Childhood Obesity, Type 2 Diabetes, and Cardiovascular Disease. RECOMMENDATIONS type 2 diabetes, and cardiovascular disease to examine the factors that …
California Department of Education
State Superintendent of Public Instruction
Jack OConnells Task Force for
Childhood Obesity, Type 2 Diabetes, and Cardiovascular Disease
RECOMMENDATIONS
Background and Overview of the Work of the Task Force
Acknowledgments
Problem Statement
Recommendations
Preamble
1 Physical Education and Physical Activity
2 Health Education
3 Nutrition
Background and Overview of the Work of the Task Force
Citing an epidemic of obesity among children and youth, State
Superintendent of Public Instruction Jack OConnell established a task
force on childhood obesity, type 2 diabetes, and cardiovascular disease to
examine the factors that contribute to the increases in these diseases
among California schoolchildren Members of the task force included
students, parents, public health experts, physicians, nutritionists,
physical education specialists, school nurses, and other educators see
Acknowledgments for a complete list The first meeting of the task force
was held on March 26, 2004, with subsequent meetings in May, July, August,
September, October, and December
All meetings were open to the public
Many guest speakers were invited to share their expertise with the task
force see Acknowledgments for a complete listing Task force members
were presented with information about current data, research, programs, and
initiatives related to the national and statewide obesity epidemic
Presentations were made at nearly every meeting, and there were
opportunities for public input at every meeting as well At the September
10, 2004 meeting, the task force approved the first draft of
recommendations to the State Superintendent to be released for public
comment These recommendations included actions that schools and their
partners should take to address the epidemic trends facing California
schools
The public comment period ran from September 15, 2004, through October 6,
2004 Comments from 126 individuals were received A summary of the
comments received was discussed at the task force meeting on October 29,
2004 A public hearing was also held at this meeting Task force members
reviewed public comments and finalized their recommendations, incorporating
recommendations as appropriate The final recommendations were presented to
State Superintendent Jack
OConnell on December 10, 2004
Acknowledgments
Superintendent Jack OConnell extends special thanks to the following
individuals for their participation as members of the Task Force for
Childhood Obesity, Type 2 Diabetes, and Cardiovascular Disease These
individuals provided valuable expertise and displayed serious commitment to
this effort Their service is deeply appreciated
Members of the Task Force
Barry Coughlin, MD, FACC, Cardiovascular Center of Lompoc, Inc, Task
Force Chair
Nancy Adalian, Vice President, Health Commission, California PTA
Ted Barone, Principal, Burlingame Intermediate School
Stanley Bassin, EdD, Clinical Professor of Cardiology, UC Irvine
William Bommer, MD, Professor of Medicine, American College of
Cardiology, California Chapter Representative
Melinda Bossenmeyer, PhD, California Association for Health, Physical
Education, Recreation, and Dance
Maria Casey, Executive Director, Partnership for the Publics Health
Rob Challinor, Chair, Child Nutrition and Physical Activity Advisory
Council, Assistant Superintendent-Educational Services, Hesperia Unified
School District
Dan Cooper, MD, Professor of Pediatrics, Vice
Chair of Program
Development, Department of Pediatrics, UC Irvine
Stephanie Davila, Youth Board Nominee, California Center for Civic
Participation and Youth Development
Harold Goldstein, DrPH, Executive Director, California Center for Public
Health Advocacy
Martin Gonzalez, Assistant Executive Director, Policy Services, California
School Boards Association
Cary Hart, MD, Department of Pediatrics, Kaiser Permanente, Sacramento
Ruby Hennessey, RN, Professional Standards Chairperson, California School
Nurses Organization
Francine Kaufman, MD, Professor of Pediatrics, USC School of Medicine
Andy Megaw, Teacher, Upland Unified School District
Ed Moreno, MD, FAAP, California Council of Local Health Officers
Gregory Payne, PED, California Medical Association, San Jose State
University
James Sallis, Jr, PhD, Professor, Department of Psychology, San Diego
State University
Selinda Shontz, RD, Senior Director of Stroke Programs, American Heart
Association
Terri Soares, RD, Nutrition Education Coordinator, Fresno County Office
of Education
Robert Wilkins, President and CEO, YMCA of the East Bay
Superintendent OConnell and task force members wish to thank the
following
