1
Childhood Obesity Intervention Strategies:
How Do The Schools Weigh In?
by
Bobby Hurt
A Research Paper
Submitted in Partial Fulfillment of the
Requirements for the
Master of Science Degree
in
School Counseling
Approved: 2 Semester Credits
The Graduate School
University of Wisconsin-Stout
May, 2011
2
The Graduate School
University of Wisconsin-Stout
Menomonie, WI
Author:
Hurt, Bobby L.
Title:
Childhood Obesity Intervention Strategies: How Do Schools Weigh In?
Graduate Degree/ Major: MS School Counseling
Research Adviser: Carol L. Johnson, Ph. D.
MonthNear: May 2011
Number of Pages: 30
Style Manual Used: American Psychological Association, 6th edition
Abstract
With childhood obesity on the rise, schools are seeing the impact obesity has on academic
progress and socialization of students. Overweight boys and girls were found to be the target of
bullying, negative rumors, verbal attacks, withdrawal of relationships, and loss in friendships. It
was also reported that some overweight boys and girls also perpetrated physical acts of violence
and bullying more than their normal weight peers. This research suggests that the struggles
obese students face in school range far beyond education in the classroom. This literature review
investigates why obese students appear to have higher rates of absenteeism, lower grade point
averages and lower graduation rates as compared to their normal weight classmates. Perhaps
above all, young obese students appear to have greater psychological issues than their non-obese
peers. Obese students are often the target of bullying and other degrading and demeaning forms
of harassment in school thus impacting their attention span, and ability to perform academic
tasks.
3
The Graduate School
University of Wisconsin Stout
Menomonie, WI
Acknowledgments
It is without hesitation that I acknowledge those that supported me through the rigorous
process of writing and researching this significant topic. I truly believe that without the
collaborative support of those around me the words in this document would never have come
together.
First, I would like to acknowledge my family. Each member has contributed to my being
here and continuing my academic progress in my master's degree. My mother, father, brother
and sisters showed true confidence in me during times when I fell short. Their love and
compassion for me during times when I could not be available to lend the same level of support
will forever inspire me that I can accomplish all things I put my mind towards.
Second, I would like to thank my friends for their understanding of my academic
endeavors and my limited availability during critical time periods in their lives. For all the
weddings, birthdays, celebrations, and paramount moments in their lives that I have missed, I
thank those that continued to support me while I pursued this dream of mine. Each one has
helped me through utmost difficulty and I will never forget the strength instilled in me to pursue
my goals in completing this research.
Lastly, I would like to thank Dr. Carol L. Johnson for her dedication to this project. It
was by her grace that I was given the privilege to work with her and this is something I will
never forget.
4
I cannot imagine the workload that Dr. Johnson has in her professional career and to guide me
through this process is a gift that I will cherish forever. She has fulfilled I vital academic need of
mine and I hope to always seek guidance in my professional career from her and other staff here
at the university.
5
Table of Contents
.................................................................................................................................................... Page
Abstract ............................................................................................................................................ 2
Chapter I: Introduction .................................................................................................................... 6
Statement of the Problem ................................................................................................... 11
Purpose of the Study .......................................................................................................... 11
Research Questions ............................................................................................................ 12
Assumptions and Limitations ............................................................................................ 12
Definition of Terms ............................................................................................................ 13
Chapter II: Literature Review ........................................................................................................ 14
Introduction ........................................................................................................................ 14
Effects of Obesity on Learning .......................................................................................... 14
Nutritional Choices in Schools .......................................................................................... 18
Obesity Intervention Strategies .......................................................................................... 20
Chapter III: Summary, Discussion, and Recommendations .......................................................... 23
Introduction ........................................................................................................................ 23
Summary ............................................................................................................................ 23
Discussion .......................................................................................................................... 25
Recommendations .............................................................................................................. 26
References ...................................................................................................................................... 28
6
Chapter I: Introduction
The United States is experiencing a health crisis that is raising awareness of the severity
of childhood obesity, currently at the highest levels in history. According to recent comparative
research on the history of obese citizens in the United States, there has been a growing shift in
the average body size since 1900 (Kluger, 2008). The average 20-year-old American male body
weight in the year 1900 was 133 pounds; the average American woman in the same age group
was 122 pounds (Kluger, 2008). In the year 2000 the average body weight reported had risen for
men to 166 pounds and women to 144 pounds within the same age groups (Kluger, 2008). Over
the past 20 years obesity rates have risen even more dramatically. In 1985, there were eight
states in America where 10% of the adult population was obese (Kluger, 2008). In 2006 nearly
half of the states reported the percentage of obese adults was 25% or more (Kluger, 2008).
These statistics show a rise in obesity in adults, but unfortunately do not reflect on the changes in
body size in school age children of America.
