9

School Environments

School Environments:
Goal, Recommendation, Strategies, and Actions for Implementation

Goal: Make schools a national focal point for obesity prevention.

Recommendation 5: Federal, state, and local government and education authorities, with support from parents, teachers, and the business community and the private sector, should make schools a focal point for obesity prevention.

Strategy 5-1: Require quality physical education and opportunities for physical activity in schools. Through support from federal and state governments, state and local education agencies and local school districts should ensure that all students in grades K-12 have adequate opportunities to engage in 60 minutes of physical activity per school day. This 60-minute goal includes access to and participation in quality physical education.

For Congress, potential actions include

  strengthening the local wellness policy requirement in Section 204 of the Healthy, Hunger-Free Kids Act of 2010 (Public Law 111-296, 111th Cong.,



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9 School Environments School Environments: Goal, Recommendation, Strategies, and Actions for Implementation Goal: Make schools a national focal point for obesity prevention. Recommendation 5: Federal, state, and local government and education authorities, with support from parents, teachers, and the business community and the private sector, should make schools a focal point for obesity prevention. Strategy 5-1: Require quality physical education and opportunities for physical activity in schools. Through support from federal and state govern- ments, state and local education agencies and local school districts should ensure that all students in grades K-12 have adequate opportunities to engage in 60 minutes of physical activity per school day. This 60-minute goal includes access to and participation in quality physical education. For Congress, potential actions include • strengthening the local wellness policy requirement in Section 204 of the Healthy, Hunger-Free Kids Act of 2010 (Public Law 111-296, 111th Cong., 329

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2d sess. [December 13, 2010] 124, 3183) or the Elementary and Secondary Education Act (Public Law 89-10, 89th Cong., 1st sess. [April 11, 1965] 27, 20) by including a requirement for local education agencies to develop and implement a K-12 quality physical education curriculum with proficiency assessments. For state legislatures and departments of education, potential actions include • enacting policies with appropriate funding to ensure the provision of daily quality physical education at school for all students in grades K-12; and • developing, requiring, and financially supporting the implementation of K-12 curriculum standards for quality physical education that (1) are aligned with guidance from practice and/or professional associations and appropri- ate instructional practice guidelines, and (2) ensure that at least 50 percent of class time is spent in vigorous or moderate-intensity physical activity. For local education agencies, potential actions include • adopting requirements that include opportunities for daily physical activity outside of physical education, such as active transport to school programs, intramural sports and activity programs, active recess, classroom breaks, after-school physical activity programming, and integration of physical activity into curricula lesson plans. For local school districts, potential actions include • improving and maintaining an environment that is conducive to safe physi- cal education and physical activity. Accelerating Progress in Obesity Prevention 330

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Strategy 5-2: Ensure strong nutritional standards for all foods and beverages sold or provided through schools. All government agencies (federal, state, local, and school district) providing foods and beverages to chil- dren and adolescents have a responsibility to provide those in their care with foods and beverages that promote health and learning. The Dietary Guidelines for Americans provide specific science-based recommendations for optimizing dietary intake to prevent disease and promote health. Implementation of these guidelines would shift children’s and adolescents’ dietary intake to prevent obesity and risk factors associated with chronic disease risk by increasing the amounts of fruits, vegetables, and high-fiber grains they consume; decreasing their consumption of sugar-sweetened beverages, dietary fat in general, solid fats, and added sugars; and ensuring age-appropriate portion sizes of meals and other foods and beverages. Federal, state, and local decision makers are respon- sible for ensuring that nutrition standards based on the Dietary Guidelines are adopted by schools; these decision makers, in partnership with regulatory agen- cies, parents, teachers, and food manufacturers, also are responsible for ensur- ing that these standards are implemented fully and that adherence is monitored so as to protect the health of the nation’s children and adolescents. For the U.S. Department of Agriculture (USDA), potential actions include • adopting nutrition standards for all federal child nutrition programs (i.e., the School Breakfast, National School Lunch, Afterschool Snack, Summer Food Service, and Special Milk programs) that are aligned with guidance on opti- mal nutrition; and • adopting nutrition standards for all snacks and beverages sold/served out- side of federal child nutrition programs that are aligned with guidance on optimal nutrition. For state legislatures and departments of education, potential actions include • adopting nutrition standards for foods sold/served outside of federal child nutrition programs that are aligned with guidance on optimal nutrition. 331 School Environments

