Addressing Physical Activity, Obesity,

and Wellness in Schools

Jay E. Maddock, PhD

Mens sana in corpore sano (a sound mind in a healthy The study by Ridgers et al.9 in this issue examines the
body) correlates of physical activity during recess periods. They
—Satire X by the Roman Poet Juvenal fınd that overall facility provision, unfıxed equipment
(e.g., balls, jump ropes), and perceived encouragement

O
besity is rapidly becoming one of the most criti-
cal public health challenges of our time. An esti- were all related to levels of physical activity. Overall, there
mated 73 million adults and 12 million children are several places during the school day where physical
and youth in the U.S. are already obese.1,2 Childhood activity can be incorporated. Getting to and from school,
obesity is of particular concern because obese children on school grounds before and after school, physical edu-
are much more likely to become obese adults.3 The num- cation classes, recess, and brain breaks during class time
ber of years carrying excess weight appears to have a can all contribute to the hour a day that our children
cumulative effect on morbidity and mortality.3 A recent need. These situations can be enhanced and physical ac-
report by the IOM recommended fıve goals to accelerate tivity can be made easier in many cases with simple,
the progress in obesity prevention.4 One of these goals is low-cost policy solutions. Safe routes to school, remote
strengthening schools as the heart of health. drop-off sites, and walking school buses can add signifı-
Schools are an essential cornerstone in the prevention cant minutes to the commute to school. Joint-use agree-
of childhood obesity. Children spend most of their wak- ments, access to facilities, and supplying unfıxed equip-
ing hours in school and afterschool programs. National ment can enhance before and after school times as well as
guidelines recommend that children and adolescents get recess. Ten-minute activity breaks can reduce classroom
1 hour a day of physical activity.5 With many children fatigue, can increase attention, and can quickly meet one
getting to school before 8:00AM and leaving afterschool sixth of the daily recommended minutes of activity.10
programs at 5:00PM, school time is needed to meet the Similar policy changes like scheduling recess before
physical activity requirements. However, only 46% of lunch, eliminating sugar-sweetened beverages in vending
high school boys and 27% of high school girls met this machines, eliminating unhealthy foods as rewards and
goal on 5 or more days of the week.6 In the Child Nutri- fundraisers, training cafeteria workers, and providing
tion and WIC Reauthorization Act of 2004, the U.S. Con- choice bars can change the nutrition environment and
gress required that all school districts with a federally help increase fruit and vegetable consumption and re-
funded school meals program develop and implement duce the intake of high-density/low-nutrient foods.
wellness policies that address nutrition and physical ac- So if these policies are fairly easy to implement and cost
tivity by the start of the 2006 –2007 school year.7 The little, why are they not being implemented? In the evalu-
paper by Smith et al.8 in this issue of the American Journal ation fıeld, the common saying is What gets measured,
of Preventive Medicine examines the strength and com- gets done. Over the past decade, our principals and teach-
prehensiveness of school wellness guidelines and com- ers have faced increasing scrutiny and accountability for
pares locally developed policies with those following state academic standards through the No Child Left Behind
level templates. The study fınds that locally developed Act. A major unintended consequence of this act is to
policies are somewhat better than those following tem- focus school time away from extracurricular activities like
plates, but the main fınding is the overall weakness of the physical education, art, and music and toward the tradi-
policies. Their study showed that only 17.4% of schools in tional academic activities of math and reading. The Child
the sample addressed all federal guidelines, and the Nutrition and WIC Reauthorization Act of 2004 includes
strength of the included policies was mediocre at best. little accountability and no inclusion of quality of the
policies. The trends in childhood obesity will not be re-
From the Department of Public Health Sciences, University of Hawai’i at versed until schools address health and wellness as essen-
Ma៮ noa, Honolulu, Hawai’i
Address correspondence to: Jay E. Maddock, PhD, Department of Pub- tial parts of their mission. In Hawai’i, positive reinforce-
lic Health Sciences, University of Hawai’i at Ma៮ noa, 1960 East-West Road, ment for creating and enforcing strong wellness
Honolulu HI. E-mail: [email protected].
0749-3797/$36.00 guidelines has been effective.11 Creating model school
http://dx.doi.org/10.1016/j.amepre.2012.06.001 programs that award small grant funding for implemen-

© 2012 American Journal of Preventive Medicine • Published by Elsevier Inc. Am J Prev Med 2012;43(3):351–352 351
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352 Maddock / Am J Prev Med 2012;43(3):351–352
tation and recognizing schools for meeting wellness 3. Daniels SR. The consequences of childhood overweight and
guidelines can help increase the priority for health and obesity. Future child 2006;16(1):47– 67.
4. IOM. Accelerating progress in obesity prevention: solving the
wellness. The participation of researchers, public health
weight of the nation. Washington DC: National Academies
practitioners, physicians, parents, and community mem- Press, 2012.
bers also will be needed to assist our schools in this effort 5. DHHS. 2008 physical activity guidelines for Americans. 2008.
to return to the view that our children need sound minds www.health.gov/PAGuidelines.
in healthy bodies to be successful and competitive in 6. CDC. Youth online: high school YRBS. apps.nccd.cdc.gov.
today’s world. 7. Section 204 of Public Law 108-265. Child Nutrition and
WIC Reauthorization Act of 2004. www.fns.usda.gov/tn/
healthy/108-265.pdf.
No fınancial disclosures were reported by the author of this 8. Smith EM, Capagrossi K, Estabrooks P. School wellness poli-
paper. cies: effects of using standard templates. Am J Prev Med
2012;43(3):304 – 8.
9. Ridgers ND, Salmon J, Paree A, et al. Physical activity during
school recess: a systematic review. Am J Prev Med 2012;43(3):
References 320 – 8.
10. Barr-Anderson DJ, AuYoung M, Whitt-Glover MC, Glenn
1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and BA, Yancey AK. Integration of short bouts of physical activity
trends in obesity among US adults, 1999-2008. JAMA into organizational routine. Am J Prev Med 2011;40(1):76 –93.
2010;303(3):235– 41. 11. Rodericks B, Lee S, Ryan J, Ross C, Horiuchi, Maddock JE.
2. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Healthy Hawai’i Initiative Model Schools 2013 Program. Pre-
Prevalence of high body mass index in US children and ado- sented at the annual meeting of the Hawai’i Evaluation Asso-
lescents, 2007–2008. JAMA 210;303(3):242–9. ciation, Honolulu, Hawai’i, 2011.

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For personal use only. No other uses without permission. Copyright ©2018. Elsevier Inc. All rights reserved.