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Diagram: Healthy Students of
All Shapes and Sizes

School wellness plans and programs designed to prevent eating and weight problems are aimed at promoting the health and well-being of all students. As in this model, the goal at the center is Healthy Students of All Shapes and Sizes.

The healthy living approach emphasizes regular moderate activity, healthy eating without dieting and a nurturing environment that promotes self-respect and respect for others. Consistent messages that
support these behaviors and attitudes come from those who work with and care about children – including teachers, counselors, school nurses,
coaches, food service and other staff, families, community leaders, health care providers and media personnel – working through the entities shown around the outside of this diagram (the eight components of the school’s Coordinated School Health Program).

Working together through all aspects of school and community life, they reinforce and support a
nurturing environment that avoids doing harm to vulnerable students, while emphasizing physical,
mental and social wellness for every child.

This model was adapted from the Health at Any Size model in "Children and Teens Afraid to Eat," by Frances M. Berg, p23- 26. It was published in the Consensus Paper, The Role of Michigan Schools in Promoting Healthy Weight, by the Michigan Department of Education in cooperation with the Michigan Department of Community Health and the Michigan Fitness Foundation, September 2001. http://www.michigan.gov/documents/healthyweight_13649_7.pdf. Copyright 2008, 2005, 2001, 1997 by Frances M. Berg, Healthy Weight Network. See also "Underage and Overweight," p232. The author permits use of this model for school programs and educational purposes provided it is reproduced in its entirety with this citation. Written permission is required for use online, in books or in publications for sale. www.healthyweight.net.

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School wellness planning
(for obesity prevention)

How is your state handling obesity prevention? What is happening in your school? If you don’t know, it may be wise to find out before problems begin to surface. Overzealous interventions aimed at larger kids in school can be detrimental to all students, particularly to those with disordered eating or body image problems. And they can hit the media fan, as happened in several localities when letters were sent to indignant parents, informing them their children had a weight problem.

In the U.S., each state has the task of developing and implementing a plan for childhood obesity prevention. A great deal of federal money is being spent for these programs, in a variety of ways. However, it is important that it go for programs supporting and nurturing children, and that the selected programs focus on the health and well being of every child – physically, mentally and socially. It is important they avoid doing harm to vulnerable children; that they help without harming. This is not necessarily the case in school districts where planners focus on overweight as a major problem and fail to consider other critical problems.

The purpose of school prevention programs is improvement in health and well-being for all children. A healthy living approach is recommended with its emphasis on regular
moderate activity, healthy eating without dieting and a nurturing environment that promotes self-respect and respect for others (also known as Health at Any Size, or Health at Every Size). A nurturing environment emphasizes acceptance and respect, and helps each child recognize his or her own worth. To discourage harassment, schools create a zero tolerance policy for bullying, name-calling and shaming others about weight or size, with clear consequences, and a reporting process that protects the victims and those who report the behaviors.

In Underage and Overweight (2005 edition) see these three chapters:

• Chapter 7: Feeding Our Kids at School: Who’s in Charge? p119-131.
• Chapter 13: What Works; What Doesn’t? p237-247.
• Chapter 17: What Schools Can Do, p314-338. (Civilizing the Lunch Room; Can Soda Sales; Comprehensive School Health; Curbing Abuses; Media Literacy; Prevention Programs; Teacher Training; Eating Disorders Screening.)

In Children and Teens Afraid to Eat (2001 edition), Chapter 12: Prevention in Schools, pg 247-272.

Wellness policy and obesity
prevention in Iowa

School programs that focus on the healthy living, health at every size approach of wellness and wholeness are being promoted in Iowa. The Iowa policy advocates childhood obesity prevention through healthy living in five settings – home, child care, school, community and health care. Detailed guidelines are set forth in five "supplements" making up the major portion of the 45-page Iowa position paper Prevention of Child and Adolescent Obesity in Iowa.

Childhood obesity is viewed as a complex disorder involving both genetic and environmental factors, with prevention preferred to the uncertainties of treatment. "Prevention avoids the pitfalls of dieting in children: possible negative impact on growth and development, body image distortion, learning restrictive eating practices, eating disorders and inappropriate control by adults to a child’s intake."

The Iowa guidelines discourage weighing in schools: "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."

Focus is on three key elements within each setting: regular physical activity, healthy eating (based on the Food Guide Pyramid, regular meals with reasonable portion sizes, using Ellyn Satter’s Division of Responsibility that respects each child’s right to decide what, how much, and whether to eat), and creating a nurturing environment (in which differences are accepted, and children are taught self reliance and resistance to society’s pressures to diet or be obsessed with weight).The plan emphasizes the importance of adults as role models. Links to helpful resources are included throughout.

Nutrition guidelines for schools include 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 hunger during the day and its consequent lack of attention to learning tasks. At the state level, adding nutrition consultants in the state department of education and area agencies who can provide technical assistance to schools is advised. Selecting and implementing nutrition education curricula is an important component so that nutrition is being taught consistently throughout the school health programs.

