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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.

Stuart L. Brown President National Institute for Play

Posted July 31, 2008, 5:27pm

Stuart L. Brown: 

Nice moderating, Joe, thanks to you and the others for your offerings which have enlarged my vistas. My comment comes via one of the National Institute for Play’s advisors and affiliates, Gary Avischious. He is a gifted coach (coachingschool.org) with a curriculum of active involvement in volunteer youth sports for coaches and parents. One of his statements is that the surest way to promote obesity and sedentarism is to enroll your kid in a volunteer sports program, since 70% drop out because it “is no fun!” They then choose virtual play as more fun, with their being in control, not the needs of their coaches, parents, or the stars of the team, and most often find video games a better alternative. 25+ million kids are enrolled in volunteer sports activities and 750,000 parent-coaches are enrolled in the US each year. Gary’s pilot program in the front range of the Rockies has had marvelous success, with virtually no drop-outs, a continuation of love of the game, full team participation, and, like your Redeemer playground kids, over Gary's 15-year play-based coaching career, his non-quantified take on continued physical activity from those in his program is virtually 100%. This population (i.e., parents and kids involved in soccer, hockey, gymnastics, etc.) spending huge amounts of car and game-watching time, seems prime for nationwide participation with lifetime fitness and anti-obesity as by-products. The day of the pick-up game, or long afternoons playing freely in vacant lots and parks without adult oversight, is over. This is an internet friendly program, with coach certification, built in assessments, etc. as part of its design.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
CLOSING STATEMENT

Posted July 31, 2008, 5:30pm

Joe L. Frost: 

This has been one of the most high-energy, instructive professional discussions of my career. Thank you all for your courtesy, expertise and abandon in standing up for kids’ (and adults’) health and fitness. Free play, wild places, traditional games and sports, and productive work helped keep kids physically fit and developmentally able for centuries. Now, in this historically unique out-of-control, regulatory cyber-world, we collaborate to help bring common sense back to the culture of childhood and counter the obesity and fitness epidemic. At what point would this epidemic become a pandemic? As you know the medical profession is pointing to a growing incidence of rickets among children stemming from lack of sunlight and Vitamin D. Now, parents may feel the need to choose between rickets from too little sunlight or cancer from too much. What advice can our medical professionals offer?

One final shot at the culprits that are diminishing play, development, and fitness. When a Florida school posted a sign, NO RUNNING ON THE PLAYGROUND, those of us already concerned had to know that we were approaching a critical juncture–fix it or lose it. Lawsuits in Florida and elsewhere have taken a toll on schools, parks and other play venues. They are a two-headed beast, leading to removal of deadly devices from playgrounds and, on the other hand, tying up personnel, funds, and time on issues best handled by parents and school and park personnel. A state university system was sued because a child fell over a stump in a forest adjacent to a school playground. Our sponsor, Common Good, is targeting such legal maladies. Yet another culprit may be high-stakes testing programs like the No Child Left Behind Act which have taken priority over physical activity, the arts, etc., in so many schools. Next week's NewTalk will address NCLB and whether the law should be rewritten. This is an opportunity for all of us to weigh in with politicians.

I am grateful to have been invited to join you in this discussion and feel that I have a new group of friends. God bless!

Sheila Franklin Executive Director National Coalition for Promoting Physical Activity

Posted July 31, 2008, 4:57pm

Sheila Franklin: 

It has been interesting to reflect on the 3 days of discussion and see we have focused on children for the most part. I actually had to go back and check to make sure that we were not tasked with specifically discussing childhood obesity since we gravitated there so quickly (myself included!). Of course, like many, I do believe that the children are the wave to the future but I also think we often forget about the adults in all this…it is not too late to try and affect the adult obesity rate, albeit that it is a tough task without question! I would love to see us have Obesity Part III and IV with those focused on physical activity and nutrition for adults as it relates to obesity. Thanks so much for the opportunity to participate and I hope to see some forward movement from these discussions.

Sheila Franklin Executive Director National Coalition for Promoting Physical Activity

Posted July 31, 2008, 4:26pm

Sheila Franklin: 

Charlene beat me to the punch–I was going to refer to the Partnership for Play as well! It is an admirable effort in the right direction. There have been some great examples listed here and I’d like to add a couple of more. In Illinois, most park and recreation departments are in fact special taxing districts with the ability to levy a tax. They are separate entities from school districts (also special taxing districts), and apart from municipalities that would fund such things as police, fire, etc. Most (although not all) park districts do cover a specific municipality–these are not county-based systems. Many park districts (including Wheaton Park District where I was employed) have had long-standing park/school agreements in place that allow not only for the use of outdoor space, but sometimes includes the indoors as well. Wheaton (as well as many park districts) also had/has a land cash agreement in place that required a developer to either donate land or cash to be used for parks when developing a new property. These agreements go back MANY years and I believe are still in place today. I would suspect that there are similar things in other states as well. It is this kind of cross-governmental cooperation that needs to happen as well as bringing in other community-based organizations and the private sector as well.

We have spoken much about the need for unstructured play and the emphasis on organized sports. I do agree that there is not nearly the amount of unstructured play needed, however, I would like to remind us that structured play has a very big role in spurring physical activity as well. What needs to change, though, is the competitive culture that has overtaken much of youth sports today with its emphasis on winning, competitiveness, the pressure to choose just one or two sports. It is important to make sure that kids have an opportunity to learn the skills needed to engage in more unstructured activity. Yes, not all unstructured activity requires skill, but some does. Take ice skating for example: yes, you can (and I did to an extent) just strap on the skates and hit the ice, but offering a class or workshop in ice skating basics may offer a child the confidence to then go out and skate whenever the weather permits, engaging in that all-important unstructured play. This tags on with Charlene’s point about PE providing necessary skills.

James O. Hill Professor of Pediatrics and Medicine University of Colorado at Denver

Posted July 31, 2008, 3:49pm

James O. Hill : 

I have enjoyed the discussion and clearly there is much to do. I want to make 4 brief points:
1) In addition to the physical environment we have to look at the social environment. Today's youth are very connected but in different ways than previous generations. We need to look at online social networking, text messaging, etc., to reach them. Right now the social networks seem to be moving people in the wrong direction–can we turn that around and use social networks to our advantage?
2) We must avoid the argument of whether obesity is due to overeating or too little physical activity–the answer is yes. Research shows that being physically active does so much more than just burn some calories during the activity. We cannot solve our problem by food alone. It is almost impossible to be as sedentary as most Americans are and maintain a healthy weight.
3) It will take the involvement of every sector of society if we have any hope of creating the social change we all recognize is needed. Let’s stop blaming some for causing the problem and start blaming those who are not working to be part of the solution.
4) Finally, there is a sense of urgency in getting more efforts focused on the problem. We may be at a critical stage if we are going to reverse the high rates of obesity and the high rates of inactivity. Some people believe we will all end up being obese. Further, the impact of the physical environment on reducing physical activity is not static, but is getting worse. We have to implement more strategies now, even if some of them will not pay off for a while.

Kevin Jeffrey Deputy Commissioner for Public Programs New York City Parks and Recreation Department

Posted July 31, 2008, 3:18pm

Kevin Jeffrey: 

In reviewing some of our dialogue over the last two days, it became apparent that there’s an aspect of this very complex subject about which not much has been said.
 
