velop, implement, and enforce school policies to create schools that are advertising-free to the greatest possible extent.


School health services should play a prominent role in addressing obesity-related issues among students and throughout the school environment. School health clinics and other school-based health services offer an often untapped resource because they have the opportunity to reach large numbers of students and the expertise to provide nutrition and health information as well as referrals to counseling and other health services. However, an emphasis on dietary behaviors and physical activity is not meant to be competitive with the other vital issues that school health services and health education curricula address, including prevention of tobacco and alcohol use and sexual education.

Although the 2000 SHPPS survey found that more than 75 percent of schools had at least a part-time school nurse, the extent and nature of health services at schools vary widely (Brener et al., 2001). Nearly all schools have provisions for administrating medications and first aid, but many lack the resources to deliver prevention services. The 2000 SHPPS survey found that 55.3 percent of schools reported offering nutrition and dietary behavior counseling and 37.2 percent offered physical activity and fitness counseling (Brener et al., 2001). Twenty-six percent of states required height and weight to be measured, or BMI to be assessed, in schools; of those, about 61.5 percent required parent notification (Table 7-2). Similarly, the survey found that physical fitness tests were required by approximately 20 percent of states or school districts.5 Some states have developed their own fitness test, while others use the President’s Challenge or the Fitnessgram (Burgeson et al., 2001). In most schools (91.1 percent) teachers provided students with explanations of what their fitness scores meant; in 59.8 percent of the schools, teachers informed the students’ parents as well.

In Chapter 8, the committee recommends that parents make their child’s weight status a priority for discussion with their medical-care provider, and in Chapter 6 the committee offers recommendations on the high priority that this issue should be given by health-care professionals themselves. However, there are an estimated 9.2 million children and youth6 in the


Physical fitness tests are required in elementary schools by 13.7 percent of states and 18.3 percent of districts, in middle or junior high schools by 15.7 percent of states and 21.3 percent of districts, and in senior high schools by 18 percent of states and 20.4 percent of districts (Burgeson et al., 2001).


In 2001, 12.1 percent of Americans aged 19 years or younger—9.2 million children and youth—were without health insurance all year (Bhandari and Gifford, 2003).

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