Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Wednesday, April 23, 2008

The Losing Fight Against Childhood Obesity – Jeffrey Yu

Obesity is a major public health issue as it currently affects nine million children over the age of six. Childhood obesity refers to children who have a body mass index (BMI) equal to or greater than the 95th percentile of the population based on the Center for Disease Control and Prevention (CDC) growth charts. The rate of childhood obesity has tripled since 1980 (1). Reports show that the increasing trend of obesity is linked to many long-term health consequences, including sleep apnea, hypertension, type 2 diabetes, depression, and low self-esteem (2). Most efforts to reduce the prevalence of obesity have been implemented in schools because youths spend the majority of their day in school (3). These obesity interventions aim to achieve an energy balance between energy expenditure and energy intake, by focusing on nutrition education and physical activity (2).
Physical education (PE) has long been integrated in schools to increase physical activity (PA). It is a vital program that assists to reduce childhood obesity by providing school time for instructed physical activity and extending into after-school intramural and sport teams. However, physical education needs significant improvements to increase its efficiency. It was recently reported that only 55.7% of high school students were enrolled in a PE class, 28.4% were attending PE class daily, and only 39.2% were physically active during PE class (4). Overall, the attendance in PE class has decreased throughout the nation because of reduced funding (4). The program’s ineffectiveness can be attributed to the lack of federal physical education standards; physical education requirements vary by states and school districts (5). Some schools even allow waivers or substitutions for PE classes. A federal standard would at least provide students the opportunity to have daily physical activity (5).
Nonetheless, the current physical activity programs in schools still face many challenges. Childhood obesity rates continue to rise although most schools generally provide physical education. It is necessary to address the design and approach of physical education. In order to effectively reduce childhood obesity, physical education programs in schools need to use the Social Networking Theory, promote self-efficacy for continued physical activity, and understand the multitude of environmental factors that can influence students.
Contextualizing with Social Networking Theory
Most physical education programs appeal to a broad audience, but fail to recognize the interests of the diverse student social groups. The Social Networking Theory posits social networks as the most important predictor of a behavior (6). In high school, there is an array of social groups ranging from the athletes to the honor students. These students often follow the actions of the peers in their social network and each social group has different views on physical activity (7). Current PE programs have not invested the time to understand the barriers that prevent certain social groups from participating in physical activity and their different interest levels of various types physical activity (8). For example, researchers found that shy students do not enjoy team sports because of the sheer number of participants. Therefore, it is important to adjust the PE program to the various barriers (8). Thus, physical education should incorporate the Social Networking Theory to make physical activity a social norm among the diverse social groups.
The Trial of Activity for Adolescent Girls (TAAG) is an example of a successful intervention that contextualized the diversity of students. TAAG designed messages that targeted the different social groups by addressing barriers and interest levels of physical activity (8). With TAAG, there was an increased rate of physical activity (8). Hence, physical education programs that tailor to each social group increases physical activity and the effectiveness of PE.
Incorporating Self-Efficacy
The current physical activity programs in schools do not support the development of self-efficacy for every student. Albert Bandura’s concept of self-efficacy states that a person is more likely to adapt a behavior if he believes that he can do so successfully (9). In addition, the person’s perception is based on similar past experiences. Therefore, children with positive experiences with physical activity will participate more than children with negative experiences (10). Self-efficacy is important because it can help students increase physical activity both in and outside of school.
Physical education in school needs to increase student self-efficacy because non-athletic and overweight children often face barriers such as athletic competition and teasing related to weight (10). And although competition can promote physical activity, it does not reduce the disparity between those who participate and those who do not participate in physical activity (10). Non-athletic children often feel uncomfortable in PE classes and are intimidated to join after-school sport teams because of different skill levels (10). This clearly demonstrates the need for PE to focus on increasing the self-efficacy of non-athletic children.
Children who are overweight frequently face the same issues as non-athletic students. However, children who are overweight are more likely to encounter bullying (10). Bullying is a major barrier that prevents overweight children from engaging in physical activities. Often times, overweight children will avoid physical education class and after-school sports, where victimization is most common (11). Consequently, PE fails to promote self-efficacy when PE instructors do not maintain a conductive and supportive environment by addressing bullying. Above all, physical education should emphasize the fun and social aspects of exercising (8). Students do not need to master a variety of sports. Rather, making fitness enjoyable can assist with developing self-efficacy that will influence the students’ level of physical activity both in and outside of school.
Environmental Factors Influencing Physical Activity
There are many outside factors that affect the physical activity of youths. These factors include the neighborhood environment, socioeconomic status, and parental support. It is important for schools to be aware of these factors because schools can integrate the information into their physical education program accordingly.
