Summary: News reports, medical studies, and daily observations have been telling us for years that America is facing an obesity crisis, particularly among our children. They are eating more and moving less. That sedentary lifestyle and fitness, particularly among kids, was the focus of the first of a two-part discussion of what has been called an epidemic. Our experts included those whose work and policies are striving to change the alarming lack of physical activity in our culture.
Moderator Joe Frost cited the historic aspect of obesity in America, noting that 50-100 years ago, we were a much more fit population. The panel had a long list of culprits: technology (from computers to push button appliances), cars, traffic, a reduction in recess, organized sports, the lack of places to walk, ride or just play, and fear of risk and of litigation. The open-air unstructured play of their own childhoods seems lost on today’s young generation.
Pointing the way to change were numerous programs and individual efforts from around the country. A school in Austin swapping a schoolyard slab for a green outdoor habitat. Families banding together for nature adventures. New York City’s swim programs for elementary school students. Imaginative playgrounds being built, often by the community itself. Developers incorporating open green spaces in new sub-divisions.
The turn-around in the public view toward smoking in recent decades served as a model for a true shift of society’s attitudes toward obesity and physical activity. All agreed that the key to turning fitness into a popular choice, not a chore, can come from a collaboration of all sectors of society. Government, business, schools, the media, and communities all must play a role.
Editor-at-Large
Psychology Today
Posted July 29, 2008, 9:27am
Children certainly were more physically active in the past. They had freer reign to play outside of schools; parents weren't hallucinating hazards of predators the way they are today. Further, activities had not yet become professionalized, dominated by the youth leagues of organized sports; there was room for casual pick-up games in which even the uncoordinated could play (far enough in the outfield). Schools themselves offered more physical activity. Recess—remember that?—existed. There were gym classes. And preschoolers and kindergarteners were free to play where today they are forced to hunker down with workbooks. There were also fewer competing demands for kids' attention—no Xboxes. I don't think these games are the end of civilization as we know it, but many parents are actually quite comfortable knowing their kids are indoors away from the predations of pedophiles they mistakenly believe are lurking everywhere.
Executive Director
National Coalition for Promoting Physical Activity
Posted July 29, 2008, 9:37am
Interesting question, Joe, and great way to start! Although I cannot offer specific scientific evidence, I do think that we have engineered physical activity out of adult daily lives in many ways with one of the chief "instigators" being technology. There was a time before email and before computer networking (or even computers for that matter!) when even an individual who worked a desk job had to get up and go down the hall to converse or discuss something with a colleague...or at the very least walk to the fax machine rather then simply hitting "send" from a computer to a remote fax. I had the occasion recently to sit next to a man on a plane who noticed that I was reading legislation—he asked what it was about and I told him physical activity. We then went on to discuss the physical inactivity in this country and he said he supposed he was part of the problem...he was a mechanical engineer who worked on automating things—in his case, machines used to make Edy's/Dreyers ice cream! He commented that even factory workers today do not have to do much in terms of physical activity compared to even 15-20 years ago, as so much of the process is automated and many factory workers simply "monitor" machines.
Professor of Pediatrics and Medicine
University of Colorado at Denver
Posted July 29, 2008, 9:42am
I agree that many things in our environment have changed to make it easier for children to be sedentary. Children used to play more outside because there was nothing interesting to do inside. That has changed. Similarly, many other things in the environment have changed to make the sedentary choice the easier one. While I think there is some use in trying to understand what has changed, we can’t go back in time and get rid of television, DVD, iPods, etc. Our challenge is to move forward and try to use technology to our advantage. I think we also have to realize that no one or two things can be changed to reverse this epidemic. It will take a lot of little changes in a lot of things. It will take more than focusing on behavior–we must focus on creating an environment that makes the active choice easier.
CEO & Co-Founder
KaBOOM!
Posted July 29, 2008, 9:58am
I think that we can't talk about our current sedentary lifestyles without talking about the outdoor and free play deficit in our country right now. Joe points to some of the culprits like screen time and perceptions of safety. These parts of our lives affect everyone – adults and children. Most people of a certain age, however, will be able to recall the times that you spent out of doors, engaged in free play, regardless of the type of place you grew up. You likely recall playing not for a few supervised minutes, but for a longer period of time, maybe even for hours at a time. If we look at recommended daily physical activity times for children, even if we go with the high numbers of at least an hour a day of moderate to vigorous physical activity, I think it's safe to say that children, at least, were likely more fit 50 and even 100 years ago if they were playing for hours at a time. You may say that we can't assume that all children had that kind of freedom to play even in a time long ago when perception of safety may have been different. Some children, surely, grew up being expected to work. Work, though, for children, likely would have entailed physical labor, so getting enough physical activity likely wouldn't have been those kids' biggest problem.
In our current culture, providing time, space, and safety to engage in free and unstructured play would be a great step toward making sure that children are physically active. How about creating playspaces that are safe and interesting enough to make adults want to allow children to come, and make children want to play harder, stay longer (like for the hours I recall playing as a kid), and come back more often?
Co-Founder and Medical Director
ProHEALTH Care Associates
Posted July 29, 2008, 10:09am
As many parents/coaches obsess on competition and winning, has the casual, recreational child athlete been driven away? The child that is not necessarily gifted athletically now has many other recreational alternatives to choose from. That, along with parents’ preference for specific sports that they believe are tickets for scholarships or are “safer” (often the perspective of injury risk is disproportional to reality) continues to drive children and adolescents away from recreational sports activity. Once these alternatives become imbedded, it is almost impossible to change as adults.
