Childhood Obesity Intervention Strategies:

How Do The Schools Weigh In?

by

Bobby Hurt

A Research Paper Submitted in Partial Fulfillment of the

Requirements for the Master of Science Degree

in

School Counseling

Approved: 2 Semester Credits

The Graduate School

University of Wisconsin-Stout

May, 2011

1

Author: Hurt, Bobby L.

The Graduate School University of Wisconsin-Stout

Menomonie, WI

Title: Childhood Obesity Intervention Strategies: How Do Schools Weigh In?

Graduate Degree/ Major: MS School Counseling

Research Adviser: Carol L. Johnson, Ph. D.

MonthNear: May 2011

Number of Pages: 30

Style Manual Used: American Psychological Association, 6th edition

Abstract

With childhood obesity on the rise, schools are seeing the impact obesity has on academic

progress and socialization of students. Overweight boys and girls were found to be the target of

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bullying, negative rumors, verbal attacks, withdrawal of relationships, and loss in friendships. It

was also reported that some overweight boys and girls also perpetrated physical acts of violence

and bullying more than their normal weight peers. This research suggests that the struggles

obese students face in school range far beyond education in the classroom. This literature review

investigates why obese students appear to have higher rates of absenteeism, lower grade point

averages and lower graduation rates as compared to their normal weight classmates. Perhaps

above all, young obese students appear to have greater psychological issues than their non-obese

peers. Obese students are often the target of bullying and other degrading and demeaning forms

of harassment in school thus impacting their attention span, and ability to perform academic

tasks.

The Graduate School University of Wisconsin Stout

Menomonie, WI

Acknowledgments

It is without hesitation that I acknowledge those that supported me through the rigorous

process of writing and researching this significant topic. I truly believe that without the

collaborative support of those around me the words in this document would never have come

together.

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First, I would like to acknowledge my family. Each member has contributed to my being

here and continuing my academic progress in my master's degree. My mother, father, brother

and sisters showed true confidence in me during times when I fell short. Their love and

compassion for me during times when I could not be available to lend the same level of support

will forever inspire me that I can accomplish all things I put my mind towards.

Second, I would like to thank my friends for their understanding of my academic

endeavors and my limited availability during critical time periods in their lives. For all the

weddings, birthdays, celebrations, and paramount moments in their lives that I have missed, I

thank those that continued to support me while I pursued this dream of mine. Each one has

helped me through utmost difficulty and I will never forget the strength instilled in me to pursue

my goals in completing this research.

Lastly, I would like to thank Dr. Carol L. Johnson for her dedication to this project. It

was by her grace that I was given the privilege to work with her and this is something I will

never forget.

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I cannot imagine the workload that Dr. Johnson has in her professional career and to guide me

through this process is a gift that I will cherish forever. She has fulfilled I vital academic need of

mine and I hope to always seek guidance in my professional career from her and other staff here

at the university.

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Table of Contents

.................................................................................................................................................... Page

Abstract ............................................................................................................................................ 2

Chapter I: Introduction .................................................................................................................... 6

Statement of the Problem ................................................................................................... 11

Purpose of the Study .......................................................................................................... 11

Research Questions ............................................................................................................ 12

Assumptions and Limitations ............................................................................................ 12

Definition of Terms ............................................................................................................ 13

Chapter II: Literature Review ........................................................................................................ 14

Introduction ........................................................................................................................ 14

Effects of Obesity on Learning .......................................................................................... 14

Nutritional Choices in Schools .......................................................................................... 18

Obesity Intervention Strategies .......................................................................................... 20

Chapter III: Summary, Discussion, and Recommendations .......................................................... 23

Introduction ........................................................................................................................ 23

Summary ............................................................................................................................ 23

Discussion .......................................................................................................................... 25

Recommendations .............................................................................................................. 26

References ...................................................................................................................................... 28

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Chapter I: Introduction

The United States is experiencing a health crisis that is raising awareness of the severity

of childhood obesity, currently at the highest levels in history. According to recent comparative

research on the history of obese citizens in the United States, there has been a growing shift in

the average body size since 1900 (Kluger, 2008). The average 20-year-old American male body

weight in the year 1900 was 133 pounds; the average American woman in the same age group

was 122 pounds (Kluger, 2008). In the year 2000 the average body weight reported had risen for

men to 166 pounds and women to 144 pounds within the same age groups (Kluger, 2008). Over

the past 20 years obesity rates have risen even more dramatically. In 1985, there were eight

states in America where 10% of the adult population was obese (Kluger, 2008). In 2006 nearly

half of the states reported the percentage of obese adults was 25% or more (Kluger, 2008).