Obesity research has recently begun to focus more on school-age populations
investigating trends regarding how youth and teens appear to be managing their health. As the
rate in adult obesity has reached historic highs, questions began to formulate about obesity's
effect on children. Research indicates that in 2003 and 2004, 18.8% of children, ages six to
eleven years old, and 17.4% of adolescents, ages 12-19 years old are now considered obese
(Thompson, Yaroch, Moser, Finney-Rutten, & Agurs-Collins, 2010). Comparisons from
previous research in 1971 show that only 4% of children aged six to eleven years, and 6.1 % of
youth aged 12-19 year were classified as obese (Kluger, 2008). This is alarming to observe an
increase of 15% and 11 % respectively in childhood obesity. The literature indicates it may be
caused by lack of exercise and poor eating habits. These studies show only percentages and
7
statistics of children that are considered clinically obese; however, estimates for children
classified as overweight range from 30-32% notion wide (Kluger, 2008). Newer research is now
beginning to focus on children in age groups ranging from two to five years of age. Statistics
indicate that 13.9% of toddlers in this age group reported being obese in the year 2008,
solidifying the amount of concern for obesity as an epidemic affecting America's youth (Kluger,
2008).
With the prevalence of obesity across all age groups increasing, there has been a demand
for new research to study the long-term effects of being overweight or obese. For most cases of
obesity, weight increases due to an abundance of energy or calories going into the body, and a
lack of energy corning out of the body through physical activity (Thompson et aI., 2010). This
cycle can begin in early childhood and due to a lack of motivation, ability, and drive often
remains constant into adulthood.
Characteristics of individuals who are obese often include low self-esteem, lack of
positive body image, reduced energy, and depression, which are all critical components to an
active lifestyle (Okunade, Hussey, & Karakus, 2009). Other social and behavioral effects of
obesity across the lifespan include social isolation, poor economic stability, psychosocial
complications, and a lower measure of quality of life (Okunade et aI., 2009; Taras & PottsDatema, 2005). Long-term clinical conditions of obesity include type-two diabetes,
cardiovascular problems, hypertension, various cancers, orthopedic complications, asthma, sleep
apnea, non-alcoholic fatty liver disease, and hyperlipidemia (Taras & Potts-Datema, 2005).
Research also indicates that adolescents classified as obese often have a life expectancy
of an average of five months less than their own parents as a result of struggling with the
complications of excess weight (Okunade et aI., 2009). With the increased likelihood of
8
developing or acquiring such diseases, obese individuals often fail to receive proper medical aid
to assist them with medication, hospital visits, and critical personal training opportunities in
order to combat these clinical diagnoses.
Okunade et aI. (2009), reports that obese individuals are less likely to graduate on time,
or not at all from high school, and as a result often fail to attend college; thus obese citizens
become less likely to acquire jobs that provide wages significant enough to offer appropriate
medical insurance and often have to rely on medical assistance programs to pay for their medical
expenses (Okunade et aI., 2009). Consequently, taxpayers are left with the financial obligation
to provide economic necessity to individuals who have been diagnosed with health conditions
linked to obesity (Okunade et aI., 2009). Some insurance programs are even recommending
higher premiums for overweight participants. Obesity also accounts for additional stress that has
been placed on the schools to enhance their students' way oflife and teach them better
nutritional habits to avoid the health conditions noted above.
In recent years, schools are increasingly becoming more populated with overweight
students and school leaders are trying to manage a variety of educational concerns that are linked
with obesity. Obesity has shown to have effects on grade point average, attendance, illness in
the school setting, and high school dropout rates (Taras & Potts-Datema, 2005). Research has
suggested that because obesity is very closely linked with depression, anxiety, and other
psychopathological disorders that this combination could be a large factor in why obese students
have such difficulty in school (Taras & Potts-Datema, 2005). Some students become the victims
of bullies due to their body size and weight. Due to setbacks in their education, obese students
tend to be academically ranked behind others in their same age and grade (Okunade et aI., 2009).
9
As stated above, a trend is emerging concerning obese students not only falling behind
their classmates in school, but also not graduating high school at all, based on students lack of
interest or motivation to go on to post secondary options for schooling (Okunade et aI., 2009).
Research by Albert A. Okunde et aI. (2009) explains the benefits of reducing obesity rates in
schools by stating: "Consequently, public policies targeted at reducing overweight and obesity
among adolescents might effectively raise high school GP A, increase on-time graduation and
post-high school college attendance, marketable skills acquisition, and overall economic and
social wellbeing of adult life stages" (p. 226-227).
There is also research that addresses concerns about the relationships obese students have
with peers at school. Adolescent weight gain tends to cOlTelate with similar age, gender, and
racial social peer groups; and indicates that obesity tends to develop in groups of children rather
than just one case at a time, making it more difficult to control obesity numbers in each school
(Okunade et aI., 2009). Students may tend to exercise and make food choices similar to their
peers indicating that overweight kids tend to socialize with other students like them. Schools
have made proactive attempts in improving the health conditions of students. Junk food and
vending machines have new guidelines for placement in schools. School lunches are being
redesigned to be more balanced and less caloric. As school systems attempts to promote a
healthier lifestyle and introduce obesity intervention strategies to the students, awareness of
childhood obesity may improve.