Deputy Commissioner for Public Programs
New York City Parks and Recreation Department
Posted July 29, 2008, 10:17am
Joe’s initial question may be as complex as the remediations necessary to get us back on track. I’m hardly the clinician among the participants online today, but as a father of young children, and one who grew up in the urban environment of New York City, I think his mention of changes in the ways that children play is extremely significant and often overlooked.
When I grew up we literally played in the street – everything from stickball and stoop ball to Ring-o-levio, tag, “skelly” etc. I actually still live in that same neighborhood and don’t let my own children venture anywhere near as far as I did.
As a Parks professional, my recall of youthful days makes it clear that these random, self-developed activities provided more calorie-burning, physical and social development, and gross motor development capacity than I could now program (with a fair amount of resources) into a block the size of the one I grew up on. As many of us are now realizing, given opportunities and adequate latitude for random and spontaneous play, children have an innate capacity to satisfy their developmental needs. (This, to your point, Hara.)
Additionally, I think a main contributor to parents’ unwillingness to allow their children to play outdoors is not only hyper-concern regarding predators and pedophiles, but also the erosion of a sense of community that many of us experienced when we were growing up. In short, when I grew up and played there were many caring and nurturing eyes that monitored our activity from a distance. For many reasons, this sense of communal child rearing is all but lost in our current society.
Editor-at-Large
Psychology Today
Posted July 29, 2008, 10:26am
It certainly is true that we can't fix the problems today by reveling in our own memories of the past. And we can't simply eliminate all the TVs, et al. We indeed have to recognize how our environments structure what is convenient for us to do, and, yes, we will take the path of least resistance. We need to build neighborhoods that have not just sidewalks where people can get outdoors and walk, but that have some interesting destinations along the way, like small stores. That builds physical activity into daily life in ways people don't even notice. Walking becomes a pleasure for social reasons. And I think most of all, we need a massive public education campaign to remind parents of two things—the enormous value of physical activity for their children and, yes, it's sometimes necessary to just push them out the door; there are things they can do to encourage activity RIGHT NOW. We need to include messages about the true risks of sedentary life for their kids.
President
National Institute for Play
Posted July 29, 2008, 10:37am
A shift of cultural consciousness is necessary. This, at its core must be undergirded by emotionally charged, evidence-based coherent beliefs about fitness so that a "mythic" shared value-laden narrative about it is pervasive.
(Myth, here defined, is not an untruth. It is a culture's believed truth, without which widespread social action is impossible.)
Play can establish the emotionally charged component that can keep the new culture of fitness viable and continuing for future generations. Action is generated more by embodied emotion than by cognition. When the action is fun, it fosters continuity and the search for variation and novelty, preventing habituation and diminished enthusiasm.
Play is the product of many millions of years of evolutionary trial and error. It is a primary element in crafting the human social brain, and by its nature, particularly in childhood, fosters movement and joyful activity.
I welcome conversation regarding the human species lifelong need for play, its contributions to overall fitness, and the benefits and risks associated with incorporating it into broad public action.
Parker Centennial Professor Emeritus
University of Texas
Posted July 29, 2008, 10:39am
Wow! These early comments promise an exciting and productive dialogue.
A century ago sedentary activity and obesity were rare, but more common among the affluent. Children in both country and city worked alongside adults at home and enjoyed two or three recesses for play each day at school. Food came directly from the land. Playgrounds in the country were the challenging streams, forests and farm yards. In larger cities, a major child saving movement was underway, including sub-movements for playgrounds, school gardens, organized camps, and nature study–all intended to protect children from the poverty and dangers of the street, and improve health, fitness and civic responsibility. Up to 200,000 children, including many orphans and immigrants, were sent to live with farm families on "orphan trains" to escape the degradation of the slums.
Theodore Roosevelt was playing a significant role in helping ensure the health and fitness of future Americans - preserving the national forests, creating national parks, encouraging fitness, creating small park playgrounds in cities, even helping create and serving as honorary president of the Playground Association of America.
A half century ago obesity, by today's standards, was still relatively uncommon, but rates were increasing slowly among both children and adults. The lean people of the Depression and World War II found jobs, affluence and leisure were growing, the technology revolution was emerging, and obesity soon began its historic rise.
Given centuries of play and work by adults and children, just how did we become one with our couches in just a few decades? What precisely, are the culprits? Are "hidden" factors at play? We appear to agree that we face very complex issues, for no single factor created the obesity and fitness problems. James seems to have it right that no one change can reverse the epidemic and early discussion is focusing on the complexity of the problems. What can we learn from history and how would that be useful in creating productive changes?
Professor of Pediatrics and Medicine
University of Colorado at Denver
Posted July 29, 2008, 10:51am
So the question is how to produce social change. This seems pretty daunting, but in 1960 who would have believed that we could reduce rates of smoking? We have to look at this as a long-term project and we have to be realistic about how to create change. Can we even imagine communities where it is easier for kids to be active and play than to be sedentary? If we can’t, how will we ever get there? We are all working toward changes that could bring about social change, but it seems there is little coordination and maybe a lack of vision about what success looks like. Further, we didn’t get to where we are today overnight, and we must realize that change will take a while. But we need to start now and we need to take a look at how we can coordinate our efforts to make the most of resources available. Social change will be hard but the alternative is just not acceptable.
CEO & Co-Founder
KaBOOM!
Posted July 29, 2008, 10:53am
Kevin makes a great point about the erosion of a sense of community. Creating innovative and interesting outdoor playspaces could not only offer great play and physical activity opportunities for children, but a chance for adults to gather and engage in meaningful interactions with other community members and provide a chance for adult physical activity. Just walking to parks, playgrounds, and outdoor greenspaces gets people moving. With municipal and schools budgets as strapped as they are, a community-build model that activates citizens to pursue a small goal, like building a fun, interesting playspace for children and adults to enjoy, could result in a community drawing together for a shared purpose toward a collective cause–the health and well-being of our children.