individuals who shared their expertise through presentations at task force
meetings
Presenters
March 26
Dan Cooper, MD, Professor of Pediatrics, Vice Chair of Program
Development, Department of Pediatrics, UC Irvine, Data and Research
Documenting the Crisis
Phyllis Bramson-Paul, Director and Assistant Superintendent, California
Department of Education CDE Nutrition Services Division, Nutrition in
Schools
Dianne Wilson-Graham, Physical Education Specialist, CDE Curriculum
Leadership Office, Physical Education and Activity in Schools
Caroline Roberts, Administrator, CDE School Health Connections/Healthy
Start, Coordinated School Health and the Health Framework for California
Public Schools
May 7
Nancy Spradling, Executive Director, California School Nurses Organization
School Nursing: Reductions in Force but Increases in Need
David Saunders, Director, Mission Delivery, American Cancer Society-
California Division, School Health Councils
Nancy Gelbard, MS, RD, Chief, California Obesity Prevention Initiative,
California Department of Health Services, Nutrition, Physical Activity, and
Obesity Prevention Efforts at the Department of Health Services
Joanne Ikeda, MA, RD,
Co-Director, Center for Weight and Health, UC
Berkeley How to Become An Overnight Expert on Childhood Obesity
William Bommer, Team for Life
July 16
Lucinda Mejdell-Awbrey, PHN, MA, Coordinator, Student Support Services,
Visalia Unified School District USD, Addressing Student Health Issues
Using the Coordinated School Health Model
Enid Hohn, RD, Director, Nutrition Services, Vista USD, Partnerships for
Healthy Schools
Phyllis Bramson-Paul, Director, California Department of Education CDE
Nutrition Services Division, What Californians Should Know About School
Lunches
Robin Jones, Supervisor, Child Nutrition Services, Folsom-Cordova USD,
Eating Healthy, Its Your Choice
Andrew Glazier, Chief of Staff to LAUSD Board Member Marlene Canter,
Seceding from Candyland: How We Kicked the Soda and Junk Food Habit at
LAUSD
Sarah Samuels, DrPH, Changing Nutrition and Physical Activity
Environments
Caroline Grannan, Executive Vice President, San Francisco USD PTA,
member of SFUSD Student Nutrition and Physical Activity Committee, and
parent, Healthy Food, Healthy Schoolchildren
Marjorie Freedman, PhD, Chair, School Nutrition Advisory Council,
Bret
Harte Middle School, San Jose USD, and parent advocate, Creating
Healthier School Environments: One Orange at a Time
August 13
James F Sallis, PhD, Professor of Psychology, San Diego State
University; Director, Active Living Research Program, School and Community-
Based Prevention of Overweight in Youth: Promoting Physical Activity
September 10
Dr Richard Jackson, MD, MPH, State Public Health Officer, California
Department of Health Services, Childhood Obesity, Schools, and Public
Health
Superintendent OConnell and task force members thank the many individuals
and organizations that reviewed and commented on the draft recommendations
during the public review process and all who provided comments at task
force meetings
Many staff members from the California Department of Education had vital
roles in the task force efforts Their support is gratefully acknowledged:
California Department of Education Staff
Sue Stickel, Deputy Superintendent, Curriculum and Instruction Branch
Margaret Aumann, Nutrition Education Consultant, Nutrition Services
Division, Program Resources, Education, and Policy Unit
Donna Bezdecheck, School Health Education Assistant,
Learning Support
and Partnerships Division, School Health Connections/Healthy Start
Office
Phyllis Bramson-Paul, Director, Nutrition Services Division
Linda Davis-Alldritt, School Nurse Consultant, Learning Support and
Partnerships Division, School Health Connections/Healthy Start
Office
Jeri Day, Health Education Consultant, Learning Support and
Partnerships Division, School Health Connections/Healthy Start
Office
Craig Gifford, Analyst, Nutrition Services Division, Administrative
Management Unit
Kelly Haarmeyer, Analyst, Learning Support and Partnerships Division
Joanna Knieriem, Office Technician, Learning Support and Partnerships
Division, School Health Connections/Healthy Start Office
Sam Lam, Web Developer, Technology Services Division, Application
Development and Maintenance Office
Rebecca Larsen, Project Management Office Analyst, Technology Services
Division, Project Management Office
Karissa Lujan, Office Technician, Learning Support and Partnerships
Division, School Health Connections/Healthy Start
Helen Ostapeck, Associate
Government Program Analyst, School Health
Connections/Healthy Start
Alberto Rivera, Office Technician, Learning Support and Partnerships
Division, School Health Connections/Healthy Start
Caroline Roberts, Administrator, Learning Support and Partnerships
