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Children and Teens Afraid to Eat


















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Promoting Healthy Weight
in Children
        S N E   PREVENTION GUIDELINES

How can we prevent weight and
eating problems in children?

The crisis continues to grow. The National Center for Health Statistics finds the number of overweight children in the U.S. has risen to 15 percent for ages 6 to 19, up from just 5 percent in the 1960s. For African American, Hispanic, and American Indian youth, the figures are even higher.

At the same time the Youth Risk Behavior Survey reveals alarming rates of hazardous weight loss practices. Eating disorders affect at least 10 percent of high school students, and nutrition monitoring reveals that a majority of teen girls consume less than two-thirds of their nutrient needs. One fourth are seriously undernourished or malnourished. Weight issues are an obsessive concern for American children of all ages, of every racial and ethnic heritage. Clearly it is a national health crisis when harmful attempts at weight loss are common in the third grade. It is a crisis when more than two-thirds of high school girls are dieting, one in five take diet pills, and both girls and boys are using laxatives, diuretics, fasting and vomiting in desperate attempts to lose weight.

Sound prevention programs will address these interrelated problems, and recognize that overweight, dysfunctional eating, the widespread undernutrition of teenage girls, hazardous weight loss, eating disorders and size prejudice are not separate issues. All are part of the same problem. All are increasing in prevalence and intensity. All are distorted by the current drive for thinness. Understanding this helps us realize we can't rush in to "fix" one problem without affecting others.

Until recently there were literally no models for moving ahead with safe and effective childhood obesity prevention. Now several states have comprehensive programs in place, and the Society for Nutrition Education has developed guidelines to assist planning groups. On these pages you'll find the SNE guidelines in full, a review of Iowa and Michigan programs, and other materials on  the prevention of obesity and eating problems and promoting healthy weight in children.

CONTENTS

Guidelines for parents: How to prevent
        weight and eating problems
Preventing child obesity in Iowa
SNE Guidelines for Childhood Obesity
        Prevention Programs: Promoting
        Healthy Weight in Children
Preventing obesity, eating disorders and
        related problems
Promoting healthy weight in Michigan
        schools (under construction)
Guidelines for collecting heights and
        weights in schools
Research briefs on children's weight and
        eating
Links to related sites (under construction

 
 

Guidelines for parents:
How to prevent weight and eating problems
 

Be active with your children. Have fun together in a variety of physical      activities.

Promote communication and sharing of feelings.

Teach positive self-talk, self-acceptance and self-respect. Praise and
     support each other.

Promote respect for others and appreciation of diversity.

Be a role model of normal healthy eating and lifestyle.

Communicate that "Every body is a good body," and avoid focusing on      weight or shape in a negative way.

Promote normal eating and diet-free living.

Eat family meals together at least once each day, if possible, and with          the television off.

Help children develop interests and skills that lead to success, pleasure
     and fulfillment in areas where appearance is less important.

Encourage friendships with caring neighbors and other adults.

from Children and Teens Afraid to Eat: Helping Youth in Today's Weight-Obsessed World

 


 
Guidelines for Childhood Obesity
Prevention Programs:
Promoting Healthy Weight in Children



October 2002

Developed by the Weight Realities Division
of the Society for Nutrition Education


SUMMARY STATEMENT
   These guidelines for obesity prevention programs encourage a health-centered, rather than weight-centered, approach that focuses on the whole child — physically, mentally and socially. The emphasis is on living actively, eating in normal and healthy ways, and creating a nurturing environment that helps children recognize their own worth, and that respects cultural foodways and family traditions. It is recognized that obesity, eating disorders, hazardous weight loss, nutrient deficiencies, size discrimination, and body hatred are all interrelated and need to be addressed in comprehensive ways that do no harm.

