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From PEKN 1P93 Winter 2014: Group 24: Health Promotion
 Health Promotion: Childhood Obesity
Childhood obesity is an important topic and is relevant to a wide range of children throughout developed countries. Many people confuse the terms "obese" and "overweight" and often mistake one for the other. As defined by the Obesity Action Coalition (2014), a child is defined as "obese" if their body mass index-for-age (or BMI-for-age) percentile is greater than 95 percent, whereas a child is defined as "overweight" if their BMI-for-age percentile is greater than 85 percent, but less than 95 percent. An increasing number of children who are overweight or obese in Canada has reached epidemic levels and is a serious health issue that is strongly linked to many diseases and health related issues. According to Healthy Kids Panel (2013), this includes type 2 diabetes, increased risks of hypertension, heart disease, gallbladder disease, stroke, and certain types of cancer, including breast and colon cancer. Health Promotion (2014) states that regular physical activity substantially reduces the risk of developing type 2 diabetes at a young age and high blood pressure later in life. Stephanie Chisolm (2007) says that it also provides positive mental health, helps to control weight, contributes to healthy bones, muscles and joints, reduces symptoms of anxiety and depression, and is associated with fewer hospitals, physician visits, and medications.
As well as physical activity, nutrition has a large importance regarding childhood obesity. According to Active Healthy Living (2006), nutritional factors contributing to the increase in obesity rates include, in no particular order, insufficient infant breastfeeding, a reduction in cereal fiber, fruit, and vegetable intake by children and youth, and the excessive consumption of over-sized fast foods and soda, which are encouraged by fast-food advertising during children's television programming and a greater availability of fast foods and sugar-containing beverages in school vending machines. With increasing advancements in technology, children are becoming more sedentary than ever before. Healthy Kids Panel (2013) says parents, caregivers, educators, the government, and the media play an important role to help conquer and support this major health issue to prevent and reduce it in future generations.
 History of Childhood Obesity
Obesity has been a large concern for many years now and the dramatic increase of obese children has caught much attention. Shannon Marks (2013) says that the National Health and Nutrition Examination Survey has been tracking childhood overweight and obesity rates since the 1960's. She also notes the following statistics: from 1963 to 1970, 4.2 percent of 6 to 11 year olds and 4.6 percent of 12 to 19 year olds were obese; In 1988, 11.3 percent of 6 to 11 year olds and 10.5 percent of 12 to 19 year olds were obese; In 2001, just over 16 percent of 6 to 11 year olds were obese; and the last survey, from 2007 to 2008, 19.6 and 18.1 percent of 6 to 11 and 12 to 19 year old kids were obese. It can be seen that the percentage of obese children has increased since 1960. Statistics Canada (2006) shows that in 1978, only 15% of children were overweight or obese and by 2007, 29% of children had unhealthy weights. These current trends still continue to increase today. In schools, physical education (PE) was, at one time, a regular part of a public education curriculum.
Nowadays, obese children are becoming more common. According to Active Healthy Living (2006), the 1991–2003 Youth Risk Behavior Surveillance data showed that although the percentage of high school students enrolled in PE class remained constant (48.9%–55.7%), the percentage of students with daily PE attendance decreased from 41.6% in 1991 to 25.4% in 1995 and remained stable thereafter (25.4%–28.4%). Shannon Marks (2013) says that California was the first state to mandate a physical education program in public schools in the 1950's; by the end of the century however, fewer than 25 percent of students in the state could achieve four out of five fitness standards. She also mentions that in 2011, few states require daily gym class, although most states do require some form of physical education.
Many children these days are often blinded by new and advanced technology, and have become less involved in physical activity. Active Healthy Living (2006) inquires that data from the 1988–1994 National Health and Nutrition Examination Survey indicated that 26% of American children (up to 33% of Mexican American and 43% of non-Hispanic black children) watched at least 4 hours of television per day, and these children were less likely to participate in vigorous physical activity. They also had greater BMI's and skin-fold measurements than those who watched less than 2 hours of television per day.