Obesity intervention strategies are starting to emerge in schools across the country to help
change the declining academic success rates for obese students. Schools with an abundance of
vending machines, soda machines, and snack bars have limited the use of these high calorie food
10
alternatives in order to promote healthier messages to the students (Taras & Potts-Datema,
2005). Obesity intervention strategies initially focused on first informing the school boards of
the messages they are sending to children by placing readily available, inexpensive high calorie
foods in every hallway as compared to healthier food options (Taras & Potts-Datema, 2005).
Other reports indicating evidence that school systems fail to satisfy children's need for
maintaining a healthy lifestyle is by only allowing students 4-6% of their necessary activity each
day (Taras & Potts-Datema, 2005). Schools are becoming more budget conscious and one of the
first courses often being cut or reduced is time spent in extended physical education classes
(Taras & Potts-Datema, 2005).
Another way obesity intervention strategies seek to change unhealthy behavior is by
educating the children on healthy alternatives rather than put a negative connotation on the
choices they are currently making (Benjamins & Whitman, 2010). Although many strategies
have shown significant success in effective behavior changes in the school setting, most fail to
report long-term levels of obesity changes. This is partially due to the generalization of such
prevention strategies and programs, and effOlis to tailor obesity prevention to age, race, and
gender, appear to yield much stronger results long-term (Benjamins & Whitman, 2010). It might
also be that schools do what they can to provide exercise and better food choices, but when kids
go home, they fall right back into the lack of good food choices and a sedentary life style. School
sanctioned obesity intervention strategies have indicated positive results by showing significant
increases in grade point average, academic involvement, attendance, improving self image, and
reducing dropout rates (Okunade et aI., 2009)
11
Statement of the Problem
The rise in childhood obesity rates is currently an issue in the United States (Benjamins
& Whitman, 2010). Perhaps one of the most concerning aspect in the increase in obesity is how
it may affect children and teens in schools. Obesity in adolescence may cause a decrease in
grade point averages, attendance, quality of life, and body self-image across the nation. Obesity
may affect levels of participation in school activities and the motivation to form social
relationships. An obese student may display a lack of interest in school and may not attempt to
attain good grades. Some schools may even be promoting an environment increasing childhood
obesity by allowing students easy access to high caloric food options, a lack of health education,
and shortened activity periods. Improved academic achievement, higher self-motivation, and
increases in school attendance may be possible with the implementation of obesity intervention
strategies. Therefore, the problem becomes what can schools do to promote healthy lifestyle
choices that may contribute to reducing childhood obesity?
Purpose Statement
The purpose of this research is to review the literature to determine what strategies may
reduce the negative impact of childhood obesity on academic achievement and social acceptance.
Literature will be researched to determine if schools are contributing to an increase in obesity in
adolescence based on the amount of high calorie food options available and advertised to
students. The literature review conducted includes the topics of obesity in schools, obesity
intervention programs, and schools' health education awareness in order to gain insight on a
relationship between these three factors. The review of the literature was conducted during
spring 2011. The literature review focused on school age students, ages five to eighteen.
12
Research Questions
1. In what ways is obesity a predictor of poor academic performance?
2. Do schools foster an environment that promotes an obese lifestyle, and if so what
educational strategies are needed to teach students how to live healthier life styles?
3. What intervention programs are most effective in changing the habits of obese
adolescents that may result in improved academic success?
Assumptions and Limitations
It is assumed that there is credible information and resources pertaining to the topic of
obesity in the school systems and intervention strategies. Within these resources it is assumed
that all of the information is accurately reported and cited in a manner that is understandable to
the reader. It is also assumed that research has been conducted on the topic of obesity in the
school system. Lastly, it is assumed that this topic is of interest to professionals in the
educational system and families dealing with obesity in their environment.
Some of the limiting factors of this study were the limited amount of research solely
based on obesity intervention strategies in the schools. There was a limited amount of literature
available on obesity and its effects to adolescent age students. Although it is important to note
the factors effecting adults in society within the broad spectrum of obesity, this research will be
limited to adolescent age students and public school systems. There is also the limitation of time
available as well as access to materials to analyze the extent of the literature and research in the
area of obesity prevention and schools systems. A final limitation is that some research may not
have been yet available in the spring of 20 11.
13
Definition of Terms
There are several definitions and terms throughout the literature that are important for the
reader to understand. Below is a list of the commonplace terms and their definitions used in this
literature review.
Body Mass Index (BMI). BMI is a tool that is often used to determine if a person is at a
healthy weight, overweight, or obese, and whether a person's health is at risk due to his or her
weight. The formula used to discover one's BMI is taking weight in pounds, multiplying it by
703, and dividing that number by height squared (National Institution of Health, 2007).
Healthy Weight. A body mass index of 18.5 to 24.9 is considered a healthy weight
(National Institution of Health, 2007).
