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Journal Issue: Childhood Obesity Volume 16 Number 1 Spring 2006

The Role of Schools in Obesity Prevention
Mary Story Karen M. Kaphingst Simone French

School Links with Communities and Families

Although most physical activity and nutrition programs directed at youth are conducted in school, communities can also provide important resources. And family involvement is often crucial.

Farm-to-School Programs and School Gardens
Some schools are offering new farm-to-school programs that link local farmers with school cafeterias. The programs provide high-quality local produce, support locally based agriculture, and often directly connect farmers and children with reciprocal visits. Some schools also sponsor gardening programs. The Martin Luther King Junior Middle School in Berkeley, California, offers the Edible Schoolyard, a nonprofit program that allows students to participate in all aspects of organic gardening and cooking, from seed to table.155  Such hands-on experience may encourage children to eat more healthfully. A recent study at three schools in California examined fourth graders' knowledge of nutrition and their preference for certain vegetables.156   Students at one school received nutrition education, those at a second school received nutrition education and planted and harvested a vegetable garden, and those at a third served as a control group. Children who received nutrition education alone and those who received nutrition education combined with gardening had much higher scores than the control group. Children who gardened also increased their preferences for certain vegetables.

Walking and Biking to School
In recent decades, dramatically fewer children have been walking or biking to school. In 1969, 48 percent of students walked or biked to school. By 2001, less than 15 percent of students aged five to fifteen walked to or from school, and just 1 percent biked.157  Today roughly one-third of students ride a school bus, and half are driven in a private vehicle.158  Because the trip to and from school happens daily, active commuting (walking or biking) can provide substantial caloric expenditures over the school year.159  One study used accelerometers, small electronic devices worn around the waist that capture minute-by-minute recordings of activity level, to measure physical activity among fourteen- to sixteen-year-old students. It found that boys who walked to school expended forty-four more calories a day and girls expended thirty-three more calories a day than did their peers who were driven.160  Projected over the course of a school year, or 200 days, this additional physical activity could account for a two- to three-pound difference between those who walk to school and those who do not, all other things held constant.

To examine why most children do not walk or bike to school, the CDC analyzed data from the annual national HealthStyles Survey.161  Households with children aged five to eighteen were asked if their children walked or biked to school and about any barriers they faced in doing so. Reported barriers included long distances (55 percent), traffic danger (40 percent), bad weather (24 percent), crime (18 percent), opposing school policy (7 percent), and other reasons (26 percent). Sixteen percent of respondents reported no barriers; notably, within this group, 64 percent reported children walking and 21 percent reported children biking to or from school at least once a week in the preceding month.

One major cause of active commuting's decline is the trend toward constructing schools away from the center of communities.162  Students with shorter walk and bike times to school are more likely to walk and bike. Recent nationwide trends toward bigger schools have also led to the decline of the “neighborhood” school. Since World War II, the number of schools has declined 70 percent, while the average size has grown fivefold. Today, however, communities are increasingly concerned about school siting decisions as they relate to children's health and overweight status. Communities, families, school districts, and governments at all levels have begun mobilizing to facilitate active commuting by improving pedestrian and biking safety, adding bike racks and crossing guards, mapping safe routes to schools, building new schools or renovating older schools in residential neighborhoods, and forming such programs as the Walking School Bus, Bike Trains, Safe Route to School, National Walk Our Children to School Day, and the federal Kids Walk-to- School Campaign.163  Programs that involve adult volunteers—such as the Walking School Bus, which organizes neighborhood chaperones to supervise children as they walk to school—also increase physical activity among adults.164

After-School Programs
After-school programs in child care centers, schools, and community centers also offer opportunities to implement obesity-prevention strategies. The 1990s saw a substantial increase in after-school programs serving children of low-income families.165  One of the best known is the federally funded 21st Century Community Learning Centers, a school-based after-school program providing academic enrichment and youth development opportunities. Federal funding grew from $40 million in 1997 to almost $1 billion in 2005. In 2001, 1.2 million elementary and middle school students in 3,600 schools participated.166  Implementing obesity-prevention strategies in the 21st Century Community Learning Centers would not only reach many young people directly but also offer a model for other such programs.

A recent survey found that most after-school programs do not address physical activity and healthful eating, and that staff at many after-school programs are untrained.167  But some programs are leading the way. For example, the Girls Health Enrichment Multi-Site Studies (GEMS) program aimed to prevent obesity among eight- to ten-year-old African American girls. In a set of four pilot interventions, girls and their parents were recruited channels to participate in after-school programs, such as ethnic dance, that targeted healthful eating, physical activity, and reduced television viewing.168 The results of the GEMS pilot interventions were promising, demonstrating the feasibility and potential effectiveness of incorporating obesity-prevention efforts into after-school programs.

Federal funds are available to provide after-school snacks to children up to age eighteen in after-school programs operated by schools, nonprofit organizations, and public agencies. Both the federal school lunch program and the Child and Adult Care Food Program (CACFP) offer cash reimbursements to after school programs for snacks. Subsidies vary by the child's family income, as they do for breakfasts and lunches. Subsidies are provided with CACFP funds to provide free snacks in programs located in areas where 50 percent or more of the children enrolled in school are eligible for free or reduced-priced school meals. Participation in the after-school snack program has increased dramatically, from some 645,000 children in 1999 to about 1.2 million in 2003.169  Reimbursable snacks must follow the CACFP's snack requirements, but more research is needed to assess the nutritional value of the snack foods being offered and to find ways to serve more fruits and vegetables.

Congress has recently allowed after-school programs in seven states—Delaware, Illinois, Michigan, Missouri, New York, Oregon, and Pennsylvania—to serve suppers as well as snacks to children in areas where more than 50 percent of the children qualify for free or reduced-price school meals.170  Some low-income children may thus eat three meals and a snack every weekday during the school year from federal food programs— a fact that highlights both the growing importance of the federal child nutrition programs for children in low-income families and the need to ensure that the foods these programs serve are consistent with the recommendations in the Dietary Guidelines for Americans.

Family Involvement
Parents and caregivers provide the primary social environment in which children form attitudes and behaviors regarding eating and physical activity. Parents create an environment conducive to active or sedentary lifestyles, they select foods brought into the home, they determine how often and what types of meals are eaten outside the home, and they model eating and physical activity behaviors. Thus, to achieve maximal and sustained behavior change, parents and caregivers must be involved in obesity prevention.

Reviews of efforts to prevent youth high-risk behaviors, such as school failure, aggressive behaviors, and substance abuse, have found that combined school and family programs deliver more benefits than those managed separately.171  Most obesity-prevention programs, however, have focused almost exclusively on school programs. Actively involving parents is not always easy, but some programs that included families achieved high rates of recruitment and retention (around 80 percent) by using such incentives as food, child care, transportation, and rewards for homework completion or attendance.172  Community organizations and other local resources can also help schools connect with low-income and minority parents.173  One creative and effective way to involve parents is to make school gyms and swimming pools available to students and their families after school and on weekends.