Regarding nutrition and diet, an increase in calorie intake has been assumed to be the main cause of obesity, but more research and evidence is required to support this claim. Dehghan et al. (2005) shows that between 1970 and 1997, the United State Department of Agriculture (USDA) surveys indicated an increase of 118% of per capita consumption of carbonated drinks, and a decline of 23% for beverage milk. Soft drink intake is known to be associated with the epidemic of obesity and type II diabetes among children. Beverage milk, along with other fruit juice beverages that provide many beneficial nutrients, are much healthier alternatives for carbonated drinks. Jeffery and French (1998) claim that two studies of dietary correlates of obesity provide suggestive data in that frequency of consumption of two commonly eaten fast foods (ie. french fries and hot dogs) was found to be associated with obesity and weight gain. The consumption of healthier foods on a regular basis such as fruit and vegetables will provide benefits and a decrease in child obesity.
 Target Audience
Although childhood obesity affects children and adolescents, the main audience that should be addressed is parents, teachers, and active members in recreation departments of cities. This audience must be aware of the obesity epidemic and possible ways they can treat it and even avoid it. At a young age, most children will not understand the reason why they have to be active, but these authority figures understand the importance of physical activity and must encourage them to be active. This target audience is directed towards parents, teachers, and active members in recreation departments because they can provide the most influence on a child’s participation in athletics. Teachers can show the children games and workouts to keep them active and build good habits that can be applied to everyday life. Parents must encourage their children to get at least 30-60 minutes of exercise out of school for healthy development. This could include joining a sports team within a local community or city. If the quality of sport facilities and leagues in a city is increased with an encouraging and welcoming atmosphere, then there will be a higher chance that children will get involved and become more active.
Numerous studies have shown evidence that physical activity can better improve your health and life quality. Now more than ever, children are at a great risk of health related diseases. As well, for the first time ever, children are not expected to live as long as their parents.
In particular, there are five studies that link physical activity (or lack there of) with child obesity. One of the studies done by Sallis and Glanz (2006) discusses how changes in different environments have promoted sedentary lifestyles and less healthful diets, and investigates whether these changes have had a direct effect on childhood obesity and whether improvements to encourage more physical activity and more healthful diets are likely to lower rates of childhood. In the nutrition environment, there has been a greater reliance on convenience foods and fast foods, leading to a lack of access to fruits and vegetables, and expanding portion sizes, which all contribute to childhood obesity. Also, children with access to safe places to be active and local markets that provide healthful foods are more often likely to be active and healthier.
For more information please visit: Role of Built Environments in Physical Activity, Eating, and Obesity in Childhood
In a similar article written by Veugelers and Fitzgerald (2005), a study conducted in Nova Scotia looked at the risk factors for childhood overweight and obesity. The article observed family life style, socioeconomic factors, and dietary habits. The research found that sedentary activity of more than an hour a day significantly increased the risk of children being overweight. As well, children who attend schools with more frequent physical education classes were more likely to have normal body weight.
For more information please visit: Effectiveness of School Programs in Preventing Childhood Obesity: A Multilevel Comparison
The third article conducted by Fung et al (2012), called “From “best practice” to “next practice”: the effectiveness of school-based health promotion in improving healthy eating and physical activity and preventing childhood obesity”, did a study that surveyed children in Alberta, Ontario from approximately 150 randomly selected schools to analyze changes in diets, activity levels, and body weight between 2008 and 2010. Their results in 2010, relative to 2008, showed that students who attended the “APPLE” schools ate more fruits and vegetables, consumed fewer calories, were more physically active, and were less likely to be obese compared to students in other schools. If all schools participated and made healthy choices like this study shows, a major decrease in the number of children with obesity would result. Children need to be taught at a very early age or else they will never learn how to live a healthy lifestyle.
For more information please visit: From "best practice" to "next practice": the effectiveness of school-based health promotion in improving healthy eating and physical activity and preventing childhood obesity
In a fourth there has been a major spike in the amount of illness in Ontario over the years, this is noticeably seen in how much money as a province we put into health care. More and more people are becoming sick and from young ages, in fact it is projected that this will be the first generation the parents will out live their children. In 2011 46% of the province’s budget was put into healthcare, and it is projected that in 2030 that 80% of our budget will be spent on health care. This is a major wake up call telling us that our society has health flaws that need to be addressed. If they are not more and more people will become sick and it will bankrupt our province.
