Childhood Obesity – 2010: Progress and Challenges

Context: Research consistently shows that the majority of American children do not consume diets that meet the recommendations of the Dietary Guidelines for Americans, nor do they achieve adequate levels of daily physical activity. As a result, more children are overweight today than at any other time in U.S. history. Schools offer many opportunities to develop strategies to prevent obesity by creating environments in which children eat healthfully and engage regularly in physical activity.

Methods: This article discusses the role of schools in obesity prevention efforts. Current issues in schools' food and physical activity environments are examined, as well as federal, state, and local policies related to food and physical activity standards in schools. The article is organized around four key areas: (1) school food environments and policies, (2) school physical activity environments and policies, (3) school body mass index measurements, and (4) school wellness policies. Recommendations for accelerating change also are addressed.

Findings: The article found that (1) competitive foods (foods sold outside of federally reimbursed school meals) are widely available in schools, especially secondary schools. Studies have related the availability of snacks and drinks sold in schools to students' high intake of total calories, soft drinks, total fat and saturated fat, and lower intake of fruits and vegetables; (2) physical activity can be added to the school curriculum without academic consequences and also can offer physical, emotional, and social benefits. Policy leadership has come predominantly from the districts, then the states, and, to a much lesser extent, the federal government; (3) few studies have examined the effectiveness or impact of school-based BMI measurement programs; and (4) early comparative analyses of local school wellness policies suggest that the strongest policies are found in larger school districts and districts with a greater number of students eligible for a free or reduced-price lunch.

Conclusions: Studies show that schools have been making some progress in improving the school food and physical activity environments but that much more work is needed. Stronger policies are needed to provide healthier meals to students at schools; limit their access to low-nutrient, energy-dense foods during the school day; and increase the frequency, intensity, and duration of physical activity at school.

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Schools and Obesity Prevention: Creating School Environments and Policies to Promote Healthy Eating and Physical Activity

BACKGROUND: Weight-based victimization has become increasingly reported among overweight youth, but little is known about adolescents’ perceptions and observations of weight-based teasing and bullying. This study examined adolescents’ observations of and reactions to weight-based victimization toward overweight students at school. METHODS: Adolescents (N = 1555) at 2 high schools in central Connecticut completed a questionnaire that examined their perceptions of how common weight-based victimization is compared to other forms of teasing at school, what types of weight-based teasing are frequently observed, who typical perpetrators of weight-based victimization are, and their own reactions to observed teasing incidents. Participants also completed the Fat Phobia Scale. RESULTS: Participants perceived being overweight as a primary reason that peers are victimized at school. At least 84% of participants observed overweight students being teased in a mean way and teased during physical activities, and 65% to 77% of students observed overweight and obese peers being ignored, avoided, excluded from social activities, having negative rumors spread about them, and being teased in the cafeteria. Most students also observed verbal threats and physical harassment toward overweight and obese students. Although the majority of participants felt comfortable stepping in to help an overweight peer who has been teased, many remain passive bystanders following these incidents. CONCLUSION: Youth perceive frequent and multiple forms of weight-based victimization. Schools’ efforts to address weight bias and assist overweight and obese students are important.

Weight-based victimization toward overweight adolescents: observations and reactions of peers.

School health guidelines to promote healthy eating and physical activity

Cardiovascular disease mortality rates have fallen by ≈50% over the past 50 to 60 years. However, cardiovascular disease prevalence remains high, and cardiovascular disease is still the leading cause of death and disability in the United States.1,2 It has been estimated that preventive efforts have contributed to at least half of this decline, with the primary contribution coming from declines in mean blood cholesterol concentrations, mean blood pressure levels, and tobacco use rates. Regrettably, during this past decade, the increased prevalence of obesity and diabetes mellitus has dramatically slowed the secular decline in cardiovascular mortality rates.1,3,4 In fact, in the United States, the contribution of prevention to the decline of cardiovascular mortality is now much lower than in other industrialized countries and the United States historically.1,5