Childhood Obesity Team Leader and Senior Program Officer
Robert Wood Johnson Foundation
Posted July 29, 2008, 11:15am
Our country needs to have a ‘sit down’ to really discuss this issue and then we all need to stand up and do something about the problem. Yes, children today lead sedentary lives more so than we may have in our youth. And those who are most affected by the childhood obesity epidemic, meaning those living in lower-income communities across the country, confront challenges each day that inhibit their ability to be active. The context of their daily lives are very real and we should understand that better in addressing this problem. The young African American girl who confronts threats of interpersonal violence, gang recruitment, or vehicular traffic patterns that do not allow walking or biking to school, or the Latino boy who may attend schools without a functioning gymnasium, physical education classes, recess or opportunities to be active in before- or after-school programs are not likely to be active. The rural children separated by distance between neighbors and who have no access to safe places for play and exercise are not likely to move in any meaningful way. And in each case, there are the parents who love their children and who know of the real threats outside of their doors–they are not likely to encourage their children to be outside unsupervised. These scenes play out every day in urban, rural and suburban settings. Our children need physical activity built back into the places where they live and learn in order for them to play and be active.
Co-Founder and Medical Director
ProHEALTH Care Associates
Posted July 29, 2008, 11:19am
The analogy to smoking before is very relevant. I remember growing up and being indoctrinated by advertisements that smoking was fun and seductive…now, many perceive smoking as dirty and unhealthy. We must find a way, as Mr. Brown commented before, to change the perception of physical activity and exercise, from chore to play. Neighborhood space, funding and education are, of course, all important to initiate change, but all must be in concert and sustained to change the societal psyche…similar to the change of perception regarding the smoking of tobacco.
Senior Research Scientist
Harvard School of Public Health
Posted July 29, 2008, 11:24am
A culture of fitness happens when environments make going outside on foot or bicycle the easy choice. Suburban environments in particular no longer foster physical activity the way they once did. In addition to what others have said, I'd add to the discussion that we have to look at two other reasons kids don't head out and explore the way they used to: traffic and bugs.
Car traffic around public schools at drop-ff and pick-up actually discourages walking to school because it creates a hazardous zone for pedestrians. Residential side streets that once were traffic free–and therefore great places to play Frisbee and four-square–now host a lot more cars than they used to. Whereas we used to actually sled down my street in suburban Boston (okay, it wasn't really a wise choice then either), this kind of street play is just impossible now. Decisions made decades ago when traffic was light to forego sidewalks now come back to haunt us. In addition, poor speed limit enforcement adds to the sense of danger on the streets and discourages walkers and cyclists, and definitely discourages parents from letting their kids head off to local stores or businesses on their own. I'd recommend that residents dialog with town engineers to ensure that road reconstruction projects favor walking and cycling. We've just done this in my town and it will result in a significantly safer roadway. And all of us need to drive less, of course.
As for the bug problem, here in the Northeast, fears about insect-borne illnesses have become so pervasive that kids don't hang around in the woods or fields anymore. In our area we are inundated with warnings about ticks and mosquitoes. Common sense suggests that bug spray and a good scrub will prevent most problems, but parents keep their kids inside anyway. And kids internalize this and add it to why they won't go out: there are bugs outside (bad) and my computer is inside (good). I'm not trying to minimize the impact of these illnesses, but everyone benefits from time immersed in nature. I hope we hear from Richard Louv on this point.
Editor-at-Large
Psychology Today
Posted July 29, 2008, 11:28am
One of the most striking features of suburban communities today is how few children one sees outdoors playing (didn't the adults move there for the children?). Yet, when I talk to parents and parent groups, all are extremely surprised to hear about the many benefits of play, and many of them ask what they can do to get their kids to play. Obviously, it's not enough for one brave parent to push a child out the door. There must be others to play WITH. At the grassroots level, parents have to be encouraged to get together with a couple of their neighbors. So yes, a massive public education campaign about the value of activity and the need for play, but also nitty-gritty suggestions for how to do it...local "organizing" seems to be desirable and necessary. This is the level at which parents seem to be receptive.
Director of the Division of Nutrition, Physical Activity, and Obesity
Centers for Disease Control and Prevention
Posted July 29, 2008, 11:31am
This has already been a rich discussion to which I would like to add several points. The broad awareness of obesity and its adverse effects may already be having an impact on the prevalence of childhood obesity. As the National Health and Examination Survey data published in JAMA several weeks ago indicate, there appears to be a plateau in prevalence. These observations are supported by data from the Youth Risk Behavior Survey, state data from Texas and Arkansas, and unpublished longitudinal data from Maine and West Virginia. With respect to tobacco, per capita cigarette consumption began to plateau with the advent of public awareness regarding the adverse health effects of cigarette consumption, but the decline in cigarette smoking did not occur until a variety of public policy initiatives began to take hold, such as limiting the access of minors to tobacco and eliminating smoking in public places. I believe that we are at a similar turning point with respect to childhood obesity. The extensive attention to this problem in the press has heightened concern, but we will not likely turn the corner until we begin to identify and implement policies that are as effective as those that were directed at tobacco consumption. I agree with Jim that a social movement will likely be required, and multiple initiatives apparent in medical settings, schools, worksites, and communities suggest that such a movement may already be underway.