These statistics show a rise in obesity in adults, but unfortunately do not reflect on the changes in

body size in school age children of America.

Obesity research has recently begun to focus more on school-age populations

investigating trends regarding how youth and teens appear to be managing their health. As the

rate in adult obesity has reached historic highs, questions began to formulate about obesity's

effect on children. Research indicates that in 2003 and 2004, 18.8% of children, ages six to

eleven years old, and 17.4% of adolescents, ages 12-19 years old are now considered obese

(Thompson, Yaroch, Moser, Finney-Rutten, & Agurs-Collins, 2010). Comparisons from

previous research in 1971 show that only 4% of children aged six to eleven years, and 6.1 % of

youth aged 12-19 year were classified as obese (Kluger, 2008). This is alarming to observe an

increase of 15% and 11 % respectively in childhood obesity. The literature indicates it may be

caused by lack of exercise and poor eating habits. These studies show only percentages and

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statistics of children that are considered clinically obese; however, estimates for children

classified as overweight range from 30-32% notion wide (Kluger, 2008). Newer research is now

beginning to focus on children in age groups ranging from two to five years of age. Statistics

indicate that 13.9% of toddlers in this age group reported being obese in the year 2008,

solidifying the amount of concern for obesity as an epidemic affecting America's youth (Kluger,

2008).

With the prevalence of obesity across all age groups increasing, there has been a demand

for new research to study the long-term effects of being overweight or obese. For most cases of

obesity, weight increases due to an abundance of energy or calories going into the body, and a

lack of energy corning out of the body through physical activity (Thompson et aI., 2010). This

cycle can begin in early childhood and due to a lack of motivation, ability, and drive often

remains constant into adulthood.

Characteristics of individuals who are obese often include low self-esteem, lack of

positive body image, reduced energy, and depression, which are all critical components to an

active lifestyle (Okunade, Hussey, & Karakus, 2009). Other social and behavioral effects of

obesity across the lifespan include social isolation, poor economic stability, psychosocial

complications, and a lower measure of quality of life (Okunade et aI., 2009; Taras & Potts­

Datema, 2005). Long-term clinical conditions of obesity include type-two diabetes,

cardiovascular problems, hypertension, various cancers, orthopedic complications, asthma, sleep

apnea, non-alcoholic fatty liver disease, and hyperlipidemia (Taras & Potts-Datema, 2005).

Research also indicates that adolescents classified as obese often have a life expectancy

of an average of five months less than their own parents as a result of struggling with the

complications of excess weight (Okunade et aI., 2009). With the increased likelihood of

developing or acquiring such diseases, obese individuals often fail to receive proper medical aid

to assist them with medication, hospital visits, and critical personal training opportunities in

order to combat these clinical diagnoses.

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Okunade et aI. (2009), reports that obese individuals are less likely to graduate on time,

or not at all from high school, and as a result often fail to attend college; thus obese citizens

become less likely to acquire jobs that provide wages significant enough to offer appropriate

medical insurance and often have to rely on medical assistance programs to pay for their medical

expenses (Okunade et aI., 2009). Consequently, taxpayers are left with the financial obligation

to provide economic necessity to individuals who have been diagnosed with health conditions

linked to obesity (Okunade et aI., 2009). Some insurance programs are even recommending

higher premiums for overweight participants. Obesity also accounts for additional stress that has

been placed on the schools to enhance their students' way oflife and teach them better

nutritional habits to avoid the health conditions noted above.

In recent years, schools are increasingly becoming more populated with overweight

students and school leaders are trying to manage a variety of educational concerns that are linked

with obesity. Obesity has shown to have effects on grade point average, attendance, illness in

the school setting, and high school dropout rates (Taras & Potts-Datema, 2005). Research has

suggested that because obesity is very closely linked with depression, anxiety, and other

psychopathological disorders that this combination could be a large factor in why obese students

have such difficulty in school (Taras & Potts-Datema, 2005). Some students become the victims

of bullies due to their body size and weight. Due to setbacks in their education, obese students

tend to be academically ranked behind others in their same age and grade (Okunade et aI., 2009).

As stated above, a trend is emerging concerning obese students not only falling behind

their classmates in school, but also not graduating high school at all, based on students lack of

interest or motivation to go on to post secondary options for schooling (Okunade et aI., 2009).

