Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 30
it all on their own, since they are part of a broader
community. The health - promoting school approach
offers a rich body of evidence indicating that healthy
students learn better and that improving knowledge,
competencies and health status of children will
improve learning outcomes. 3 Some successful and
promising examples of dealing with obesity prevention
via the school setting are described here.
So far, there is a lack of long - term evidence of effective
and comprehensive approaches for the issue of
obesity prevention in the school setting. A recent
review on school - based obesity interventions by
4
Shaya concluded that no persistence of positive
results in reducing obesity in school - age children has
been observed. However, the review by Stewart -
Brown 5 demonstrated that effective programs on
school health promotion in general adopted whole -
school approaches. It is clear that action against
obesity should be part of overall strategies on promoting
healthy lifestyles.
Dealing with h ealthy e ating and
p hysical a ctivity in s chools
The period that children spend in schools, usually
from age 4 through to adolescence (16 – 18 years) is
very important for their mental and physical development.
The school historically and still today is seen by
many as a site for health messages and activities. 3
During the period of industrialization in the mid -
nineteenth century, churches and charities in Europe
started schools in order to support the social development
of children and to care for them when both
parents were working in cities. Rules for healthy living
were taught at school, including proper hygiene measures,
regular eating, enough physical activity and sufficient
sleep. From the beginning of the twentieth
century, health education in schools was introduced
mainly by the medical profession because of the
spread of infectious diseases and the role prevention
could play. Medical care was provided through special
school doctors and nurses, later also dental care, by
specialized school dentists. Added to this was the
introduction of school meals and physical education
in schools, for example, in the UK, at the turn of the
twentieth century.
During this time, in public health there was a shift
from communicable to non - communicable diseases,
and the recognition that good health is related to lifestyle.
There has been a dramatic shift in morbidity and
mortality, from infectious diseases to lifestyle - related
causes such as cardiovascular diseases and cancers;
and an increase in the prevalence of mental health
problems. From the 1960s, this was recognized by a
change in health education in schools, towards trying
to influence health behaviors of children, mainly
by providing information about risks related to specific
diseases. However, it became clear that knowledge
itself was insufficient to change an individual ’ s
lifestyle.
The last two decades have seen a shift towards the
more holistic and ecological approach of health promotion.
Based on the Ottawa charter, 6 it became clear
that promoting health in a school setting should
include teaching in the classroom (or “ health education
”), but also take the school environment and ethos
into account, as well as considering links with the
wider community. The charter states that health promotion
is a process concerned with enabling people
to gain more control over their own health and over
their environment. This multi - faceted approach has
strongly influenced the health - promoting schools
concept, which has implied a shift in dominant paradigms
over the years. This in turn had a great impact
on the introduction of new health promotion programs
and interventions for schools on healthy eating
and physical activity (see Box 30.1 ).
Eating habits and diet have a significant influence
on the health and well - being of children. More specifically,
the overall health and nutrition of the child is
recognized as one of the factors that influence academic
performance, among other factors such as
gender, ethnicity, quality of school and school experience,
and socio - economic status. 4 Past studies have
focused on the effects of a lack of nutrients or malnutrition
on decreased school attendance and performance.
A number of studies have demonstrated the
positive effects of breakfast on school performance,
but there are gaps in the literature about the long - term
effects. A recent study in Canada 8 examined the
impact of the quality of the whole diet, not just certain
nutrients or meals on academic performance.
Components of a high quality diet were defined as a
high consumption of fruit and vegetables and a moderate
fat intake. This was one of the first studies of this
kind and it demonstrated that children with overall
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