Senior Research Scientist
Harvard School of Public Health
Posted July 29, 2008, 11:46am
Dwayne and James have got it right. We need to have a “sit-down” and then stand up for social change that promotes healthy development and healthy living in every environment. We have to look far upstream at some of the policy decisions that have shaped current lifestyles in ways that were probably never intended, and work diligently to fix them. For example, federal transportation funding allocations in years past shaped our interstate highway system at the expense of building public transportation infrastructure. As another example, a cascade of upstream decisions influences the local ability of schools to provide recess, physical education, and delicious, fresh foods for lunch. Or even time to eat lunch. At the same time we're working upstream, we all have a responsibility to our local communities to reach out and work across disciplines to infuse concern about healthy living into local policy as well. Getting a bike rack installed near local stores may seem trivial, but when people work together on "small" successes they build a sense of efficacy for bigger work, and gradually begin to reshape norms when neighbors see neighbors biking with a grocery basket.
Editor-at-Large
Psychology Today
Posted July 29, 2008, 11:52am
Putting physical activity back into schools seems essential and the place to start. One of the primary reasons play and recess have been eliminated is the pressure for achievement, as if more time for physical activity leaves less time for schoolwork. Of all people, the educators need to be educated and shown the evidence–that breaks for physical activity during the day actually increase the ability of kids to concentrate (especially boys). Yes, in education, as in architecture, sometimes less is more; taking a little time away from instruction actually makes class time more efficient. Kids learn better after recess. Then there are all the studies showing that physical activity stimulates brain development; it boosts the production of nerve growth factors in the prefrontal cortex. It's counterintuitive, but play seems to promote growth of the very brain centers that will allow children to focus their attention and learn. We need to make use of this important information and take another look at the rush to remove play and activity from our schools simply because it looks like a waste of learning time.
CEO & Co-Founder
KaBOOM!
Posted July 29, 2008, 12:03pm
Community organizing and support does seem to be a key factor in whether spaces in the built environment get usage. Our organization spends a great deal of time looking at how to create social change one playground at a time. In communities where beautiful playspaces have been installed without input from the people who live there, usage isn’t as high as it is in places where community members have come together to design, fundraise for, and build the space themselves. Where there is no investment from children and adults in the surrounding community, there is no value placed in that space. Vandalism and undesirable usage can result, along with simple lack of use. Any public space in the built environment should be designed and implemented with the user community’s input. Organizing your community to build a great place to play is one way to begin to expand the social capital in a neighborhood.
Executive Director
National Coalition for Promoting Physical Activity
Posted July 29, 2008, 12:27pm
I too think that it is essential that this become a united effort…across organizations but most importantly across departments in government, at the local and state level, but especially at the federal level. The need for a united cross-departmental federal effort towards a reduction in obesity has been a topic at several meetings I have recently attended. I agree that it is essential that policies be enacted that foster engineering physical activity back into people’s lives. I think that there is no one policy or program that is going to solve the problem (physical inactivity) at all levels and that it will take a multi-pronged approach that targets specific populations. My organization (National Coalition for Promoting Physical Activity) was pleased that in the last transportation bill, a national Safe Routes to School program was included for the first time–we are working towards expanding that in the next bill that is due up relatively soon. We have also been advocating hard to include a variety of physical activity and physical education initiatives in the next Elementary and Secondary Education Act (currently known as NCLB). Some of these are as simple as adding language to a purpose while others of course come with a larger price tag.
Deputy Commissioner for Public Programs
New York City Parks and Recreation Department
Posted July 29, 2008, 12:31pm
Jean’s mention of vehicular traffic and vehicle use is of much interest, and I’d like to expand on it briefly. In New York City, the Department of Parks & Recreation, in partnership with the City’s Department of Transportation, has been advancing a Greenway master plan.
During the current Mayoral administration these projects have been accelerated substantially in effort to create safe recreational corridors for bikers, walkers, joggers, and skaters that not only connect the public to recreational resources, but also provide a very significant alternative to automotive transportation. The city has been able to leverage federal programs such as the Congestion Mitigation and Air Quality Improvement program to support what has been to date the creation of nearly 150 miles of safe thoroughfare.
The significance of reintroducing walking and biking as forms of urban travel is that it not only addresses issues of environmental sustainability, but also responds to the need for adults and children to integrate physical activity as a routine part of their lives.
Childhood Obesity Team Leader and Senior Program Officer
Robert Wood Johnson Foundation
Posted July 29, 2008, 12:35pm
Social change happens when multiple actors with a shared vision, in this case of healthy kids living, learning and playing in healthy communities and schools, come together to achieve a goal. Collaborations between and across sectors are necessary. Our urban planners, transportation experts, educators, and public health and health care professionals need to know the role that they can play and the space to bring their expertise to the prevention table. Our businesses and corporations need seats, too. We need to encourage the use of incentives to bring bankers, insurers and others to join us so that our policymakers see that they have the popular support to pass impactful legislation. We need our media at the table, too. The media sets the public and policy agendas and we need to gain a commitment from them right now to being part of the solution. Young people should not be relegated to the “kiddie table”…they should sit right there with us so that they can add their thoughts, concerns and perspectives to a movement that will affect them and their future. And, of course we need our food and beverage companies who can reformulate and create healthy affordable options and position those products to the most vulnerable among us. If this social change is to be efficient and meaningful we’ll need a broad constituency with a shared vision to make it happen.
Professor of Pediatrics and Medicine
University of Colorado at Denver
Posted July 29, 2008, 1:12pm
I would like to raise an issue about whether there are opportunities in linking efforts to increase physical activity (and nutrition) with environmental or sustainability efforts. It has been tough to get people to walk for their health, but I am ok if they walk to save gas. Our kids are learning that taking care of the environment is the right thing to do. They in turn will make sure their parents understand this as well. I think we can link taking care of your body with taking care of the planet. I know there are the beginnings of such efforts, but we could facilitate these. Taking care of the environment is a BIG force that will change behavior and has the potential to facilitate social change. Let’s see if we can link the behaviors we are interested in with that force.
