Physical Education and Activity – one way to combat overweight/obesity

August 5

2009

Childhood Obesity is a critical issue that needs immediate attention by individuals, policy makers, and community. A multiple approach to combat the obesity epidemic is necessary. Effective evidence based programs and practices need to be implemented to prevent obesity, and encourage healthy living - Leena Mehta

Why Wait to Enact Childhood Activity?

America is getting “obesogenic” because of the prevalence of obesity and overweight in the

US. In 1985, when overweight or obesity did not seem to be an issue, the Body Mass Index

(BMI) was not tracked for all states, 8 states had 10% - 14% population with obesity (with BMI

>/=30), and 11 states had less than 10% population with obesity. Obesity increased in 1995

when 15 states all in the West, some mid west, all North East states, South Dakota, Oklahoma,

and Georgia had 10%-14% of obese population, and the remainder of the States showed higher

obesity prevalence of 15% - 19%. The increasing obesity trend continued in 2005 with 3 states -

Louisiana, Mississippi, and West Virginia having more than 30% obesity prevalence rate, 15

states with 25%-29% obesity rate, 3 states with 15% - 19% rate, and the rest with 20% - 24%

prevalence rate. By 2007, less than 10 states had less than 24% obesity prevalence rates.1A

recent article in Reuters stated that obesity rate in US is 26%. 8 The obesity rates doubled in

children, and tripled in adolescents in the last couple of decades. Currently, over 12 million

children (including adolescents) are estimated to be obese and about 30% do not exercise at

least three days a week.2,8 No wonder, in 2001, the Surgeon General declared obesity as a US

epidemic.4

The burden of this obesity/overweight surge is affecting healthcare spending, and the

quality of life. Obesity has cost our country and its citizen a huge amount which can be reduced

only if obesity associated diseases are prevented, and barriers to healthy living are eliminated.

In 2000, the obesity associated annual cost was estimated at $117 billion, but at a recent

“Weight of the Nation” conference, the Agency for Healthcare Research and Quality (AHRQ)

shared findings from their new study that the annual spending for obesity associated care could

be $147 billion, which is $30 billion increase since Yr 2000.2,4,9 Also, AHRQ shared that medical

spending for obesity associated conditions had increased since 1998 from 6.5% to 9.1% of

annual medical expenses.2 According to Helen Darling, President of National Business Group

on Health, it costs the employers $13 billion a year. Also, in an article in Politico dated July 30,

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2009, by Christine Ferguson, a faculty member at The George Washington University, she

mentions that ‘Health Affairs’ did a study which indicated that on an average an obese person

spends $1400 a year more than average health expense.6

Overweight/Obese children and adolescents are having serious health implications

earlier than ever before and they have a higher risk exposure to chronic illnesses that fall

among the top 6 leading causes of death in the US.4 65% of obese 5-10 year olds have a

minimum of 1 cardiovascular risk factor, and 25% have 2 risk factors.11 The affected children will

have a shorter life span than their parents have.10 According to Center for Disease Control and

Prevention, if the obesity trend continues then 1/3rd of the 10 year old children in the US will

have Diabetes Type 2 by age 21.4 Almost 95% of healthcare spending is on treatment of

diseases instead of prevention, even though 50% of deaths are preventable, such as the

chronic diseases associated with obesity – Cardiovascular conditions, Diabetes type 2, stroke,

certain cancers, metabolic syndrome, and several others.4,6

Since the obesity related diseases are preventable, efforts to combat the disease must

be focused on immediately to reap the benefits of experiencing better health first, which will

automatically result into reduced health expenses eventually. Given the magnitude of the issue,

this paper focuses on Childhood Obesity Policies related to physical activity, and physical

education only. Before recommending or calling for any action, some understanding about the

1) Opportunities 2) Barriers to Physical Activity and 3) Gaps in Policy Options need to be

reviewed.

Fe w opportunities available to stem the obesity issue:

At the CDC’s “Weight of the Nation” conference on July 28, 2009, a plan outlining strategies

to develop a National Obesity Prevention & Control Roadmap was shared for programs that

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promote increased physical activity, eating healthy foods, and development of safe

environments for children.

