as adults.

The effects of obesity are detrimental to children, adults, and the nation, as obesity continues to become a more severe pandemic. Obesity places individuals at extremely high risk for cardiovascular and other diseases. Increased risk for obese children has also been seen in psychological and social disorders, poor academic outcomes, and strain on economic and health resources. For example, academic research has shown that school-age children who are obese may have increased risk for academic failure and engagement in risky health behavior such as substance abuse, premature sexual behavior, and unhealthy eating habits, which may compound weight problems. Such studies have also consistently shown that, even after adjusting for other known factors, obesity adversely affects a child’s standardized test scores, grades and likelihood of being bullied.

Not only can this impact the future occupational success of generation Z, it can also place a strain on economic and health resources, as roughly $100 billion has been spent in the United Stated on health care costs related to obesity in 2011 alone. If the current obesity trends continue, the life expectancy of the current generation could ultimately decrease by up to five years, making them the first generation in U.S. history to not experience a life-expectancy increase from their parents.

Weight gain is most often the result of unbalanced calorie consumption versus calorie or energy expenditure. Many other causal factors are known to exist, but this aspect is the most well-researched and the most likely to yield to school and societal changes. Many policies and programs have been attacking this issue from the nutritional or calorie intake portion of the equation through school-based obesity intervention and health promotion programs.

The other side of the balance is calorie expenditure. With the ever increasing amounts of screen time (aka “technology induced inactivity”) and decreases in physical activity, sedentary behaviors are being implicated as a culprit for childhood obesity. Recent studies show positive results for increasing physical activity duration for school children; however, many schools only implement such programs under mandate, as these programs force them to reduce instructional time to compensate for additional physical activity.

The key is to combine increased physical activity WHILE learning. Once outside of the school setting, affecting child health behaviors is extremely difficult, regardless of the resources invested in those efforts. Recognizing this dynamic, many health promotion programs seek to use schools as a vehicle for delivering interventions. As mentioned previously, events and interactions that occur in a school setting become increasingly important as a child ages, as children typically spend an increasing amount of time in school and less time at home as they advance academically. Unfortunately, school-based obesity intervention programs that do not promote academic achievement often impose a significant burden on teachers and administrators due to the demands these programs place on instructional time.

The largest obstacle for obesity related interventions in schools to date come in the form of “unfunded mandates.” This term may be cliché, but it aptly stresses the point that public health experts need to bring ideas to schools that are self-sustaining, self-funded or requiring minimal investment, and that combine both successful obesity interventions WITH academic upgrades for students and teachers (e.g., better classroom management, improved attention and focus for students, improvements in test scores, improvements to grades, etc.,). With this criterion not met, there will continue to be a significant lag in the desired improvement and implementation of childhood obesity interventions. In other words — “Ask not what your obesity program can do for the children, but instead, ask what it can do for the schools, teachers and administrators.” If that question is asked and answered with improvements to metrics that are at the top of school officials’ lists, then the health improvements, as by-products, have a chance to become policy while enjoying widespread use.

Designing a more dynamic classroom to increase physical activity during the school day that subsequently promotes the prevention of childhood obesity can consist of simple school-based environmental changes, such as incorporating physical education into part of academic lessons and/or standing — rather than sitting — during instructional time by adding stand-biased workstations to the classroom.

Another example would be setting universal drop-off points one mile from school with a safe and supervised walking route for students and staff to use to walk to and from transportation parking lots. These types of changes don’t require loss of instructional time, increased staffing or specialized training. However, they do require some planning and informed effort on the part of administrators, groups like the school health advisory boards and an overall increase in awareness in the architecture and design of the surrounding community. These interventions holds great benefits, however, as they target ALL children, not just low socioeconomic status children, overweight children or children not in a particular after-school club or team.

Evaluation of the effectiveness and scalability of these interventions will improve and inform scientific knowledge by increasing the evidence base regarding environmental change strategies to prevent childhood obesity and may impact new policy development for schools and state and national education agencies.

Reducing obesity is one of several potential benefits for children who are able to move while learning, hence the importance of the targeted setting for dynamic classrooms. In fact, for those influencing decisions about implementation of dynamic classrooms, preventing obesity is likely to be only one of the important benefits. Those decision makers in school administration may in fact be more concerned with product price and the academic performance of children using the desks. In addition to increasing caloric burn, teachers that have converted their classrooms to dynamic workstations have commented that they reduce disruptive behavior and increase student academic achievement.

Children become more restless and inattentive with prolonged sitting. This increase in inattention and restlessness can be attributed to the novelty of the task. That is, children become less engaged with seat work and engage in off-task and disruptive behaviors with time because seated classroom activities become less novel to them. It is possible that more dynamic workstations can reduce disruptive behavior problems and increase students’ attention or academic/behavioral engagement by providing students with a different method for completing academic tasks — e.g., fidgeting, walking, rocking, standing — that breaks up the monotony of seated work.

Recent research indicates that academic behavioral engagement is the most important contributor to student achievement. School-based obesity interventions that align with schools’ academic goals to improve academic achievement are more likely to be implemented and have higher rates of success and sustainability. New approaches for addressing childhood obesity should be in harmony with children’s natural habits, tendencies and engagement.

What is working for your district? What would you like to see implemented that meets these requirements? What will it take to get all of us working together to answer these tough questions? After all, the promise of a better tomorrow for an entire generation hangs in the balance.

Mark Benden is co-director of the Ergonomics Center, EOH Department, Texas A&M School of Rural Public Health in College Station, Texas. For more information, call 979-845-8773 or e-mail [email protected].
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