Senior Research Scientist
Harvard School of Public Health
Posted July 29, 2008, 2:30pm
This is a great line of discussion. What Kevin Jeffrey described is exactly, I think, the sort of outcome that Jim Hill is alluding to, and addresses Dwayne Proctor's comments as well. It's possible that we have to promote healthy eating and physical activity more as collective decisions that benefit our communities and the climate (altruistic) rather than as good for us as individuals per se. YMCA, CDC, and RWJF have been leaders in supporting healthy communities. Are communities they work with making the link between environmental stewardship and personal health? What can public health learn about the effectiveness of health messaging from the green movement?
Going back to the fitness promotion issue we started with, I'd like to circle back to my "bug" comment: behavioral economics tells us that people will make short-term choices that appear to have instant benefits but may have long-term costs. With physical activity and eating, this dynamic is always present ("I'll start exercising tomorrow..."). In health promotion, we need to be careful about characterizing risk in ways that may promote unhealthy long-term choices. For example, press reports about skin cancer and Lyme disease activates perceptions of immediate health threats that may be difficult to reconcile with admonitions to be active daily for some abstract long-term benefit. When we talk about getting parents energized about kids' play, we have to be mindful of providing truly supportive messaging, and as others have noted, assess risks accurately and deal with real barriers.
Senior Vice President and Chief Innovation Officer
YMCA of the USA
Posted July 29, 2008, 2:40pm
In Jim’s comment on the environment, he suggests that we let kids take the lead. Our collective efforts in tackling this nationwide challenge often start with what we can do–rather than engaging kids of all ages in the solution. When young people are engaged in creating activities, preparing meals, solving problems they often land on solutions that we as grown-ups can no longer see. I recognize that we need a multi-pronged approach yet we often forget that kids have a voice and an opportunity to contribute. How do we allow kids of all ages to be part of the solution?
Deputy Commissioner for Public Programs
New York City Parks and Recreation Department
Posted July 29, 2008, 3:11pm
This discussion of social change is right on target. I couldn’t agree more with Dwayne’s most recent post that what’s required is a shared vision that leads to collaboration and partnership with many different partners. Although achievement of this on a national level may be more difficult, some of our most successful pilot innovations to combat the problem of overweight/obesity were born out of inter-organizational collaborations.
In 2001, when alarming statistics documenting the epidemic of overweight/obesity among city populations, especially among children, were presented during the course of interagency meetings with the Health & Hospital Corporation, the Department of Health, the Department of Education, and representatives from the Mayor’s office, the Parks Department began a targeted involvement in addressing the problem.
As one of New York City’s largest operators and providers of athletic facilities that include ballfields, courts, beaches, pools, golf courses, bridle paths, rinks, tracks, and indoor gyms, as well as 28,000+ acres of parkland, Parks already possessed the infrastructure needed to support increased fitness programming. The challenge would be to create, develop, and implement programs designed to attract target populations in neighborhoods most in need of these activities–populations that for the most part, and for various reasons, did not avail themselves of these facilities on a regular basis.
As a first step, we worked with the NYC Department of Health and Mental Hygiene to map the neighborhoods with the highest incidences of overweight/obesity; we then overlaid this data on a grid showing facilities and institutions with some capacity to prevent or mitigate some of the contributory factors to obesity. In the process we began to not only identify and refine the Parks Department’s role in delivering fitness-oriented services to youth, but also to redefine and strengthen linkages with other City agencies. These linkages have begun to erode longstanding institutional barriers, resulting in a clearer understanding of areas of overlap in our respective missions, and increasing our collective ability to respond to the fitness needs of a diverse urban population.
Professor of Pediatrics and Medicine
University of Colorado at Denver
Posted July 29, 2008, 3:33pm
I want to follow up on a comment Bill Dietz made earlier today. There are some recent data from NHANES suggesting that childhood obesity rates may have stabilized over the past few years. I wonder what all of you think about this. Is this an indication that we are making some progress or do you think this is just a breather before rates start escalating again. And if you think we have made progress, to what do you attribute this? Can we learn from things we have done well. I don’t see any clear indication that we are getting kids more active. But, maybe people are beginning to listen to some of the messages we are getting out to the public.
CEO & Co-Founder
KaBOOM!
Posted July 29, 2008, 3:42pm
Lynne is right-on about engaging kids in the solution. Allowing kids to be a part of the process will result in solutions and strategies that last. For instance, promoting child-directed, child-initiated activities and play in addition to adult-directed programming like sports and physical education classes could ultimately result in better health outcomes. In terms of the built environment, not only do adults have to plan and design better, more livable spaces, children have to be able to have a say in telling adults what they like to do and what they like to play with. This participatory process has to be part of the evidence-gathering and research as well.
Assistant Secretary for Health
U.S. Department of Health and Human Services
Posted July 29, 2008, 5:10pm
If I may join the discussion with a few basics from the CDC’s report on the contributing factors of obesity and overweight: “One of the
reasons for children being less active is that children are spending
less time engaged in physical activity during school. Daily
participation in school physical education among adolescents dropped 14
percentage points over the last 13 years–from 42% in 1991 to 28% in
2003. In addition, less than one-third (28%) of high school students
meet currently recommended levels of physical activity.
Children have become more sedentary and spend a considerable amount of
time with media. One study found that time spent watching TV, videos,
DVDs, and movies averaged slightly over 3 hours per day among children
aged 8–18 years. Several studies have found a positive association
between the time spent viewing television and increased prevalence of
overweight in children. Media use, and specifically television viewing,
may displace time children spend in physical activities, contribute to
increased energy consumption through excessive snacking and eating
meals in front of the TV, influence children to make unhealthy food
choices through exposure to food advertisements, and lower children's
metabolic rate.”