Obese. An adult with a BMI of 30 or higher is considered obese. Also described as
being at or above the 95 th percentile ofBMI scales (National Institution of Health, 2007).
Obesity Intervention Strategies. Strategies may include primary prevention of
overweight or obesity itself, secondary prevention or avoidance of weight regains following
weight loss, and prevention of further weight increases in obese individuals unable to lose weight
(Dehghan, Akhtar-Danesh, & Merchant, 2005).
Overweight. Having a BMI of 25 to 29.9. Overweight can also be described as being in
th
the 85 th to 95 percentile of BMI.
14
Chapter II: Literature Review
Introduction
Obesity may impact the school performance of children at all grade levels. Some of the
literature indicated which areas of school performance are most impacted and to what extent.
Schools have a responsibility to keep students safe while promoting a positive learning
environment. This chapter will outline how schools are potentially harming students by offering
minimal opportunities for healthy food consumption and reduced physical activity. In addition,
this chapter outlines how some schools may fail to offer the required curriculum necessary to
teach children how to live a healthy lifestyle and prevent a pattern of obesity. Lastly, the chapter
includes how children are currently finding success in obesity prevention programs and how the
implementation of such programs in all school settings could improve the health and educational
experience for all students.
Effects of Obesity on Learning
Obesity levels in school-age children have increased three-fold over the last 20 years
(Kluger, 2008). This is an alarming statistic when research indicates and displays the adverse
effects of obesity on young students. Obese students generally have higher absenteeism, lower
self-esteem, delayed graduation, and a lower grade point average (Bin, Chih-Ping, Spruijt-Metz,
Reynolds, Clark, Palmer, et aI., 2006). Perhaps above all, young obese students appear to have
greater psychological issues than their non-obese peers. Obese students are often the target of
bullying and other degrading and demeaning forms of harassment in school thus impacting their
attention span, and ability to perform academic tasks (Janssen, Craig, Boyce, & Pickett, 2005).
Janssen et aI, (2005), conducted a cross-sectional study of Canadian youth (5,749
children grades 6 through grade 10). Utilizing the World Health Organization Health Behavior
15
in School-Aged Children's Survey, students filled in a questionnaire regarding their overweight
status and relationships in school. The purpose of the research study was to discover any
negative treatment toward students who were classified as obese. The researchers reported that
overweight boys and girls were the target of bullying, negative rumors, verbal attacks,
withdrawal of relationships, and loss in friendships. Janssen et aI, (2005) also reported that some
overweight boys and girls also perpetrated physical acts of violence and bullying more than their
normal weight peers. This research suggests that the struggles obese students face in school
range far beyond education in the classroom. This type of research led to the investigation of
why obese students appear to have higher rates of absenteeism as compared to their nOlmal
weight classmates.
In a study conducted by Schwimmer, Burwinkle, and Varni (2003), obese students, ages
5-18, were referred to their physicians to monitor their quality of life as it could potentially
impact the likelihood of developing anxiety disorders, depression, and other psychopathologies.
The researchers recorded absenteeism and discovered that severely obese students reported many
more missed school days than the general population. The average obese student missed four
days of school per month with a median of one day of missed school per month for non-obese
students. The research showed a significant relationship between obesity and missed school days
for children and adolescence. The researchers conclude that Body Mass Index (BMI) has
become a stronger predictor for absenteeism than previous indicators of race, ethnicity, and
socioeconomic status (Schwimmer et aI., 2003). Students who miss school may be more likely to
miss valuable lessons and have homework to catch up upon their return. These absenteeism
statistics may coincide with the amount of school obese students miss each year and the potential
impact on their on-time graduation.
16
Obesity appears to be linked with a delay of on-time graduation in some high school
students (Okunade, Hussey, & Karakus, 2009). In research by Okunade et ai. (2009), a
longitudinal study was conducted to determine if obesity levels in high school students had an
effect on their graduation date. The researchers sampled over 5,000 12-17 year old students and
asked them to report via survey grade point average, activity levels, level of absenteeism,
expected graduation date, and BMI. The researchers controlled the experiment for individual,
household, and community effects. After three years the same students were contacted and
surveyed again asking the same questions about their high school academic behavior. Results
indicate that BMI was a reasonable predictor of graduation date for females but not males.
Males however, did show signs of academic decline, but not to a significant degree. The
researchers concluded that with the delay in on-time graduation, obese students are less likely to
attend college and gain as much capital investment as their normal weight peers (Okunade, et aI.,
2009).
Grade point average has been used in research as a predictor for academic success,
understanding, and competence (Datal', Sturm, & Magnabosco, 2004). To determine if obese
students are having more academic difficulty than their normal weight peers, researchers
reviewed grade point averages for both categories of students in comparison. Comparisons
drawn from seventh through ninth grade students found that students who were classified as
overweight or obese had significantly lower grade point averages than their normal weight
classmates (Bin, et aI., 2006). The overweight students from the study were twice as likely as
their normal weight counterparts to have lower scores in mathematics, and in their language
skills. Further research conducted by Bin et ai. (2006), focused on detelmining if perceived
weight status had a significant effect on the grade point averages of 11 to 12 year olds in China.
