Understanding school-age obesity: through participatory action research

PURPOSE: This study aimed to assess current levels of overweight (obesity) and fitness among school students using objective data. METHODS: School-based action research teams were recruited statewide by the New Hampshire Healthy Schools Coalition, the state team of the National Action for Healthy Kids Coalition. Action teams consisted of a physical education teacher, a school nurse, and a school administrator. Data were collected from 6,511 student participants aged 6 to 14 years, which was a representative cross-section from New Hampshire school districts. Key variables of interest in the study were body mass index, and ability to pass five fitness tests using FITNESSGRAM. Pearson's correlation was used to assess the relationships among body mass index, age, gender, and the percent of students that passed FITNESSGRAM tests. RESULTS: The ability of participants to pass the FITNESSGRAM tests declined markedly with age and differed between boys and girls, although the healthy fitness zones for any particular test was lower for girls. Body mass index was significantly negatively correlated with performance on all tests. Age was also statistically negatively correlated with performance on all tests; the relationship between gender and performance on the tests was less striking. CLINICAL IMPLICATIONS: Results reflected an increase in the prevalence of overweight school children, even in New Hampshire, which is purported to be one of the healthiest states in the nation. Results offered evidence that body mass index is a valid proxy measure for fitness levels and that fitness programs are necessary to effectively combat the obesity epidemic. Evidence-based changes need to be implemented to address obesity-related factors in schools, because children spend many of their waking hours in that setting. Physical activity during recess and physical education classes could help to increase energy expenditure and develop sound minds and bodies. Schools should consider the development of school-based wellness teams to advise and advocate improved school-based wellness policies. School nurses can take an active part in these initiatives.     

Association of physical activity and health status with intelligence quotient of high school students in Jeddah

[Purpose] The present study investigated the relationships of physical activity and healthiness with the intelligence quotients of high school students in Jeddah. [Subjects and Methods] A total of 135 male and female students were randomly drawn from public and private secondary schools in Jeddah. A self-designed questionnaire was distributed to the students that included demographic, physical activity, and health status sections. Body mass index measurement and an intelligence quotient test were carried out for all students. In addition, samples of blood were collected to estimate hemoglobin and serum iron. [Results] The highest proportions of males and females (39.1% and 51% respectively) had an intelligence quotient score of more than 75%. Moreover, the findings revealed that about 35% of the students were categorized as overweight obesity, and there was aninverse correlation between body mass index and physical activity. Students who shared physical education classes and exercising at and outside school showed a positive correlation with high IQ scores. Regarding hemoglobin and iron levels, there were significant correlations between their levels in blood and IQ. [Conclusion] The intelligence quotient of adolescent students is positively associated with physical activity and health status.Key words: Adolescence, Intelligence Quotient, Physical activity     

An evaluation of elementary school nutrition practices and policies in a southern Illinois county

The purpose of this study is to assess elementary school nutrition programs in a rural county in southern Illinois. The researcher interviewed the food service managers of eight schools and completed the School Health Index (SHI) based on their responses. Eighty-seven percent of the schools did not have venues such as vending machines outside the cafeteria. Three food service managers stated that from 75% to 80% of the students in the district ate lunch in the cafeteria. The SHI corresponds to the eight components of a coordinated school health program; nutrition services are just one of the eight components. The SHI is a tool that can be used to identify strengths and weaknesses in the nutrition program. It covers items from healthy, low-fat choices to food preparation and cafeteria practices. School nurses can work with teachers and food service personnel to create nutrition programs and a curriculum related to healthy nutrition practices.     

Adolescents' attitudes about obesity and what they want in obesity prevention programs.

Obesity is a major pediatric public health problem. Adolescents are a priority population for intervention strategies. School nurses are in key positions to design intervention strategies to promote healthy lifestyles and prevent adolescent obesity in the students they serve. To design effective programs, school nurses need to know what components their students perceive as important. This study involved the development and administration of a questionnaire to middle school students to determine their attitudes about overweight/obesity and what they felt would work for them. Adolescents are willing to exercise more, to change eating habits to include more fruits and vegetables, drink more water, and eat less junk food. They are not willing to give up soda, video/computer games, and watching television to improve their health. School nurses can use this questionnaire to collect data that will assist in the development of effective programs for their students.     