   Improvement in health and well being for all children, both immediate and long-term, is the desired outcome of addressing childhood overweight and obesity. The World Health Organization defines health as a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.1 Consistent with this, we encourage the health at any size approach, which is health-centered, rather than weight-centered, and focuses on the whole person — physically, mentally, and socially. This approach shifts the emphasis to living actively, eating in normal, healthy ways, respecting each individual, and health and well being for all at whatever size they may be. Health at any size supports appropriate lifestyle behavior changes to achieve these objectives.

   As in all programs serving children, overweight and obesity prevention programs appropriately focus on supporting and nurturing every child, while avoiding doing any harm. It is important to treat all children with respect and help them understand that healthy behaviors they can reasonably incorporate into their lives will enhance their normal growth and development. Adults are responsible for creating a nurturing environment that helps children recognize their own worth and respects cultural foodways and family traditions.

   Overweight, obesity, eating attitudes and behaviors, physical activity, and body image are all interrelated and will need to be addressed in comprehensive ways that do no harm. Thus, safe and effective overweight and obesity prevention programs will include measures to prevent related problems, such as eating disorders, hazardous  weight loss, nutrient deficiencies, size discrimination, and body hatred. Harm can result if obesity prevention efforts move ahead without appropriate attention to these related problems.2

   Based on these premises, we offer the following recommendations to program planners, parents, teachers, school staff, and health professionals who are concerned about children and weight.


I. Framework for addressing childhood obesity prevention

   A. Planning groups. We recommend that decisionmaking groups addressing healthy weight and  overweight and obesity prevention be diverse and include health professionals, eating disorder specialists, teachers, health at any size advocates, and the general public. These individuals need to be committed to improving school and community environments so that efforts evolve into  sustainable programming. As with any planning group, membership disclosure policies are advisable, especially addressing members with special interests, such as financial affiliationswith the weight loss industry.3, 4 Reading these Guidelines for Childhood Obesity Prevention Programs as well as the papers listed below under Recommended Readings issues, as well as  acquire a great deal of practical information on promoting physical activity, healthy eating, and will help planners resolve various nurturing environments for children.

   B. Healthy lifestyle. A comprehensive, successful program will focus on promoting and supporting healthy lifestyles for all children at home, in school, and in the community, as  integral to the well being of children of all sizes. It will develop and implement activities that  (a) create a nurturing environment, (b) provide education on healthful eating, and (c) promote  and support opportunities for enjoyable physical activity.


II. Setting appropriate goals

   A. Set goals for health, not weight, as appropriate for growing children. Expecting all children to be at an ideal weight range is unrealistic and can lead to problems.5 It is more realistic to expect that children maintain a healthy weight. Healthy weight can be defined as the natural weight the body adopts, given a healthy diet and meaningful level of physical activity.6

   B. Set goals for a nurturing environment. A nurturing environment promotes all aspects of  growth and development for children — physically, mentally, and socially. This environment fosters self-esteem, body satisfaction, and a positive body image, qualities that facilitate health-promoting behaviors. It’s what’s inside that counts is a guide for dealing with children,  such that character, aspirations, talents, and gifts of all are recognized and cultivated. Youth today need tools to empower them to combat our culture’s current extreme focus on appearance. This can be addressed through media literacy training, including analysis of marketing techniques and  how the media and advertising affect culture and body image.
   Policies for creating a nurturing environment will also include recognition of weight- and  size acceptance. Within each school’s policy on acceptance of diversity, weight and size  discrimination, name calling, and shaming about weight and size can be addressed. Such a policy promotes self-confidence and respect, as well as safety for schools and communities.