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For school boards and state departments of education, potential actions include • developing school district policies (including wellness policies for districts participating in federal child nutrition programs) and related regulations that include nutrition standards for foods sold/served outside of the federal programs that are aligned with guidance on optimal nutrition. Strategy 5-3: Ensure food literacy, including skill development, in schools. Through leadership and guidance from federal and state governments, state and local education agencies should ensure the implementation and monitoring of sequential food literacy and nutrition science education, spanning grades K-12, based on the food and nutrition recommendations in the Dietary Guidelines for Americans. For the federal government, potential actions include • USDA developing K-12 food and nutrition curriculum guides that can be used by states and updating information in these guides as appropriate with each periodic revision of the Dietary Guidelines for Americans; and • as USDA develops regulations to implement Section 204 of the Healthy, Hunger-Free Kids Act of 2010 (Public Law 111-296, December 13, 2010), including a requirement for local education agencies to adopt and implement a K-12 food and nutrition curriculum based on state and federal guidance. For states, state legislatures, and departments of education, potential actions include • state legislatures and departments of education adopting, requiring, and financially supporting K-12 standards for food and nutrition curriculum based on USDA guidance; • state departments of education establishing requirements for training teachers in effectively incorporating nutrition education into their curricula; Accelerating Progress in Obesity Prevention 332

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• states requiring teacher training programs to include curriculum require- ments for the study of nutrition; • state legislatures and departments of education adopting and requiring proficiency assessments for core elements of their state food and nutrition curriculum standards in accordance with the Common Core State Standards Initiative, and local education agency wellness policies articulating ways in which results of food and nutrition education proficiency assessments can be used to inform program improvement; and • state and local departments of education working with local education agency wellness policies to link changes in the meals provided through child nutrition services with the food literacy and nutrition education cur- riculum to the extent possible. S chools are uniquely positioned to support physical activity and healthy eating and therefore can serve as a focal point for obesity prevention among chil- dren and adolescents. Schools can be leaders in reversing trends that have made a physically active lifestyle more difficult and high-calorie, nutrient-poor foods more accessible. Children spend up to half of their waking hours in school. In an increasingly sedentary world, schools therefore provide the best opportunity for a population-based approach to increasing physical activity among the nation’s youth. Likewise, because children and adolescents consume up to one-third or even one-half of their daily calories in school, schools have a unique opportunity to influence the quality of their diets. The mission of schools is broader than simply teaching academic skills. Schools have an acknowledged responsibility for supporting the health and well- being of their students, for example, by requiring immunizations, providing health screenings, and offering meal programs that support a healthy diet. Both physical activity and a nutritious diet are associated with improved cognitive function and academic performance. Physically active and well-nourished students are better able to learn and less likely to miss school for health reasons (Florence et al., 2008; Taras, 2005a; Trudeau and Shepherd, 2010). Improvements in school physi- cal activity and nutrition also will address social inequities, enabling children and 333 School Environments

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adolescents with the fewest resources to have improved opportunities to become productive citizens. RECOMMENDATION 5 Federal, state, and local government and education authorities, with support from parents, teachers, and the business community and the private sector, should make schools a focal point for obesity prevention. School environments are interrelated with the other areas of focus addressed in this report, such as the physical activity and food and beverage environments, discussed in earlier chapters (see Figure 9-1). For example, schools not only provide physical education and serve foods and beverages to students, but also serve as powerful role models, providing a culture that can support, rather than undermine, the efforts of children and adolescents and parents to promote health- ful living. As powerful influences, school food-related policies have been shown to affect not only what students consume at school but also what they and their parents perceive to be healthy choices. Immigrant families in particular look to public institutions to learn about cultural norms and practices (Gordon-Larsen et al., 2003). As far back as 1946, a report of the House Committee on Agriculture during hearings for the National School Lunch Act1 stated that “the educa- tional features of a properly chosen diet served at school should not be under- emphasized. Not only is the child taught what a good diet consists of, but his parents and family likewise are indirectly instructed.” Structuring school environments to encourage and support physical activity and healthy living offers a unique opportunity to reach nearly all children and adolescents, promoting their health both today and in the future, as lifelong health habits are initiated early in life. Today, the role of the school is more important than ever as fewer families have a parent at home who is not participating in the paid labor force, and children and adolescents are spending more time in before- and after-school programs outside of the home. The Healthy, Hunger-Free Kids Act of 20102 created an opportunity to improve nutrition for students in the school setting. Recent efforts to change school physical education and food policies have been well received, but they are neither widespread, integrated, nor strong enough to produce the needed reduc- 1 Public Law 396, 79th Cong., 2d sess. (June 4, 1976), 60, 231. 2 Public Law 111-296, 111th Cong., 2d sess. (December 13, 2010), 124, 3183. Accelerating Progress in Obesity Prevention 334