There is a possibility of $200 billion a year savings if we reduce the obesity to what it was in

1987. According to a health economist, Kenneth Thorpe, if we reduce the obesity to that

level, we could reduce health care spending by 10% per person and have enough money to

cover the uninsured in America.10

It has been well put in an article mentioned in ‘RollCall’ by Helen Darling, “Any move to

reform the health care system will fail unless it addresses obesity…As Congress and the

president focus on health reform, reducing the nation’s obesity rates must be a top priority.”10

The Stimulus Package signed earlier under the American Recovery and Reinvestment Act

provided $144 billion to states and local government to be able to build an infrastructure with

healthy environment for children and families. It included $650 million for chronic disease

prevention programs based on evidence based strategies for healthy communities.

In early July, Boston Globe reported that the Trust for America’s Health (TFAH) urged

Congress to add the availability of community grants for community projects as part of the

health reform legislation. The funding will enable building an infrastructure to create a

healthy neighborhood that supports physical activity, nutritious food, and safe environment.

Community projects including creation of walking and bike paths, farmer’s markets, and

involving community effort will become available to state and local government agencies

and decisions will be made by the Secretary of the US DHHS.2

There are tools being studied and developed to eliminate or overcome barriers to physical

activity. The CORE Tool or the KNOWME Networks challenge participants to stay with their

planned physical activity.7,8

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Some Barriers to Physical Activity that were observed:

Kids walking to school decreased from 80% to 10% in one generation. Also, there is

declining rate of kids and teens between ages of 5 and 18 walking or biking to school - from

42% that was observed in 1969 to 13% that was observed in 2001.3 because in the last 20

years or so children did not have access to neighborhood parks, schools like the previous

generation, Baby Boomers experienced. More kids are transporting using motorized vehicle

which has reduced the active transport trend.3

Only 48% of kids are enrolled in physical education program in school.11

The younger, GenerationX and Millennials have more sedentary lifestyle compared to the

previous Baby Boomers generation since they spend more time on technology and socialize

on cyberspace. The cyberspace socialization and being indoors has reduced the physical

activity and increased consumption of unhealthy eating while watching TV.

It is estimated that 30% of children and teens are inactive physically or do not exercise the

minimum recommended three days a week.4 The increasing trend in childhood obesity was

observed at the same time as the social and the environmental changes that limited the outdoor

activities occurred. Hence lack of physical activity is associated with the increase in childhood

obesity, and therefore implementing policies to support physical activity is critical for

obesity/overweight prevention among youth. Twelve million children are estimated to be

overweight or obese.4 In the last 30 years, obesity almost tripled among kids under 5 years;

reached more than three times for children between 12 years and 19 years, and went beyond

four times for children between 6 years and 11 years old.3,4

Several policies have been considered, some have been enacted and programs have been

implemented. Although, policy options related to BMI measurement and reporting to parents,

Insurance coverage for obesity prevention and treatment, nutrition education, nutrition

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standards in schools, and several other childhood obesity legislations were also considered and

enacted by the states, the scope of this review is limited to policies related to physical activity

and physical education. The following table was created which shows all the 50 states that

considered and enacted policies related to physical activity and physical education or recess

from 2003 to 2008. The policies related to physical education or physical activity in schools

varied from state to state. Earlier daily physical education (PE) for school children was not

required, only Illinois required daily PE. Slowly, more states have increased PE requirements or

encouraged physical activities in schools during recess. Waivers are granted to children if they

are involved in other physical activity opportunities at school. Currently, 49 states require PE in

schools, and in 2008, 23 states requested considerations or enactments to new or existing PE

or physical activity policies, but only 6 states enacted:

Colorado (HB 1224) expanded their wellness policies to increase the availabilty of PE courses

to be able to enroll 1500 students.

Florida (SB 610) now requires daily one hour PE class for 6, 7, 8 graders for one semester each

year.

Maryland (HB1411) requires students with disabilities to be provided equal opportunity in the

mainstream PE programs.

New Mexico (H2) got appropriated $8 million for elementary PE provisions from K – 6 grade.

Oklahoma (HB1186) requires school boards to provide an average of 60 minutes per week of

physical activity to students in K-5.