   C. Set goals for healthy eating. We urge attention to both what and how children eat. Good nutrition focuses on following the Dietary Guidelines,7 understanding portion size and energy  density, and regularly eating recommended servings from all five groups of the Food Guide Pyramid.7 Healthy eating patterns include eating a variety of foods, having regular meals and snacks, responding to body signals of hunger and fullness, creating a positive environment for meals, and eating family meals together when possible. Healthy eating also means taking time to relax, enjoy the food, and feel satiety.8

   D. Set goals for physical activity. Aim for all children to achieve the following: be active at least one hour a day9; reduce sedentary activities (limiting television to less than 2 hours a day and  replacing excessive television and screen time with more involving activities)9; increase strength, endurance, and fitness; enjoy movement as natural and pleasurable; and learn skills for sports and activities they will continue and enjoy through life. Children need access to a variety of activities so each can succeed in some activities. These goals are achievable by children of all sizes and weights. Having a large body size need not be a barrier if the activity program is thoughtfully and sensitively planned and executed. Opportunities for physical activity need to be available within the school day,  in after-school activities, and at home with family and friends.
    Among young children the appropriate focus of physical activity is to provide ample opportunity for active free play and movement. As children mature, they need to master movement skills, so they can participate confidently in many different forms of activity, and come to understand that fitness is intimately related to long-term health and well being.
    Communities are encouraged to support fitness and physical activity by providing parks, playgrounds, and other facilities that are safe, convenient, appealing, and affordable places for children and parents to spend time.


III. Special considerations in avoiding harm

   A. Self-worth. Teaching children that theirs is a good body will encourage them to keep it healthy. Children and youth deserve safe and respectful treatment of their bodies and themselves by parents, teachers, peers, school staff, and health professionals. Harm can result when they receive messages that suggest their personal worth and the esteem of others is related to their body size.10

   B. Assessment. Appropriate weighing and measuring of children is conducted under private conditions, recognizes individual differences in growth rates and body size and shape, and avoids using data to label children. Special thought should be given toassessments so stigmatization and humiliation are avoided.

   C. Intervention. Research suggests that safe and effective childhood obesity treatment and prevention programs focus on positive lifestyle changes for the whole family, creating an environment in which the child can be physically active, eat to satiety, and grow into his or her weight. There is evidence that some interventions, even by health professionals, may harm while attempting to do good.11 For example, placing children on weight loss diets is seldom safe or effective. Typically this causes weight loss and regain, or weight cycling, which can itself be a health risk.12 Restricted feeding, even for the preschool-age child, often leads to overeating.13
   Other documented outcomes of inappropriate interventions include disordered eating (nearly every eating disorder begins with a weight loss diet),14, 15 depression, malnutrition, injury, and even death.16 Addressing healthy weight in positive ways is preferable to emphasizing obesity risks, as this can contribute to fear, shame, disturbed eating, social discrimination, and size harassment.


IV. Setting school policies

   A. Positive eating environments. To promote positive attitudes toward a variety of foods and the consumption of healthy food choices, school policies will assure every child access to a nutrient-dense lunch (as well as breakfast and snacks in some schools), provide a pleasant, positive eating environment, and allow enough time to eat — at least 15-20 minutes of actual  eating time after being served.17 We recommend limiting competition from sources of less nutritious foods, and avoiding sales of soft drinks and candy during school hours and for at least 30 minutes before and after school.
.
   B. Physical activity opportunities for all children. Physical education classes or recess on a daily basis as appropriate can greatly contribute to a child’s access to physical activity. These experiences should provide a variety of activities so that every child has the opportunity to discover activities that he or she can succeed in and will enjoy.

   C. Promotion of size and weight acceptance. Acceptance and respect for oneself and others can be effectively addressed as part of the overall school policy on acceptance of diversity and refusal to tolerate teasing or harassing of students or staff. Obesity prevention programs need t be periodically assessed by appropriate professionals to ensure that they do not create unintentional stigmatization or promote dangerous eating and exercise behaviors.18