17
The researchers measured and weighed the participants and then gathered a series of self-report
data from the students. Such questions focused on perceived weight status and actual weight
status in comparison to grade point average. The results indicated that individuals who were
overweight, regardless of their perceptions tended to have significantly lower grade point
averages than those who had an actual weight status of normal.
Other research on the topic of obesity and grade point averages focused on kindergarten
age students and their math and reading abilities. Datal', Sturm, and Magnabosco (2004),
conducted a study to see if first time kindergarten students' ability to learn was effected by
obesity. The researchers gathered a nationally representative sample (according to the Early
Childhood Longitudinal Study) of 11,192 first-time kindergarteners and conducted math and
reading assessments during four data collection points from kindergarten to first grade. The
authors controlled for socioeconomic status, parent-child interaction, birth weight, physical
activity and television watching.
The data showed that 1 out of 10 kindergarteners is overweight and had significantly
lower test scores in the areas of math and reading in comparison to non-overweight students.
Both categories of students had progressed at an equal level from kindergarten to first grade
resulting in lower math and reading scores for obese students at the end of first grade in
comparison to kindergarten. This shows potential that as obese students get older (from
kindergarten) they may fall farther behind than their non-obese peers (Datal', et aI., 2004).
Nutritional Choices in Schools
Over the past twenty years soft drink consumption has risen 41 % in the United States.
As reported by Teras and Potts-Datema (2005), "The increase is significant when contrasted with
one estimate that the odds of becoming obese increase 1.6 times for each can of a sugar
18
sweetened beverage consumed every day" (p. 291). As of2005, soda and vending machines
have been commonplace in education facilities ranging from elementary to high school (Teras &
Potts-Datema, 2005). By the year 2000, over one-half of school districts nationwide had a
substantial contract with a corporate or commercial vending company and that number is likely
to increase to over 75% currently (Teras & Potts-Datema, 2005). What is concerning about these
statistics is that of the schools that have vending contracts, nearly one-third receives a financial
incentive for sales reaching a certain amount. Some schools rely heavily on the profits made
from vending machines.
This reinforcing behavior for schools to promote soda and vending machine use to their
students is in place because schools can benefit financially from sales. As of2005, 56% of
elementary and 93% of high schools allowed students to purchase soda or candy products from
school stores, snack bars, canteens, or various vending machines at any time during the day
(Teras & Potts-Datema, 2005). Because of the high volume of consumption paired with schools
need for financial gain, this pattern of vending machine use is suggested to continue and grow
throughout the years in schooling systems. Most recently, current legislation is addressing these
concerns of profit over pupil health and recommendations are in place to turn the machines off
during portions of the day and further recommendations to replace high calorie food with better
choices for students.
It is not only that schools make available unhealthy snack choices, but also that these
choices are significantly less costly than healthier choices for the student consumers. With the
average student carrying less than ten dollars to school, daily spending money at school is
relatively minimal (Teras & Potts-Datema, 2005). Healthy food choices such as fruits and
vegetables are rarely available outside of lunch hours, and cost on average ten cents more than
19
candy from vending machines (Teras & Potts-Datema, 2005). Underpriced soda outsells milk
and 100% fruit juices due to the fact that soda costs far less, and is available throughout the
entire day (Teras & Potts-Datema, 2005). Schools are not only charged with providing healthy
food options for students, but they are also held accountable to make sure they are providing
opportunities to teach students how to stay healthy through curriculum and activity.
Physical education and nutritional education is often overlooked in the school curricula
due to the demands of subjects such as math, reading, English, and the sciences (Teras & PottsDatema, 2005). With limited time during the school day and pressure to meet and exceed
academic standards, teachers and school leaders are left with the dilemma of what is most
important. One of the largest predictors for obesity is the amount of activity children get in their
day (Teras & Potts-Datema, 2005). Children spend up to seven hours at school each day and
with budget cuts affecting areas of physical education, each student's available time for physical
activity is generally lowered considerably (Teras & Potts-Datema, 2005). In the 1970's students
spent nearly 40% of their available time outside and physically active during the day, which
exceeded the recommended daily activity for children and adolescence at that time period. Now,
only 6% to 8% of schools provide the recommended daily physical education or its equivalent
for the entire school year (Teras & Potts-Datema, 2005).
The nutritional education for students appears to be lacking in schools as well.
According to research by Benjamins and Whitman (2010), students were surveyed about proper
health choices and only 15.9% of students realized the amount of vegetables they should
consume daily in order to fulfill their bodies needs for nutrition. To emphasize this perspective
out of a typical class size of 30, less than 5 students have the knowledge to adequately feed their
body the foods they need to foster healthy growth (Benjamins & Whitmen, 2010).
