Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 18
key environmental factors at the school level that are
potentially responsible for the rapid increase in childhood
obesity rates among school - age children in the
country. A summary of the results follows.
An initial assessment of the school environment
and the physical education program was conducted in
12 public schools in Mexico City. Qualitative and
quantitative tools were used to help identify barriers
and opportunities in the design and implementation
of potential strategies. The focus of the initial assessment
was to get a measure of food availability and
intake, as well as the physical activity patterns of 4th
and 5th grade students during school hours. Based on
the IOTF cutt - off points and classification systems the
Results from this evaluation revealed that 20 —27% of
the study population was overweight and 14% was
obese (41% combined prevalence). The evaluation of
the school environment indicated a wide availability
of food high in fat and sugar and low nutritional value
and a lack of policies or regulations concerning food
sales in and around schools. It was also found that on
average children have five opportunities to eat over
the course of the 4.5 hours they spend at school every
day and that only a small minority of children bring
food to eat at school from the home.
Interestingly existing food distribution programs at
the school were also found to contribute a significant
amount of calories to children ’ s overall intake while at
school. The menu offered as part of the National School
Breakfast Program — designed at a time when undernutrition
was still the most pressing nutritional challenge
— distributes energy - dense foods, rich in fat and
sugar, including flavored sugar - sweetened whole milk,
ready - to - eat sugar sweetened cereals or bread, and
other products rich in fat and sugar, cookie or dessert
that is also high in fat and sugar. In turn, the program
offers a limited variety of fruits about once a week. The
formative research assessment also revealed that children
have limited drink choices. A limited or total lack
of access to potable water was documented. Consecuently,
for those children who do not bring water from home
the only beverage option at the school is the sugar -
sweetened beverages available for purchase.
In order to better capture the quality of food available
within the school, a system was developed to
categorize food based on nutritional value. Healthy
foods included fruits, vegetables, low fat dairy products
and water. Unhealthy foods were classified into
into two groups: foods that would be acceptable if
prepared or served differently — for example, baked
instead of fried or served in smaller portions — and
those that could not be modified and had a low nutritional
value. In addition, a food inventory was developed
to quantify all food and beverage portions. Based
on this evaluation system, only 19% of the foods listed
were considered to be healthy, while 81% were
classified as unhealthy. Of these, only 31% would be
acceptable if modifications were made while 50%
were packaged or processed foods with no room for
improvement.
Observations of children ’ s physical activity patterns
during physical education class and recess pointed to
very low physical activity levels among children.
Evaluations conducted using various methodologies
including the System for Observing Fitness Instruction
Time ( SOFIT ), pedometers and accelerometers confirmed
that children spent most of their time standing.
Overall, during PE class children engaged in moderate
to vigorous physical activity ( MVPA ) a total of 11
minutes per week or 26% of the time, two thirds of
the time walking and only about one third in vigorous
physical activity. During recess, children engaged in
MVPA 36.1% of the time or an average of 10.7 minutes
per day. The other 77% of the time was spent walking.
Overall, the total amount of time spent engaged in
physical activity physical was approximately 65
minutes per week and less than 20 minutes was
devoted to activities other than walking.
Based on the information collected as part of the
initial assessment previously described mentioned
above a science - based school intervention was developed
with the input of the Secretariat of Education
and the school community. Given the breadth of the
formative research conducted prior to the design of
the intervention it is expected that the program will
have a significant impact in food and beverage intake,
activity patterns and health and nutrition knowledge.
If proven to be successful, it can serve as a concrete
model for other countries to follow in the near future.
There are several additional examples of other
school - based initiatives, programs and policies likely
to have a positive impact in halting the obesity epidemic
in developing countries. 21 However, no published
information was found with regards to their
impact. For instance, in Brazil it is mandatory for 70%
of the foods provided by the school meals program to
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