   D. Sensitive practices related to assessment, referral, and re-entry. Weighing and measuring students in a school setting can potentially have lasting stigmatizing effects (especially for larger students, shorter boys, and taller girls). Safeguards include continuous attention to issues of privacy, respect, social environment, education on growth patterns and realistic body image, follow-up with parents, and referral for diagnosis (see Guidelines for Collecting Heights and Weights, below). Our recommendation is that screening for weight, height, and body fat in schools be limited to situations of identified need and purpose, such as initial assessment and program outcome evaluations.
   Height/weight measurements and BMIs need to be considered as part of an overall assessment and not as the single measurement for determining health status. Use of BMIs alone has resulted in inaccurately labeling of children.19 Tables for interpreting weight for height or BMI are based on assumptions that higher weight means higher body fat. However, some children with higher body weights will not be over fat, depending on physical activity, age, stage of puberty, gender, and ethnicity. For example, a recent US Department of Agriculture study shows that one in four children categorized as “at risk” (BMI of 85th to 95th percentile) have normal body fat, and one in six in the normal weight range have high body fat.1 behaviors, weight loss practices, and body image attitudes. Interpretation of data may be 9 Children grow and mature in different ways, and a child’s weight for height or BMI can best be evaluated in relation to his or her own growth history.19, 20 Also, growth spurts may be preceded by an increase in body fat. 21 When weights are measured in schools, we recommend measuring and tracking related factors as well, including fitness levels, eating and activity completed by qualified school personnel or consultants as needed.
   It is also desirable for schools to develop a process for dealing with eating problems. This process starts with early detection of eating disorder warning signs, and includes parental involvement and appropriate referrals.
   When a problem is diagnosed, the school can be helpful in supporting treatment plans. This is especially critical  in the case of students re-entering school after inpatient treatment. Providing training and consultation for school personnel is helpful in dealing with these situations.


RECOMMENDED READINGS
  • Prevention of Child and Adolescent Obesity in Iowa: Iowa position paper. Provides detailed nutrition, physical activity, and child nurturing guidelines for preventing obesity in home, child care, school, community, and health care settings (48-pages). Nov. 2000. Iowa Dept of Public Health, Lucas State Office Bldg, Des Moines, IA 50319. May be downloaded from website www.idph.state.ia.us (click on Resources).
  • The Role of Michigan Schools in Promoting Healthy Weight: A Consensus Paper. Guidelines addressing obesity prevention in schools set the goal of healthy students of all shapes and sizes, and give specific recommendations for nutrition concerns, physical activity, and safe and supportive learning environment. September 2001. Michigan Dept of Education, Michigan Dept of Community Health, Governors Council on Physical Fitness, Health & Sports, Michigan Fitness Foundation. May be downloaded at www.michiganfitness.org; www.mde.state.mi.us; and www.emc.cmich.edu.
  • Guidelines for Collecting Heights and Weights on Children and Adolescents in School Settings. How to Measure in a Private, Respectful Way. Discusses weighing and measuring problems and how to avoid them. Sept 2000. Center for Weight and Health, College of Natural Resources, University of Calif. May be downloaded from center website: www.CNR.Berkeley.EDU/cwh/resources/childrenandweight.shtml