For more information please visit: Therapy or surgery? (electronic resource): a prescription for Canada's health system / Don Drummond
A fifth article mentions that childhood obesity is not just a concern for the person as a child. It shows the effects of causing long-term damage to one’s health. The concern is that children and adolescents are currently complaining about pain involving joints, and the fear is that this will eventually lead to arthritis as an adult. The fear is that the additional weight that children are carrying around is having an impact on their knees which is a more common injury seen in adults. There has been an increasing number of forearm fractures, as well as radial fractures of children over the past decade. It is believed that the number is on the rise because of child obesity. In the past, the falls and incidents that have been causing these injuries did not lead to such fractures. The children were consuming the proper nutrients leading to stronger bones. Esposito et. al (2014) believes that with the increasing size of children, there was low bone mass and that children had more muscle mass compared to fat mass.
 Existing Physical Activity Programs
There have been many programs put in place and regulated by the government with concerns to keeping children physically fit. Many of these are a response to the obesity epidemic and the low percentages of fit youth and teens. In order to address this problem, both mandatory and optional fitness programs have been implemented to encourage kids.
 Daily Physical Activity (DPA)
The most common physical activity program for children and teenagers is daily physical activity in schools. Daily physical activity is mandatory and part of the curriculum in grades kindergarten through grade 8. Children in school are expected to get at least 20 minutes of intense physical exercise. This mandate ensures the kids get physical activity so they can learn better stay healthy. Healthy Schools: Daily Physical Activity (2011) claims that more and more children at this age get no physical activity out of school, which is very important to developing a healthier lifestyle.
 Physical Education Courses in Ontario School Curriculums
High school has also adapted to the amount of unfit teenagers and they have put physical education into their curriculum. In order to graduate with an Ontario high school diploma students must have take at least one physical education course. This keeps these teenagers active for over an hour each day and teaches them about healthy living so they can apply these principles to their life. What Do I Need To Graduate (2013) suggests that on top of the physical aspect, it teaches these students preventative physical and nutritional measures to keep them from becoming obese.
 Promoting Lifestyle Activity for Youth (PLAY)
The PLAY (Promoting Lifestyle Activity for Youth) is a program that encourages the accumulation of 30-60 minutes of moderate to vigorous physical activity daily. This activity takes place beyond school time and during regular school hours outside of PE classes (such as recess). It has been proven to increase the physical activity levels and improve fitness of children participating, especially girls. Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity (2006) suggests that communities encourage children to use fields, recreation centers, blacktops, and other recreational facilities for extra physical activity.
 Organized Sports
The government also offers a tax credit to children involved in physical activity programs, such as organized sports. These programs must include cardio-respiratory endurance and to at least one of: muscular strength, muscular endurance, flexibility, or balance. Munroe (2014) states that parents who enroll children under 16 in these programs are eligible to get $500 tax credit and an additional $500 if their child has a physical disability.
 RBC Learn to Play Project
A non-government funded program is the RBC learn to play project. This charitable program gives grants for improving the quality and delivery of sport programming across the nation. Grants of $1,000 - $25,000 are given cities so that sport programs and facilities can have better equipment and better organization. RBC Learn To Play Project (2013) suggests this benefits the children by making them more active and also helps build their physical literacy for healthy development.
 Best Practice Activity Suggestions
 Inclusion Games and Programs
Active Living through Physical Education: Maximizing Opportunities for Students who are Physically Awkward (1994) states the term “inclusion” implies that learning experiences are available to all students in the class, regardless of skill, fitness, personal attributes, social behaviours, or the level of knowledge, understanding, and appreciation of physical activity. To successfully include all students in physical education, it requires continual encouragement, praise, and assistance, particularly at the beginning of an activity or program. Physical education provides all students with opportunities to develop effective and efficient movement through active participation in a variety of physical environments, according to Active Living through Physical Education: Maximizing Opportunities for Students who are Physically Awkward (1994).