Without doubt, there is a sweeping disparity between the public cost of medically treating obesity and its associated illnesses, and the allocation of public funds supporting programs that offer prevention or mitigation. Early estimates from the American Diabetes Association conservatively place the national cost of treating diabetes alone at $132 billion. I have no raw data on hand, but I am certain that the cost of treating obesity-related cardiovascular disease and certain related cancers adds significantly to this number.
 
When it comes to policy development and advocacy, I think it is important that we be prepared to discuss the ineffectiveness of how we allocate dollars for medical treatment, as opposed to how we allocate dollars for prevention programs.
 
On a federal level, it would be heartening to see at least a portion of the public dollars now dedicated to medical treatment of obesity and its related health issues diverted to support preventive programs. David Rockwell’s imagination playgrounds and the play worker movement, Richard Louv’s design concepts that incorporate natural elements as features, programs like the YMCA’s assessment initiative, and the refunding of legislated programs such as the Land and Water Conservation Fund and the Urban Parks and Recreation Recovery fund that helped develop and maintain open recreation spaces throughout the country, as Sheila Franklin mentioned yesterday are, as we have discussed over the last two days, examples of effective responses to this crisis.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 31, 2008, 2:55pm

Darell Hammond: 

Unstructured play, like being outdoors, impacts a variety of different developmental processes. Just as the solutions to childhood obesity is not ever as simple as behavior change, and requires multi-level support from all of the stakeholders we have discussed today, the impact of play on a developing child is much more than just physical. Free or unstructured play affects the social, emotional, and physiological development of children. Not to mention that if you ask teachers they will tell you that a playtime break helps children to concentrate more effectively in class. I know that we all acknowledge that the stakeholders who need to be engaged are much more varied across education, medicine, and even business. We are facing the challenge of reinvesting to create experiences meant to grow more well-rounded members of society.

KaBOOM! and the Rockwell Group, a leading architecture firm in NYC are working, as I mentioned yesterday, on a new concept in play equipment called Imagination Playground. The first large scale installation will be at Burling Slip at the South Street Seaport, but the more accessible, lower cost and more adaptable version, appropriate for every-day communities, is being tested and evaluated this summer in Brownsville. The portable equipment allows for use in spaces where land ownership is a challenge, or even indoors when inclement weather makes outside play impossible. The loose parts allows for the creation of a unique play experience each time a child participates. The size of playground blocks encourages collaboration. And finally, the concept requires Play Workers to supervise the play experience. We need a game-changing shift in the mindset of what our children need to succeed. The challenges are great, but we should must remember not to back off of the BEST ways to provide a creativity ground, a cooperation ground, a development ground for our kids. I believe this will be the type of innovation that brings back a reinvigorated conversation, and commitment to the built environment will reshape childhood to the days we all remember.

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 31, 2008, 2:30pm

Hara Estroff Marano: 

If I get to live my life over again, I'd like to come back as a student at the Redeemer School Joe describes. In the meantime, the discussion has identified many fronts on which change can and should be implemented. I'd like to emphasize one of them that perhaps has not been given much weight (if you excuse the pun). We insiders are very knowledgeable about the benefits of play. But one of the major reasons schools have been able to get away with eliminating recess and play is that parents have no clear understanding that play has any benefits other than pleasure. There has been very minimal parental response, let alone protest, over many of the changes at schools with regard to activity. In order for change at many other levels, it is essential that parents understand the value of play. For this there needs to be a large public education campaign about the value of play. Against this backdrop, it will be much easier to implement many of the policy and program suggestions aired in this discussion.

Lynne Vaughan Senior Vice President and Chief Innovation Officer YMCA of the USA

Posted July 31, 2008, 1:45pm

Lynne Vaughan: 

A few posts back, Dwayne really hit the nail on the head with his comments about advancing multiple policies and engaging multiple sectors. We, at the YMCA, also believe this strategy is the key to gaining sustainable results. To help facilitate cross-sectoral approaches, YMCA of the USA has been working on the development of a community assessment tool that measures opportunities for physical activity and healthy eating in areas that impact an individual’s daily life (Charlene mentioned this in a previous posting). We created this tool with support from the CDC and in partnership with Stanford University School of Medicine, Harvard School of Public Health, and St. Louis University. The assessment tool is intended for schools, businesses, community-based organizations, and governmental entities and is structured to ensure a consensus-driven, collaborative approach. This tool is no cure-all, but we believe it has the opportunity to stimulate dialogue, action, and evaluation across sectors.

Kevin Jeffrey Deputy Commissioner for Public Programs New York City Parks and Recreation Department

Posted July 31, 2008, 12:47pm

Kevin Jeffrey: 

Another example of municipal innovation is the Swim to Safety program. As part of the Department of Education’s recent fitness agenda, Parks and DOE initiated Swim to Safety in 2005. This collaborative school-year program actually began as an expansion of Parks’ Summer Learn to Swim program with the purpose of providing site alternatives to in-school activity while supporting physical education in school. Briefly, the program brings elementary school students into Parks recreation centers and provides water safety instructors who teach students basic aquatic skills and essential swimming and in-water survival techniques over a ten-week course that occurs within the school day. Students travel to and from Parks recreation centers as a group once a week, and participants are also automatically enrolled as members in Parks recreation centers at no cost. Note: (Membership in Parks recreation centers is free to all youth aged 17 and under.) In addition to the primary benefit of saving children’s lives, achieving competency in the water enhances their enjoyment of aquatic activities, provides a means to improve their overall fitness, and builds self-confidence through mastery of a life skill.

We have had some success in reincorporating a school day fitness program, despite some of the infrastructure and budget challenges faced by city agencies, by purposefully designing the curricula in concert with the YMCA and other premier providers of aquatic programming so that any similar service providers with a funding stream can replicate this program.

Kevin Jeffrey Deputy Commissioner for Public Programs New York City Parks and Recreation Department

Posted July 31, 2008, 12:45pm

Kevin Jeffrey: 

The link between education departments and the prioritization of physical education seems to be a recurring theme in both the policy development and the implementation sides of our conversation.  The importance of breaking down the institutional barriers that sometimes prevent agencies from working together toward the general public good cannot be overstated.  One example of how this is being done, which also speaks to your comment, Joe, regarding a nationwide trend of abandoning playgrounds, is what we have begun to accomplish in New York City.
 
Darell mentioned yesterday New York City’s expanded playground access as an example of a municipal policy change regarding the opening of city schoolyards. This policy change is part of  an ambitious, visionary, yet practical plan called PlaNYC. Adopted as a Mayoral priority, PlaNYC ‘s goal is to make New York City America’s first “sustainable” city by the year 2030.

A large component of PlaNYC is the creation of more open space, ensuring that all residents live within a 10-minute walk of a city park.
 
Under PlaNYC, 290 schoolyards in underserved neighborhoods will be open and accessible after school, on weekends, and during school breaks. Millions of dollars have been dedicated for playground improvements, and to date, 69 playgrounds have been opened under this program.

Parks, in collaboration with the NYC Department of Education (DOE) and the Trust for Public Land will transform the remaining 221 schoolyards into model community parks through a participatory design process that will include children, parents and teachers in the planning. Parks will utilize its design expertise and incorporate current technology that promotes imaginative play, while leaving room for traditional recreation.