REFERENCES
  1. World Health Organization. Basic documents. 39th ed. Geneva: WHO, 1992.
  2. Piran N. The Last Word: Prevention of eating disorders. Eating Dis 1998;6:365-371.
  3. Fraser L. Losing it: America’s obsession with weight and the industry that feeds on it, 1994. New York: Penguin/Dutton.
  4. Berg F. How the diet industry exerts control. In: Women Afraid to Eat, 2000, 193-211. Hettinger, ND: Healthy Weight Network.
  5. Stice E, Agras WS, Hammer LD. Risk factors for emergence of childhood eating disturbances. Int J Eat Disorder 1999;25:375-387.
  6. Hawks SR, Gast JA. The ethics of promoting weight loss. Healthy Weight J 2000;14:25-26.
  7. Dietary Guidelines for Americans. 5th edition, 2000. H&G Bulletin 232. US Dept. Agric/ US Dept Health and Human Services. Also, Using the Dietary Guidelines for Americans, 2000. Program Aid 1676. USDA.
  8. Satter E. How to get your kid to eat but not too much, 1987. Palo Alto, CA: Bull Publ.
  9. Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Press conference Dec 13, 2001.
  10. National Education Association. Report on size discrimination, Oct 7, 1994. NEA, Washington, DC.
  11. Kassirer JP, Angell M. Losing weight — an ill-fated New Year’s resolution. N Engl J Med 1998;338:52-54.
  12. Lissner L, Odell P, D-Agostino D, et al. Variability of body weight and health outcomes in the Framingham population. New Engl J Med 1991;324:1839-44.
  13. Fisher JO, Birch LL. Parents’ restrictive feeding practices are associated with young girls’ negative self-evaluation of eating. J Am Diet Assoc 2000;100:1341-1346.
  14. Wilson GT. The controversy over dieting, 1995:87-92. New York: Guilford Press.
  15. Position of American Dietetic Association: Nutrition intervention in treatment of anorexia nervosa, bulimia, binge eating. J Am Diet Assoc 2001;101: 810-819.
  16. Berg FM. Hazardous weight loss. In: Children and Teens Afraid to Eat, 2001, 92-116. Hettinger, ND: Healthy Weight Network.
  17. What time is lunch? J Am Diet Assoc 1996:96.
  18. Levine MP. Prevention of eating disorders, eating problems and negative body image. In: Controlling eating  disorders with facts, advice and resources, 2nd ed. 1999, p64-72. R Lemberg. Phoenix: Oryx Press.
  19. Federal update: BMI poor indicator of body fat in individual kids. J Am Diet Assoc 2000;100:628.
  20. Malina RM, Katzmarzk P. Validity of the body mass index as an indicator of the risk and presence of overweight  in adolescent. Am J Clin Nutr 1999; 70(suppl):131S-136S.
  21. Tanner JM. Physical growth and development. In: Textbook of Pediatrics. JO Forfar & GC Arneil (eds), Edinburgh, Scotland: Churchill Livingstone; 1984.
Guidelines for Childhood Obesity Prevention Programs: Promoting Healthy Weight in Children was developed by the Weight Realities Division of the Society for Nutrition Education (SNE) to assist planning groups concerned with obesity prevention. Available in English and Spanish. This paper does not necessarily reflect the viewpoint of all SNE members. Questions or comments should be directed to the Society for Nutrition Education, 9202 N. Meridian Street, Suite 200, Indianapolis, IN 46260 (800-235-6690).

All rights reserved. Permission is hereby granted to republish, reproduce, and distribute these guidelines in their entirety, provided full and proper credit is given. Copyright 2002, Society for Nutrition Education. The Guidelines are available at www.sne.org and www.healthyweight.net.

These Guidelines were developed by a committee of nutrition experts in the Weight Realties Division of the Society for Nutrition Education, including the Writing Team: Francie Berg, MS, LN (chair); Jennifer Buechner, RD, CSP; and Ellen Parham, PhD, RD; and the Review Team: Laurie Aomari, RD, LD; Bev Benda-Moe, LRD; Linda Bobroff, PhD, RD, LD/N; Cindy Byfield, PhD, RD; Fern Gale Estrow, MS, RD, CDN; Ann Hertzler, PhD, RD, LDN; Sharon Hoerr, PhD, RD; Joanne Ikeda, MA, RD; Ann Macpherson, EdD, MNS, RD; Frances Montalvo, MHSN, LND; Suzanne Pelican, MS, RD; and Adrienne White. PhD, RD.

Preventing Child Obesity in Iowa

Prevention of Child and Adolescent Obesity in Iowa is a 46-page position paper developed by the Iowa Child and Adolescent Obesity Task Force.

It is remarkable in its focus on healthy lifestyle, not weight, and its concern that no child be stigmatized or harmed -- every child deserves to be protected in a nurturing environment.

Published in November 2000, the paper includes guidelines for five settings: home, child care, school, community and health care. Focus is on three key elements within each setting: healthy eating, physical activity, and creating a nurturing environment.