Division, School Health Connections/Healthy Start
Lila Rose-Skates, Retired Annuitant, Learning Support and Partnerships
Division, School Health Connections/Healthy Start Office
Deborah Tamannaie, Nutrition Education Consultant, Nutrition Services
Division, Program Resources, Education, and Policy Unit,
Gwyneth Tracy, Education Program Consultant, Education Data Office
Cindy Villines, Manager, Technology Services Division, Application
Development and Maintenance Office
Dianne Wilson-Graham, Physical Education Consultant, Curriculum
Leadership Office
Michelle Zumot, Associate Government Program Analyst, Executive Office
Problem Statement
The percentage of children and adults who are overweight and obese has
reached epidemic proportions nationally and in California Nationwide, the
proportion of
young people who are overweight has tripled since 1980 Of
US children and adolescents aged 6 to 19 years, 15 percent-almost 9
million young people-are considered overweight1, and in California the
situation is worse According to an analysis of the 2004 FITNESSSGRAM data
by the California Department of Education, over 32 percent of youth are
overweight, and close to 74 percent are unfit2 Americas children and
youth are less active, consume more fat and sweetened beverages, and eat
fewer healthy foods, especially fruits and vegetables, than children of
previous generations Alarmingly, only 51 percent of todays children and
youth eat even one serving of a fruit or vegetable each day3
Overweight children and youths are more prone to developing serious health
problems now and in the future The US Surgeon General states that
children who have an unhealthy diet and low levels of physical activity
are at a greater risk for developing chronic health problems, including
type 2 diabetes, high blood pressure, asthma, and heart disease4 Centers
for Disease Control and Prevention CDC scientists recently predicted
that 30 percent of US children born in 2000 will develop type 2 diabetes
in their
lifetimes5 If left unchecked, diabetes can lead to complications
such as kidney failure, blindness, heart attack, and amputations It is
feared that overweight and obesity may erase the last centurys victories
over heart disease and stroke, and that the rates of breast, prostate, and
colon cancer will increase6
The economic burden of so many children and adolescents being overweight
is high The CDC reports that in one two-year period, US taxpayers spent
127 million on hospital costs associated with caring for overweight
children and adolescents5 This represents almost a four-fold increase in
two decades Across all ages, California paid nearly 25 billion in health
care costs and lost productivity in 2000 due to overweight, obesity, and
physical inactivity6 The social stigmatization and low self-esteem often
associated with being an overweight child or adolescent may lead to even
higher costs in future years7
The epidemic of childhood overweight is a complex, multi-faceted problem
that requires a multi-level state and community response to reverse the
upward trend 4 When addressing this problem, however, care must be taken
so that other eating disorders, specifically anorexia
nervosa and bulimia
nervosa are not perpetuated Anorexia nervosa typically appears in early to
mid adolescence In the United States, as many as ten million females and
one million males are fighting a life and death battle with an eating
disorder such as anorexia nervosa Schools are an important venue for
addressing all eating disorder issues
The CDC has identified effective strategies for schools that promote
lifelong healthy eating and prepare children and youth for physically
active lifestyles8 Its recommendations emphasize comprehensive nutrition
education and quality physical education programs that are supported across
all settings-at home, at school, and in the community The Surgeon General
calls for improving the school environment through approaches that extend
beyond nutrition and physical education programs to include school policy,
the school physical and social environment, and links among schools,
families, and communities9
Using strategies from these documents in conjunction with California-
specific data and objectives, the California Department of Education can
play an important role in addressing the poor eating patterns and
inadequate physical activity
exhibited by students and adults during the
school day
Task Force Recommendations
Preamble
The members of the Superintendents Task Force on Childhood Obesity, Type 2
Diabetes, and Cardiovascular Disease,
Recognizing that the number of overweight children in California and the
nation has reached epidemic levels,
Concerned that childhood obesity increases the risk of serious medical