Richard Louv Author Last Child in the Woods

Posted July 31, 2008, 12:42pm

Richard Louv: 

This has been a terrific discussion. Clearly, the causes and solutions are complex, and there are no magic bullets. But as the society moves toward solutions, it would be useful to focus on nature experience at two levels. First we need more research on the impact of the natural world on child development and health. Second, growing public concern about the disconnect between children and nature can serve as a strong organizing tool to increase public awareness and action regarding child obesity. To many adults, particularly those who are overweight themselves, the topic of child obesity, per se, may be an abstract and uncomfortable issue to confront. Progress may be especially slow in states where the majority of the adult populations are overweight or obese. But people of all sizes and political points of view can relate to the fact that so many children are missing out on the gifts of nature.

Therefore, the children and nature movement has a special utility on the child obesity front. As Joe Frost said earlier, the nature deficit is an emotionally charged issue–in a positive way. People feel it viscerally. Their concern transcends political and religious boundaries. As a consequence, bills are being passed or considered, including the federal No Child Left Inside Act. In the U.S. and Canada, the Children and Nature Network has identified over 50 state and regional campaigns, community-based, multi-sector collaboratives. In addition, tools for more direct cultural change are emerging. For example, nature clubs are being launched by families–on their own, without waiting for funding or formal programs. In inner cities, suburbs and rural areas, families can turn to other families to arrange for weekend hikes and other nature adventures, and feel safer doing so. What if such family networks spread as quickly as Neighborhood Watch programs did in the 1970’s? Two weeks ago, the Today Show produced a segment on the idea, which can be viewed at childrenandnature.org–along with a map of the regional campaigns and other information. A focus on childhood obesity is already a part of this movement. With new partnerships, the potential is even greater.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
MODERATOR

Posted July 31, 2008, 12:36pm

Joe L. Frost: 

Charlene wisely identified the need for physical education in schools. Children need both organized activity and free, spontaneous play. The research program at Redeemer School in Austin has operated continuously since 1976 with the assistance of University of Texas faculty and graduate students. The school yards were transformed from a barren landscape with traditional equipment to three extensively equipped playgrounds providing graduated physical challenges. These have been dismantled and replaced regularly to study provisions for broad developmental needs (see The Developmental Benefits of Playgrounds by the Association for Childhood Education International). The grounds include a schoolyard habitat certified by the National Wildlife Federation, wet-lands, green houses and gardens, all integrated with the three playgrounds. Food from the gardens is donated by the children to Meals on Wheels and served in the school cafeteria. The 500+ Anglo, Asian, Hispanic, and African American children, ages 2 - 14, live in predominantly middle class homes.

The Redeemer children participate in daily PE and recess. There are few restrictions on free, spontaneous play. Contact games, chase, rough and tumble, tag, dodge ball, and using increasingly challenging play structures at full speed in these games is allowed. The obesity rate is less than five percent in a state where the rate is 19 percent. Some of the obese are new students, usually with obese parents. The habitats and gardens allow exploration, productive work, hands-on learning, and the advantages that Rich Louv discussed yesterday. They are integrated with indoor curricula and complement the challenging playground apparatus. Playgrounds and natural areas offer common and unique benefits. Playground equipment, wisely selected, is essential for developing strength, coordination, balance, spatial perspectives, flexibility, brachiation skills, and overall fitness. Fitness, not fear, is essential to avoiding injury on challenging apparatus and in contact games. Medical attention has been needed for one simple fracture per decade and two loose teeth. The school is private and does not participate in high stakes testing (No Child Left Behind) but maintains a national assessment program with scores among the highest in the nation. This school is basically free of several constraints that diminish children's fitness and contribute to obesity - decline of recess and PE, high stakes testing, over regulation, and paranoid adults. It works!

Joxel Garcia President Ponce School of Medicine

Posted July 31, 2008, 12:30pm

Joxel Garcia: 

A couple of years ago I was presented with some data that suggested just that, the incidence of pre-diabetes and diabetes in youth will probably decrease the life expectancy on that population subset. Another issue is the idle time from the end of the school day to the time that parents or care shows up. High risk time for TV, junk food, internet. Nevertheless, an opportunity time for physical activity.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 31, 2008, 10:56am

Darell Hammond: 

I couldn’t agree more, Dwayne, that grassroots advocacy is needed to create a sense of urgency and accountability. Three weeks before Hurricane Katrina I was contacted about a plan to cut recess in New Orleans’ schools. The school district was able to remove recess all together, as the superintendent stated “without consequence”, because only three parents showed up to voice their opposition. What is needed is 300 parents fighting for a child’s need for time outdoors, engaged with their peers, reaping the benefits of unstructured play. We need to change passive agreement about the benefits of play and physical activity for children into active engagement with communities raising their civic voices together.

Charlene R. Burgeson Executive Director National Association for Sport and Physical Education

Posted July 31, 2008, 10:33am

Charlene R. Burgeson: 

The Partnership for Play Every Day wants to see all communities gather key stakeholders to create a community environment that encourages play. Through the partnership’s efforts, the Play Every Day Act has been introduced in the Senate (S651; by Harkin) and House (HR2045; by Udall) See pdf. The two main components of the bill are development of a Community Play Index for assessment and planning (which is already well underway thanks to YMCA of the USA; one of the Partnership conveners) and funding for models of Communities of Play ($250,000 per community for three communities). $250K won’t do the job in a community, but this is a good example of the roles for both federal and local–seed money from the federal government requiring action and additional funding from the local community. This is the type of bill that could be introduced by state legislatures as well.

Dwayne Proctor Childhood Obesity Team Leader and Senior Program Officer Robert Wood Johnson Foundation

Posted July 31, 2008, 10:07am

Dwayne Proctor: 

I have heard that today's generation of young people may be the first American generation to live sicker and die younger than the previous generation. These stark words make reversing the childhood obesity epidemic a top priority for all of us. If we want our government to do the right thing, then we need to draw their attention to these issues and work with them to make our communities and schools places where affordable healthy foods and safe places for children to play and exercise are commonplace. We need to have the evidence of what works to prevent childhood obesity. We need to demonstrate how environmental changes can yield healthier children. And to paraphrase Douglass, we need to "advocate, advocate, advocate" –in the streets and in the legislative houses–to give our leaders the popular support and push to champion our cause. RWJF supports programs that hit on all of these points. Government at all levels needs to know better how policies and resources that affect farm production, transportation, maternal and childcare, education, employment, school foods, public safety, land use, school siting, zoning, sprawl, etc., all impact our childrens' ability to lead healthy lives. It's not one policy, it's policies. It's not just federal, state and local policies either. It's also the policies of our corporations, community-based organizations, religious institutions, health care centers and all others who influence our families' ability to have the opportunity to live healthy lives.

James O. Hill Professor of Pediatrics and Medicine University of Colorado at Denver

Posted July 31, 2008, 9:30am

James O. Hill : 

In response to Joe's challenge I want to tell you about our strategy in Colorado. First we are committed to trying to get the many groups working in this space to have some coordinated efforts. To do this we created a new nonprofit Livewell Colorado. This organization has received substantial funding from the Kaiser Permanente Foundation. Livewell will set the state agenda and priorities for addressing obesity in Colorado. We will welcome and provide funding for organizations to accomplish the work. We will work largely with communities across the state. We will work toward both local and state policies to help achieve goals. Livewell will likely be fully active in the fall of 2008. I invite all of your organizations to contact us about working with us in Colorado.