Following are excerpts from the school section of the Iowa position paper.

Promoting Healthy Eating

A. Providing access to a variety of nutritious, culturally appropriate foods that promote growth and development, pleasure in healthy eating, and long term health, as well as prevent school day hunger and its consequent lack of attention to learning tasks.  

There is no question that school meal programs can have a powerful influence on children's future food choices. More than one half of youth in the U.S. eat one of their three major meals in school and one in ten children and adolescents eats two of their three main meals in school. Adequate nutrition throughout the day plays an important part in performance at school and enables the child to make wise choices when eating. Children who go hungry or are only allowed a hurried meal through the morning or afternoon, are likely to arrive at home after school extremely hungry. This can lead to overeating, particularly high fat, easy to prepare snack foods. This pattern of behavior, once learned, is difficult to change and can lead to obesity. Providing attractive healthy meals in a pleasant environment at school is an important part of obesity prevention.

A successful school food program meets the dietary guidelines and encourages children to try a variety of new foods. Dining room strategies include:

  • Monitoring of school menus and food preparation techniques to assure that meals  meet the dietary guidelines.
  • Offering a variety of attractive, culturally diverse foods. The Bureau of Food and  Nutrition of the Iowa Department of Education offers summer short courses and  periodic opportunities during the school year through the Team Nutrition program  to train food service staff to meet these goals. The USDA School Food Program   and the Food Guide Pyramid provide guidelines for healthy meals which can also  be obtained through the Iowa Department of Education.  Linking classroom nutrition education lessons to food service activities such as  menu planning, taste testing, new menu offerings, and cultural celebrations.
  • Creating a positive environment for meals. These suggestions can improve the school lunch environment:
  • Hold recess before lunch to allow children to take their time and eat, rather than hurry to finish so that they can play.
  • Stagger arrival times of each class to the lunch room to shorten waiting time.
  • Allow at least 15 to 20 minutes of actual seating time to eat. 
  • Arrange to have an adult stay with the children until they are through the serving line.
  • Appoint dining room supervisors to encourage children to try foods, but not force them.
    • Carefully reviewing the impact of vending machines, franchised vendors and contracts with fast food vendors on the overall health environment of the school
B. Nutrition education that empowers students to select and enjoy healthy food and physical activity.

Characteristics most likely to be effective: 
  • behaviorally focused content that is developmentally appropriate and culturally relevant;
  • active, participatory learning strategies;
  • fun activities;
  • repeated opportunities for students to taste foods that are low in fat, sodium, and added sugars and high in vitamins, minerals, and fiber;
  • focuses on positive, appealing aspects of healthy eating patterns; emphasizes the benefits of healthy eating behaviors in the context of what is already important to students; and
  • learning techniques including role modeling, incentives, self-confidence in making dietary
Clearly a comprehensive, targeted approach is required to promote healthy food and physical activity choices. Key elements:
  1. Focus on specific behavioral messages, e.g. eat more fruits and vegetables, rather than on general nutrition information;
  2. Diet self-assessment, particularly among older students; 
  3. Family involvement, particularly for programs directed at elementary students;
  4. Classroom education component (particularly when integrated into other subjects or into a coordinated school health programs); and
  5. Community impact strategies.
The USDA Team Nutrition program, implemented by some schools in Iowa, is designed to address the key elements found in the review. It includes a nutrition education curriculum that can be integrated into core curricular areas throughout the elementary and middle school years. The classroom lessons are also connected to cafeteria and school wide activities and include links to the home and community. The curriculum not only suggests activities for repeated taste testing in a variety of settings, but also builds on the notion of the dining room as a learning laboratory. The curriculum includes successful teaching strategies, such as goal setting, reinforcements and incentives.

C. Screening, assessment, counseling and referral for nutrition problems 

School staff should be trained to recognize nutrition problems and be knowledgeable about community resources that can address them. Many schools routinely weigh and measure children. While this practice may provide for early identification of growth abnormalities, weight problems and eating disorders, it may also be disturbing to some children. When weights and heights are measured, they should be conducted in private and the information should be kept confidential.