Evidence-based practice guideline: increasing physical activity in schools--kindergarten through 8th grade.

Because of the growing obesity epidemic across all age groups in the United States, interventions to increase physical activity and reduce sedentary behaviors have become a priority. Evidence is growing that interventions to increase physical activity and reduce sedentary behaviors have positive results and are generally inexpensive to implement. National and international health organizations are calling for a comprehensive approach for reducing obesity in children that includes increasing physical activity in the school setting. Although the call to increase activity levels in schools is clear, little guidance has been given to schools on specific methods to accomplish this task. This article provides an overview of an evidence-based guideline developed by a physical education teacher and a school nurse to provide inexpensive, easy-to-implement, effective strategies to increase physical activity in students. Tools are also included in the guideline to measure the effectiveness of the intervention.     

Medication management in primary and secondary schools: evaluation of mental health related in-service education in local schools

An increasing number of students are taking medications while they are in school or are under the influence of medication during school hours. In a novel effort, clinical pharmacists and mental health therapists worked together to provide "mini-in-service" educational programs on psychological disorders and medications used to treat these disorders. The purpose of this study was to implement and evaluate the effectiveness of these educational programs presented to school nurses, teachers, school administrators, and other personnel. The study compared participant responses before and after attending a medication in-service session on a psychological disorder and its related medications. Results indicated that in-service education on attention deficit/hyperactivity disorder (ADHD) and depression improved the knowledge and confidence levels of school personnel regarding medications and symptoms. Feedback indicated school personnel wanted longer educational sessions and more information on these disorders and treatments. School nurses working with health professionals can improve education for staff, families, and students about mental health disorders and their treatment.     

Current clinical research on type 2 diabetes and its prevention in youth

The SEARCH, TODAY, and HEALTHY studies, and NASN's SCOPE intervention, illustrate that collaboration between schools, school nurses, clinicians, students, and families can help treat and prevent diabetes and obesity in youth. Findings will help identify the prevalence of diabetes in young people, the best ways to treat youth with new-onset type 2 diabetes, and healthful practices that can reduce risk factors for cardiovascular disease. Findings about diabetes prevention in the school setting can guide school nurses and school leadership to incorporate effective changes into food and physical activity offerings to students. Finally, school nurses can communicate with primary care providers and provide culturally sensitive letters to parents and guardians regarding the BMI results for the child.     

Transition Best Practice: Who is Responsible for Preparing our Educators to Promote Transition Related Best Practice?

Graduate students taking a class on transition for students with disabilities surveyed personnel of school districts in which they lived and worked to determine if the districts were engaging in transition best practices. Ten school districts in Southeast Texas were surveyed. The majority of these districts did not engage in transition best practices. There was a gap between what was being taught in the graduate class and what was actually happening in the public school classrooms. Implications for educator preparation programs and public school professional development programs are discussed.     

Parental perceptions of the schools' role in addressing childhood obesity.

As childhood obesity has increased, schools have struggled with their role in this epidemic. Parents with a school-age child in a suburban latchkey program were surveyed regarding their perceptions of childhood obesity, body mass index, and the school's role in prevention and treatment of obesity. More than 80% of participants identified inactivity, poor eating behavior, lack of parental control in what children eat, and eating too much as the main causes of childhood obesity. Parents preferred receiving information about their child's body mass index from the school via a letter from the school nurse. Participants agreed that physical education classes, as well as units on nutrition and weight control, should be present in schools. Parents also supported eliminating junk food machines and offering special low-calorie meals. By supporting these strategies, parents indicated that schools should have a role in childhood obesity. School nurses can advocate for parental preferences in their school district.     

