Children's Healthy Weight and the School Environment

• DOI: 10.1177/0002716207308953
• Author: Laura C. Leviton
• Published date: 01 January 2008
• Date: 01 January 2008
• Subject Matter: Articles

38 ANNALS, AAPSS, 615, January 2008

As people became aware of the epidemic of childhood

obesity, policy makers and public health practitioners

called for the schools to change their environments to

encourage healthy eating and increased physical activ-

ity. This article describes recent policy developments

and clarifies what can and cannot be expected of

schools based on existing and emerging evidence for

prevention of childhood obesity.

Keywords: childhood obesity; prevention; energy

balance; school environment; wellness

policies

Concern about the recent increase in the

percentage of overweight children has led

many policy makers and the public to call for

changes in schools to address the problem.

This chapter outlines the promise and limita-

tions of schools in preventing childhood obe-

sity. While schools are unlikely to reverse the

epidemic of childhood obesity by themselves,

they are an important venue for prevention, in

concert with a comprehensive community-

wide effort.

The schools seem like an obvious choice

for prevention, since more than 97 percent of

Children’s

Healthy Weight

and the School

Environment

By

LAURA C. LEVITON

Laura C. Leviton has been a senior program officer of

the Robert Wood Johnson Foundation since 1999. She

has been a professor at two schools of public health,

where she collaborated on the first randomized experi-

ment on HIV prevention, and later on two large place-

based randomized experiments on improving medical

practices. She received the 1993 award from the

American Psychological Association for Distinguished

Contributions to Psychology in the Public Interest. She

was appointed by the Secretary of the U.S. Department

of Health and Human Services to the National Advisory

Committee on HIV and STD Prevention of the Centers

for Disease Control and Prevention (CDC). She was

president of the American Evaluation Association in the

year 2000 and has coauthored two books: Foundations

of Program Evaluation and Confronting Public Health

Risks. She is interested in all aspects of evaluation

methodology and practice.

DOI: 10.1177/0002716207308953

THE SCHOOL ENVIRONMENT 39

children five years and older spend six to eight hours a day there for nine to ten

months a year (Institute of Medicine 2006; Trust for America’s Health 2006).

The policies that affect factors within schools can be monitored more readily than

the wide variety of policies affecting community environments (Institute of

Medicine 2006). Advocates have noted disturbing trends in school environments

and are calling for reversal of those trends (e.g., Action for Healthy Kids 2007).

They have called for reforms to restore time spent on recess and physical educa-

tion, to limit “competitive foods” (foods of little nutritional value that compete

with the school breakfast and lunch), and to improve healthy offerings in the

school cafeteria.

There is also a public perception that schools should initiate efforts to prevent

childhood obesity. A recent national poll revealed that 87 percent of respondents

believed schools should address the problem (Research!America 2006). Other

polls consistently mirror this trend (Napier 2006; Stein 2004). Public health pro-

fessionals agree: a survey of state health department chronic disease directors

(who have responsibility for preventing obesity) rated school-based approaches

as the highest priority to prevent childhood obesity (Trust for America’s Health

2006; Segal and Gadola 2008 [this volume]). In line with these perceptions, fed-

eral and state policy makers are requiring changes to make the school environ-

ment conducive to preventing obesity. The environmental factors in school seem

readily apparent and somewhat easier to change than the many forces in com-

munities that are contributing to the problem.

At the same time, there are limits to what schools can do about the problem.

Historically, health promotion has never been a priority of the schools. School

health services are often criticized for poor planning, a lack of clear goals, and

failure to keep up with the changing needs of students. Schools are often hard-

pressed financially, forcing them to make difficult choices about programs to

save or cut, including physical education. Schools have been forced into an

almost exclusive focus on improving achievement scores (the “No Child Left

Behind” legislation is merely the most recent pressure). The focus on achieve-

ment has consumed limited time in the school day, forcing out many activities

that are not seen as directly supporting student achievement (Pedulla et al.

2003; Stecher and Barron 2001, Trust for America’s Health 2006). Finally,

school personnel often suffer from “innovation fatigue”: they have seen many

changes come and go (Troman and Woods 2001). Control over school program

implementation depends on cooperation at several levels: the district level, the

school facilities, and the individual teacher or staff person (Berends, Bodilly, and

Kirby 2002). Without staff buy-in, who will implement any reforms to prevent

childhood obesity?

Fortunately, these obstacles can be overcome. Recent innovations for school

programming and experiences in policy reform suggest that the obstacles to

changing the environment are not as great as we feared, and some perceived

obstacles are not well founded in actual experience.