D. Systematically assess the nutrition and physical activity needs of students 

A variety of excellent tools are available to assist schools in evaluating their practices and policies related to nutrition and physical activity promotion. Schools should be diligent in reviewing their environments to determine whether changes are needed and whether new programs and policies are having their intended impact.


Promoting Physical Education
Requiring all students to participate in physical education programs and developing curricula that take into account the limitations of students with physical or mental disabilities will enhance the health of all students. The following recommendations should be considered:

A. Plan a physical education program that is inclusive, promotes lifelong physical activity, and is rewarding for all children

  • Offer a variety of experiences including both team sports and individual activities. 
  • Expose children to lifetime recreational activities such as walking, biking, roller blading, swimming, fishing, and canoeing.
  • Adapt physical education instruction for students with special needs; include special needs students in regular classes whenever feasible.
  • Provide special classes for students who are severely handicapped or who are otherwise unable to participate in the regular program.
  • Provide both indoor and outdoor facilities
  • Maintain facilities and equipment to meet safety standards.
  • Provide quality equipment and supplies in sufficient quantity to allow all students to participate.
B. Allow adequate time for physical education
  • Provide at least 30 minutes daily in Grades K-3 with 20 minutes spent in actual physical activity.
  • Provide a minimum of 45 minutes daily for Grades 4-8.
  • Require a minimum of 2 years in daily physical education for grades 9-12, with the option of taking an additional two years of physical education on an elective basis.
  • Keep class size similar to other subjects in the school curriculum, preferably not more than 30 students.
  • Establish minimum standards for physical education at state or local district levels to ensure equal benefits for all children.
C. Recognize physical education as an important part of the total school curriculum
  • Mandate that physical education instructors are certified for the grade level taught.
  • Include physical education grades in the overall GPA.
  • Disallow exemptions for students for participating in any curriculum or extra curricular activities.
D. Emphasize physical fitness, including concepts that will encourage the achievement of personal physical fitness, as a vital component of the curriculum at all levels
  • Conduct an annual fitness evaluation of all students and report results to their parents. Utilize the following criteria to ensure that the program provides opportunity for aerobic and/or skill building:
    • Three 10 minutes bouts of moderate to vigorous physical activity daily (5 school days each week).
    • Three or more 30 minute bouts of moderate to vigorous physical activity at least
    • Three or more 30 minutes sessions of motor skill practice and/or development each week.
Recess and before and after school programs are important to a school's total physical activity program. Schools are encouraged to offer both structured and free time for physical activity.

Promoting a Healthy Body Image
To ensure that children feel good about their bodies and to avoid the pitfalls of dieting or eating disorders, it is important that adults treat all children with respect and provide adequate information to children about growth and development and nutrition.

  • Create an environment that helps children recognize their individual value by rewarding
  • Prepare students for anticipated body changes through human growth and development and health education classes.
  • Discuss the social and emotional aspects of physical changes associated with maturation in human growth and development and health education classes.
  • Increase awareness of how the media and advertising influences cultural norms.
  • Encourage physical education instructors to be sensitive to ways in which body image can affect children's willingness to participate in physical education and activity. Changing clothes, showering, and the type of activity offered may deter children with body image problems from participating in and benefitting from physical activity.
  • Coaches should be cautious when advising students to lose or gain weight to participate in a sport. Students may respond to criticism or comments about their bodies by engaging in destructive dieting.
  • Consider body image and self- esteem issues when addressing weight concerns in children.
  • Be alert to signs of eating disorders and refer appropriately.
Reprinted from Prevention of Child and Adolescent Obesity in Iowa, available from the Bureau of Nutrition and WIC, Iowa Department of Public Health, Lucas State Office Building, Des Moines, IA 50319-0075. The position paper may be viewed and downloaded at www.idph.state.ia.us.