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Lessons Learned at the Action on Obesity Summit 2007

Christy Greenleaf, University of North Texas

Megan Babkes-Stellino, University of Northern Colorado

The theme of the 4th annual Action on Obesity Summit held at the Mayo Clinic was “A policy approach to action.” Stemming from last year’s focus on childhood obesity, the 2007 Summit was an excellent opportunity for health professionals from various disciplines to come together and examine policy approaches to addressing the issues of childhood obesity. The Summit was well attended, with representatives from over 42 organizations including AASP; American Alliance for Health, Physical Education, Recreation and Dance; American College of Sports Medicine; American Heart Association; Yale School of Public Health; and Sodexho. Drs. Megan Babkes-Stellino, University of Northern Colorado, and Christy Greenleaf, University of North Texas, attended the Summit as representatives of AASP.

The impetus for the Action on Obesity Summits was Dr. Hugh Smith’s AASP keynote presentation in 2003, in which he highlighted the growing concerns regarding obesity. Dr. Hugh Smith challenged AASP and its membership to “take action” on obesity. He pointed out that AASP members have much of the psychosocial and health expertise needed to assist in efforts to address the public health issues of obesity and inactivity. Dr. Aynsley Smith, along with her colleagues at the Mayo Clinic, wasted no time in taking up the challenge and organized the first Action on Obesity Summit in 2004. The Action on Obesity Summits are purposefully designed to promote brainstorming, discussion, debate, and consensus building among attendees, with the ultimate goal of attendees returning to their organizations and advocating for action on relevant and timely issues regarding obesity.

Many of the topics discussed during the 2007 Summit have particular relevance for AASP and its membership. In the following sections, we highlight issues raised during the Summit on which AASP and its members may be able to take action.

Psychosocial Aspects of Childhood Inactivity and Obesity

In the dynamic opening session of the Summit, Dr. David Katz, Yale School of Medicine, spoke about the prevalence, economics, and policies of childhood obesity. He used the phrase “complex simplicity” to describe the challenge of weight control. That phrase seems to perfectly capture the sentiment of the conference – on one hand, health and medical professionals know a great deal about the factors that contribute to childhood obesity; on the other hand, little is known about effective and long-term programs for the prevention and alleviation of childhood obesity. Healthy nutrition, appropriate serving sizes, and physical activity are the “simple” solutions to childhood obesity. However, the complexity of the situation is that we live in social and physical environments that promote overeating and physical inactivity. The practical issue of how to motivate children to make healthy eating and physical activity choices in environments that promote neither was raised several times throughout the Summit. Thus, in addition to promoting policies that promote creating healthier environments for children, applied research is needed to determine effective strategies for addressing the interaction of the physical and social environment and psychosocial issues of childhood obesity and inactivity.

Both, Dr. Katz and Dr. John Jakicic, University of Pittsburg Physical Activity and Weight Management Research Center, suggested that children have a natural desire to move and to explore their environment. They recommended that parents, educators, and health professionals recognize the desire to move as a good thing rather than something to be punished. For example, rather than creating educational environments that require children to remain sedentary and quiet for long periods of time, children’s natural motivation to move could be taken advantage of by building numerous opportunities for physical activity into the daily schedule. Several programs using this approach, such as “Activity Bursts in the Classroom,” need further evaluation and, if determined to be effective, need to be disseminated on a larger scale. Other areas where AASP members may be able to use their expertise to influence policy include examining school recess and physical education policies and youth sport programming to advocate for best practices in motivating children to be physically active.

A moving presentation by Naomi Boak, Twin Cities PBS and producer of a documentary titled “Fat: What No One is Telling You,” brought the issue of social stigma to the forefront of the discussion. Being considered fat is a source of teasing and social isolation for children. Parents of overweight children may also experience a sense of shame and guilt for “allowing” their children to become overweight. While ideas of personal and parental control are prevalent (akin to the “simplicity” part of the childhood obesity issue that suggests children should just eat less and move more!), placing blame on children and their parents is overly simplistic and, in the end, ineffective. Placing blame and reinforcing the social stigma of childhood obesity does little to promote healthy behaviors. More effective approaches are needed to de-stigmatize childhood obesity and to create environments in which children of all shapes and sizes can participate in and enjoy moving their bodies. One potential “action step” for AASP may be to consider writing a white paper or a position statement on the issue of the social stigmatization of overweight children in youth sport and physical activity settings. Based on existing social stigma research and youth sport and physical activity literature, practical guidelines could be developed to assist physical educators, youth sport coaches, and youth sport organizations in creating positive environments, free of weight-based stigma in which children can be active.

Limited Resources Exist for Health Professionals in Contact with Children Identified as Overweight or Obese

One contentious topic at the center of the childhood obesity debate is whether to approach assessment, intervention, and treatment through screening or surveillance based on age and gender appropriate BMI (body mass index) scores. According to Dr. Martha Kubik, Assistant Professor of Nursing at University of Minnesota, who spoke at the summit, surveillance and screening are different processes with very contrasting implications. BMI surveillance involves assessment of a representative sample of children to determine the prevalence, inform policy and monitor intervention effects. Screening consists of measuring every child’s BMI and becomes an actual assessment of a vital sign. Although screening is beneficial for understanding the scope of prevalence and informing public policy, it involves the generation of reports on individual children’s health status. Screening, theoretically, is effective as a primary prevention method; however, problems arise due to limitations in the secondary prevention methods and lack of appropriate referral systems for families with children who are diagnosed as at-risk for or as overweight or obese.