20
Obesity Intervention Strategies
Some school systems are making obesity intervention a priority and taking initiatives to
lower childhood obesity based on the adverse effects on academics. Schools that are making
time to offer students additional physical education and nutritional education on how to be
healthier have seen some positive gains in general student body health. A study by Newton et al.
(2010) on the effects of obesity intervention on sixth grade students discovered that with
training, obese students developed better eating habits, and adjusted eating behavior to a
healthier standard. The study consisted of an 18-month intervention, which was designed to alter
the school environment to prevent excess weight gain by developing healthier eating choices and
making physical activity opportunities more available. Newton et al. (2010) did not report
significant weight loss, but with the change in behaviors across this age group noted the potential
for longitudinal data to reveal significant changes over longer periods of time.
A study by Benjamins and Whitman (2010) revealed similar findings for school based
obesity intervention plans, and recorded weight loss among their sample population. This
project attempted to discover if a fully funded intervention strategy was placed in schools, would
educators be more receptive, and would students would benefit from the expertise of a highly
paid staff. A team enhanced the school's program and included an epidemiologist project
director, a dietitian, a mental health consultant, a social worker from the school system, and a
joint school wellness council implemented the project.
The pilot program took place from September 2006 to June 2008. For two years the pilot
schools enhanced their cUlTiculum to meet the standards for healthy living and the National
Institution of Health criteria for a healthy schooling environment. Physical education
departments were provided a grant of $10,000 to spend on activities that can relate to weight
21
loss, along with activities that can be easily accomplished by students outside the classroom.
Health curriculum was implemented and staff had brief orientation to the new material provided
in order to facilitate an accurate transfer of knowledge to the students about maintaining healthy
living. Lastly, schools were held under strict guidelines to limit the usage of vending and soda
machines during school hours and offered new healthy food choices in order to send a positive
message about the issue of health within each school. Students were then given surveys to selfreport how they managed their health within the obesity intervention plan time period and
scorers marked changed in behavior, health, and attitudes towards healthy living (Benjamins &
Whitman, 2010).
The results indicated that students in early years, those in grades 2-4, showed improved
ability in recognizing how to lead a healthy lifestyle. The most significant change for this age
group following the intervention period was in nutritional knowledge. Specifically, the
percentage of girls in grades 2 and 3 who could correctly identify the healthiest foods increased
throughout the study. As an example, findings for one ofthe questions showed that the
percentage of all girls who knew that whole wheat bread was healthier than white bread
increased from 75% to 93%. In addition, almost 100% could identify the unhealthiest foods,
such as doughnuts, cookies, and candy. However, only 36% got all 6 knowledge questions
correct, compared with 18% in 2006 (Benjamins & Whitman, 2010). This research shows that in
two short years knowledge has improved regarding identifying unhealthy choices as well as
learning essential food groups for healthy living.
Federal funding for school lunches has not changed much in the last 30 years - until now.
Low cost lunch choices including chicken nuggets, pizza, french fries, canned fruits and
vegetables, and other high fat and high calorie food options were all readily available and funded
22
by many public school budgets. First Lady Michelle Obama is proposing a bill that would raise
the ,amount of funding by over one nickel per public meal (NBC News, 2010). If the bill were to
pass it would not only bump up the amount of money each school would receive, it would also
require schools to add grains to food items such as pizza crusts, pasta and breads. In addition,
schools will be given the funding to add more fruit and vegetable choices to their meals in order
to encourage healthier eating.
Margo Wooten of the Center for Science in the Public Interest says, "It's not just enough
to just stick and apple on the tray. If the child doesn't like an apple, they're not going to eat it.
You need to give them a few different choices" (NBC News, 2010). After her tours to several of
the nation's public schools, Michelle Obama noted the lack of options school lunch programs
have to provide for our hungry students. According to NBC News Michelle Obama stated:
Kids can lead the way for us and the food that our kids are getting
in school each and every day needs to be as healthy as it can be.
When kids are bringing some of the nutrition lessons home we'll
begin to see how we are making a difference (Pg. 2).
As the First Lady's concern for American's health grows, experts like Margo Wooten agree that
an improved school lunch program, an increase in physical activity and a nutritional educational
program would likely help raise a generation of children capable of making lifelong healthy
eating choices. It is this kind of leadership and partnership that schools need to work within
communities to help families afford good nutrition, offer extracurricular activities that are
inclusive of all children and have areas where kids have safe places to play. Schools can make a
difference in the lives of the students who struggle with weight issues. Reducing childhood
obesity may help improve attendance, may increase graduation rates and help a generation of
children live longer and more fulfilling lives.
23
Chapter III: Summary, Discussion, and Recommendations
Introduction
As mentioned in the literature, obesity rates are escalating in America. Adolescents
appear to be adversely affected by the consequences from poor nutritional choices and lack of
physical activity. This chapter highlights the application of obesity research and recommends
how school officials may enhance the learning environment for students of all ages nationwide.