Research by Albert A. Okunde et aI. (2009) explains the benefits of reducing obesity rates in

schools by stating: "Consequently, public policies targeted at reducing overweight and obesity

among adolescents might effectively raise high school GP A, increase on-time graduation and

post-high school college attendance, marketable skills acquisition, and overall economic and

social wellbeing of adult life stages" (p. 226-227).

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There is also research that addresses concerns about the relationships obese students have

with peers at school. Adolescent weight gain tends to cOlTelate with similar age, gender, and

racial social peer groups; and indicates that obesity tends to develop in groups of children rather

than just one case at a time, making it more difficult to control obesity numbers in each school

(Okunade et aI., 2009). Students may tend to exercise and make food choices similar to their

peers indicating that overweight kids tend to socialize with other students like them. Schools

have made proactive attempts in improving the health conditions of students. Junk food and

vending machines have new guidelines for placement in schools. School lunches are being

redesigned to be more balanced and less caloric. As school systems attempts to promote a

healthier lifestyle and introduce obesity intervention strategies to the students, awareness of

childhood obesity may improve.

Obesity intervention strategies are starting to emerge in schools across the country to help

change the declining academic success rates for obese students. Schools with an abundance of

vending machines, soda machines, and snack bars have limited the use of these high calorie food

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alternatives in order to promote healthier messages to the students (Taras & Potts-Datema,

2005). Obesity intervention strategies initially focused on first informing the school boards of

the messages they are sending to children by placing readily available, inexpensive high calorie

foods in every hallway as compared to healthier food options (Taras & Potts-Datema, 2005).

Other reports indicating evidence that school systems fail to satisfy children's need for

maintaining a healthy lifestyle is by only allowing students 4-6% of their necessary activity each

day (Taras & Potts-Datema, 2005). Schools are becoming more budget conscious and one of the

first courses often being cut or reduced is time spent in extended physical education classes

(Taras & Potts-Datema, 2005).

Another way obesity intervention strategies seek to change unhealthy behavior is by

educating the children on healthy alternatives rather than put a negative connotation on the

choices they are currently making (Benjamins & Whitman, 2010). Although many strategies

have shown significant success in effective behavior changes in the school setting, most fail to

report long-term levels of obesity changes. This is partially due to the generalization of such

prevention strategies and programs, and effOlis to tailor obesity prevention to age, race, and

gender, appear to yield much stronger results long-term (Benjamins & Whitman, 2010). It might

also be that schools do what they can to provide exercise and better food choices, but when kids

go home, they fall right back into the lack of good food choices and a sedentary life style. School

sanctioned obesity intervention strategies have indicated positive results by showing significant

increases in grade point average, academic involvement, attendance, improving self image, and

reducing dropout rates (Okunade et aI., 2009)

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Statement of the Problem

The rise in childhood obesity rates is currently an issue in the United States (Benjamins

& Whitman, 2010). Perhaps one of the most concerning aspect in the increase in obesity is how

it may affect children and teens in schools. Obesity in adolescence may cause a decrease in

grade point averages, attendance, quality of life, and body self-image across the nation. Obesity

may affect levels of participation in school activities and the motivation to form social

relationships. An obese student may display a lack of interest in school and may not attempt to

attain good grades. Some schools may even be promoting an environment increasing childhood

obesity by allowing students easy access to high caloric food options, a lack of health education,

and shortened activity periods. Improved academic achievement, higher self-motivation, and

increases in school attendance may be possible with the implementation of obesity intervention

strategies. Therefore, the problem becomes what can schools do to promote healthy lifestyle

choices that may contribute to reducing childhood obesity?

Purpose Statement

The purpose of this research is to review the literature to determine what strategies may

reduce the negative impact of childhood obesity on academic achievement and social acceptance.

Literature will be researched to determine if schools are contributing to an increase in obesity in

adolescence based on the amount of high calorie food options available and advertised to

students. The literature review conducted includes the topics of obesity in schools, obesity

intervention programs, and schools' health education awareness in order to gain insight on a

relationship between these three factors. The review of the literature was conducted during

spring 2011. The literature review focused on school age students, ages five to eighteen.

Research Questions

1. In what ways is obesity a predictor of poor academic performance?

2. Do schools foster an environment that promotes an obese lifestyle, and if so what

educational strategies are needed to teach students how to live healthier life styles?

3. What intervention programs are most effective in changing the habits of obese

adolescents that may result in improved academic success?