Richard Louv Author Last Child in the Woods

Posted July 31, 2008, 9:18am

Richard Louv: 

On a positive note, real estate developers are taking notice of a potential new market. Last year, Clint Eastwood sponsored a gathering in Carmel of some of California’s largest developers to consider the issues raised in the book, and to discuss how they can design, build, and market future communities that connect children to nature. Among the ideas proposed by these and other developers: leave some land and native habitat in place (that’s a good start); employ green design principles; incorporate nature trails and natural waterways; throw out or reduce the conventional covenants and restrictions that discourage or prohibit natural play and rewrite the rules to encourage it; allow kids to build forts and tree houses or plant gardens; and create small, on-site nature centers. In such a discussion, it’s a short conceptual leap from excusing more sprawl by giving it a green patina to redeveloping decayed portions of decaying urban and suburban neighborhoods, into eco-communities where nature would be an essential strand in the fabric of daily life. The fact that developers, builders, and real estate marketers—at least the ones I met with—would approach this challenge with such apparently heartfelt enthusiasm was encouraging. We’ll see how serious they are.

Richard Louv Author Last Child in the Woods

Posted July 31, 2008, 9:15am

Richard Louv: 

While considering the environments that shape kids, we need to review the connection between child obesity and fear of litigation and the legal structures of both public and private governments. As a powerful deterrent to natural play, fear of liability ranks right behind the bogeyman. Public government restricts children’s access to nature and independent play. So does private government. Most housing tracts, condos and planned communities constructed in the past two to three decades are controlled by strict covenants that discourage or ban the kind of outdoor play many of us enjoyed as children. These private regulations are not enforced evenly, but in some communities, young people who try to recreate their parents' childhoods may face misdemeanor charges or see their parents sued. (One woman told me that her community association banned chalk-drawing on the sidewalks.) Just try to put up a basketball hoop in some of these neighborhoods, let alone let the kids build a tree house or a fort. Regarding the issue of choice, in areas such as Southern California and much of Florida–as well as the suburban rings around most cities in the U.S.–there isn’t much of a choice anymore.

One goal should be a nationwide review of public laws and private rules that restrict play. Also, as Common Good has recommended, we need to establish public risk commissions to examine areas of our lives that have been radically changed by litigation. We should encourage lawyers, insurance agencies and the public to embrace the concept of comparative risk as a legal and social standard. (Yes, there is risk out there, but there are also huge risks to physical and mental health when we raise a generation of children under protective house arrest.) In the new edition of “Last Child in the Woods,” I report an provocative idea suggested by a California environmental lawyer: Create a Leave No Child Inside Legal Defense Fund that would, using pro bono attorneys, help families and organizations fight egregious lawsuits that restrict children’s play and bring media attention to the issues.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
MODERATOR

Posted July 31, 2008, 9:00am

Joe L. Frost: 

As we move into day three for proposing program solutions and steps for local, state, and national coordination, we can focus on factors that underpin the obesity epidemic–tech play, excessive safety standards, fear of lawsuits, abandonment of nature, risk aversion, safety fears, neutered neighborhoods, etc. We appear to be in agreement that no single approach will be sufficient. Diet and nutrition will be the subject of our Obesity Part 2 discussion in a future week.

What is the appropriate role of government? Do we need government mandates? What steps should state and national law makers consider? What can local groups do to redevelop their neighborhoods and maximize physical activity? What are the appropriate roles of local governments? courts? schools? park districts? health professionals? We have been quite successful in engineering the abandonment of outdoor play and learning environments. How can we reverse this trend?

DAY THREE

William H. Dietz Director of the Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention

Posted July 31, 2008, 8:25am

William H. Dietz: 

One of the most interesting developments is the amount of activity that has begun around the problem of obesity, particularly childhood obesity. For example, the School Health Policies and Programs Survey released in October 2007 by CDC's Division of Adolescent and School Health showed impressive improvements in the choices and quality of the foods available in schools. These changes, as well as a wide awareness of the risks of obesity likely contributed to the plateau in obesity prevalence among children and adolescents. Several weeks ago, we hosted a conference of communities that had developed obesity initiatives. Although the time frame for applications was only 2 weeks, and there was little advance notice, we received over 70 applications for 25 slots. We believe there are at least as many communities that did not apply that have similar efforts underway. The communities that came were all doing innovative programs that attempt to address a variety of multi-sectoral factors that could reduce obesity. Many of these community efforts were funded by local foundations, and a concern that these communities shared was how to sustain their programs. External funding distinguished these obesity programs from what happened with tobacco. In the early years of the tobacco wars, states and communities took the initiative to focus on policy changes, such as excluding smokers from public buildings. The decline in per capita cigarette consumption was driven by a variety of policy initiatives that began well before the infusion of dollars from the tobacco settlement. In contrast to the early years of tobacco control, much of the focus on obesity that we heard from the communities that attended our conference appeared to be more focused on programmatic interventions, based on an individual behavior change paradigm. I think this approach is vulnerable to ongoing external funding, in contrast to policy and environmental change which is more likely to be sustained. In the discussions that have occurred in this forum, there has been a lot of attention to policy and environmental change that I do not believe is reflected in the broader public discussion of obesity. If that is correct, how can we effectively we shift the discussion from behavior change to policy change?

Charlene R. Burgeson Executive Director National Association for Sport and Physical Education

Posted July 31, 2008, 7:58am

Charlene R. Burgeson: 

There was a request for sharing information about programs. NASPE’s mission goes beyond school physical education programs, but we do believe that physically educating individuals (through physical education) is the foundation to an active lifestyle. Since almost all children attend school, and almost all schools offer some amount of physical education, the foundation is in place to utilize physical education as a key strategy for increasing physical activity and decreasing overweight and obesity. While there are a variety of challenges associated with schools providing daily physical education (150+ minutes/week for ES; 225+ minutes/week for MS and HS), many of the challenges are created or exacerbated by inappropriate or ineffective physical education programs. NASPE’s motto is “quality physical education.” When quality physical education is provided, administrators and parents/community understand its value and rally behind it – they want more of it for their children. However, too many teachers are providing bad physical education (e.g., only “traditional” sports, kids waiting around for a turn, same goals/choices/instruction for all kids without regard to their current abilities/fitness, etc.). Why in the world would a community ask for more of a bad thing? NASPE is trying like crazy to help all physical education programs become high quality. We need to set the bar high and demonstrate what is possible; thus, the NASPE STARS program. We need to train teachers on how to teach knowledge and skills (the “education” part of physical education) while utilizing instructional practices that keep students moderate to vigorously active the majority of class time; thus, the Physical Best program. We need to help teachers use technology to increase activity time, motivation, and personal responsibility/goal-setting; thus, the EnergyNow! program. And perhaps most importantly, we need to ensure that there are goals and objectives (not just “roll-out the ball and play”) and accountability for creating physically educated and active students; thus, our new science-based, nationally-tested accountability tools. What do physical education teachers need to provide what our students truly need–time (with students), tools, and training. These are all in short supply. They require funding–which of course is always a challenge, but, we must invest in proactive solutions such as physical education. As I know we all believe, we must invest in prevention.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
MODERATOR

Posted July 30, 2008, 6:00pm

Joe L. Frost: 

We are seeing a growing number of promising national programs for combating obesity. The Robert Wood Johnson Foundation programs (Dwayne) are examples of the national support and initiatives in progress. School recess and school and park playgrounds are among the historically valuable antidotes for obesity, yet they are being abandoned and children are restricted from traditional, active play and games.