Summary
According to the comparative research data from studies by Kluger (2008) and Stevens
(2010) it appears that obesity is a growing trend in America. From the research presented,
statistics indicate that larger numbers of adolescents are now facing more severe health risks than
in the past. With obesity now affecting the youth of America more than ever before, research
has recently been dedicated to discover some of the impacts of poor nutrition and lack of
physical activity at school. The trend of childhood obesity is showing up in kids as young as
ages three and four with lasting negative effects through childhood.
Obesity is posing a dilemma for adolescents in school and is often times creating a barrier
to learning. Childhood obesity is often linked with psychological conditions such as depression,
anxiety, low self-esteem, low self-image, and a lower quality of life. Because children affected
by obesity tend to have low self-worth, and look different than their non-obese counterpmis,
bullying is often likely to occur. They are often teased and the last picked for team sports.
Obese students tend to become affected by their non-overweight peers at school
sometimes creating difficulty to obtain classroom related information due to higher absenteeism
and low self-esteem. Children affected by obesity are more likely to miss more days of school
than their normal weight peers due to medical conditions and a lack of motivation. Research by
24
Okunade (2009) indicates that due to a higher rate of absenteeism obese students tend to delay
on-time graduation and in many cases do not attend college. This creates minimal workforce
0ppOliunities for obese adults with low education and a lack in their ability to treat overweight
conditions, resulting in a cycle of obesity for years to come. Many of the research studies
presented obesity as a contributor for lower grade point averages in comparison to normal weight
peers in the same groups. Children as young as kindergarten-age appeared to be affected by
obesity and their ability to adapt to their surroundings and enhance educational opportunities
(Benjamins & Whitman, 2010).
Many believe schools have a responsibility to provide a safe, positive environment for
learning and control influences that can have an effect on all students' learning. With the use of
soda and vending machines, some schools may be promoting and fostering an environment for
an unhealthy lifestyle. Obesity is the result of high amounts of calories coming into the body
(high caloric intake) and low amounts of energy coming out of the body (burning calories
through exercise). Schools offer sugary beverages and snacks at a low price, which are higher in
calories than healthier whole food options costing much more. Schools adveliise the use of
obesity-inducing foods because of the profits and perks they can attain from the vendors of the
sweet snacks that they sell. With budget cuts projected in many schools nationwide, districts
may be unable to offer the amount of physical education required to maintain adequate activity
levels for adolescents. Curriculum in schools is focused on passing vital academic tests, passing
core classes, and meeting graduation deadlines, but does not always attempt to teach students
vital skills about living a healthy lifestyle.
School-wide obesity intervention programs have helped in educating students how to
manage their weight and control eating habits to maintain good physical health (Benjamins &
25
Whitman, 2010; Newton et aI., 2010). Evidence from these studies indicated that while students
don't always lose weight within the allotted time frames of the intervention program they do
learn how to change their habits and gain insight on how to make better life style choices. The
objective of the intervention programs has been teaching students how to make healthy food
choices, rather than to help students physically lose more weight.
Discussion
The research on obesity among school age children is a recent phenomenon that appears
to be expanding rapidly with more information that becomes available to researchers. Some of
the studies performed do not take into account that obese individuals often face other difficulties
in life rather than just weight. Perhaps obesity alone is not causing adverse effects in teens but is
simply a marker for further distractions in education. In the study performed by Okunade
(2009), the author reached the conclusion that obesity had a significant positive relationship with
delays in on-time high school graduation and that obesity is linked with depression, bullying,
anxiety, low-self esteem, low self-value, and low quality of life. A critical component of the
interventions should indicate how being obese can impact one's performance in school. Perhaps
obesity is simply a marker for more serious conditions that can affect performance in academics.
More research studies conducted on children within the ages of six to ten needs to be
investigated based on the difficulty to classify obesity within that age group. In order for
children to be classified as obese a BMI reading over 30 must be present in order to show high
weight values compared to height values. One of the problems with this reading and measure is
that according to Stevens (2010), children often store body fat to prepare for growth during these
years of their development. So it is possible that the children are not obese, but rather that they
are healthy and preparing for years of growth. Many of the studies indicate how difficult it is to
26
get an accurate reading ofBMI based on the ages of the children and have made attempts to
account for this by gauging family history and genetics.
Gender within the realm of obesity is a critical factor to consider when gauging the
growth patterns for young children. According to Stevens (2010), young girls and boys grow
very differently and can show spikes in development at different ages. To categorize children by
age may not be the most relevant information due to the differences in body size for girls and
boys at different ages. Girls were undenepresented in the data because of how quickly they
increase in height at earlier ages than boys. This may give them a lower BMI score based on
how the BMI is calculated in the research designs for most of the studies presented. It is
important to note the differences in adolescent males and females and why more males appear to
have higher obese levels when analyzing the data for future research (Stevens, 2010).
Recommendations
Recommendations for school leaders include the need to start taking action to develop
opportunity for healthy food choices in the school setting. Obesity is caused by many factors
and perhaps the most influential is large consumptions of sugary beverages and foods. Future
researchers may wish to explore how gender and cultures, regions of the country and genetics all
play into the childhood obesity epidemic.