Below is a table of States that considered or enacted the Childhood Obesity Physical Education,

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Physical Activity or Recess Policies from 2003 to 20084:

State 2003/2004 2005 2006 2007 2008Alabama Considered Considered ConsideredAlaska ConsideredArizona Enacted Considered ConsideredArkansas Enacted Enacted- PE, and

Physical Activity; Resolution adopted-Recess

California Enacted Enacted Enacted ConsideredColorado Enacted Vetoed Enacted

Connecticut Enacted Vetoed EnactedDelaware Enacted EnactedFlorida Enacted Enacted EnactedGeorgia Considered ConsideredHawaii Considered Considered Considered ConsideredIdahoIllinois Enacted ConsideredIndiana Considered EnactedIowa Considered Considered ConsideredKansas Enacted Enacted Considered ConsideredKentucky Enacted Considered Considered ConsideredLouisiana Enacted Enacted ConsideredMaine ConsideredMaryland Considered Considered EnactedMassachusetts Considered Considered Considered ConsideredMichigan Considered Considered ConsideredMinnesota Considered Considered ConsideredMississippi Considered Considered Enacted ConsideredMissouri Enacted Considered, includes

RecessMontana EnactedNebraska ConsideredNevada Resolution adoptedNew Hampshire Enacted Considered EnactedNew Jersey Considered Considered- RecessNew Mexico Enacted Enacted EnactedNew York Considered Considered Considered ConsideredNorth Carolina Considered ConsideredNorth Dakota EnactedOhio Considered ConsideredOklahoma Enacted Enacted Enacted Enacted, includes

RecessOregon Considered Enacted -RecessPennsylvania Enacted Enacted Resolution adoptedRhode Island Considered Enacted Considered Enacted ConsideredSouth Carolina EnactedSouth DakotaTennessee Considered Enacted ConsideredTexas Enacted Enacted

Utah EnactedVermont Considered EnactedVirginia Considered Considered Considered EnactedWashington Considered ConsideredWest Virginia Enacted EnactedWisconsin ConsideredWyoming Considered TOTAL ENACTED: 2 21 10 10 6

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Recommendations: It is evident from the above table that more needs to be done urgently by

states to be able to outpace the growth in obesity that is climbing faster than the policies created

to combat the issue. President Obama and his administration are focused to bring reform to the

current US Healthcare System and be able to control health spending. Since obesity is costing

our country $147 billion per year, it is imperative that policy makers make an immediate call for

action at local and at state levels to reduce obesity by implementing proven evidence based

programs.

At the ‘Weight of Nation’ conference, the US Department of Health and Human Services

(DHHS) Secretary, Kathleen Sebelius shared the department’s recommendations that included

development of healthy living, and building an infrastructure with safe environments such as

investing in projects for walking trails, bike paths, more physical education in schools, and

others.2 Also, she stated that additional federal funding for obesity prevention and control efforts

are expected and that the federal government will also propose measures to increase physical

activity at school, encourage community projects, and physical education as tools for healthy

living.5 Locally, the Wake County gets funds from North Carolina State under Community Health

Promotion/Disease Prevention, a consolidated agreement with the state (NC, G.S 130A-1.1 and

G.S 130A-4.2) to provide a set of chronic disease prevention and management services that

include screenings to address obesity, cardiovascular disease, stroke, diabetes to at risk

population. Also, in the County clinic, the children receive comprehensive prevention and

treatment for uninsured and underinsured children (NC G.S 130A). More opportunities need to

be explored to implement Collaborative Groups like the one in Arkansas.

In the Healthy States Trends Alert publication, prepared for the Council of State

Government (CSG) with the partnership of CDC staff as part of the Healthy States Initiative

funded by CDC, titled “Using Sound Science to Prevent Chronic Disease: State Policy

Implications”, which is developed for the policy makers to be able to focus on their states efforts

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to prevent chronic diseases. It encourages policy makers to support the “20 Key Proven

Strategies to Prevent Chronic Diseases and Promote Good Health” as a guide to effective

evidence based strategies. The strategy #s 5, 6, 7, 8, and 9 are specific to increasing physical

activity:

#5- Increasing Physical activity: Community-wide campaigns.