The International Play Association/USA reported that 40 percent of schools are deleting or considering reducing recess and Hara reported in Psychology Today that 40,000 schools no longer have recess. School administrators frequently cite lawsuits as the primary reason for this dilemma but Texas has tort immunity, yet schools are reducing recess (and physical education), and educators point to pressures for high test scores on selected subjects. Let’s address those and other hurdles as we move into day three.

James O. Hill Professor of Pediatrics and Medicine University of Colorado at Denver

Posted July 30, 2008, 5:17pm

James O. Hill : 

In Denver we have brought together some of the leaders in the community through the Metro Denver Health and Wellness Commission. One of the projects we are working on is a pilot "Lean and Green School". We have funding from local foundations to create a model school for health, wellness and sustainability. We are now bringing in experts in different areas to provide ideas for this school both from the health side and the sustainability side. The idea is to create a school where healthy eating and physical activity occur as a part of just going to school. We also want to link the school to the community through restaurants, grocery stores, parks, etc.. This is just in the planning stage, but has already created a lot of interest. If successful, we believe aspects of this school would be copied without the need for any specific policy changes. All in all, we need some concrete examples of how some of the ideas we have been talking about could work. I think that we need to create more "success models" where we show what is possible–whether that is a school, worksite, or community. It becomes a visible model for others to see and follow.

Joxel Garcia President Ponce School of Medicine

Posted July 30, 2008, 5:15pm

Joxel Garcia: 

I agree with the concept of environmental change. As an example of projects that could help increase physical activity I would mention some examples:

First: the Double Dutch Duel State Jump-Off which was hold in Jefferson City in Missouri. It brings the issue of competition and training at the same time that brings the communities to work together. It succeeded in using an inexpensive tool (rope) to bring kids and communities together and create a systematic approach to tackle lack of physical activity; plus it brings a sense of continuity. The kids need to feel that it is important, as well as fun but they need to have continuity. I believe that although we still need data about it outcomes, simple things like this are the ones that create change.

Another story but from abroad: In Colombia the crime in several cities was very high. To tackle the issue the city changed the sidewalks to allow for bicycles, walking and jogging. They added more community vigilance. That brought crime down but fitness activity up.

Also here, my children and their friends joined the Presidential Champion program in their school. And they not only participated but challenged each other and their friends. That was an excellent tool to get them to understand the issue and their benefits.

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 30, 2008, 5:00pm

Hara Estroff Marano: 

This post will probably appear as a non sequitur to the above conversation but my observations of the day are relevant to the topic. I just happened to have spent most of the day with a CNN crew interviewing me about the issues I raise in my newest book (A Nation of Wimps: The High Cost of Invasive Parenting). At the end of the interview, we walked down to the local playground (I live in New York City) where my sons played when little and when not so little. The change in the playground is remarkable. There were, today, many little ones; none appeared to be older than 3, most with their nannies, a few with mothers. These little ones were having a grand old time, moving about, sliding down the slide, even a few playing with each other. But what I didn't see was anyone older than, say, 3, because there is no longer any equipment in the playground to attract them. Monkey bars are gone. Tall structures are gone. It goes without saying that seesaws are gone. So is that large, circular spinning platform—I have no idea what it's called—that required a little agility to jump on and off. If we want to encourage activity, we definitely need to outfit playgrounds with equipment that appeals to more than toddlers. What we have now leaves nothing for the older kids. And the rise of organized sports, which I see as the professionalization of activity, leaves out all casual activity and play; it requires a commitment that many can't or don't want to make. What regularly accessible activities are there for an 8-year-old or 10-year-old who is not a committed athlete? We are actively turning many children off activity right now.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 30, 2008, 4:32pm

Darell Hammond: 

Another concrete example of a policy change on a municipal level is the opening of schoolyards in places like New York City and New Orleans to community members after school and on weekends. The rationale was to provide playgrounds within walking distance of children in those communities where access to public parks and playgrounds isn’t sufficient. Dwayne’s point that multiple sectors and other aspects of the built environment need to support this access is well-taken. If the sidewalks and streets leading to the open schoolyards aren’t safe, perceived as safe, or walkable, then access is still a problem, even if the schoolyards remain open 24 hours a day, every day. Additionally, making sure that the schoolyards are designed to attract and encourage active use by community children is an important factor. A policy decision like this requires input and support from decision makers in schools, city planning departments, parks departments, public works departments, and even health departments.

Dwayne Proctor Childhood Obesity Team Leader and Senior Program Officer Robert Wood Johnson Foundation

Posted July 30, 2008, 3:01pm

Dwayne Proctor: 

I’m with you Lynn, so let’s play this out further. I’m a firm believer that environmental changes could encourage outdoor activities like walking. We need sidewalks to encourage walking. If the sidewalks are wide enough groups of children could walk side by side comfortably and they may feel less threatened, as there is “safety in numbers.” The experts tell me the sidewalks should also have a wide enough “green strip” (grass) to give distance between passing cars and walkers, and bicycle lanes for cyclists. Crossing guards or a public safety presence could also encourage a feeling of it’s okay to be outside. In each case these changes require multiple sectors to come together to do their part. For more information on design aspects that encourage healthy behaviors feel free to consult Active Living By Design.

Jean Wiecha Senior Research Scientist Harvard School of Public Health

Posted July 30, 2008, 2:43pm

Jean Wiecha: 

Joe asked how programs can be expanded and coordinated across the nation. Although implementation is always a local issue, the broad policy context in which organizations decide what they're implementing is something we can influence on a broad scale. Regulation, legislation, and corporate/organizational policies are critical here. Bill Dietz raised up the importance of the transportation bills in influencing physical activity–when communities across the country are redesigning roadways according to federal funding guidelines that promote physical activity, then we have a high level of coordination and congruence. We can expect other critical pieces of federal legislation to coordinate change as well. Legislation that governs child nutrition programs is another great example–it currently sets the norms for food served in a vast number of programs (school and daycare meals, WIC vouchers etc). Since programs need to comply with regulations to get their reimbursements, they will change what they serve if the regulations change. Of course, ensuring that the regulations change to promote science-based health promotion strategies is a coordination challenge in and of itself. Outside of the legislative realm, organizations and corporations with multiple branches have great potential to put policies in place that encourage healthy foods at meetings, physical activity breaks, etc.