CEO & Co-Founder
KaBOOM!
Posted July 29, 2008, 5:31pm
The findings that Joxel highlights illustrate what we’re facing when it comes to media displacing time children spend in physical activities. It is essential that we provide kids with physical activity and play opportunities and playspaces that they find interesting and want to use for sustained periods of time and that they will return to over and over. In addition, those opportunities and spaces need to be actually safe and perceived as safe by parents. Innovation will be key in developing these opportunities and spaces, and children and parents must be involved during the planning, implementation, and evaluation process.
Editor-at-Large
Psychology Today
Posted July 29, 2008, 5:48pm
To respond to an earlier question, I'm staring at a new paper just released by the National Bureau of Economic Research estimating that the prevalence rates for obesity will rise to 40% for men and 43% for women by 2020 (from 33% and 38% respectively in 2010). The predictions use data from the NHANES surveys and the National Health Examination Survey. The paper notes that the body weight distribution of the American population did not begin changing until AFTER the second NHANES survey of 1976-1980. And the greatest change in body weight occurred among those already most overweight. There are significant differences in prevalence of obesity among those of high socioeconomic status (1.9% are obese at age 18 and 19.6% are obese at age 40) and low SES (4.6% obese at age 18 and 31.3% obese at age 40). The single most important correlate with obesity is years of schooling.
Parker Centennial Professor Emeritus
University of Texas
Posted July 29, 2008, 6:04pm
This is a fascinating discussion. There appears to be general agreement about the range of causes for the obesity and fitness crisis. Many of the participants are pointing to the need for multiple initiatives involving schools, work sites, medical and health groups, media, communities, businesses, professional organizations, law makers, etc. The efforts must be coordinated across local, state, and national boundaries and the structure of communities should be reconsidered to make it easy for people to be active.
The obesity plateau that Bill Dietz discussed is promising, and perhaps indicative of a slowly emerging movement to bring common sense back to dietary and activity patterns. When Louv weighs in we will hear about the extremely positive steps underway in this country and abroad to reacquaint children (and adults) with nature. Darell and KaBOOM! and other organizations are peppering the planet with playscapes, organizations such as the Alliance for Play and Stuart's National Institute for Play are informing about the lifelong need for humans (and animals) to play, and professional organizations are making convincing arguments that high stakes testing in its present form cannot stand.
This is an opportunity for everyone to learn more about the initiatives you are personally engaged in. What are the most promising current approaches to reversing the obesity crisis? What is needed to make them more effective? How can they be coordinated for greater effect?
Senior Vice President and Chief Innovation Officer
YMCA of the USA
Posted July 29, 2008, 10:14pm
To respond to Joe, I am optimistic about the work we are undertaking at the YMCA. Through our Activate America® effort, we have a dual strategy to promote healthier lifestyles. First, we are redefining the YMCA itself to be more supportive of children, adults, and families who struggle to adopt and sustain healthier lifestyles. To do so, we are enhancing the skills of our staff to be more supportive of people who are ambivalent about engaging in lifestyle behavior changes (such as increasing physical activity). We are offering different kinds of programs for people with chronic diseases. And as the nation’s largest non-profit provider of child care, we are integrating more physical activity and healthier eating options into our programs. Our second strategy is to move outside of our facilities to act as a catalyst in communities to improve community health–advocating at the local and state level for policies that promote healthier living. With nearly 70 million households within 3 miles of a YMCA and a 160 year history of responding to the country’s most pressing social needs, we believe that we are uniquely positioned–in partnership with others–to impact this crisis. That said, I will confess that it’s too early for us to declare success, but I firmly believe that we are headed in the right direction.
DAY TWO
Parker Centennial Professor Emeritus
University of Texas
Posted July 30, 2008, 9:40am
Welcome to day two of our discussion. Day one was very productive in laying the groundwork for more specific discussion about promising approaches and recommended steps for reversing the obesity crisis. Our host at NewTalk, Philip Howard, raises good questions in Reader Comments about specific activities that could make a difference. Today we can discuss approaches we have seen or participated in that could make a difference. Tomorrow, consider making specific recommendations resulting from your experience and best thinking. What effect would such approaches or projects have in changing our culture?
Texas is one of several states recently considering and passing legislation requiring minimum time periods for physical education and recess in public schools. This resulted from studies about the growing levels of obesity and declining levels of fitness across the nation. A report released July 1, 2008, by the Texas Education Agency reported the results of administering the Kenneth Cooper FITNESSGRAM assessment to 2.6 million students in grades 3-12. Fitness levels declined with each passing grade level. More than 19% of children 10-17 were rated obese. Texas ranks sixth among states in levels of fitness. The fitness testing was supported by $2.5 million from private sources. Texas businesses spent about $3.3 billion in 2005 on costs related to obesity. This has served as a wake-up call and legislators are at work drafting new legislation.
What project observations and results have you experienced?
Editor-at-Large
Psychology Today
Posted July 30, 2008, 9:50am
The schools are anchor institutions of our country. It's the one institution that serves ALL children of ALL backgrounds. It's no secret that schools all across the country have been eliminating opportunities for physical activity at every turn. They cancel recess, they remove play from pre-k and kindergarten classrooms in favor of academic curricula, and they ban running and ball games on school grounds. Part is fear of liability. Part is achievement pressure. And many parents welcome the change. Are there any innovative programs to reintroduce physical activity in the schools? And what can be done to manage the liability fears of institutions and individuals? Yes, all movement entails some risk. But not moving at all entails great risk, too, although that risk plays out on such a longer time frame that it is easy for people to miss the connection.