Physical education, as an important part of the total school curriculum, is recommended to increase to 30 minutes of daily PE with 20 minutes of actual activity for grades K-3; 45 minutes daily for grades 4-8; and two years of daily PE for grades 9-12, with optional electives for the other two years. Class size similar to that of other subjects, preferrably not more than 30, is advised. In Iowa, where children spend an average of three hours a day watching television, parents are advised to limit television and computer time to one to two hours a day. Child care providers are urged to limit TV and video time to one hour or less.

Self-esteem and body image guidelines for children of all sizes, are as follows:

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 children for their accomplishments and ensuring that children of all body
  sizes receive recognition.
• 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.
• Consider body image and self- esteem issues when addressing weight concerns in
  children.
• Be alert to signs of eating disorders and refer appropriately.
• 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 benefiting 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.
  

(from Prevention of Child and Adolescent Obesity in Iowa: Iowa position paper, 45 pages, Nov 2000. Child and Adolescent Obesity Prevention Task Force, Bureau of Nutrition and WIC, Iowa Dept of Public Health, Lucas State Office Bldg, Des Moines, IA 50319.)

May be downloaded from website www.idph.state.ia.us (insert title at search)
http://www.idph.state.ia.us/wic/common/pdf/obesity.pdf

Role of Schools in Promoting Healthy Weight (Michigan)

An excellent state plan, developed in Michigan, focuses entirely on school wellness using the goal of Healthy Students of All Shapes and Sizes, as shown in the diagram above.

The Role of Michigan Schools in Promoting Healthy Weight , a 29-page consensus paper, is based on the “healthy weight concept” developed by the Michigan Advisory Council.

Three separate but related problems are addressed jointly:

• Excessive weight gain
• Social pressure for excessive slenderness and weight discrimination
• Unhealthy weight loss practices

If schools address only weight, the advisors warn, they could inadvertently cause harm in the second and third areas. Schools are urged to adopt the concept model, or diagram, to more easily visualize the meaning. This places the primary goal of healthy students of all shapes and sizes in the center with four arrows leading to it. The arrows show consistent messages of physical activity, healthy eating, self-respect and respect for others. These are to be delivered consistently throughout the school day by faculty, staff, students and parents. The healthy weight concept is taught throughout the shcool, and emphasized in health classes.

The Michigan plan defines six overall recommendations:

• Create an environment where students can be physically active.
• Increase student participation in physical education
• Create a healthy nutrition environment
• Strengthen nutrition education
• Create a safe and supportive learning environment
• Work with families to promote physical activity and healthy eating.

In the first area of safe and supportive environment, these are important points:

• School staff should model respectful behavior by refraining from making disparaging comments about their own weight or the weights of other adults.
• Create a policy that all students and staff are to be treated with respect.
• Educate athletic coaches, cheerleading coaches, drama directors, and other program advisors in body weight and size sensitivity to eliminate weight discrimination from all school activities. Refrain from using labels for students such as “overweight, fat, obese, underweight, too thin or anorexic.”
• Create a zero tolerance policy for criticizing, bullying, name-calling, and shaming others about weight or size.
• Define and enforce clear consequences for disrespectful behavior.
• Create a process for students to report bullying or disrespectful behavior. The process should protect the victims and those who report the behaviors from reprisal.

The paper gives extensive recommendations in the physical activity and nutrition areas (explained more fully in Chapters 7 and 8). A few key points are:

• Provide recess at least twice each day for elementary school students and once each day for middle school students.
• Offer intramural and physical activity programs that feature a range of competitive, cooperative, and individual physical activities.
• Encourage students to walk or ride bikes to school where it is safe for them to do so. Encourage parents to assess routes for safety. If unsafe conditions are found, the school health team may be able to take steps to improve them.
• Create a nutrition integrity policy. This would spell out the principle that all foods available in the school should be consistent with what students are taught in nutrition lessons.
• Teach developmentally appropriate nutrition concepts at every grade level.
• Use active learning strategies and activities that students find enjoyable and personally relevant.

Michigan schools are urged to establish local policies that support some or all of the prevention measures given in the paper. This can provide three benefits:

• It can have positive effects on student health.
• It can improve the learning environment for all children.
• It will most likely help prevent excessive weight gain among students.

Throughout, the reader is referred to Michigan resources that provide more detailed information on how to accomplish the objectives.

The Michigan Weight Advisory Group points out that schools cannot completely solve weight-related problems faced by students. Family influence is seen as far more powerful. Yet schools have the potential to be part of the solution. Their main role is suggested as preventive.

The Role of Michigan Schools in Promoting Healthy Weight Weight: A Consensus Paper. Sept. 2001. Michigan Dept. of Education, in cooperation with the Michigan Dept. of Community Health, Governor’s Council on Physical Fitness, Health & Sports, and the Michigan Fitness Foundation. Websites/ May be downloaded at www.mde.state.mi.us; www.michiganfitness.org; www.emc.cmich.edu.