conditions, such as diabetes and cardiovascular disease, resulting in
tremendous human and economic cost, excess personal tragedy, and daily
suffering,
Recognizing that along with the physical consequences of obesity, there
are serious psychological and social consequences as well,
Recognizing also that healthy, well-nourished children are better able to
learn,
Affirming that families, schools, and communities must all work together
to resolve the problem of childhood obesity,
Acknowledging that approaches to obesity prevention and weight management
must include the promotion of self esteem and body satisfaction, along
with respect for individual and cultural differences,
Convinced that addressing the problem of childhood obesity will require
ensuring that schools have adequate funding to support physical
education, health, and nutrition programs,
Set forth the following recommendations to build on Building Infrastructure
for Coordinated School Health: Californias Blueprint:
1 Increase the quality and quantity of instruction in physical education
to provide more physical activity and enhance student achievement of
Californias Physical Education Model Content Standards
a Include physical education as core curriculum and treat physical
activity as essential to all students education and health
b Maintain and enforce the required 200 minutes of physical
education in kindergarten and grades one through five, with a
recommended additional 100 minutes of physical education each 10
school days, exclusive of recesses and the lunch period
c Maintain and enforce the required 400 minutes of physical
education in grades six through twelve, with a recommended
additional 100 minutes of physical education each 10 school
days,
exclusive of recesses and the lunch period
d Do not grant exemptions to these minimum requirements to any
school or class However, individual student exemptions could be
made based on documented medical or hardship reasons and for
eleventh and twelfth grade students in approved athletic
programs with daily physical activity of 40 minutes or more
Repeal Education Code sections 51241[c][1] and 51242
e Ensure that at least 50 percent of physical education time is
spent doing moderate to vigorous physical activity Encourage
and provide funds for physical education class size to be
similar to core curriculum courses
f Strongly encourage implementation of evidence-based programs and
practices with demonstrated impact on physical activity
g Provide funding for on-site instruction, evaluation, and ongoing
support to implement evidence-based physical education programs
and practices conducted by certified master physical education
teachers
h Strengthen mechanisms eg coordinated compliance reviews and
visits conducted as part of the Distinguished School Award
Program for monitoring and enforcing physical education
requirements
i Improve assessment and public reporting procedures for
effectiveness of school-based physical education programs
report in School Accountability Report Card
j Conduct periodic coordinated statewide monitoring of school-
based physical education based on progress toward physical
education content standards and physical activity programs,
using the highest quality available measures to evaluate
progress in providing more physical activity for California
youth FITNESSSGRAM
k Provide monetary support to encourage schools to use school
facilities and resources to provide opportunities for physical
activity throughout the school day
l Provide funding and encouragement for supervision and equipment
for physical activity before and after school and after lunch
if lunch period is more than 30 minutes
m Provide funding and encourage the use of safe school facilities
as community wellness and activity centers available during non-
school hours
n Collaborate with physical activity-providing agencies for
wellness center programs
o Fund and encourage schools to provide, maintain, and remodel
facilities needed to implement quality physical education and
physical activity programs
p Require that schools provide students in kindergarten and grades
one through six with opportunities for physical activity breaks
recess at least once per 120 minutes of instruction
q When possible, build schools within neighborhoods for easy and
safe access, and plan physically active modes of commuting
2 Increase the quality and quantity of health education to promote
healthful eating and physical activity
Build Health Education Infrastructure
a Enact legislation to create preschool and kindergarten through
grade twelve health education standards by 2006
b Obtain State Board of Education approval of health standards by
2007
c Establish health education, including an
emphasis on nutrition