重庆市某中学学生营养不良和肥胖的相关因素分析

背景中学生在生长发育过程中可同时具有营养不良和营养过剩两类问题.目的了解中学生的营养不良和肥胖情况及其相关的影响因素.设计横断面调查.单位重庆市卫生局卫生监督所、重庆医科大学营养与食品卫生学教研室及重庆市第八中学.对象于2004-03/05采取整群抽样法抽取重庆市沙坪坝区某中学15个班级的全日制学生896人,排除患遗传性代谢性疾病、有外伤或其他疾病引起的继发性、病理性营养不良或肥胖者,均知情同意.其中826人填写的问卷内容详实(有效率达92.19%),男生414人,女生412人,年龄13～18岁.方法对入选学生进行问卷调查,内容包括基本身体情况、疾病状况、父母情况、饮食行为、营养知识、饮食习惯等方面.学生现场自行填写、现场回收.学生营养状况评价采用近期体格检查表中身高、体质量值,以"中国学生7～22岁身高体质量值"作为参考标准.体质量标准是利用同等身高人群体质量的第80百分位数为标准制定,以此体质量标准为100%,低于此标准90%为营养不良,高于此标准120%为肥胖.并对调查数据进行非条件logistic逐步回归分析,探讨中学生营养不良和肥胖的影响因素.主要观察指标[1]中学生营养不良和肥胖的患病率.[2]中学生营养不良和肥胖的影响因素.结果826人进入结果分析.[1]营养不良和肥胖的患病率分别为9.44%和24.21%.营养不良的患病率女生高于男生[4.84%,14.08%(χ2=15.1036,P＜0.05)];肥胖的患病率男生高于女生[30.09%,18.2%(χ2=10.5737,P＜0.05)].[2]营养不良和肥胖的影响因素营养不良的发生与性别、是否偏食挑食、睡眠时间、早餐情况及是否吃动物内脏5个因素显著相关(P＜0.05～0.01).肥胖的发生与性别、父亲的体质量指数、进食速度、是否吃宵夜、是否偏食挑食等5个因素显著相关(P＜0.05～0.01).结论调查发现中学生群体营养不良和肥胖的患病率较高,且均与性别因素和是否偏食挑食密切相关.纠正中学生的营养不良和肥胖,要给予正确的营养知识,帮助他们合理安排饮食,建立良好的生活模式.     

A coordinated school health program approach to adolescent obesity.

Obesity has become one of this country's most significant nutritional diseases. The prevalence of childhood and adolescent obesity has steadily increased over the past 20 years. The risk of developing health problems increases as the obese child becomes an obese adolescent and adult. The 1997 Youth Risk Behavior Survey reports adolescents participate in behaviors that put them at risk for obesity. The recognition of these unhealthy behaviors among our youth has led to the need for early intervention. The Coordinated School Health Program is a mechanism to address adolescent obesity at the school-age level. This program includes an organized set of policies, procedures, and activities intended to protect and promote the health and well-being of students and staff. The eight components of a Coordinated School Health Program (CSHP) include school health services, a healthy school environment, comprehensive school health education, counseling and guidance, physical education, food service, worksite health promotion, and the integration of school and community. This paper describes integration of prevention and treatment strategies for adolescent obesity for each of the eight components of a CSHP.     

Evaluating the effectiveness of the Kids Living Fit program: a comparative study.

After-school programs can be implemented by school nurses to facilitate healthy lifestyle choices in children with the goal of decreasing obesity. Kids Living Fit (KLF), an after-school program designed by community hospital nurses, was implemented in elementary schools and focused on best lifestyle choices regarding foods consumed and activities chosen for children in grades 2 through 5. Study measures included comparison of body mass index (BMI) percentiles for age and gender and waist circumference between two self-selected groups composing a total sample size of 185 participants: the KLF intervention group (n = 80) and the no-intervention/ contrast group (n = 105). The 12-week intervention included a weekly fitness program and monthly dietitian presentations. Participants completed food and activity diaries and wore pedometers. In pairwise comparisons, the KLF group had a significant decrease in BMI percentile between baseline and follow-up (-2.3%) compared with the contrast group. The KLF group also demonstrated a smaller increase in waist circumference than the contrast group.     

Development of an obesity prevention and management program for children and adolescents in a rural setting

This study applied theory-based health behavior change constructs to childhood obesity prevention. Constructs such as goal setting, self-efficacy, and readiness for change were used within a rural community-based program designed to be developmentally appropriate for 6th graders. The project included 2 studies across 12 months. The 1st assessed the scope of the obesity problem within a 3-county area with key stakeholders in health and education. The 2nd implemented a pilot community intervention program within a rural middle school. Participants in the intervention included 65 middle-school students and the families of 25 of these students. Qualitative and quantitative analyses were conducted to assess the effectiveness of the intervention. Changes from pre- to postintervention on relevant measures were statistically significant for families but not for students. Issues related to family versus individual behavior change are discussed, along with implications for managing behaviorally based activity and nutrition interventions within a rural community.     