Assumptions and Limitations

It is assumed that there is credible information and resources pertaining to the topic of

obesity in the school systems and intervention strategies. Within these resources it is assumed

that all of the information is accurately reported and cited in a manner that is understandable to

the reader. It is also assumed that research has been conducted on the topic of obesity in the

school system. Lastly, it is assumed that this topic is of interest to professionals in the

educational system and families dealing with obesity in their environment.

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Some of the limiting factors of this study were the limited amount of research solely

based on obesity intervention strategies in the schools. There was a limited amount of literature

available on obesity and its effects to adolescent age students. Although it is important to note

the factors effecting adults in society within the broad spectrum of obesity, this research will be

limited to adolescent age students and public school systems. There is also the limitation of time

available as well as access to materials to analyze the extent of the literature and research in the

area of obesity prevention and schools systems. A final limitation is that some research may not

have been yet available in the spring of 20 11.

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Definition of Terms

There are several definitions and terms throughout the literature that are important for the

reader to understand. Below is a list of the commonplace terms and their definitions used in this

literature review.

Body Mass Index (BMI). BMI is a tool that is often used to determine if a person is at a

healthy weight, overweight, or obese, and whether a person's health is at risk due to his or her

weight. The formula used to discover one's BMI is taking weight in pounds, multiplying it by

703, and dividing that number by height squared (National Institution of Health, 2007).

Healthy Weight. A body mass index of 18.5 to 24.9 is considered a healthy weight

(National Institution of Health, 2007).

Obese. An adult with a BMI of 30 or higher is considered obese. Also described as

being at or above the 95th percentile ofBMI scales (National Institution of Health, 2007).

Obesity Intervention Strategies. Strategies may include primary prevention of

overweight or obesity itself, secondary prevention or avoidance of weight regains following

weight loss, and prevention of further weight increases in obese individuals unable to lose weight

(Dehghan, Akhtar-Danesh, & Merchant, 2005).

Overweight. Having a BMI of 25 to 29.9. Overweight can also be described as being in

the 85th to 95th percentile of BMI.

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Chapter II: Literature Review

Introduction

Obesity may impact the school performance of children at all grade levels. Some of the

literature indicated which areas of school performance are most impacted and to what extent.

Schools have a responsibility to keep students safe while promoting a positive learning

environment. This chapter will outline how schools are potentially harming students by offering

minimal opportunities for healthy food consumption and reduced physical activity. In addition,

this chapter outlines how some schools may fail to offer the required curriculum necessary to

teach children how to live a healthy lifestyle and prevent a pattern of obesity. Lastly, the chapter

includes how children are currently finding success in obesity prevention programs and how the

implementation of such programs in all school settings could improve the health and educational

experience for all students.

Effects of Obesity on Learning

Obesity levels in school-age children have increased three-fold over the last 20 years

(Kluger, 2008). This is an alarming statistic when research indicates and displays the adverse

effects of obesity on young students. Obese students generally have higher absenteeism, lower

self-esteem, delayed graduation, and a lower grade point average (Bin, Chih-Ping, Spruijt-Metz,

Reynolds, Clark, Palmer, et aI., 2006). Perhaps above all, young obese students appear to have

greater psychological issues than their non-obese peers. Obese students are often the target of

bullying and other degrading and demeaning forms of harassment in school thus impacting their

attention span, and ability to perform academic tasks (Janssen, Craig, Boyce, & Pickett, 2005).

Janssen et aI, (2005), conducted a cross-sectional study of Canadian youth (5,749

children grades 6 through grade 10). Utilizing the World Health Organization Health Behavior

15

in School-Aged Children's Survey, students filled in a questionnaire regarding their overweight

status and relationships in school. The purpose of the research study was to discover any

negative treatment toward students who were classified as obese. The researchers reported that

overweight boys and girls were the target of bullying, negative rumors, verbal attacks,

withdrawal of relationships, and loss in friendships. Janssen et aI, (2005) also reported that some

overweight boys and girls also perpetrated physical acts of violence and bullying more than their

normal weight peers. This research suggests that the struggles obese students face in school

range far beyond education in the classroom. This type of research led to the investigation of

why obese students appear to have higher rates of absenteeism as compared to their nOlmal

weight classmates.

In a study conducted by Schwimmer, Burwinkle, and Varni (2003), obese students, ages

5-18, were referred to their physicians to monitor their quality of life as it could potentially

impact the likelihood of developing anxiety disorders, depression, and other psychopathologies.

