Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 10
the release of energy and stress and it may also help
children concentrate in the classroom. It should not
be scheduled before or after PE classes. Intramural
activities can offer opportunities to increase physical
activity, but mostly better - off children take advantage
of them, because even though the school may offer
them, lower - income students may have transportation
problems. 10
Health education including formal instruction in
healthy eating and promotion of physical activity is
needed in all grades in order to improve children ’ s
knowledge and encourage children to adopt a healthy
lifestyle. Research supports the use of behavioral techniques
to achieve effectiveness in this task. 11 Aspects
of health education can also be integrated into the
lesson plans of other subjects such as mathematics,
language, art, and so on. In addition to health education,
school health centers can play an important role
offering students, primary care or referral services to
other health centers. Such centers can be found in
state - funded and private schools in developed countries
and private schools in developing countries, and
may provide screening as well as information on prevention
and treatment of obesity. In addition, schools
can provide opportunities to implement obesity -
prevention programs through after - school programs.
In the United States there are several large - scale federally
funded after - school programs to prevent obesity
among low - income children. These may include academic
enrichment, physical activity and free snacks. 12
School - based obesity prevention programs can also
provide a means of reaching the family. Family
involvement and active participation by parents in
obesity prevention is crucial; nevertheless, this can be
quite difficult. Some programs that have achieved
high rates of recruitment and retention have used
incentives such as food, transportation and rewards.
A promising initiative to involve parents may be to
open school facilities such as gyms and swimming
pools after school and at weekends. Another strategy
of family involvement is parental notification of the
child ’ s BMI. Kubik et al 13 reports that parents of elementary
school children are generally supportive of
BMI reporting, but they want assurance about student
privacy, respect and to know that overweight children
will not be stigmatized. The US Institute of Medicine
endorses BMI reporting and making it available once
a year to parents with appropriate indications in cases
where the child is overweight. This activity should be
tested in other societies so as to assess its effectiveness
in different settings. The box below lists some of the
issues that should be taken into account before deciding
whether to use BMI reporting, and the chapter on
ethics within this book provides more detail on ethical
considerations.
Parental n otification of
c hildren ’ s BMI
• Which parents are going to be notified? — all of
them, or only parents of overweight children.
• What will the parents be told when notified?
• Will they be advised to seek medical guidance or
will they receive other recommendations? Are these
readily available?
Finally, schools and school - based prevention programs
can help to provide links with communities and
families. For example, some schools have programs
that link local farmers as suppliers for school meals.
These programs have the advantage of providing
high - quality produce and supporting local agriculture.
Other initiatives include walking and cycling to
school which, being a daily activity, can provide substantial
energy expenditure over the school year. 14
Unfortunately, active commuting to schools has
declined dramatically in recent decades. The reasons
reported include long distances, traffic danger and
crime. A final means by which schools can involve
the larger community is through School Wellness
Programs. Because schools are large employers, they
become ideal places for health promotion for teachers
and staff. This could encourage them to value the
importance of healthy eating and physical activity and
eventually to become role models for their students
and their families
Type of Interventions
Interventions in primary school settings may be
grouped together by aspects such as the aim, target
population, intervention levels, extent of stakeholders
involved, determinants addressed, specific intervention
components, duration of the intervention and
the outcomes measured. The intervention aim can be
82