The neighborhood environment has a major influence over a student’s physical activity level at home. In some neighborhoods, the major barriers include crime, violence, lack of place for physical activity, and drug dealers (12). Generally, unsafe neighborhoods with no alternatives encourage children to stay indoors. These factors negatively impact the ability for youths to spend time outside exercising (12).
It is also important to note that socioeconomic status is closely linked to the neighborhood environment. Typically, those with lower socioeconomic status live in unsafe neighborhoods (13). Hence, children with lower socioeconomic standing tend to engage in less physical activity (13). Additionally, the expensive costs for joining an after-school physical activity program contribute to lower physical activity among the impoverished population (12).
Parent and the home environment have a crucial role in childhood obesity. Albert Bandura’s Social Learning Theory asserts that modeling determines a person’s behavior (6). Supporting studies have shown that girls tend to be more active with active parents and siblings and when parent’s support physical activity (14). Girls consider family to be the most influential factor for their decision to be physically active (14). Additionally, one report described that an overweight parent increases a child’s risk of obesity (15). Therefore, parents often do have a major role in influencing their children’s physical activity behavior.
Some states, such as Arkansas and Pennsylvania, have developed school-based BMI screening and parent notification programs to address childhood obesity (16). Although the intervention is controversial, some focus groups have shown that parents are supportive of the program if they are notified ahead of time and the measurements are taken respectfully (16). Additionally, some parents supported sharing the BMI data with the school community because they believe the information can assist in garnering support for school nutrition and physical activity funding (16). Hence, parents should be involved with the school in reducing childhood obesity.
Conclusion
Physical education has the potential to affect a large amount of students because children spend most of their day in school. However, the PE program is not effective as childhood obesity rates continue to rise. The present PE program needs to redesign its approach as it does not contextualize the program for the diverse student body. Furthermore, the competition in physical education classes does not help promote self-efficacy for non-athletic and overweight children. Instead, the competition broadens the gap between those who participate and those who do not participate. Additionally, external factors such as dangerous neighborhoods and parents can limit the student’s physical activity outside of school.
In order for the physical education program to increase its impact, PE needs to be tailored to the various social groups. Personalizing physical education can change attitudes towards physical activity. The intervention would also be more successful if it promoted self-efficacy for all of the students by providing a supportive environment and reducing bullying. It is important for schools to provide affordable alternatives, such as free or subsidized after-school physical activity programs for students with lower incomes. In addition, schools should involve parents in the intervention because they have a major a role in influencing their children. It is possible to lower childhood obesity rates by continually evaluating current PE programs and incorporating environmental factors.
REFERENCES
1. National Center for Health Statistics. Obesity Still a Major Problem, New Data Show. Hyattsville, MD: Center for Disease Control and Prevention. http://www.cdc.gov/nchs/pressroom/04facts/obesity.htm.
2. Institute of Medicine. Childhood Obesity in the United States: Facts and Figures. Institute of Medicine. http://www.iom.edu/File.aspx?ID=22606.
3. Moe S, et al. Using School-Level Interviews to Develop a Multisite PE Intervention Program. Health Education & Behavior. 2006; 33:52-65.
4. Centers for Disease Control and Prevention. Participation in High School Physical Education. Atlanta, GA: Center for Disease Control and Prevention. http://www.cdc.gov/mmwR/preview/mmwrhtml/mm5336a5.htm.
5. Collins J. Shape of the Nation Report: Most States Receive a Failing Grade on Physical Education Requirements. Reston, VA: National Association for Sport and Physical Education, 2006.
6. Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007.
7. Washington Post. In high school, groups provide identity. Washington Post. Washington, DC: The Washington Post Company. http://www.washingtonpost.com/wpsrv/local/daily/april99/cliques28.htm
8. Staten L, et al. A Typology of Middle School Girls: Audience Segmentation Related to Physical Activity. Health Education & Behavior. 2006; 33:66-80.
9. Bandura A. Self-efficacy: Toward a Unifying Theory of Behavioral Change. Psychological Review. 1977; 84:191-215.
10. Bauer K, et al. How Can We Stay Healthy When You’re Throwing All of This in Front of US: Findings From Focus Groups and Interviews in Middle Schools on Environmental Influences on Nutrition and Physical Activity. Health Education & Behavior. 2004; 31:34-46.
11. Storch E, et al. (2007). Peer victimization, psychosocial adjustment, and physical activity in overweight and at-risk-for-overweight youth. Journal of Pediatric Psychology, 32: 80-89.
12. Ries A, et al. Adolescent’s Perceptions of Environmental Influences on Physical Activity. American Journal of Health Behavior. 2008; 32:26-39.
13. Burton N, et al. Participation in Recreational Physical Activity: Why do Socioeconomic Groups Differ. Health Education & Behavior. 2003; 30:225-244.
14. Vu M, et al. Listening to Girls and Boys Talk About Girl’s Physical Activity Behaviors. Health Education & Behavior. 2006; 33:81-96.
15. Brandt M. Obese Parents Increase Kids' Risk of Being Overweight. Stanford Report. 2004.
16. Kubik M, Story M, Rieland G. (2007). Developing school-based BMI screening and parent notification programs: Findings from focus groups with parents of elementary school students. Health Education & Behavior, 34: 622-633.

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1 Comments:

  • At April 23, 2008 at 7:20 PM , OpenID sunkistraindrops said...

    Nice paper Jeffrey! I've experienced many of the factors you discussed in your paper when teaching for PHE in west roxbury. Many of the kids live in areas that are unsafe to play in and also many of the schools do not even have a gym for PE. All the points you made are very true.

    -Nisha

     

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