The researchers recorded absenteeism and discovered that severely obese students reported many

more missed school days than the general population. The average obese student missed four

days of school per month with a median of one day of missed school per month for non-obese

students. The research showed a significant relationship between obesity and missed school days

for children and adolescence. The researchers conclude that Body Mass Index (BMI) has

become a stronger predictor for absenteeism than previous indicators of race, ethnicity, and

socioeconomic status (Schwimmer et aI., 2003). Students who miss school may be more likely to

miss valuable lessons and have homework to catch up upon their return. These absenteeism

statistics may coincide with the amount of school obese students miss each year and the potential

impact on their on-time graduation.

16

Obesity appears to be linked with a delay of on-time graduation in some high school

students (Okunade, Hussey, & Karakus, 2009). In research by Okunade et ai. (2009), a

longitudinal study was conducted to determine if obesity levels in high school students had an

effect on their graduation date. The researchers sampled over 5,000 12-17 year old students and

asked them to report via survey grade point average, activity levels, level of absenteeism,

expected graduation date, and BMI. The researchers controlled the experiment for individual,

household, and community effects. After three years the same students were contacted and

surveyed again asking the same questions about their high school academic behavior. Results

indicate that BMI was a reasonable predictor of graduation date for females but not males.

Males however, did show signs of academic decline, but not to a significant degree. The

researchers concluded that with the delay in on-time graduation, obese students are less likely to

attend college and gain as much capital investment as their normal weight peers (Okunade, et aI.,

2009).

Grade point average has been used in research as a predictor for academic success,

understanding, and competence (Datal', Sturm, & Magnabosco, 2004). To determine if obese

students are having more academic difficulty than their normal weight peers, researchers

reviewed grade point averages for both categories of students in comparison. Comparisons

drawn from seventh through ninth grade students found that students who were classified as

overweight or obese had significantly lower grade point averages than their normal weight

classmates (Bin, et aI., 2006). The overweight students from the study were twice as likely as

their normal weight counterparts to have lower scores in mathematics, and in their language

skills. Further research conducted by Bin et ai. (2006), focused on detelmining if perceived

weight status had a significant effect on the grade point averages of 11 to 12 year olds in China.

17

The researchers measured and weighed the participants and then gathered a series of self-report

data from the students. Such questions focused on perceived weight status and actual weight

status in comparison to grade point average. The results indicated that individuals who were

overweight, regardless of their perceptions tended to have significantly lower grade point

averages than those who had an actual weight status of normal.

Other research on the topic of obesity and grade point averages focused on kindergarten

age students and their math and reading abilities. Datal', Sturm, and Magnabosco (2004),

conducted a study to see if first time kindergarten students' ability to learn was effected by

obesity. The researchers gathered a nationally representative sample (according to the Early

Childhood Longitudinal Study) of 11,192 first-time kindergarteners and conducted math and

reading assessments during four data collection points from kindergarten to first grade. The

authors controlled for socioeconomic status, parent-child interaction, birth weight, physical

activity and television watching.

The data showed that 1 out of 10 kindergarteners is overweight and had significantly

lower test scores in the areas of math and reading in comparison to non-overweight students.

Both categories of students had progressed at an equal level from kindergarten to first grade

resulting in lower math and reading scores for obese students at the end of first grade in

comparison to kindergarten. This shows potential that as obese students get older (from

kindergarten) they may fall farther behind than their non-obese peers (Datal', et aI., 2004).

Nutritional Choices in Schools

Over the past twenty years soft drink consumption has risen 41 % in the United States.

As reported by Teras and Potts-Datema (2005), "The increase is significant when contrasted with

one estimate that the odds of becoming obese increase 1.6 times for each can of a sugar

18

sweetened beverage consumed every day" (p. 291). As of2005, soda and vending machines

have been commonplace in education facilities ranging from elementary to high school (Teras &

Potts-Datema, 2005). By the year 2000, over one-half of school districts nationwide had a

substantial contract with a corporate or commercial vending company and that number is likely

to increase to over 75% currently (Teras & Potts-Datema, 2005). What is concerning about these

statistics is that of the schools that have vending contracts, nearly one-third receives a financial

incentive for sales reaching a certain amount. Some schools rely heavily on the profits made

from vending machines.

This reinforcing behavior for schools to promote soda and vending machine use to their

students is in place because schools can benefit financially from sales. As of2005, 56% of

elementary and 93% of high schools allowed students to purchase soda or candy products from

school stores, snack bars, canteens, or various vending machines at any time during the day

(Teras & Potts-Datema, 2005). Because of the high volume of consumption paired with schools

need for financial gain, this pattern of vending machine use is suggested to continue and grow

throughout the years in schooling systems. Most recently, current legislation is addressing these

concerns of profit over pupil health and recommendations are in place to turn the machines off

during portions of the day and further recommendations to replace high calorie food with better

choices for students.