School counselors should take notice of the students who are classified as obese and the
struggles they inevitably face on a daily basis. Obesity is linked with many psychological
challenges that could be overwhelming for young students while in school. Doing further
research on the front lines, counselors may wish to monitor individual attendance, grade point
average and academic load on these students and should be aware of how obese students interact
27
with their peers. Offering support groups for students who are being bullied or have low self
esteem may help with the academic success of obese students.
School counselors and principals need to keep students who are classified as obese on
track for graduation. Students who are obese and at risk for delaying on-time graduation and
seeking higher education should be offered academic, career, and personal/social support.
Maintaining data records may provide fUliher insight into patterns of obesity related baniers to
success. School leaders and educators should consider the implementation of obesity
intervention programs based on their effective approach of teaching students to live healthy
lifestyles. Such programs have successfully educated students on healthy food groups, daily
exercise requirements, and avoiding sedentary lifestyles. While educators and parents can work
together to minimize the impact of childhood obesity, it is up to the individual to follow through
making good food choices and maintaining an active life style to prevent further complications.
28
References
Benjamins, M., & Whitman, S. (2010). A culturally appropriate school wellness initiative:
Results of a 2-year pilot intervention in 2 Jewish schools. Journal ofSchool Health,
80(8),378-386. doi:10.l111/j.l746-1561.2010.00517.x
Bin, X, Chih-Ping, C., Spruijt-Metz, D., Reynolds, K., Clark, F., Palmer, P., et al. (2006).
Weight perception, academic performance, and psychological factors in chinese
adolescents. American Journal ofHealth Behavior, 30(2), 115-124. Retrieved from:
http://search.ebscohost.comllogin.aspx?direct=true&db=awh&AN=20 182183&site=ehost
-live.
Datar, A., Sturm, R., & Magnabosco, J.L. (2004). Childhood overweight and academic
performance: National study of kindergartners and first-graders. Obesity Research, 12(1),
Retrieved from: www.nature.comloby/journal/v12/n1/abs/oby20049a.html doi:
10.1038/oby.2004.9
Dehghan, M., Akhtar-Danesh, N., & Merchant, A.T. (2005). Childhood obesity, prevalence and
prevention. Nutrition Journal, 4(24), Retrieved from: www.nutritionj.com/content/41l124
doi:10.l1861l475-2891-4-24
Janssen, I., Craig, W.M., Boyce, W.F., & Pickett, W. (2005). Associations between overweight
and obesity with bUllying behaviors in school-aged children. Pediatrics, 113(5), 11871194.
Kluger,1. (2008, January 12). How America's children packed on the pounds. Time Magazine,
Retrieved from: www.time.comltime/healthiarticle/0.8599.1813700-2.00.html
29
Mo-suwan, L., Lebel, L., Puetpaiboon, A., & Junjana, C. (1999). School performance and weight
status of children and young adolescents in a transitional society in Thailand.
International Journal of Obesity & Related Metabolic Disorders, 23(3), 272. Retrieved
from: http://www.medscape.comlviewarticle/558799_5
National Institution of Health. (2007). Obesity, physical activity, and weight-control glossary.
Us. Department of Health and Human Services. Retrieved from:
http://win.niddk.nih.gov/publications/glossary/AthruL.htm#B
NBC News. (2010, September 24). New bill brings more expensive healthy school lunches and
controversy. NBC. com, Retrieved from:
http://wbir.comlnews/nationallstory .aspx?storyid= 125563catid= 16
Newton, 1., Hongmei, H., Anton, S., Martin,
c., Stewart, T., Lewis, L., et al. (2010). An
environmental intervention to prevent excess weight gain in African-American students:
a pilot study. American Journal of Health Promotion, 24(5), 340-343.
Okunade, A., Hussey, A., & Karakus, M. (2009). Overweight adolescents and on-time high
school graduation: Racial and gender disparities. Atlantic Economic Journal, 37(3),225242. doi:1O.1007/s11293-009-9181-y
Schwimmer, J.B., BUlwinkle, T.M., & Varni, J.W. (2003). Health-related quality of life of
severely obese children and adolescence. JAMA, 289(14), 1813-1819.
Stevens, C. (2010). Obesity prevention interventions for middle school-age children of ethnic
minority: A Review of the Literature. Journal for Specialists in Pediatric Nursing, 15(3),
233-243. doi: 10.11111j.l744-6155.2010.00242.x
Taras, H., & Potts-Datema, W. (2005). Obesity and student performance at school. Journal of
School Health, 75(8),291-295.
30
Thompson, O.M., Yaroch, AL., Moser, R.P., Finney-Rutten, L.J., & Agurs-Collins, T. (2010).
School vending machine purchasing behavior: results from the 2005 youthstyles survey.
Journal a/School Health, 80(5), Retrieved from: http://pubget.com/paper/20529195