Sheila Franklin Executive Director National Coalition for Promoting Physical Activity

Posted July 30, 2008, 2:41pm

Sheila Franklin: 

This has truly been a fascinating discussion. There are so many ways to approach the problem. I do think when dealing with children that it is important to let them have a say in what they are doing. I was a recreation programmer for 8 years at an Illinois park district and I tried very hard to do this. I talked to kids and found out what they wanted; read all kinds of pieces that discussed trends, etc., so that I could offer activities that they wanted to do. I think that adequate safe space for activity is paramount (and lacking in many areas of the country). I don’t think this always has to mean a playground–in fact, I actually wonder if playground use has gone down over the years even at some of the more innovative ones (based purely on anecdotal evidence). I do think it means areas to let kids be creative–use their imaginations, similar to what kids did when I was a kid (dating myself here!)–we played for hours on the “prairie” in my city of Chicago neighborhood…the “prairie” was, in reality, an empty lot but not in our minds! One might counter that kids of today are not used to doing this–their entertainment tends to be created for them–as in video games, etc. however I think this is a culture that needs to be changed. We have already discussed the transportation bill and how applicable it is towards physical activity. I think another federal government program that is overlooked in terms of physical activity (and one that does indeed create safe spaces to play!) is the Land and Water Conservation fund. Certainly the name of the bill would not immediately bring physical activity to one’s mind, but that fund has provided funding for over 41,000 local and state projects in 98% of America’s counties (source: National Recreation and Park Association). These funds are used to obtain open space and/or develop outdoor recreation facilities including athletic fields, trails, tennis courts, playgrounds, etc. This is also a fund that has to be fought for on a yearly basis and one that the current administration has called for termination of the last several years, not to mention that it has never been close to funded at what it is authorized to be.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 30, 2008, 2:01pm

Darell Hammond: 

When we look at broader environmental and policy implications for obesity prevention, public school priorities, like Charlene mentioned this morning regarding physical education, should be considered. A school district in Illinois recently passed a billion dollar bond issue that didn’t build in any money for infrastructure to support play and recess. Individual school administrators and teachers are now trying to raise money for playgrounds. As Charlene said, school administrators and teachers seem to realize the importance of incorporating physical activity into the school culture, but what are the real priorities when it comes to budgeting?

Joe L. Frost Parker Centennial Professor Emeritus University of Texas

Posted July 30, 2008, 1:59pm

Joe L. Frost: 

I’d like to take the liberty to mention Richard Louv’s influence. In 2007 a children and nature group, inspired by his work, was formed in Austin (others are active around the country). The prevailing objective, “no child left inside,” is to form wild places for kids to get back to nature. Wild places are children's oldest playgrounds with a centuries-old record of preventing obesity, but have been abandoned in recent years to favor indoor sedentary play. Now dozens of national, state and local agencies and organizations collaborate in pursuing nature-related programs. For example, the National Wildlife Federation helps schools and community groups develop natural habitats for play and learning in schools, parks, and other private and public places. These are complementary to challenging playgrounds. This is an emotionally charged, expansive, coordinated program for getting kids off the couch.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
MODERATOR

Posted July 30, 2008, 1:53pm

Joe L. Frost: 

Hara raises intriguing obesity-related issues. The seemingly simple issue of risk carries multiple implications. Stuart points to the critical but immensely complex problems of linking physically charged exploration to play outcomes. This means finding ways to reduce the adult motivated negative consequences of risk aversion. Risky play was normal and accepted for centuries. Now aversion to risk influences excessive safety standards, lawsuits, sedentary behavior, deletion of recess, and results in obesity and poor fitness. Eventually we see in observational studies at our research site that over time obesity itself becomes a cause of play deprivation and further promotes obesity. Obesity is typically a creeping, growing malady, turning back on itself in circular fashion over time.

Collectively we are identifying promising programs and research for creating novel approaches. Keep them coming. For example, Charlene noted the NASPE initiatives for physical education. Darell identified several promising school-based programs. Jean and others wisely point out that we need a coherent national policy for coordinating programs. How can programs can be expanded and coordinated across the nation?

Stuart L. Brown President National Institute for Play

Posted July 30, 2008, 1:50pm

Stuart L. Brown: 

My sense of it is that it must align with our basic human design biologically and socially. Play provides the glue that can bind some of the best features of our biologic heritage and our social needs in a lifelong process species-wide. And play is driven from within, is voluntarily participated in because it appeals, etc. It also fosters, particularly in youth, active physical involvement with the environment. Openness to change, adaptive capabilities, optimism, empathy and altruism, and physically charged exploration can be linked to long-term outcomes of authentic play behavior. The fun that is the emotional component provides continuing motivation. So infusing each of the projected “solutions” to the immensely complex problems associated with obesity with elements of play will propel them more effectively. This means that a new climate of understanding about the union of risk with positive outcomes, (a fundamental aspect of vigorous play behavior which can be provided credibility via current evidence) versus the negative consequences of behavior that is motivated by adults, not from within the vitality of the kids, etc.… should be an integral aspect of the overall strategy for remediation.

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 30, 2008, 1:37pm

Hara Estroff Marano: 

The concern about magic bullets is well-founded. We didn't get into this obesity predicament overnight and by only one route, and we will not solve it by one action or one magic bullet. And that is the reason I hope the American Academy of Pediatrics reconsiders or overrides its recent recommendations. Concerned about America's "epidemic of obesity," and even recognizing that physical activity has been cut out of schools, the group went ahead and issued strong recommendations about testing for and treating high lipid levels in kids. The goal is to prescribe the cholesterol-lowering drugs known as statins to reduce the risk of cardiovascular disease brought on by childhood obesity. The pediatricians are thus recommending lifetime use of statins, although their long-term effects in children are unknown. Remember, they are talking about children age 8 and up, for whom lifetime patterns of eating or activity or anything else have not yet been established. How much more appropriate it would have been to take the focus off the magic bullet and for the pediatricians to use their power to go into the schools and boards of education and lobby for programs of physical activity. So already one major opportunity has been missed, although I hope it can soon be rectified. Perhaps all of us can help educate the pediatricians about the value of fostering healthy activity levels in the nation's children.

Richard Louv Author Last Child in the Woods

Posted July 30, 2008, 1:33pm

Richard Louv: 

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 part of an overall solution, but we do need a wider array of approaches–including a greater focus on nature experience, and better message framing. Last year, I was honored to share a byline with Howard Frumkin, Director of the National Center for Environmental Health /Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention. The article pointed to research that has linked nature experience and "green exercise" to surprisingly broad and special benefits, including more likelihood of physical activity, greater use of the imagination and the senses, enhanced ability to focus, stress reduction, and cognitive advantages. Researchers in England and Sweden have found that joggers who exercise in a natural green setting with trees, foliage, and landscape views, feel more restored, and less anxious, angry, and depressed than people who burn the same amount of calories in gyms or other built settings. Green exercise not only adds value to physical movement, it's less expensive than joining a gym. As Dr. Frumkin says, “there is still much we need to learn…But we know enough to act.” During the past three years, we’ve seen a burgeoning national movement to get kids into nature. Some of the actions involve urban design and architecture, changes in government policy, and organized programs. In some cases, families are acting independently. For example, one of the approaches that the Children & Nature Network hopes to encourage involves the spread of home-grown nature clubs for families–but more about that in a later post.

Lynne Vaughan Senior Vice President and Chief Innovation Officer YMCA of the USA

Posted July 30, 2008, 1:28pm

Lynne Vaughan: 

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.”

Dwayne Proctor Childhood Obesity Team Leader and Senior Program Officer Robert Wood Johnson Foundation

Posted July 30, 2008, 12:37pm

Dwayne Proctor: 

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.

Kevin Jeffrey Deputy Commissioner for Public Programs New York City Parks and Recreation Department

Posted July 30, 2008, 11:08am

Kevin Jeffrey: 

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.

William H. Dietz Director of the Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention

Posted July 30, 2008, 10:48am

William H. Dietz: 

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.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 30, 2008, 10:38am

Darell Hammond: 

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.

Charlene R. Burgeson Executive Director National Association for Sport and Physical Education

Posted July 30, 2008, 10:10am

Charlene R. Burgeson: 

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.

Jean Wiecha Senior Research Scientist Harvard School of Public Health

Posted July 30, 2008, 10:04am

Jean Wiecha: 

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.