It is not only that schools make available unhealthy snack choices, but also that these

choices are significantly less costly than healthier choices for the student consumers. With the

average student carrying less than ten dollars to school, daily spending money at school is

relatively minimal (Teras & Potts-Datema, 2005). Healthy food choices such as fruits and

vegetables are rarely available outside of lunch hours, and cost on average ten cents more than

candy from vending machines (Teras & Potts-Datema, 2005). Underpriced soda outsells milk

and 100% fruit juices due to the fact that soda costs far less, and is available throughout the

entire day (Teras & Potts-Datema, 2005). Schools are not only charged with providing healthy

food options for students, but they are also held accountable to make sure they are providing

opportunities to teach students how to stay healthy through curriculum and activity.

19

Physical education and nutritional education is often overlooked in the school curricula

due to the demands of subjects such as math, reading, English, and the sciences (Teras & Potts­

Datema, 2005). With limited time during the school day and pressure to meet and exceed

academic standards, teachers and school leaders are left with the dilemma of what is most

important. One of the largest predictors for obesity is the amount of activity children get in their

day (Teras & Potts-Datema, 2005). Children spend up to seven hours at school each day and

with budget cuts affecting areas of physical education, each student's available time for physical

activity is generally lowered considerably (Teras & Potts-Datema, 2005). In the 1970's students

spent nearly 40% of their available time outside and physically active during the day, which

exceeded the recommended daily activity for children and adolescence at that time period. Now,

only 6% to 8% of schools provide the recommended daily physical education or its equivalent

for the entire school year (Teras & Potts-Datema, 2005).

The nutritional education for students appears to be lacking in schools as well.

According to research by Benjamins and Whitman (2010), students were surveyed about proper

health choices and only 15.9% of students realized the amount of vegetables they should

consume daily in order to fulfill their bodies needs for nutrition. To emphasize this perspective

out of a typical class size of 30, less than 5 students have the knowledge to adequately feed their

body the foods they need to foster healthy growth (Benjamins & Whitmen, 2010).

20

Obesity Intervention Strategies

Some school systems are making obesity intervention a priority and taking initiatives to

lower childhood obesity based on the adverse effects on academics. Schools that are making

time to offer students additional physical education and nutritional education on how to be

healthier have seen some positive gains in general student body health. A study by Newton et al.

(2010) on the effects of obesity intervention on sixth grade students discovered that with

training, obese students developed better eating habits, and adjusted eating behavior to a

healthier standard. The study consisted of an 18-month intervention, which was designed to alter

the school environment to prevent excess weight gain by developing healthier eating choices and

making physical activity opportunities more available. Newton et al. (2010) did not report

significant weight loss, but with the change in behaviors across this age group noted the potential

for longitudinal data to reveal significant changes over longer periods of time.

A study by Benjamins and Whitman (2010) revealed similar findings for school based

obesity intervention plans, and recorded weight loss among their sample population. This

project attempted to discover if a fully funded intervention strategy was placed in schools, would

educators be more receptive, and would students would benefit from the expertise of a highly

paid staff. A team enhanced the school's program and included an epidemiologist project

director, a dietitian, a mental health consultant, a social worker from the school system, and a

joint school wellness council implemented the project.

The pilot program took place from September 2006 to June 2008. For two years the pilot

schools enhanced their cUlTiculum to meet the standards for healthy living and the National

Institution of Health criteria for a healthy schooling environment. Physical education

departments were provided a grant of $10,000 to spend on activities that can relate to weight

21

loss, along with activities that can be easily accomplished by students outside the classroom.

Health curriculum was implemented and staff had brief orientation to the new material provided

in order to facilitate an accurate transfer of knowledge to the students about maintaining healthy

living. Lastly, schools were held under strict guidelines to limit the usage of vending and soda

machines during school hours and offered new healthy food choices in order to send a positive

message about the issue of health within each school. Students were then given surveys to self­

report how they managed their health within the obesity intervention plan time period and

scorers marked changed in behavior, health, and attitudes towards healthy living (Benjamins &

Whitman, 2010).