Professor of Pediatrics and Medicine
University of Colorado at Denver
Posted July 30, 2008, 9:56am
For the past few years I have been an advocate of helping people make small lifestyle changes. I helped start a non-profit initiative, America On the Move to promote this approach. In fact, we do a campaign called “Steptember” each fall with the YMCA to get people walking more and thinking about healthy food choices. I think that small changes are what most people can do and that if we make enough small changes it can make a big difference. We have not been successful in promoting large behavior changes, because these are not sustainable for most people. That is why we have great success with weight loss but very low success with weight loss maintenance. We can move people gradually toward healthier lifestyles by showing them that they can make small changes to eat smarter and to be more active. These changes can fit permanently into our crazy, busy lifestyles. I have been amazed at how many people start with just one or two small changes and end up with big changes over time. Further, the small changes approach can apply not just to behavior but to the environment. In fact, this may be the only way to get some environmental changes. For example, we aren’t going to reduce portion sizes overnight, but could do this gradually over years. We have had great success in applying the small changes approach with both behavior and the environment to families. We conducted a randomized controlled trial to show that the approach works and now have a family program available free of charge on our website. I don’t think we can focus on children alone without also getting the whole family involved if we want sustainable change. The small changes approach may not be the only way to address our obesity problem, but it is certainly one way that seems to show some success.
Senior Research Scientist
Harvard School of Public Health
Posted July 30, 2008, 10:04am
I'm also responding to Joe's question about promising approaches to reverse the obesity epidemic. I believe environmental approaches that facilitate behavior change by making healthy behaviors easy to choose are the way to go. Examples include built environments that favor pedestrians and cyclists over drivers, and institutional environments where healthy food is more accessible than high calorie, low nutrient density choices. Healthy environments promote healthy behavioral norms. Studies show for example that children's food choices are highly influenced by what's offered to them, and by the social context in which it's offered, i.e., kids will follow role models. Effectiveness of environmental change is difficult to measure at the individual level and that's something evaluators need to really wrestle with; however at the program or organizational level, measures of change are feasible. Unfortunately, there's "No effectiveness without implementation" (Fixsen et al, 2005) and so a major route to enhancing effectiveness is by being relentlessly attentive to the ways that organizations adopt policy change, train staff, set goals and monitor progress. More coordination within organizations and across communities, agencies, etc. is important. Although energy intake is a major determinant of obesity, for example, the public is receiving mixed messages about this–food ads abound–and this ambiguity undermines prevention efforts. Recent statements by IOM and AAP show emerging convergence on nutrition messaging for children that can help coordinate efforts across schools, communities, child care settings, camps, etc., but the absence of a coherent national policy on food advertising aimed at children (see today's New York Times on this) likely will continue to slow behavior change.
Lynne's description of YMCA of the USA's work, which I've had the honor of being involved with, demonstrates what a coordinated delivery system can do to become part of the solution–taking science-based health promotion strategies and working on integrating them both deeply and broadly.
Executive Director
National Association for Sport and Physical Education
Posted July 30, 2008, 10:10am
Forgive me for my absenteeism yesterday, I very much enjoyed reading all of yesterday’s discussion this morning. The overriding thought I have related to a number of challenges posed is the idea of the importance of people valuing physical activity. When you think about it, for the most part people find a way to do the things that they value–even with all types of challenges and barriers. Opinion-type surveys tell us that people do value physical activity (conceptually or cognitively at least), but participation surveys tell us that people do not actually (via “practice”) value it as much as they say they do. That’s where I think the social change needs to be focused. And we need to be accepting of all the reasons people might value physical activity (for some it is not the health reasons–it may be: being outside, time alone, being with friends, competition, personal goal achievement, stress-reduction, etc.). One of the National Standards for Physical Education, published by my organization–the National Association for Sport and Physical Education (NASPE) is “A physically educated person values physical activity for health, enjoyment, challenge, self-expression, and/or social interaction.” Note: the “and/or.” NASPE and RWJF national surveys showed that about 90% of teachers, students, and parents thought that schools should offer physical education class every day. But just how strongly do they feel/value this–what decision are they making when the school district budget has to be reduced or the high school student decided to fit certain advanced placement or elective courses in his/her schedule–instead of physical education.
CEO & Co-Founder
KaBOOM!
Posted July 30, 2008, 10:38am
To respond to Joe’s question about observations and results from promising programs, I recently had the pleasure of touring Alice Waters’s Edible Schoolyard at Martin Luther King School in Berkeley. I was struck by how beautifully systematized and structured this program is while at the same time allowing children to find their own place and role in a local and organic food system. The children at this school are gaining an appreciation for nutritious food and building a solid foundation of good eating habits. It seems that connecting this kind of nutritional approach to one that encourages kids to be physically active at recess would result in healthier kids. Another program, Sports for Kids, is an interesting approach to play and recess. It is a roving recess program that brings recess leaders from school to school. These adults take on the role of supervising children at recess so that teachers, particularly in schools that tend to underperform in low income areas, can have essential planning time. Tulane researchers have found that observed levels of physical activity increase in schoolyards when those schools install community-built playgrounds. Finally, at the pilot installation of Imagination Playground in a BOX in Brownsville, Brooklyn, anecdotal observations indicate the manipulable loose parts are engaging children in play that is more intense, longer, and that kids are coming back more frequently.
