1963-70 1971-74 1976-80 1988-94 1999-2000 2001-02 2003-06 2007-080

5

10

15

20

Percentage of U.S. Children and Adolescents Who Were Obese, 1963-2008*

4.6

4.2

19.6

18.1

**

*>95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts. **1963-1970 data are from 1963-1965 for children 6-11 years of age and from 1966-1970 for adolescents 12-17 years of age.CDC, National Center for Health Statistics

Ages 6-11 Ages 12-19

Consequences of Obesity in Children

26% 13%

% of children, aged 5-17, with 1 or more risk factors for heart disease:

% of children, aged 5-17, with 2 or more risk factors for heart disease:

obese

70%

obese

39%

Freedman DS et al. JPediatr 2007;150(1):12-17

Economic Costs Associated with Obesity are High

• Direct health care costs of obesity and overweight:

– 1998: $74 billion

– 2008: $147 billion

• ½ of costs publicly financed by Medicare or Medicaid

• Obesity accounts for 9.1% of annual medical spending

Finkelstein EA et al. Annual medical spending attributable to obesity: payer and service-specific estimates. Health Affairs 2009;28

• 60 or more minutes of physical activity daily, most of which should be aerobic

• At least 3 days per week of:

Vigorous-intensity physical activity

Muscle-strengthening physical activity

Bone-strengthening physical activity

Physical activities should be age appropriate, be enjoyable, and offer variety

www.health.gov/paguidelines

Guidelines for Youth

Percentage of High School Students Who:

• Are physically active at least 60 minutes per day on all 7 days: 18%

• Do not participate in at least 60 minutes of physical activity on any day: 23%

• Do not attend PE classes: 44%

Source: CDC, National Youth Risk Behavior Survey, 2009

A Comprehensive School Physical Activity Program

• High quality physical education as its foundation• Elementary school: Daily recess period

• Physical activity throughout the school day

• Extra-curricular physical activity programs

− Inclusive, intramural programs and physical activity clubs

− High school: Interscholastic athletics

• Walk/bike to school program (“safe routes”)

• Staff wellness program

Enhanced School PE is Strongly Recommended

• Enhanced PE: modified curricula and policies designed to make PE classes longer or have students be more active during class

• All PE studies reviewed (n = 14):– Increased time and intensity of PA

during PE– Improved physical fitness– Effective across diverse racial,

ethnic, and socioeconomic groups in urban and rural settings

Health is Academic Because…

• School health programs can help improve students’ educational outcomes

• Helping young people stay healthy is a fundamental part of the mission of our schools

Percentage of U.S. High School Students Getting Mostly A’s, Mostly B’s, Mostly C’s and Mostly D’s and F’s* Who

Engage in Selected Health Risk Behaviors

*As reported by students Source: Unpublished analyses of CDC, National Youth Risk Behavior Survey, 2003

29 28323937

454147

0

20

40

60

80

100

Insufficient amount of physical activity Watched television ≥ 3 hours/day

Mostly As Mostly Bs Mostly Cs Mostly Ds & Fs

www.cdc.gov/HealthyYouth/health_ and_academics/pdf/pa-pe_paper.pdf

Physical Activity Contexts

• Physical education

• Recess

• Classroom-based

• Extracurricular

Academic Outcomes

• Achievement (grades, test scores)

• Behavior (time on-task, attendance, conduct)

• Cognitive skills and attitudes (concentration, memory, mood)

www.cdc.gov/HealthyYouth

• Increasing or maintaining time for PE does not appear to adversely impact academic performance

• Substantial evidence that school-based physical activity can:

−help improve academic achievement (including grades and standardized test scores)

−have a positive impact on cognitive skills and academic behaviors

Critical Educationally Relevant Health

Factors

www.equitycampaign.org

• Vision

• Asthma

• Teen Pregnancy

• Aggression & Violence

• Physical Activity

• Breakfast

• Inattention/ Hyperactivity

www.equitycampaign.org

What Can Schools Do?

• Make health a fundamental part of elementary and secondary education

• Create effective and efficient school health programs−High quality, evidence-

based−Strategically planned−Effectively coordinated

Strategies to Close the Educational Achievement Gap

• Standards and assessments

• Data systems

• Effective teachers and principals

• Charter schools

• Reducing educationally relevant health

disparities

“Give about two [hours], every day to exercise; for health must not be sacrificed to learning. A strong body makes the mind strong.”