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Message Environments School Environments Physical Food and Activity Beverage Environments Environments Health Care and Work Environments FIGURE 9-1 Five areas of focus of the Committee on Accelerating Progress in Obesity Prevention. NOTE: The area addressed in this chapter is highlighted. tion in childhood obesity rates. The committee recommends three strategies and associated actions to address these limitations. These strategies and actions are detailed in the remainder of this chapter. 9-1 Indicators for measuring progress toward the implementation of each strategy, organized according to the scheme presented in Chapter 4 (primary, process, foundational), are presented in a box following the discussion of that strategy. The strategies in this chapter are focused on school-aged children because of the broad reach of schools to children and adolescents. Early childhood educa- tion is not nationalized, nor is there sufficient evidence for all of the strategies presented in this chapter as applied to preschools to recommend all of them for 335 School Environments

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younger children. The committee recognizes that the earlier years are critical times to promote children’s health and has offered recommendations for physical activity in child care centers (Chapter 5, Strategy 1-3) and nutrition standards for government-owned and/or -operated child care centers (Chapter 6, Strategy 2-3). STRATEGIES AND ACTIONS FOR IMPLEMENTATION Strategy 5-1: Require Quality Physical Education and Opportunities for Physical Activity in Schools Through support from federal and state governments, state and local educa- tion agencies and local school districts should ensure that all students in grades K-12 have adequate opportunities to engage in 60 minutes of physical activity per school day. This 60-minute goal includes access to and participation in quality physical education. For Congress, potential actions include • strengthening the local wellness policy requirement in Section 204 of the Healthy, Hunger-Free Kids Act of 2010 (Public Law 111-296, December 13, 2010) or the Elementary and Secondary Education Act (Public Law 89-10, 89th Cong., 1st sess. [April 11, 1965] 27, 20) by including a requirement for local education agencies to develop and implement a K-12 quality physi- cal education curriculum with proficiency assessments. For state legislatures and departments of education, potential actions include • enacting policies with appropriate funding to ensure the provision of daily quality physical education at school for all students in grades K-12; and • developing, requiring, and financially supporting the implementation of K-12 curriculum standards for quality physical education that (1) are aligned with guidance from practice and/or professional associations and appropriate instructional practice guidelines, and (2) ensure that at least 50 percent of class time is spent in vigorous or moderate-intensity physical activity. Accelerating Progress in Obesity Prevention 336

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For local education agencies, potential actions include • adopting requirements that include opportunities for daily physical activity outside of physical education, such as active transport to school programs, intramural sports and activity programs, active recess, classroom breaks, after-school physical activity programming, and integration of physical activity into curricula lesson plans. For local school districts, potential actions include • improving and maintaining an environment that is conducive to safe physi- cal education and physical activity. Context Data from the 2006 School Health Policies and Programs Study (Lee et al., 2007) indicate that nationwide, 78 percent of schools require students to take some physical education as a requirement for graduation or promotion to the next grade or school level (69 percent of elementary schools, 84 percent of middle schools, and 95 percent of high schools). The frequency and length of activity breaks, opportunities for physical education, and adherence to expert guidance and assessment in implementing these requirements vary widely by school district, state, and grade level. A small number of schools provide physical education opportunities at all grade levels every day or even a few days a week. In 2006, nearly 4 percent of all elementary schools (excluding kindergarten), 8 percent of all middle schools, and 2 percent of all high schools provided daily physical education or its equivalent for the entire school year for students in all grades. More schools provide physical education or its equivalent at least 3 days per week for the entire school year— almost 14 percent of elementary schools (excluding kindergarten), 15 percent of middle schools, and 3 percent of high schools (Lee et al., 2007). Apart from physical education opportunities, the number and length of physi- cal activity breaks required throughout the school day vary by state, district, and grade. Among all school districts, 39 percent require or recommend 30 minutes or more of recess per day, 23 percent require or recommend 20-29 minutes per day, and 16 percent require or recommend 10-19 minutes per day in elementary schools. Among all districts, 16 percent require and 25 percent recommend that elementary schools provide regular physical activity breaks; 10 percent of all dis- percent dis- 337 School Environments