Director of the Division of Nutrition, Physical Activity, and Obesity
Centers for Disease Control and Prevention
Posted July 30, 2008, 10:48am
With respect to getting the population moving again, there is probably no more important legislation than the transportation bill, which will be up for reauthorization in the next session of Congress. The bill is known as the Safe, Accountable, Flexible, Efficient Transportation Equity Act : a Legacy for Users (SAFTEA-LU).This bill includes support for public transportation, safe routes to school, and community infrastructure that supports physical activity, such as recreational trails, bicycle transportation and pedestrian walkways. This bill is to physical activity what the farm bill is to nutrition. For example, we know that 30% of adults who use public transportation achieve the recommended 30 minutes per day of physical activity by walking to and from public transportation. Efforts to increase public transportation are timely in view of the fuel crisis. The Lynx Blue Line light rail line, which was just built in Charlotte, NC, has had an average daily ridership of 14,000, well over the 9000 riders they anticipated. In Davis, CA, a carefully designed bike network includes a dedicated traffic lane for cyclists. 25% of all the trips there are by bicycle, and the city has eliminated busing children to school, and expects them to walk or bike instead. Other communities could move in these directions by pushing for the allocation of more highway funds to similar programs that support physical transport.
Deputy Commissioner for Public Programs
New York City Parks and Recreation Department
Posted July 30, 2008, 11:08am
In New York City, the Parks Dept., our sister agencies, and neighborhood-based organizations have begun a number of initiatives based on the collaborative framework described in my last post. Throughout the day I’ll forward outlines of several of them, but I thought I’d start with Shape Up, New York.
Lynne Vaughan’s mention of the need to target individuals who, for a variety of reasons, have not integrated regular fitness activities into their lives captures a significant challenge to all of us who are engaged in this effort. As many on the panel have observed, attitudes towards fitness, nutrition, and what it means to be “healthy” are the products of a combination of determinants including cultural and socioeconomic factors.
It was of primary importance then, when we first proposed our Shape Up, New York program, to not only consider those factors in a clinical way, but to then build a program that would be a fit for the target population. In designing Shape Up, New York, our first goal was to offer a program that people would not only use, but use regularly and over a sustained period. In keeping with this goal, we purposefully placed the programs in communities of need such as Bushwick, Bedford Stuyvesant, East Harlem, and the South Bronx.
On-site staff lead light aerobics, group walking, stretching, and breathing exercises that ease–not jolt–individuals whose lifestyles may have become somewhat sedentary into a workable exercise regimen. The supportive group environment energizes and enhances the activities, and many Shape Up participants have been in the program since its first season (2003).
Funded by the NYC Department of Health, staffed by Parks Dept.’s Recreation professionals, and offered in both Parks Dept. recreation centers and NYC Housing Authority facilities, Shape Up has encouraged families to develop healthy lifestyles through regular participation in non-taxing, non-competitive, energizing physical activity.
Childhood Obesity Team Leader and Senior Program Officer
Robert Wood Johnson Foundation
Posted July 30, 2008, 12:37pm
There are several approaches that will help in preventing childhood obesity. We know that kids need safe places for play and exercise in their communities. We know that they need to have opportunities for vigorous, daily physical activity built into each school day. We know that limiting “screen time” in school and at home presents opportunities to be active and decreases exposure to advertisements for “foods” that are high in fat, salts and sugars and enticements to be sedentary (“Stay tuned for more…”). And we also know that healthy affordable foods need to be accessible in our schools and communities, especially if we want our children to have the proper “fuel” to lead active lifestyles. To that extent the Robert Wood Johnson Foundation offers a repository of promising interventions, approaches and the latest knowledge on our website .
I worry about leapfrogging to magic bullet solutions for physical activity. Dr. Dietz points out quite correctly that there are federal policies that deserve greater attention. Our interventions will be more successful if conducted in healthier environments. Our policies should work towards improving our community environments towards supporting physical activity and making affordable healthy foods more accessible.
Senior Vice President and Chief Innovation Officer
YMCA of the USA
Posted July 30, 2008, 1:28pm
Kevin’s, Dwayne’s, and Jim’s postings underscore for me one of my great learnings in this arena–that we need solutions that both support individuals in adopting behavior change and we need solutions that address more macro policy changes. It is wonderful to have sidewalks in a neighborhood to encourage people to walk, but if someone feels too uncomfortable in his or her own skin to put on shorts and a T-shirt to walk, it doesn’t help. Similarly, it’s terrific to help an individual who is struggling with adopting a new behavior, but it is a very inefficient way to address broad scale societal issues. It’s a “both-and,” not an “either-or.”
Author
Last Child in the Woods
Posted July 30, 2008, 1:33pm
First, let me also apologize for being late to the discussion. I spent most of yesterday on airplanes–part of that time sitting on a Chicago runway for hours–which didn’t do much to improve my own weight. The discussion so far has been fascinating, and speaks to the need for a diversity of approaches. It’s important to acknowledge that the greatest increase in child obesity in our history occurred during the same decades as the greatest increase in organized sports for children. Soccer is good, and
Posted July 29, 2008, 9:00am
Joe L. Frost:Welcome to this NewTalk forum examining the obesity epidemic and the urgent need to encourage a culture of fitness nationwide for children and adults. The obesity crisis is real—The U.S. Centers for Disease Control and Prevention say that, as of 2008, fully a quarter of American adults are clinically obese. One third of American children are overweight and 70% of these will become overweight adults.
As we know, overweight vs. obesity is based on "body mass index" (BMI). An adult 5' 9", weighing 169-202 pounds is considered overweight, while 203 or more is considered obese. BMI is one indicator of potential health risks.
While obesity is a complex issue with many causes, our discussion will focus on the role of physical activity in combating this crisis. It's clear that our sedentary lifestyles are a critical factor contributing to the rise of obesity. How can we encourage fitness for everyone? And how will our population's health further decline if we do not?
Let's start at the beginning. How did our society become so sedentary? Some of the culprits are obvious: TV, video games, the Internet, suburban life, dwindling green space, an ultra-safety-conscious culture, and high stakes testing in schools. But if we are to reverse these unhealthy patterns, we should better understand their origins. Were we more fit 50 years ago? How about 100?