James O. Hill Professor of Pediatrics and Medicine University of Colorado at Denver

Posted July 30, 2008, 9:56am

James O. Hill : 

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.

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 30, 2008, 9:50am

Hara Estroff Marano: 

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.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
MODERATOR

Posted July 30, 2008, 9:40am

Joe L. Frost: 

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?

DAY TWO

Lynne Vaughan Senior Vice President and Chief Innovation Officer YMCA of the USA

Posted July 29, 2008, 10:14pm

Lynne Vaughan: 

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.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
MODERATOR

Posted July 29, 2008, 6:04pm

Joe L. Frost: 

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?

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 29, 2008, 5:48pm

Hara Estroff Marano: 

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.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 29, 2008, 5:31pm

Darell Hammond: 

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.

Joxel Garcia President Ponce School of Medicine

Posted July 29, 2008, 5:10pm

Joxel Garcia: 

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.”

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 29, 2008, 3:42pm

Darell Hammond: 

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.

James O. Hill Professor of Pediatrics and Medicine University of Colorado at Denver

Posted July 29, 2008, 3:33pm

James O. Hill : 

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.

Kevin Jeffrey Deputy Commissioner for Public Programs New York City Parks and Recreation Department

Posted July 29, 2008, 3:11pm

Kevin Jeffrey: 

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.

Lynne Vaughan Senior Vice President and Chief Innovation Officer YMCA of the USA

Posted July 29, 2008, 2:40pm

Lynne Vaughan: 

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?

Jean Wiecha Senior Research Scientist Harvard School of Public Health

Posted July 29, 2008, 2:30pm

Jean Wiecha: 

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.

James O. Hill Professor of Pediatrics and Medicine University of Colorado at Denver

Posted July 29, 2008, 1:12pm

James O. Hill : 

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.

Dwayne Proctor Childhood Obesity Team Leader and Senior Program Officer Robert Wood Johnson Foundation

Posted July 29, 2008, 12:35pm

Dwayne Proctor: 

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.

Kevin Jeffrey Deputy Commissioner for Public Programs New York City Parks and Recreation Department

Posted July 29, 2008, 12:31pm

Kevin Jeffrey: 

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.

Sheila Franklin Executive Director National Coalition for Promoting Physical Activity

Posted July 29, 2008, 12:27pm

Sheila Franklin: 

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.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 29, 2008, 12:03pm

Darell Hammond: 

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.

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 29, 2008, 11:52am

Hara Estroff Marano: 

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.

Jean Wiecha Senior Research Scientist Harvard School of Public Health

Posted July 29, 2008, 11:46am

Jean Wiecha: 

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.

William H. Dietz Director of the Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention

Posted July 29, 2008, 11:31am

William H. Dietz: 

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.

 

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 29, 2008, 11:28am

Hara Estroff Marano: 

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.

Jean Wiecha Senior Research Scientist Harvard School of Public Health

Posted July 29, 2008, 11:24am

Jean Wiecha: 

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.

Elliot Pellman Co-Founder and Medical Director ProHEALTH Care Associates

Posted July 29, 2008, 11:19am

Elliot Pellman: 

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.

Dwayne Proctor Childhood Obesity Team Leader and Senior Program Officer Robert Wood Johnson Foundation

Posted July 29, 2008, 11:15am

Dwayne Proctor: 

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.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 29, 2008, 10:53am

Darell Hammond: 

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.

James O. Hill Professor of Pediatrics and Medicine University of Colorado at Denver

Posted July 29, 2008, 10:51am

James O. Hill : 

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.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
MODERATOR

Posted July 29, 2008, 10:39am

Joe L. Frost: 

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?

Stuart L. Brown President National Institute for Play

Posted July 29, 2008, 10:37am

Stuart L. Brown: 

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.

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 29, 2008, 10:26am

Hara Estroff Marano: 

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.

Kevin Jeffrey Deputy Commissioner for Public Programs New York City Parks and Recreation Department

Posted July 29, 2008, 10:17am

Kevin Jeffrey: 

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.

Elliot Pellman Co-Founder and Medical Director ProHEALTH Care Associates

Posted July 29, 2008, 10:09am

Elliot Pellman: 

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.

Darell Hammond CEO & Co-Founder KaBOOM!

Posted July 29, 2008, 9:58am

Darell Hammond: 

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?

James O. Hill Professor of Pediatrics and Medicine University of Colorado at Denver

Posted July 29, 2008, 9:42am

James O. Hill : 

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.

Sheila Franklin Executive Director National Coalition for Promoting Physical Activity

Posted July 29, 2008, 9:37am

Sheila Franklin: 

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.

Hara Estroff Marano Editor-at-Large Psychology Today

Posted July 29, 2008, 9:27am

Hara Estroff Marano: 

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.

Joe L. Frost Parker Centennial Professor Emeritus University of Texas
MODERATOR

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?

Participating

Stuart L. Brown National Institute for Play
Charlene R. Burgeson National Association for Sport and Physical Education
William H. Dietz Centers for Disease Control and Prevention
Sheila Franklin National Coalition for Promoting Physical Activity
Joe L. Frost University of Texas
Joxel Garcia Ponce School of Medicine
Darell Hammond KaBOOM!
James O. Hill University of Colorado at Denver
Kevin Jeffrey New York City Parks and Recreation Department
Lee M. Kaplan MGH Weight Center and MGH Obesity Research Center
Richard Louv Last Child in the Woods
Hara Estroff Marano Psychology Today
Elliot Pellman ProHEALTH Care Associates
Dwayne Proctor Robert Wood Johnson Foundation
Lynne Vaughan YMCA of the USA
Jean Wiecha Harvard School of Public Health

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Reader Comments

It really is going to take an effort from every possible resource to change the statistics of this problem. It has been noted in this discussion that there aren't just one or two factors that can be changed to make a difference.

On thing I have seen on a local level is that hospitals are becoming more involved and offering classes for obese children who may not be receiving the education at home. There is also a program for teens in the planning stages. They teach healthy eating habits as well as the importance of physical activity each day. These are 8-hour courses for children referred by a physician. Of course children can fall through the cracks on that if they aren't receiving health care to begin with. However, we know that every bit helps, and that the reason we need so many resources is that not just one program can reach everyone on this multi-faceted issue.

On the state level, we have representatives from University of Idaho involved with the University of Colorado, doing research on this. James, I assume that could be the same research you are involved with? I'm so glad to see groups coming together, and to see this public discussion to help with this. How many other states are involved?

It is going to take such a hugely concerted effort to make a change, which I like to think is possible. We publish information on this topic each year in Playground magazine in hopes of helping this cause. An article on this will run in the October issue. I will do whatever I can to help unite for this cause and publish helpful information. Thank you all for opening this discussion in this forum.

-- Shannon Amy Stockwell, Editor, Playground Magazine

This has been a terrific discussion. What I take from it is not just a need to change programs and priorities, but a need for a fundamental shift in values, as Hara and Stuart suggest. We must embrace the uncertainty and risk that attracts children to be physically active, and provide institutional structures to encourage activity--from school programs, to public investment, to legal protections against lawsuits when the inevitable accident occurs.

At Common Good, we're beginning a project to create a "Play Book" which would assert standards for healthy play and activity, and which would have authority that courts would honor if it was broadly endorsed. We hope to work with each of the organizations represented here to develop these standards.