A number of specific limitations were discussed at the Summit. Health-related professionals, such as physicians, school nurses, school counselors, and others who are in direct contact with children need help and assistance in identifying resources to effectively promote physical activity and healthy eating among youth identified as obese, overweight or at-risk of these conditions. Physicians, in particular may understand the medical nature of the predictors and risks of childhood overweight and obesity but may not know how to advise patients about weight and physical activity and do not have many practical tools to suggest for combating the issue. School health professionals may feel over-burdened and also lack resources to effectively support and intervene with youth identified as overweight or at-risk for overweight. As a result a vicious cycle of school health and medical professionals referring children screened as overweight or at-risk of overweight to the opposite entity often occurs. Further compounding the issues of the assessment, referral, and intervention process is that many health professionals themselves may be overweight, inactive, or both, and feel uncomfortable telling others to lose weight or increase their physical activity.

AASP, as an organization of individuals devoted to understanding how to promote positive sport and physical activity experiences can potentially ameliorate the chasm between identification of childhood obesity or overweight and referral to effective interventions. AASP members can promote the existence, or aid in the development of, evidence-based programs that provide substantial resources and support for overweight, obese or inactive youth. AASP professionals could engage in the study of best practices for dissemination of education information on energy balance to the public. In addition, applied research is needed on how to effectively educate medical professionals involved in the referral process for youth with high BMI. The examination of current and best practices for physician counseling of youth weight and inactivity issues should be conducted. As a result, medical and health professionals could be informed by this research and learn effective counseling techniques and intervention tools for working with families of children identified as, or at-risk of, overweight or obesity.

Lack of Adequate Physical Activity Levels Among Children

 Many of the issues that presently limit children’s level of physical activity and potentially contribute to the increasing likelihood of childhood obesity were discussed. Dr. Jakicic provided considerable information regarding the current lack of physical activity among children. He stated that, “simply building a trail, park or playground does not necessarily increase physical activity” and suggested that children simply do not know how to “play” anymore. Too much structure and organization seems to be leading to decreases in children’s physical activity levels. Quality physical education programs are often identified as a solution to this lack of physical activity. The importance of quality physical education should not be underestimated as one approach to reducing childhood obesity and overweight, but PE should not and cannot be the only source of physical activity. Research findings suggest that PE is currently only providing children with 25% of recommended daily physical activity. Furthermore, PE cannot be counted on as the solution to the childhood obesity epidemic. PE programs are in somewhat dire straights as many programs have been hurt by the No Child Left Behind Act of 2001. Under pressure to meet federal academic achievement standards, many schools are unfortunately reducing not only time committed to physical education, but also limiting other physical activity outlets at school, such as recess. Given these limitations, other sources of physical activity need to be available for children. Considerable discussion of the ways that researchers, health professionals, teachers and others can provoke increased physical activity in the schools occurred during the summit. Programs such as the Take 10! Program, ABC (Activity Bursts in the Classroom), and many others were highlighted as possibilities to compensate for limited physical activity and PE outlets to increase children’s energy expenditure and thereby reduce the propensity for obesity and overweight.

As an organization, AASP and its members are superbly posed to be advocates for quality physical education and for keeping sport, physical activity, and other opportunities for children to move their bodies present in the schools. The knowledge generated in the field of sport and exercise psychology on the effective predictors and benefits of youth sport and physical activity participation can be the foundation up on which to stage a legitimate fight against eliminating PE, recess, and other opportunities to for children to be active in school in order to increase academic test scores. Professionals in the AASP membership can also lend their expertise to solving the predicament of children’s lack of physical activity by conducting studies that examine the effectiveness of alternative opportunities for physical activity and evaluations of implemented interventions to promote increased physical activity.

Childhood Obesity: A Multifactorial Issue

It was concluded at the Summit that childhood obesity and overweight is a “multifactorial” issue and addressing the problem requires a comprehensive approach. Single factor solutions such as only addressing lack of physical activity, poor dietary intake, or excessive screen time will not yield adequate results in the fight to reduce the rising rates of children who are overweight or obese. Relevant factions that need to be actively involved in creating solutions include, but are not limited to, parents and family, schools, community, healthcare, worksites, local, state and federal government and the media industry. These entities need to arrive at consensus and be consistent in the areas of encouraging and modeling healthy eating habits, increases in physical activity, and monitoring, assessment and provision of support services. Proven programs that have evidence of effectiveness implemented with a multifaceted and coordinated approach can best be accomplished by individuals with knowledge of social influence, applied research, and other areas exemplified by the membership of AASP professionals.

We would like to reiterate Dr. Hugh Smith’s 2003 challenge to AASP and its members to “take action on obesity.” AASP is well positioned with a strong scientific knowledgebase and an applied emphasis to make great contributions in the area of preventing and alleviating childhood obesity and physical inactivity. Attention needs to be drawn to what AASP members are already doing on this front – AASP members conduct excellent and informative applied research and develop and implement innovative practical programs in youth sport and physical activity settings. Such contributions could be a central focus at future AASP conferences or in a special topic issue of JASP. Moreover, the time seems right for AASP to take a leading and more prominent role in the national and international dialogue on this issue. There are many organizations involved in the study of childhood obesity such as ACSM, The Obesity Society, American Heart Association, and International Association for the Study of Obesity. AASP has a unique contribution to make to this dialogue – we are an organization founded on the key idea of bridging the gap between science and practice. In preventing and combating childhood obesity, this is exactly the bridge that is needed. AASP – it is time to take action on obesity.