Percentage of U.S. Children and Adolescents Who Were Obese, 1963-2008 *

1. Percentage of U.S. Children and Adolescents Who Were Obese, 1963-2008* 19.6 18.1 4.6 4.2 Ages 6-11 Ages 12-19 ** *>95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts. **1963-1970 data are from 1963-1965 for children 6-11 years of age and from 1966-1970 for adolescents 12-17 years of age. CDC, National Center for Health Statistics

2. Consequences of Obesity in Children obese obese % of children, aged 5-17, with 1 or more risk factors for heart disease: % of children, aged 5-17, with 2 or more risk factors for heart disease: 13% 26% 39% 70% Freedman DS et al. JPediatr 2007;150(1):12-17

3. Economic Costs Associated with Obesity are High Direct health care costs of obesity and overweight: 1998: $74 billion 2008: $147 billion ½ of costs publicly financed by Medicare or Medicaid Obesity accounts for 9.1% of annual medical spending Finkelstein EA et al. Annual medical spending attributable to obesity: payer and service-specific estimates. Health Affairs 2009;28

4. Guidelines for Youth • 60 or more minutes of physical activity daily, most of which should be aerobic • At least 3 days per week of: • Vigorous-intensity physical activity • Muscle-strengthening physical activity • Bone-strengthening physical activity • Physical activities should be age appropriate, be enjoyable, and offer variety www.health.gov/paguidelines

5. Percentage of High School Students Who: • Are physically active at least 60 minutes per day on all 7 days: 18% • Do not participate in at least 60 minutes of physical activity on any day: 23% • Do not attend PE classes: 44% Source: CDC, National Youth Risk Behavior Survey, 2009

6. A Comprehensive School Physical Activity Program • Elementary school: Daily recess period • Physical activity throughout the school day • Extra-curricular physical activity programs • Inclusive, intramural programs and physical activity clubs • High school: Interscholastic athletics • Walk/bike to school program (“safe routes”) • Staff wellness program High quality physical education as its foundation

7. Enhanced School PE is Strongly Recommended • Enhanced PE: modified curricula and policies designed to make PE classes longer or have students be more active during class • All PE studies reviewed (n = 14): • Increased time and intensity of PA during PE • Improved physical fitness • Effective across diverse racial, ethnic, and socioeconomic groups in urban and rural settings

8. School health programs can help improve students’ educational outcomes Health is Academic Because… • Helping young people stay healthy is a fundamental part of the mission of our schools

9. Percentage of U.S. High School Students Getting Mostly A’s, Mostly B’s, Mostly C’s and Mostly D’s and F’s* Who Engage in Selected Health Risk Behaviors *As reported by students Source: Unpublished analyses of CDC, National Youth Risk Behavior Survey, 2003

10. Physical Activity Contexts • Physical education • Recess • Classroom-based • Extracurricular Academic Outcomes • Achievement (grades, test scores) • Behavior (time on-task, attendance, conduct) • Cognitive skills and attitudes (concentration, memory, mood) www.cdc.gov/HealthyYouth/health_ and_academics/pdf/pa-pe_paper.pdf

11. Increasing or maintaining time for PE does not appear to adversely impact academic performance • Substantial evidence that school-based physical activity can: • help improve academic achievement (including grades and standardized test scores) • have a positive impact on cognitive skills and academic behaviors www.cdc.gov/HealthyYouth

12. Critical Educationally Relevant Health Factors • Vision • Asthma • Teen Pregnancy • Aggression & Violence • Physical Activity • Breakfast • Inattention/ Hyperactivity www.equitycampaign.org

13. What Can Schools Do? • Make health a fundamental part of elementary and secondary education • Create effective and efficient school health programs • High quality, evidence-based • Strategically planned • Effectively coordinated www.equitycampaign.org

14. Strategies to Close the Educational Achievement Gap Reducing educationally relevant health disparities • Standards and assessments • Data systems • Effective teachers and principals • Charter schools

15. “Give about two [hours], every day to exercise; for health must not be sacrificed to learning. A strong body makes the mind strong.” Thomas Jefferson

