The "calories in" part of the "calories in-calories out" formula for managing overweight in children got special attention last month, in the form of a policy statement on active healthy living for children from the American Academy of Pediatrics (AAP) and a once-in-five-years report from the National Association of Sport and Physical Education on what states do and do not mandate for school physical education.

Both reports pointed out that it is hard to ignore childhood overweight, which has increased exponentially in the past decade, to the point that 16 percent of children between the ages of 6 and 19 years are now overweight. That is more than 9 million young people, the National Association noted; and the AAP called the situation "an epidemic driven by multiple factors," among them marked declines in the amount of physical activity children engage in, both in school and out of school.

Active Healthy Living

In its policy statement, "Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity," the American Academy of Pediatrics urged pediatric health care providers and public health officials to advocate for increased physical activity for children and teenagers in a number of ways, including improving access to physical education at school on a daily basis. The Academy notes that schools alone cannot solve the overweight and obesity crisis, but since children spend most of their waking hours at school, "the availability of regular physical activity in that setting is critical."

A study in 2000 found that only 8 percent of American elementary schools, 6.4 percent of middle schools, and 5.8 percent of high schools with existing physical education requirements actually provided daily PE classes for all grades for the entire year. Add to that the fact that a poll of parents of children 9 to 13 years old found that 61.5 percent of the youngsters did not participate in any organized physical activities after school and 22.6 percent didn’t engage in non-organized physical activity after school hours, and you have a picture of across-the-board inactivity, both in school and out, the AAP pointed out.

And while physical activity needs to be promoted at home and in the community, "school is perhaps the most encompassing way for all children to benefit," the AAP said. The policy statement noted that there is an opportunity for pediatricians to get involved with school districts on this issue, under a federal revision of child nutrition programs that calls for every school receiving funding from the National School Lunch and Breakfast Programs to develop a local wellness policy by the beginning of the 2006-2007 school year, with goals for physical activity as well as nutrition. "In light of the school wellness policy, many schools are looking to modify their present PE programs to improve physical activity standards," the policy statement said.

The AAP policy statement is critical of past physical education programs that used calisthenics and acquisition of sports-specific skills to promote fitness. Instead, the statement calls for curricula and instruction that emphasize knowledge, attitudes, and motor and behavioral skills required to adopt and maintain lifelong habits of physical activity. That could include aerobics and strength training, the report suggests, and walking and dancing.

Among the most difficult but most important challenges in an effort to increase childhood physical activity are making exercise alternatives as attractive, exciting, and enjoyable as video games; convincing school boards that PE and other school-based physical activities are as important to long-term productivity as are academics; and engineering physical environments to promote physical activity, the AAP concluded.

The Shape of the Nation

In its first report since 2000, the National Association for Sport and Physical Education gave states and the federal government a failing grade on physical education in the American school system. Noting that no federal law requires that physical education be offered in schools or provides any incentive for physical education programs, the report says states too are dodging the issue, with many setting some general or minimum requirements but delegating responsibility for meeting those standards to individual school districts.

In detailed tables put together during the winter of 2006, the Association in cooperation with the American Heart Association reported on the status of physical education in each state and the District of Columbia in the areas of:

• time requirements;
• exemptions, waivers, and substitutions;
• class size;
• standards, curriculum, and instruction for physical education;
• student assessment and program accountability;
• physical education teacher certification and licensure;
• national board certification in physical education;
• whether there is a state physical education coordinator; and
• whether the state requires collection of body mass index (BMI) data.

State profiles of what is currently required in each of those areas show that while most states mandate physical education, most do not require a specific amount of instructional time, and about half allow exemptions, waivers, and/or substitutions, loopholes that the report notes "significantly reduce the effectiveness of the mandate." And even within states there are "very diverse patterns of delivery" of physical education, as the result of commitment to local control of education, which leaves specific decisions regarding time, class size, and student assessment to local school districts or even schools.

At the federal level, the report notes that five years after a U.S. Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity put forth quality daily K-12 physical education as key action, a federal law, the No Child Left Behind Act, is actually threatening the amount of time available for physical education, with schools concentrating on assessing student achievement in defined core academic subjects. "As states conduct standardized tests to hold schools and students accountable, content that is not tested, such as physical education, has become a lower priority."

In one surprising development, the survey found that almost one-fourth of states now allow required physical education credits to be earned through what the report calls "online physical education courses." Of the 12 states (Alaska, Connecticut, Florida, Indiana, Kentucky, Minnesota, New Hampshire, North Dakota, Oregon, South Carolina, Utah, and Virginia) with online options, six offer comprehensive physical education (defined as addressing all state and national standards), five offer online personal fitness/wellness courses, and two offer online sports and weight training courses. In six of the states, all students are allowed to take the courses; in others, students must request permission and be approved.

The American Academy of Pediatrics policy statement, "Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity," was published in the May 2006 issue of the journal Pediatrics. The 2006 report of the National Association for Sport and Physical Education, "The Shape of the Nation," will be available for downloading at www.naspeinfor.org

See also: "Experts Cite Physical Activity as Key in Preventing Childhood Obesity," at http://www.healthinschools.org/ejournal/2005/dec2.htm
Parents Resource Center: Sports, Physical Exercise, and Fitness, at http://www.healthinschools.org/parents/sports.htm
Keeping Kids Healthy: Overweight, Nutrition & Physical Exercise, at http://www.healthinschools.org/sh/obesity.asp.