Injuries associated with teacher assaults: magnitude, nature, cost, and outcome.

The purpose of this retrospective study was to describe the magnitude, nature, and costs of assault injuries among teachers, a high-risk group. Review of assault cases (N = 341) was based on internal and case management vendor records. The 3-year assault rate was 3.24 per 1,000 teachers. Assaults were predominately physical, occurring during classroom disputes and while restraining students. Assaults accounted for 2,480 lost workdays and more than dollars 714,000 in lost wages and case management fees. The most costly injuries on a per-case basis were strain-sprain injuries resulting in lost workdays and fractures not resulting in lost workdays. Less than 20% of the assaults accounted for all of the lost workdays and most of the case costs. Study variables accounted for 13% of case costs. Occupational health nurses should collaborate with school personnel, administrators, and parents to develop prevention programs, which may include de-escalation techniques for teachers as well as case management strategies.     

Addressing School Challenges for Children and Adolescents With Type 1 Diabetes: The Nurse Practitioner's Role

Children with type 1 diabetes need to monitor their blood glucose and food intake, administer insulin, and participate in physical activity during school hours. School concerns for this group include school personnel, the medical directive plan, classmates, school lunches, and physical education classes. Nurse practitioners should take an active role in advocating for improved T1DM management in schools by talking with patients and their parents about experiences in school, identifying challenges and discussing possible solutions for improving diabetes management during school hours, and accessing online resources to assist patients, parents, and school personnel.     

Stage-based interventions for low-fat diet with middle school students

Preventing obesity and cardiovascular disease at early ages is important; however, few effective interventions for early adolescents have been reported. In this study, low-income, culturally diverse students from an urban middle school (n = 60) received four classroom interventions with the use of a combined Health Promotion/Transtheoretical Model to control fat in diet and increase physical activity. A control group (n = 57) received the usual classroom education. Pretest percentage fat in diet was regressed on demographics, access to low-fat foods, perceived self-efficacy, benefits/barriers, and stage of change with results as proposed by the model [F(9,64) = 5.77; p =.000; adjusted R(2) = 0.35]. Posttest percentage fat in food was significantly less for the intervention group as compared with the control group (t = 2.06; df, 115; p =.04).     

The relationship between children’s somatotypes,motor examination results,and motor skills: assessing 6- to 10-year-olds

[Purpose] Childhood motor disorders and obesity are major health problems and concerns in children today. We performed a physical examination to test the motor system and motor ability of elementary school children based on their body types. [Participants and Methods] The obesity levels of 161 elementary school students aged six to ten were calculated based on the gender, age, and standard weight for each height category to classify them into somatotype groups, and analyze the relationships among the results of four motor examination items, Physical Fitness Test, and body composition analysis for two groups. [Results] More obese children were unable to reach the floor while performing a standing forward bend compared to non-obese children. In addition, a significant difference was found in the assessment of motor performance while performing side-to-side jumping, and obese children showed better values. Many endomorphic children were also unable to touch the floor with their hands when performing the standing forward bend. Among the items from a physical fitness test, the side-to-side hops revealed significant differences. There were no somatotype-related differences in the results of the body composition analysis. [Conclusion] In children aged six to ten years, somatotype differences were not associated with motor skill or body composition.     

Evaluation of a Pilot Hospital-Based Community Program Implementing Fitness and Nutrition Education for Overweight Children

PURPOSE.  Evaluate the effect of the Kids Living Fit™ hospital-based intervention on body mass index (BMI) percentile, adjusted for age (months) and gender in children ages 8–12 years with BMI percentiles ≥ 85.
DESIGN AND METHODS.  Twelve weekly exercise sessions and three nutrition presentations were held. Nurses recorded BMI and waist circumference at baseline, week 12, and week 24. Participants completed food and activity diaries .
RESULTS.  Of the 32 participants enrolled, 16 completed all outcome measures and experienced a decrease in average BMI, BMI percentile, and waist circumference between baseline and weeks 12 and 24.
PRACTICE IMPLICATIONS.  Hospitals can offer exercise and nutrition programs to decrease childhood obesity in their communities.