16. “We know what the Greeks knew: that intelligence and skill can only function at the peak of their capacity when the body is healthy and strong, and that hardy spirits and tough minds usually inhabit sound bodies.” John F. Kennedy

17. “The more we instill in our children early in life these [physical activity] habits that will last them a lifetime, the better they're going to do. And so we'll try to do what we can to expand those opportunities before school, during the school day, after school.…this is going to help a lot academically…This doesn't take away from our core mission. This is central to that core mission.” Arne Duncan U.S. Secretary of Education

18. “Health and success in school are interrelated. Schools cannot achieve their primary mission of education if students and staff are not healthy and fit physically, mentally, and socially.” National Association of State Boards of Education

19. “No educational tool is more essential than good health…Policies and practices that address the health and developmental needs of young people must be included in any comprehensive strategy for improving academic performance.” Council of Chief State School Officers

20. Based on national standards Emphasizes lifetime physical activity Meets the needs of all students Keeps students active most of class time Is enjoyable High Quality Physical Education

21. Adequate time (150 min/week for elementary; 225 min/week for secondary) Highly qualified teachers Adequate facilities and supplies Reasonable class sizes A written curriculum Student assessment High Quality Physical Education Requires

22. School PE Practices • Only 4% of ES, 8% of MS, and 2% of HS provided daily PE or its equivalent for entire school year for all students1 • 31% of ES, 16% of MS, and 5% of HS did not require students to take any physical education1 • 19% of 3rd grade students were offered at least 150 minutes of weekly PE2 • CDC, School Health Policies and Programs Study, 2006 • Bridging the Gap, data for 2007-2008 school year

23. Barriers to High Quality PE • Insufficient time • Inadequate facilities, equipment, and supplies; large class sizes • Poor quality curricula or no curricula • Use of teachers not certified to teach PE or insufficiently trained in high quality instructional techniques • Lack of support from administrators • Lack of champions • Lack of accountability measures

24. Policies to Support High Quality PE • Increase time for PE • Limit PE class size • Support use of curricula based on PE standards and evidence-based PE programs • Have all classes taught by certified PE teachers and fund ongoing professional development • Implement student assessment for PE

26. Recommendations include: • Local wellness policies should include strong physical activity components, on par with nutrition components. • State and local education agencies should require increased quality and frequency of sequential, age- and developmentally-appropriate physical education for all students, taught by certified teachers.

27. 65% of U.S. adults believe schools should play a major role in fighting the obesity problem1 81% of parents of children in K—12 want their kids to receive daily physical education2 Opinions of U.S. Adults About School Health Programs 1. Survey by Lake Snell Perry and Associates for Harvard Univ., based on interviews with a nationally representative sample of 1,002 adults, May-June 2003 2. Survey by Opinion Research Corp. based on interviews with a nationally representative sample of 1,017 adults, February 2000 (margin of error = +6%)

28. Obesity: A National Security Threat “Obesity rates threaten the overall health of America and the future strength of our military. We must act, as we did after World War II, to ensure that our children can one day defend our country, if need be.” Retired U.S. Army Gens. John M. Shalikashvili and Hugh Shelton Source: The Washington Post, April 30, 2010

29. Lifestyle and Energy Expenditure Kcal estimates for 150-160 pound person. Slide developed by Steve Blair with information taken from article by L. Beil, Dallas Morning News

30. Lifestyle and Energy Expenditure • Assume a person’s caloric intake remains the same • Completing all of the tasks reviewed daily or as listed • Active way=10,500 kcal/month • Sedentary way=1,700 kcal/month • Difference of 8,800 kcal/month is energy equivalent of 2.5 pounds/month or 30 pounds/year

31. Laws and regulations Reference materials Collaboration / team approach Involving students and families Attention to the process /intensive follow-up Keys to Success

32. Marketing techniques/ customer focus Positive attitude/ enthusiasm Data collection Developing quality first Keys to Success

33. The Single Most Consistent and Important Key to Success: The Local Change Agent