The continuing challenge is preventing the development of cardiovascular disease, especially early in life. Nutrition remains a cornerstone of that effort. Modernization and industrialization of the food supply and distribution patterns, as with our lifestyles, have produced many benefits but also unanticipated consequences.6 Decline in saturated fat and cholesterol intake, influenced by public awareness of adverse health consequences, coupled with increased availability of foods lower in cholesterol and saturated fat, has been associated with reductions in cardiovascular disease. However, recent studies of trends in the dietary patterns of the United States suggest a significant drift toward less healthful eating patterns and overconsumption of energy, which have been associated with increases in prevalence of obesity, metabolic syndrome, and type 2 diabetes mellitus.1–4 These data strongly suggest that additional emphasis is needed on ways to implement current guidelines in contemporary society. A great benefit can be achieved from adopting a heart-healthy nutrition pattern at a young age, thereby preventing the rise in cholesterol and blood pressure levels associated with excess saturated …

Implementing American Heart Association pediatric and adult nutrition guidelines: a scientific statement from the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular Disea

BACKGROUND: School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth. METHODS: An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided expertise on an earlier version of this article. The panel comprised experts in public health, education, school counseling, school medical care, and a parent organization. This article describes the purposes of BMI measurement programs, examines current practices, reviews existing research, summarizes the recommendations of experts, identifies concerns, and provides guidance including a list of safeguards and ideas for future research. RESULTS: The implementation of school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted; however, considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI screening programs are a promising practice for addressing obesity. CONCLUSIONS: Based on the available information, BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools. Schools that initiate BMI measurement programs should evaluate the effects of the program on BMI results and on weight-related knowledge, attitudes, and behaviors of youth and their families; they also should adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1746-1561.2007.00249.x

Body mass index measurement in schools.

BACKGROUND AND OBJECTIVE: School-based BMI measurement has attracted attention across the nation as a potential approach to address obesity among youth. However, little is known about its impact or effectiveness in changing obesity rates or related physical activity and dietary behaviors that influence obesity. This article describes current BMI-measurement programs and practices, research, and expert recommendations and provides guidance on implementing such an approach. METHODS: An extensive search for scientific articles, position statements, and current state legislation related to BMI-measurement programs was conducted. A literature and policy review was written and presented to a panel of experts. This panel, comprising experts in public health, education, school counseling, school medical care, and parenting, reviewed and provided expertise on this article. RESULTS: School-based BMI-measurement programs are conducted for surveillance or screening purposes. Thirteen states are implementing school-based BMI-measurement programs as required by legislation. Few studies exist that assess the utility of these programs in preventing increases in obesity or the effects these programs may have on weight-related knowledge, attitudes, and behaviors of youth and their families. Typically, expert organizations support school-based BMI surveillance; however, controversy exists over screening. BMI screening does not currently meet all of the American Academy of Pediatrics’ criteria for determining whether screening for specific health conditions should be implemented in schools. CONCLUSION: Schools initiating BMI-measurement programs should adhere to safeguards to minimize potential harms and maximize benefits, establish a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.

https://pediatrics.aappublications.org/content/pediatrics/124/Supplement_1/S89.full.pdf

BMI measurement in schools.

Objectives. To evaluate and describe outcomes of state and local medical countermeasure preparedness planning, which is critical to ensure rapid distribution and dispensing of a broad spectrum of life-saving medical assets during a public health emergency.Methods. We used 2007 to 2014 state and local data collected from the Centers for Disease Control and Prevention’s Technical Assistance Review. We calculated descriptive statistics from 50 states and 72 local Cities Readiness Initiative jurisdictions that participated in the Technical Assistance Review annually.Results. From 2007 to 2014, the average overall Technical Assistance Review score increased by 13% for states and 41% for Cities Readiness Initiative jurisdictions. In 2014, nearly half of states achieved the maximum possible overall score (100), and 94% of local Cities Readiness Initiative jurisdictions achieved a score of 90 or more.Conclusions. Despite challenges, effective and timely medical countermeasure distribution and dispensing is possib...

Improvements in State and Local Planning for Mass Dispensing of Medical Countermeasures: The Technical Assistance Review Program, United States, 2007–2014

Chris Reinold

Papers

Body mass index measurement in schools.

BMI measurement in schools.

Improvements in State and Local Planning for Mass Dispensing of Medical Countermeasures: The Technical Assistance Review Program, United States, 2007–2014