The results indicated that students in early years, those in grades 2-4, showed improved

ability in recognizing how to lead a healthy lifestyle. The most significant change for this age

group following the intervention period was in nutritional knowledge. Specifically, the

percentage of girls in grades 2 and 3 who could correctly identify the healthiest foods increased

throughout the study. As an example, findings for one ofthe questions showed that the

percentage of all girls who knew that whole wheat bread was healthier than white bread

increased from 75% to 93%. In addition, almost 100% could identify the unhealthiest foods,

such as doughnuts, cookies, and candy. However, only 36% got all 6 knowledge questions

correct, compared with 18% in 2006 (Benjamins & Whitman, 2010). This research shows that in

two short years knowledge has improved regarding identifying unhealthy choices as well as

learning essential food groups for healthy living.

Federal funding for school lunches has not changed much in the last 30 years - until now.

Low cost lunch choices including chicken nuggets, pizza, french fries, canned fruits and

vegetables, and other high fat and high calorie food options were all readily available and funded

22

by many public school budgets. First Lady Michelle Obama is proposing a bill that would raise

the ,amount of funding by over one nickel per public meal (NBC News, 2010). If the bill were to

pass it would not only bump up the amount of money each school would receive, it would also

require schools to add grains to food items such as pizza crusts, pasta and breads. In addition,

schools will be given the funding to add more fruit and vegetable choices to their meals in order

to encourage healthier eating.

Margo Wooten of the Center for Science in the Public Interest says, "It's not just enough

to just stick and apple on the tray. If the child doesn't like an apple, they're not going to eat it.

You need to give them a few different choices" (NBC News, 2010). After her tours to several of

the nation's public schools, Michelle Obama noted the lack of options school lunch programs

have to provide for our hungry students. According to NBC News Michelle Obama stated:

Kids can lead the way for us and the food that our kids are getting in school each and every day needs to be as healthy as it can be. When kids are bringing some of the nutrition lessons home we'll begin to see how we are making a difference (Pg. 2).

As the First Lady's concern for American's health grows, experts like Margo Wooten agree that

an improved school lunch program, an increase in physical activity and a nutritional educational

program would likely help raise a generation of children capable of making lifelong healthy

eating choices. It is this kind of leadership and partnership that schools need to work within

communities to help families afford good nutrition, offer extracurricular activities that are

inclusive of all children and have areas where kids have safe places to play. Schools can make a

difference in the lives of the students who struggle with weight issues. Reducing childhood

obesity may help improve attendance, may increase graduation rates and help a generation of

children live longer and more fulfilling lives.

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Chapter III: Summary, Discussion, and Recommendations

Introduction

As mentioned in the literature, obesity rates are escalating in America. Adolescents

appear to be adversely affected by the consequences from poor nutritional choices and lack of

physical activity. This chapter highlights the application of obesity research and recommends

how school officials may enhance the learning environment for students of all ages nationwide.

Summary

According to the comparative research data from studies by Kluger (2008) and Stevens

(2010) it appears that obesity is a growing trend in America. From the research presented,

statistics indicate that larger numbers of adolescents are now facing more severe health risks than

in the past. With obesity now affecting the youth of America more than ever before, research

has recently been dedicated to discover some of the impacts of poor nutrition and lack of

physical activity at school. The trend of childhood obesity is showing up in kids as young as

ages three and four with lasting negative effects through childhood.

Obesity is posing a dilemma for adolescents in school and is often times creating a barrier

to learning. Childhood obesity is often linked with psychological conditions such as depression,

anxiety, low self-esteem, low self-image, and a lower quality of life. Because children affected

by obesity tend to have low self-worth, and look different than their non-obese counterpmis,

bullying is often likely to occur. They are often teased and the last picked for team sports.

Obese students tend to become affected by their non-overweight peers at school

sometimes creating difficulty to obtain classroom related information due to higher absenteeism

and low self-esteem. Children affected by obesity are more likely to miss more days of school

than their normal weight peers due to medical conditions and a lack of motivation. Research by

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Okunade (2009) indicates that due to a higher rate of absenteeism obese students tend to delay

on-time graduation and in many cases do not attend college. This creates minimal workforce

0ppOliunities for obese adults with low education and a lack in their ability to treat overweight

conditions, resulting in a cycle of obesity for years to come. Many of the research studies

presented obesity as a contributor for lower grade point averages in comparison to normal weight

peers in the same groups. Children as young as kindergarten-age appeared to be affected by

obesity and their ability to adapt to their surroundings and enhance educational opportunities

(Benjamins & Whitman, 2010).