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tricts require and 24 percent recommend that middle schools provide such breaks; and 4 percent of all districts require and 9 percent recommend that high schools provide such breaks (Lee et al., 2007). Among all states, 14 percent have a policy encouraging districts or schools to support or promote walking or biking to and from school, and nearly 18 percent of all districts have a policy that supports or promotes walking or biking to and from school. Significant improvement has been seen in state and district policies to follow expert guidelines in implementing physical education policies. Between 2000 and 2006, the percentage of states that required or encouraged districts or schools to follow standards or guidelines based on the National Standards for Physical Education increased from 59 percent to 76 percent. In addition, the percentage of districts with a policy stating that schools must follow national, state, or district physical education standards or guidelines increased from 67 percent to 81 per- cent (Lee et al., 2007). Finally, state assessment and graduation proficiency requirements for physical education are limited. The 2010 Shape of the Nation report (NASPE and AHA, 2010) found that 27 percent of states require that grades be given for physical edu- cation classes, but few include physical education in comprehensive assessment tests, if given. Of the 40 states that have an education “report card” for schools, only 5 include physical education in that report. Of the 45 states that require high school physical education, 75 percent specify the number of credits needed for graduation (12 states require 0.5 credit; 15 states require 1 credit; 3 states require 1.5 credits; 7 states requires 2 credits; and New Jersey requires 3.75 credits per year, the high- est in the nation). In addition, 9 states require a health or wellness course to fulfill graduation requirements. Physical education is required only in grades K-12 in five states (Illinois, Iowa, Massachusetts, New Mexico, and Vermont) and is required in grades 1-12 in two states (New Jersey and Rhode Island). The inconsistencies in frequency, duration, assessments, and requirements for physical education and opportunities for physical activity breaks throughout the day indicate that states and local education agencies can improve policies to help students achieve 60 minutes of physical activity per day. Evidence The 2005 Institute of Medicine (IOM) report Preventing Childhood Obesity: Health in the Balance recommends that children and adolescents participate in a minimum of 30 minutes of physical activity during the school day and that oppor- tunities for physical activity and physical education be expanded. In addition, the Accelerating Progress in Obesity Prevention 338

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report recommends that health curricula be enhanced to devote adequate attention to physical activity, reducing sedentary behaviors, nutrition, and energy balance, with a focus on behavioral skills (IOM, 2005). Many of these recommendations were based on a systematic review of the effectiveness of increasing the amount of time students spend in physical education, as well as large-scale school-based interventions that have been successful in increasing activity levels. Likewise, the Task Force on Community Preventive Services concluded that there is strong evi- dence that school-based physical education increases levels of physical activity, although evidence indicates minimal or inconsistent effects on body mass index (BMI) (Kahn et al., 2002). Another review found that two elementary school- based interventions—SPARK (Sports, Play, and Active Recreation for Kids) and CATCH (Coordinated Approach To Child Health)—and a small number of inter- ventions involving older students were effective in increasing activity levels, with some interventions being associated with positive improvements in BMI (IOM, 2005). Reviews also have concluded that attending longer physical education classes did not affect academic performance (Kahn et al., 2002). Schools’ interest in physical activity begins with the brain (Trudeau and Shepherd, 2010). Movement and exercise increase breathing and heart rate so that more blood flows to the brain, thus enhancing energy production and waste removal. Physical activity oxygenates the brain, which is why taking a walk can help people “clear their head” and think better. Exercise has effects as well on higher mental executive functions involving memory, planning, organization, and the capability to juggle different intellectual tasks (Sibley and Etnier, 2003). Exercise also helps youth who have difficulty with impulse control (Kelder, 2010). A recent meta-analysis studying the impact of combinations of school-based interventions focused on increasing physical activity among children and adolescents aged 6-18 found “good evidence that school-based physical activity interventions have a posi- tive impact on” duration of physical activity, television viewing, VO2 max,3 and blood cholesterol (Dobbins et al., 2009, p. 24). The authors also report that, in addition to the positive outcomes they studied, “the current evidence suggests that school-based physical activity interventions may be effective in the development of healthy lifestyle behaviors among children and adolescents, which will then translate into reduced risk for many chronic diseases and cancers in adulthood. The evidence also suggests that the best primary strategy for improving the long-term health of children and adolescents through exercise may be creating lifestyle patterns of regu- lar physical activity that carry over to the adult years” (Dobbins et al., 2009, p. 2). 3 Maximal oxygen uptake. 339 School Environments

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