#6- Increasing Physical activity: “Point-of-decision” prompts to encourage stair use

#7- Increasing Physical activity: School-based physical education.

#8- Increasing Physical activity: Social support interventions in community settings, such

as walking groups and support groups.

#9- Increasing Physical activity: Enhanced access to places for physical activity and

informational outreach activities.

On July 2009, the Campaign to End Obesity honored 6 Congress members for their

outstanding work related to Obesity.9 We need many more like them interested and focused in

addressing the obesity/overweight related issues.

Obesity cannot be handled by an individual alone, it is a multifaceted issue needing a

multiple collaborative approach from strong leaders with community effort, public awareness,

and partnerships built to reduce obesity and make a change.

Programs that have proven significant changes in removing environmental barriers limiting

children in being physically active should be explored. Programs such as Safe Routes to School

(SRTS), a federal program created opportunities for children to transport actively on their way

to/from school by increasing bike paths and side walk for pedestrians, building neighborhood

schools, enforcing safety measures around school, and educating community on advantages of

walking or biking to and from school. Studies showed that youth who biked or walked to school

were more physically active overall. Also, physical environment had a significant influence on

children wanting to actively transport to school.3

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Massachusetts that demonstrated that their two community programs, “Shape Up

Somerville” and the “Physical Activity Club” in Attleboro based on a neighborhood design that

resulted in weight loss among children.2

Collaborative efforts and programs such as “Balance it Out” designed in Arkansas based on

partnership between Pfizer, Arkansas DHHS, Department of Education to provide education

and coaching services to overweight/obese children and their families through community and

school based programs.11

KNOWME is a wireless body area network device that monitors the physical activity of the

overweight teen and sends a text message to be more active. This is a million dollar study

supported by NIH to the University of Southern CA in LA. By the year end, a pilot with 24 high

school students will be studied in preparation to track 50 over weight teenagers.5

A joint national public service advertising campaign between the US Forest Service and the

Ad Council was launched to encourage children from 8 – 12 years, and their parents to spend

more time outdoors and gain physical and medical benefits from it. The PSAs were on TV,

radio, outdoor, and web based to direct them to a website that had information on outdoor

activities.

These and many more need to be implemented for the future of America’s health and

economy. It’s time to get moving.

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Bibliography

1) Obesity Trends Among U.S Adults. www.cdc.gov/brfss:2007

2) “Childhood Obesity News Digest.” Robert Wood Johnson Foundation July 2009: www.rwjf.org /childhoodobesity/

3) “Walking and Biking to School, Physical Activity and Health Outcomes.” Active Living Research – San Diego

State University May, 19, 2009: www.activelivingresearch.org

4) “Childhood Obesity – 2008 Update of Legislative Policy Options.” National Conference of State Legislatures. Amy

Winterfield. 2008 http://www.ncsl.org/Home/SearchResults/tabid/702/Default.aspx?zoom_query=Obesity

5) Kaplan, Northwest Herald, 6/21/09; “Researchers Develop Text Message System to Encourage Physical Activity

Among Teens”; www.rwjf.org: June 22, 2009

6) “Director of STOP Obesity Alliance Talks Weighty Issues in Politico.” STOP (Strategies to Overcome &

Prevent) Obesity Alliance July, 2009: obesity@gwu.edu

7) “Core Tools and Patient Information – Strategies to Overcoming Physical Activity Barrier” - Obesity Management:

Vol 3, Number 4, August 2007. Pgs 183-4.

8) “Obesity costs US health system $147 billion:study.” Reuters.July 27, 2009: www.reuters.com

9) “Second Annual Breakfast With Champions.” Campaign to End Obesity. July 22, 2009

http://obesitycampaign.org

10) Darling, Helen “We Need to Address Obesity Now, Or Health Reform Will Fail.” Roll Call July30, 2009:

www.rollcall.com

11) Lichti, Donna. “Engaging Medicaid Beneficiaries and Their Families in a Community-Based Health Improvement

Initiative to Combat Childhood Obesity.” Disease Management Association of America (DMAA) Obesity

Management Summit. September 18, 2007

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