Thomas Jefferson

“We know what the Greeks knew: that intelligence and skill can only function at the peak of their capacity when the body is healthy and strong, and that hardy spirits and tough minds usually inhabit sound bodies.”

John F. Kennedy

“The more we instill in our children early in life these [physical activity] habits that will last them a lifetime, the better they're going to do. And so we'll try to do what we can to expand those opportunities before school, during the school day, after school.…this is going to help a lot academically…This doesn't take away from our core mission. This is central to that core mission.” Arne Duncan

U.S. Secretary of Education

“Health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.”

National Association of State Boards of Education

“No educational tool is more essential than

good health…Policies and practices that

address the health and developmental needs

of young people must be included in any

comprehensive strategy for improving

academic performance.”

Council of Chief State School Officers

High Quality Physical Education

• Based on national

standards

• Emphasizes lifetime

physical activity

• Meets the needs of all

students

• Keeps students active

most of class time

• Is enjoyable

High Quality Physical Education Requires

• Adequate time (150 min/week for elementary; 225 min/week for secondary)

• Highly qualified teachers

• Adequate facilities and supplies

• Reasonable class sizes

• A written curriculum

• Student assessment

School PE Practices

• Only 4% of ES, 8% of MS, and 2% of HS provided daily PE or its equivalent for entire school year for all students1

• 31% of ES, 16% of MS, and 5% of HS did not require students to take any physical education1

• 19% of 3rd grade students were offered at least 150 minutes of weekly PE2

1. CDC, School Health Policies and Programs Study, 20062. Bridging the Gap, data for 2007-2008 school year

Barriers to High Quality PE

• Insufficient time

• Inadequate facilities, equipment, and supplies; large class sizes

• Poor quality curricula or no curricula

• Use of teachers not certified to teach PE or insufficiently trained in high quality instructional techniques

• Lack of support from administrators

• Lack of champions

• Lack of accountability measures

Policies to Support High Quality PE

• Increase time for PE

• Limit PE class size

• Support use of curricula based on PE standards and evidence-based PE programs

• Have all classes taught by certified PE teachers and fund ongoing professional development

• Implement student assessment for PE

Recommendations include:

• Local wellness policies should

include strong physical activity

components, on par with nutrition

components.

• State and local education

agencies should require increased

quality and frequency of

sequential, age- and

developmentally-appropriate

physical education for all students,

taught by certified teachers.

Opinions of U.S. Adults About School Health Programs

• 65% of U.S. adults believe schools should play a major role in fighting the obesity problem1

• 81% of parents of children in K—12 want their kids to receive daily physical education2

1. Survey by Lake Snell Perry and Associates for Harvard Univ., based on interviews with a nationally representative sample of 1,002 adults, May-June 20032. Survey by Opinion Research Corp. based on interviews with a nationally representative sample of 1,017 adults, February 2000 (margin of error = +6%)

Obesity: A National Security Threat

“Obesity rates threaten the overall health of

America and the future strength of our military.

We must act, as we did after World War II, to

ensure that our children can one day defend our

country, if need be.”

Source: The Washington Post, April 30, 2010

Retired U.S. Army Gens. John M. Shalikashvili and Hugh Shelton

Lifestyle and Energy Expenditure

Kcal estimates for 150-160 pound person. Slide developed by Steve Blair with information taken from article by L. Beil, Dallas Morning News

Lifestyle and Energy Expenditure

• Assume a person’s caloric intake remains the same

• Completing all of the tasks reviewed daily or as listed– Active way=10,500 kcal/month– Sedentary way=1,700 kcal/month

• Difference of 8,800 kcal/month is energy equivalent of 2.5 pounds/month or 30 pounds/year

Keys to Success

• Laws and regulations

• Reference materials

• Collaboration / team approach

• Involving students and families

• Attention to the process /intensive follow-up

Keys to Success

• Marketing techniques/ customer focus

• Positive attitude/ enthusiasm

• Data collection

• Developing quality first

The Single Most Consistent and Important Key to Success:

The Local Change Agent