Some examples of inclusion games are:
- Crossing the Falls
- Touch the Ball
- Ultimate Frisbee
These games are great because everyone is included in play and they incorporate a variety of different skills such as communication, teamwork, cooperation, and much more.
Gymnastics can provide participation opportunities across a wide range of activities varying considerably in difficulty, complexity, and skill requirement as mentioned by Active Living through Physical Education: Maximizing Opportunities for Students who are Physically Awkward (1994). It also states the teachers are able to select and suggest specific activities which best meet the needs, interests, and capabilities of all students. With careful selection of suitable apparatus and tumbling activities can help to reduce frustrations of children. Active Living through Physical Education: Maximizing Opportunities for Students who are Physically Awkward (1994) suggest apparatus’ such as rings, parallel bars (even/uneven), and pommel horse demand much strength, coordination, and agility and may initially be inappropriate for the younger students and physically awkward. Some appropriate activities they recommend are floor tumbling, trampoline, and box horse. Students who are obese or overweight may have limits experience in gymnastics, lack body awareness in invert positions, and may be unable to bear body weight in extended positions, according to Active Living through Physical Education: Maximizing Opportunities for Students who are Physically Awkward (1994). Some appropriate activities that are recommended are body orientation and strength-building lead-up tasks, initially without equipment.
Involves the movement of multiple muscles at once. Dance is a fun way to improve cardiovascular endurance, and muscle strength. The activity can be done alone, in small groups, as well as large groups. The more people involved the better. According to Active Living through Physical Education: Maximizing Opportunities for Students who are Physically Awkward (1994), dance offers opportunities for self-discovery and self expression.
 Circuit Training
A form of exercise involving many activities completed at a high pace, with certain set time intervals. The activities should be completed using one’s own body weight before being attempted with additional weights. The training focuses on a time efficient way to build muscle strength and endurance.
 Invasion Games
Invasion games include everyone to form teams, with the objectives to attack or protect specific areas of the playing space. These games involve the participation of many as well as incorporating cardiovascular endurance with an objective making the activity more enjoyable.
 Instructional Video of Teaching Games for Understanding (TGfU): Invasion Games
This video is about invasion games using the TGfU approach which involve controlling an object, keeping it away from an opponent or moving it into scoring position. These types of games can be modified into simple running games or to use specified skills such as kicking or throwing. These are activities based upon PlaySport program: http://www.opheaprograms.net/playsport/en/
 Future Directions
In order to drastically reduce the amount of obese youth there must be more preventative measures taken. Forty-six percent of Ontario’s budget was put into health care in 2011, while only 0.35% of the budget was put into health promotion. Our current society takes shortcuts and we wait until we get ill then they try to treat it instead of preventing it in the first place. Parents, teachers, and members of communities must step up and encourage children to stay healthy so they are not contributing to the increasing number of sick youth. If no preventative measures are taken more and more of the budget will be spent on trying to treat children with illnesses associated with obesity. Drummond (2011) emphasizes that daily physical activity is not a recommendation, it is a necessity.
 Changemakers Initiative
Our group's idea on how to make a healthier Canada through the "Changemakers Initiative" can be found below.
Our Play Exchange Competition entry is located on this website: http://www.changemakers.com/playexchange Our title of submission is called "PEKN Wiki Group 24: Health Promotion (Childhood Obesity). LET'S MAKE A CHANGE."
 External Links
 Teaching Games for Understanding (TGfU)
 Physical and Health Education Canada
 Childhood Obesity Foundation
This link describes childhood obesity and possible causes of obesity. It discusses the importance of a healthy diet and ways to eat healthy to avoid child obesity. Current programs are included, as well as plans for healthier food servings in elementary and high schools.
 Healthy Kids Panel
This link is a great resource for children, youth, parents, and teachers to use as a guideline to help prevent childhood obesity and it will start kids on a healthy path to living a healthy lifestyle.