-- Philip Howard

Upcoming See All

  • Risk and Legal Fear in Schools
    With Lenore Skenazy, Frederick Hess, Megan Rosker, Walter Olson, and Nancy McDermott. Start date: June 5

Reader Comments (9)

Add Yours
1. July 29, 2008 9:44 AM

I believe our society has become more sendentary because more and more jobs are less about manual labor and more about sitting in front of a computer. This then translates to less "exercise" during the day and forms patterns of behavior in peoples personal life. It would be interesting to look at trends in fitness as it relates to the type of work that people have done historically and what people are doing now. I would hypothesize that 50 years ago when there were more manual labor jobs vs service jobs, there were less people considered obese.

I would also add the types of food that we eat are geared for a much more busy lifestyle. Processed vs fresh and fast food vs home cooked meals. There has been a big shift in our eating habits. Not to mention the whole concept of SUPER SIZE.

-- David Flanigan
2. July 29, 2008 11:35 AM

There are lots of factors creating the obesity epidemic. It's refreshing to see the panelists pointing to the changing parental perceptions of safety over video games and television as the culprits - if your parents won't let you go outside and play, what else is there to do but play video games and watch TV? You can't blame the symptom. (Some video games, like My Weight Loss Coach, Dance Dance Revolution, Wii Fit, Yourself! Fitness, etc. can actually help get kids - and adults! - off the couch.) For kids, the key seems to be giving kids both the TIME and SPACE to play, and to let at least some of that play be self-directed. There's a deficit of time to play - with recess being cut from schools and homework and after-school activities piling up at early ages. Play becomes less of a priority as activities designed to make kids more "successful" take precedence. There's also a deficit in safe and fun places to play outside the home - playgrounds, fields, parks, etc. We need to address both, through public policy and good, old-fashioned community building, in order to truly beat the childhood obesity epidemic.

-- Annie
3. July 29, 2008 8:47 PM

I have three questions for the participants: 1)Most of the discussion has been devoted to activity levels. What about eating habits? I have heard that Americans ate 1000 more calories a day in 2000 than they did in 1960. Is that true, and if so, what should we do about that? 2)Would someone talk about the economic costs of obesity? I understand that obesity-related diabetes and heart disease are on the rise. Is this true? 3)Who should take the lead in changing activity and eating habits? Should this be a governmental effort? If obesity results in increased health bills, should all Americans pay for the bad habits of some?

-- Dana Miller Ervin
4. July 30, 2008 5:11 AM

I'd like to see the panel talk about concrete changes that might begin to shift the culture of young people towards activity. For example: 1. restoring free play periods at recess, with more things to do in the gym or playground. Letting kids play tag and dodgeball and red rover... 2. Community outreach programs that involve some physical activity (walking around cleaning up litter, repainting hydrants.) 3. Re-introducing the excitement of exploration (letting kids wander off in the neighborhood or woods, as Richard Louv recommends) and the inherent interest of slightly risky activities (high slides, merry-go-rounds).

-- Philip Howard
5. July 30, 2008 4:16 PM

Good afternoon, and my apologies for entering the discussion at this late hour. Philip asked for concrete suggestions, so here is one, directed particularly at urban folks. Parents and kids should eschew elevators and instead walk up stairs in almost all situations. At first they will be a bit breathless but soon they will have the satisfaction of feeling less so. By the same token, they should ride bicycles and walk whenever possible. If one is careful, the danger is minimal, even in a city like New York where I ride everywhere. Another suggestion is that parents and kids engage in a very modest degree of periodic and self-conscious fasting, giving the monetary savings to charity. This can easily evolve into an enjoyable competition to lose weight and raise money for good causes through readily achieveable self-sacrifice. I suppose that there is a risk of encouraging anorexia, especially among teenage girls who are already at risk of it. If that risk can be avoided, this would improve health, not impair it, as we eat far more than our sedentary lives require. Finally, none of these changes will work unless the parents set the example, adhere to it, and appear to be enjoying themselves in pursuing worthy goals.

-- Peter H. Schuck
6. July 30, 2008 10:36 PM

I have just got through reading through everything and wanted to add a few things. I think the smoking comparison is apt, it took decades though to get to where we are and billions in add campaigns and strict legislation. Yet still many smoke despite the hardship and cost. Look how hard it is for people to give up their cars when they know it is costing them double or more to operate them than it was a few years ago. We are not real good at sacrifice.

I am not surprised there is a plateau in obesity rates, I think there is a growing awareness. I speak to many parents and teacher groups about this and there is great concern expressed by all. It is sometimes very hard to discuss obesity in front of a group of parents or teachers that are obese themselves about this issue, but there is great desire for information. The problem is that there are contradictory pressures from many directions, from media inflation of stranger danger to completely contradictory diet advice.

I would suggest a first step. At the turn of the 19th century as I am sure Dr. Frost can attest there was a playground movement that did not just build playgrounds but ensured that they were supervised. If parents can send their children to the park or the pool and be certain that responsible adults will be there to make sure nothing happens to the children I think it would relieve a great burden many parents feel including myself to be their children's constant supervisor.

In response to Peter's comment above. The majority of the children I work with who are obese are very low income, I suggest rather than donating to charity, that they be paid to lose weight. Even if we paid kids $5 a pound to lose weight it would be paid back in health care savings, increased productivity and quality of life.

This country made a huge investment to decrease smoking, we don't need small steps any more. We need a Marshal Plan to attack obesity.

-- john sutterby
7. July 31, 2008 2:07 PM

It really is going to take an effort from every possible resource to change the statistics of this problem. It has been noted in this discussion that there aren't just one or two factors that can be changed to make a difference.

On thing I have seen on a local level is that hospitals are becoming more involved and offering classes for obese children who may not be receiving the education at home. There is also a program for teens in the planning stages. They teach healthy eating habits as well as the importance of physical activity each day. These are 8-hour courses for children referred by a physician. Of course children can fall through the cracks on that if they aren't receiving health care to begin with. However, we know that every bit helps, and that the reason we need so many resources is that not just one program can reach everyone on this multi-faceted issue.

On the state level, we have representatives from University of Idaho involved with the University of Colorado, doing research on this. James, I assume that could be the same research you are involved with? I'm so glad to see groups coming together, and to see this public discussion to help with this. How many other states are involved?

It is going to take such a hugely concerted effort to make a change, which I like to think is possible. We publish information on this topic each year in Playground magazine in hopes of helping this cause. An article on this will run in the October issue. I will do whatever I can to help unite for this cause and publish helpful information. Thank you all for opening this discussion in this forum.

-- Shannon Amy Stockwell, Editor, Playground Magazine
8. July 31, 2008 4:46 PM

This has been a terrific discussion. What I take from it is not just a need to change programs and priorities, but a need for a fundamental shift in values, as Hara and Stuart suggest. We must embrace the uncertainty and risk that attracts children to be physically active, and provide institutional structures to encourage activity--from school programs, to public investment, to legal protections against lawsuits when the inevitable accident occurs.

At Common Good, we're beginning a project to create a "Play Book" which would assert standards for healthy play and activity, and which would have authority that courts would honor if it was broadly endorsed. We hope to work with each of the organizations represented here to develop these standards.

-- Philip Howard
9. December 21, 2009 6:54 PM

This really was a terrific discussion. It has been about a year and a half since it transpired, and I am wondering if anyone involved has seen any progress within their sector.

-- Shannon Hoffmann, Former Editor, Playground Magazine