and physical activity, as a separate core curriculum topic based
on the Health Framework for California Public Schools
d Ensure that the health education curriculum follows the Health
Framework for California Public Schools
e Provide adequate and reliable funding sources for health
education, emphasizing nutrition and physical activity
Build Health Education Program
f Provide adequate and reliable funding sources to ensure
credentialed school nursing services at every school, with a
goal of one school nurse for every school site or cluster of
schools with a student population of 1,000 by the year 2014
g Utilize school nurses, registered dietitians, and health
education specialists to coordinate and help provide health
education
h Provide training in health, nutrition, and physical activity for
parents, teachers, administrators, and other school staff
i Train health education providers to use instructional strategies
that affect student behavior reference: Health Framework
for
California Public Schools
j Foster collaboration between schools including students,
families, teachers, and staff and the public, private, and
nonprofit sectors to support health education, nutrition, and
physical activity
k Ensure consistency between health education in the classroom and
the school environment
l Provide students opportunities to practice learned behaviors in
a variety of home, school, and community settings
3 Ensure the availability and quality of healthy foods and beverages
served and sold at and by schools
School Meals
a Provide additional funding for school districts to increase the
availability and ensure the quality of school meals in order to
reduce dependence on revenue from competitive food sales
b Require professional education standards for food service
directors/managers
c Provide funding and adequate staffing for the California
Department of Education to provide training and technical
assistance to support school districts in meeting state and
federal nutrition requirements
d Eliminate, over a reasonable period of time, the marketing on
campus of all foods/beverages that do not meet established
nutritional standards
e Work with the Legislature and the State Allocation Board to
identify and make available funds to establish and modernize
school cafeterias, kitchen facilities, and other eating areas
f Prohibit high fat, high sugar foods and beverages from 1 being
sold or served on K-12 campuses outside the school meal program;
or 2 being sold as fundraisers Nutritional standards shall
1 be developmentally appropriate and based on a review of
Senate Bill SB 19, SB 677, and federal and state guidelines;
2 be established and enforced by state statute and/or
regulation; and 3 not apply to foods/beverages brought from
home for personal consumption This requirement should be phased
in over a reasonable period of time A committee should be
established by the California Department of Education to develop
strategies for implementing these
recommendations
1 Centers for Disease Control and Prevention Obesity Still on the Rise,
New Data Show National Center of Chronic Disease Prevention and Health
Promotion, Division of Nutrition and Physical Activity Web site
Available at http://wwwcdcgov/nchs/releases/02news/obesityonrisehtm
Accessed on February 23, 2004
2 California Department of Education California Physical Fitness
Testing 2004: Report to the Governor and Legislature Sacramento, CA
2003 Available at http://wwwcdecagov/nr/ne/yr04/yr04rel102asp
3 Krebs-Smith, Susan, et al Fruit and vegetable intakes of children and
adolescents in the United States Archives of Pediatric and Adolescent
Medicine 1996; 150: 81-6
4 US Department of Health and Human Services The Surgeon Generals
Call to Action to Prevent and Decrease Overweight and Obesity
Rockville, MD: US Department of Health and Human Services, Public
Health Service, Office of the Surgeon General; 2001
5 Centers for Disease Control and Prevention Preventing obesity and
chronic diseases through good nutrition and physical activity Available
at
http://wwwcdcgov/nccdphp/publications/factsheets/Prevention/obesityht
m Accessed November 23, 2004
6 California Department
of Health Services, Strategies to Reduce Obesity
and Overweight, 2004
7 American Academy of Pediatrics, Prevention of Pediatric Overweight and
Obesity, 2003 Downloaded August 18, 2003 from
http://aaporg/policy/s100029html
8 Centers for Disease Control and Prevention, Guidelines for School Health
Programs to Promote Lifelong Healthy Eating, 1997
9 Centers for Disease Control and Prevention, Promoting Better Health for
Young People through Physical Activity and Sports, 2000 Downloaded
February 3, 2004 from
http://wwwcdcgovnccdphp/dash/physicalactivity/promoting_health/calltoacti
onhtm
Source:cde.ca.gov