 Video: Connecting Physical Literacy and Physical Education
This link is a great resource for teachers and parents to use as a guideline to help increase physical literacy in children. It is extremely important for the children to stay active throughout their lives and learning from an early age is vital. The more physically literate children, the better.
 Notes and References
Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity. (2006). Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity. Retrieved from http://pediatrics.aappublications.org/content/117/5/1834.full#content-block
Active Living through Physical Education: Maximizing Opportunities for Students who are Physically Awkward. (1994). Ontario: The Canadian Association for Health, Physical Education, Recreation, and Dance.
Chisolm, S. (2007). Promoting Health for a Nation: Healthy People 2010. The Health Professions: Trends and Opportunities in U.S. Health Care, 21-40. Sudbury, Massachusettes: Jones and Bartlett Publishers
Dehghan, M., Akhtar-Danesh, N., & Merchant, A. T. (2005). Childhood obesity, prevalence and prevention. Nutrition Journal. Retrieved from http://www.nutritionj.com/content/4/1/24
Drummond, D. (2011). Therapy or surgery? [electronic resource]: a prescription for Canada's health system / Don Drummond. Toronto, Ont.: C.D. Howe Institute, 2011 (Saint-Lazare, Quebec: Canadian Electronic Library, 2012).
Esposito, W, P., Caskey, P,. Heaton, E, L,. & Otsuka, N.(2014). Orthopaedic Nursing. 33(1), 8-13
Fung, C., Kule, S., Lu, C., Purcell, M., Schwartz, M., Storey, K., & Veugelers, P. J. (2012). From “best practice” to “next practice”: the effectiveness of school-based health promotion in improving healthy eating and physical activity and preventing childhood obesity. International Journal Of Behavioral Nutrition & Physical Activity, 9(1), 27-35.
Health Promotion - Physical Activity. (2014). Health Promotion - Physical Activity. Retrieved from http://www.healthpromotion.ie/health/physical_activity
Healthy Kids Panel. (2013, February). No Time to Wait: The Healthy Kids Strategy [PDF document]. Retrieved from http://www.health.gov.on.ca/en/common/ministry/publications/reports/healthy_kids/healthy_kids.pdf
Healthy Schools: Daily Physical Activity. (2011). Ontario Ministry of Education. Retrieved from http://www.edu.gov.on.ca/eng/healthyschools/dpa.html
Jeffery, R. W., and French, S. A., (1998). Epidemic obesity in the United States: are fast foods and television viewing contributing? American Journal of Public Health February 1998: 88(2), pp. 277-280.
Marks, S. (2013). The History of Obesity in Children. LIVESTRONG.COM. Retrieved from http://www.livestrong.com/article/364363-the-history-of-obesity-in-children/
Munroe, Susan. (2014). Children's Fitness Tax Credit. About Canada Online. Retrieved from http://canadaonline.about.com/od/personalincometax/qt/fitnesscredit.htm
Obesity Action Coalition: What is Childhood Obesity? (2014). Obesity Action Coalition: What is Childhood Obesity Comments. Retrieved from http://www.obesityaction.org/understanding-obesity-in-children/what-is-childhood-obesity
RBC Learn To Play Project. (2013). RBC. Retrieved From http://www.participaction.com/programs-events/programs/rbc-learn-to-play-project/
Sallis, J., F., & Glanz, K. (2006). The role of built environments in physical activity, eating, and obesity in childhood. The Future of Children, 16(1), 89-108.
Sparksandiego (2011). Child Obesity: Quality Physical Education as a Solution. Retrieved from https://www.youtube.com/watch?v=-FOPaJqjCM0
Statistics Canada. (2006). Childhood obesity: A troubling situation. Retrieved from http://www41.statcan.gc.ca/2006/2966/ceb2966_004-eng.htm
Veugelers, J, P., & Fitzgerald, L, A. (2005). Effectiveness of School Programs in Preventing Childhood Obesity: A Multilevel Comparison, 95(3), 432-435.
What Do I Need To Graduate? (2013). Ontario Ministry of Education. Retrieved from http://www.edu.gov.on.ca/extra/eng/ppm/graduate.html