   |  | | A case of "many children left behind" and a nice "FIT" for health care | By Mike Magee, MD
I recently had a conversation with Claus von Zastrow, PhD, executive director of Learning First Alliance, a non-profit partnership of 18 major national education associations that collectively represent over 10 million educators, parents and policymakers.1 He said, "I was wondering if you had ever taken on the issue of physical education in schools, which more and more advocates are characterizing as a public health issue. As more of a typical child's school day is given over to math or reading instruction, time for physical activity--recess or physical education -- has all but evaporated in many schools. A number of my members are quite concerned about the public health implications of childhood obesity coupled with the erosion of physical/health education."
I shared with Dr. von Zastrow some of the programs I have written on childhood activity and obesity over the past five years. They included “Overweight Kids in America,” “Exercise and Childhood Obesity,” “The Real Story Behind Obesity,” and “The Cost of Obesity in America.” In each of these programs, at some point, the connection between childhood health, weight and exercise was made. And a distressing admission: Little has changed in five years at the interface of childhood obesity and exercise. In fact things appear to be getting worse. 2,3,4,5
That childhood obesity is on the rise is undeniable. The rates have been advancing steadily for the past 35 years, with obesity growing substantially to the point that 6 percent of young people between the ages of 6 and 19 are now overweight today. An additional 31 percent more are viewed as at-risk of becoming overweight.6 A sedentary lifestyle is a known major contributor to obesity and poor health. Almost half of all young people between ages 12 and 21 get no vigorous exercise at all on a daily basis.7 Sedentary children are more likely to be obese, and obese children have higher blood pressure, higher cholesterol levels and a greater incidence of type 2 diabetes.8
Obese children are very likely to become obese adults, troubled for life by a wide variety of chronic diseases. Young women and minorities are at special risk. The probability of becoming an obese adult, if obese at age six, is 50 percent. The chances rise to 70 percent to 80 percent if the child is still obese at age 13.8 In young women, inactivity and obesity go hand in hand. Twenty-five percent of American women do not exercise at all, and 60 percent do not exercise at recommended moderate levels during the day.9 If women are at special risk for inactivity and obesity, so are African Americans and Hispanic Americans. Four of 10 African Americans and Mexican American youths between the ages of 6 to 19 are overweight or at-risk of becoming overweight.10
We know that physical activity can really help. According to the U.S. Centers for Disease Control: "Inactivity among adolescents is a contributing factor to the increasing trends in overweight. Regular physical activity has additional health benefits, including improvements in aerobic endurance and muscular strength, reduction of risk factors for cardiovascular and other chronic diseases, increases in bone mass density, higher levels of self-esteem and self-concept, and lower levels of anxiety and stress. In 2003, one third of high school students did not engage in the minimum recommended level of moderate or vigorous physical activity. Schools have been recognized as a key setting for increasing participation in physical activity among students. The findings in this report indicate that the prevalence of being enrolled in PE class and being physically active during PE class has not increased since 1991."11
The CDC has developed Guidelines for School and Community Programs to Promote Lifelong Physical Activity among Young People. Although the guidelines recommend daily PE for all students, only 8 percent of elementary school students, and 6 percent of middle school and high school students, provide daily physical education.10,11
Some point to the 2001 No Child Left Behind legislation as a contributor to the problem. Since the outcome-based approach placing schools at-risk for poor performance was enacted, 9 percent of school districts reported decreasing time on PE by an average of 40 minutes a week to make more time for English/language arts and mathematics. Schools serving economically disadvantaged students fared worse. In disadvantaged school, 14 percent of districts with at least one school identified for improvement, corrective action, or restructuring under the No Child Left Behind Act reported cutting PE by an average of 57 minutes per week to make more time for reading/language arts and math.12
But cutting PE may actually have an unintended consequence for the designers of No Child Left Behind, and the school districts that are doing their best to comply. And it's this: Studies have shown that organized school-based physical activity can have additional academic benefits. Five days a week of regular physical activity has been shown to have a positive effect on children’s cognitive function.13 Children who score well on two measures of physical fitness (aerobic fitness and body-mass index) tend to score higher on state exams in reading and mathematics, a relationship that holds true regardless of gender and socioeconomic differences.14
And that brings me to the Fitness Integrated with Teaching Kids Act or the FIT Kids Act. It is currently under consideration by Congress. It would require state accountability systems, under part A of title I of the Elementary and Secondary Education Act of 1965 (ESEA), to measure not only student academic progress, but their progress toward a national goal of 150 minutes of weekly physical education in elementary school and 225 minutes of weekly physical education in middle and high schools.
It also directs the Secretary of Education to contract with the National Academy of Sciences to formally study approaches to improve student health and participation in physical activities, assess the cognitive impact of physical education and evaluate the overall value of physical activity for student health, enjoyment, challenge, self-expression, and social interaction.15
The Fit Kids Act sounds like a great "fit" for advancing this nation's preventive health.
References:
1. Learning First Alliance: Strengthening Public Schools for Every Child. 2003.
2. Magee M. Status of Overweight Kids in America. 18 Oct. 2006.
3. Magee M. Exercise and Childhood Obesity. 22 Oct. 2003.
4. Magee M. The Real Story Behind Obesity. 10 Nov. 2004.
5. Magee M. The Cost of Obesity in America. 19 May 2004.
6.National Center for Health Statistics. 1999 National Health and Nutrition Examination Survey (NHANES). Hyattsville, MD: U.S. Dept of Health and Human Services. 1999.
7.The Medical Center of Central Georgia. Cardiovascular Disorders.
8.Moran R. Evaluation and treatment of childhood obesity. Am Fam Physician. 1999; 59:861-8, 871-3.
9.U.S. Dept of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Dept of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion; 1996.
10. National Association for Sport and Physical Education & American Heart Association. 2006 Shape of the nation report: Status of physical education in the USA. Reston, VA: National Association for Sport and Physical Education.
11. CDC-MMWR. Participation in High School Physical Education--United States, 1991-2003.
12. McMurrer J. The Center on Education Policy. Choices, Changes, and Challenges: Curriculum and Instruction in the NCLB Era. A report in the series from the capital to the classroom: year 5 of the No Child Left Behind Act. Washington, DC: Center on Education Policy. Dec. 2007.
13. Davis C.L. et al. Effects of aerobic exercise on overweight children’s cognitive functioning: a randomized controlled sample. Research Quarterly for Exercise and Sport. Dec. 2007. 78(5), 510-519.
14. Castelli D. et al. Physical fitness and academic achievement in third-and-fifth graders. Journal of Sport and Exercise Psychology. April 2007. 29(2).
15. S.2173, The FIT Kids Act.
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