Many believe schools have a responsibility to provide a safe, positive environment for

learning and control influences that can have an effect on all students' learning. With the use of

soda and vending machines, some schools may be promoting and fostering an environment for

an unhealthy lifestyle. Obesity is the result of high amounts of calories coming into the body

(high caloric intake) and low amounts of energy coming out of the body (burning calories

through exercise). Schools offer sugary beverages and snacks at a low price, which are higher in

calories than healthier whole food options costing much more. Schools adveliise the use of

obesity-inducing foods because of the profits and perks they can attain from the vendors of the

sweet snacks that they sell. With budget cuts projected in many schools nationwide, districts

may be unable to offer the amount of physical education required to maintain adequate activity

levels for adolescents. Curriculum in schools is focused on passing vital academic tests, passing

core classes, and meeting graduation deadlines, but does not always attempt to teach students

vital skills about living a healthy lifestyle.

School-wide obesity intervention programs have helped in educating students how to

manage their weight and control eating habits to maintain good physical health (Benjamins &

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Whitman, 2010; Newton et aI., 2010). Evidence from these studies indicated that while students

don't always lose weight within the allotted time frames of the intervention program they do

learn how to change their habits and gain insight on how to make better life style choices. The

objective of the intervention programs has been teaching students how to make healthy food

choices, rather than to help students physically lose more weight.

Discussion

The research on obesity among school age children is a recent phenomenon that appears

to be expanding rapidly with more information that becomes available to researchers. Some of

the studies performed do not take into account that obese individuals often face other difficulties

in life rather than just weight. Perhaps obesity alone is not causing adverse effects in teens but is

simply a marker for further distractions in education. In the study performed by Okunade

(2009), the author reached the conclusion that obesity had a significant positive relationship with

delays in on-time high school graduation and that obesity is linked with depression, bullying,

anxiety, low-self esteem, low self-value, and low quality of life. A critical component of the

interventions should indicate how being obese can impact one's performance in school. Perhaps

obesity is simply a marker for more serious conditions that can affect performance in academics.

More research studies conducted on children within the ages of six to ten needs to be

investigated based on the difficulty to classify obesity within that age group. In order for

children to be classified as obese a BMI reading over 30 must be present in order to show high

weight values compared to height values. One of the problems with this reading and measure is

that according to Stevens (2010), children often store body fat to prepare for growth during these

years of their development. So it is possible that the children are not obese, but rather that they

are healthy and preparing for years of growth. Many of the studies indicate how difficult it is to

get an accurate reading ofBMI based on the ages of the children and have made attempts to

account for this by gauging family history and genetics.

26

Gender within the realm of obesity is a critical factor to consider when gauging the

growth patterns for young children. According to Stevens (2010), young girls and boys grow

very differently and can show spikes in development at different ages. To categorize children by

age may not be the most relevant information due to the differences in body size for girls and

boys at different ages. Girls were undenepresented in the data because of how quickly they

increase in height at earlier ages than boys. This may give them a lower BMI score based on

how the BMI is calculated in the research designs for most of the studies presented. It is

important to note the differences in adolescent males and females and why more males appear to

have higher obese levels when analyzing the data for future research (Stevens, 2010).

Recommendations

Recommendations for school leaders include the need to start taking action to develop

opportunity for healthy food choices in the school setting. Obesity is caused by many factors

and perhaps the most influential is large consumptions of sugary beverages and foods. Future

researchers may wish to explore how gender and cultures, regions of the country and genetics all

play into the childhood obesity epidemic.

School counselors should take notice of the students who are classified as obese and the

struggles they inevitably face on a daily basis. Obesity is linked with many psychological

challenges that could be overwhelming for young students while in school. Doing further

research on the front lines, counselors may wish to monitor individual attendance, grade point

average and academic load on these students and should be aware of how obese students interact

with their peers. Offering support groups for students who are being bullied or have low self

esteem may help with the academic success of obese students.

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School counselors and principals need to keep students who are classified as obese on

track for graduation. Students who are obese and at risk for delaying on-time graduation and

seeking higher education should be offered academic, career, and personal/social support.

Maintaining data records may provide fUliher insight into patterns of obesity related baniers to

success. School leaders and educators should consider the implementation of obesity

intervention programs based on their effective approach of teaching students to live healthy

lifestyles. Such programs have successfully educated students on healthy food groups, daily

exercise requirements, and avoiding sedentary lifestyles. While educators and parents can work

together to minimize the impact of childhood obesity, it is up to the individual to follow through

making good food choices and maintaining an active life style to prevent further complications.

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