Health care Chapter 1 Scarcely a news report goes by that does not address the number one health concern in the United States, obesity. Obesity has long been a concern of the healthcare industry, and the focus on children is increasing. Obesity is considered the number one health risk for children in the United States today. Research demonstrates it is not only a concern but one that is now reaching epidemic proportions. The number of children who are overweight has doubled in the last two to three decades; currently, one child in five is overweight. Research further indicates that if a child is overweight at age 6, his or her likelihood of adult obesity is more than 50 percent. Obesity presents numerous health problems for children; hypertension and Type II diabetes, coronary heart disease, stress on weightbearing joints, low selfesteem, and the risk for chronic health problems in adulthood. One of the most severe problems is sleep apnea (interrupted breathing while sleeping), which, in some cases, can lead to problems with learning and memory. (Blasi, 2003) Problem Statement, Purpose and Rationale Childhood obesity has become an epidemic in recent years, with more than 9 million children labeled obese, and the decrease in physical education requirements may be affecting the health of children. Children need to maintain a regular rate of physical activity to maintain optimal health and this activity should be present in the physical education program. The purpose of this study is to determine if participating in a routine exercise program can help reduce excess weight and maintain optimal fitness, by designing and implementing a daily fitness program for students. Obesity is defined as body weight, which is more than normal for a particular age, gender, and height. Obesity can be measured through BMI (Body Mass Index) calculations that are based on a person’s height and weight. Obesity is the end result of a person taking in more calories than they expend in a day. Even a small imbalance between energy input and output can lead to significant weight gain over time. Most obese children demonstrate a slow but consistent weight gain over several years. Eating too much and moving around too little are the main causes of obesity. Most experts agree that watching excessive amounts of television is a significant risk factor associated with obesity. Research has demonstrated that almost half of children ages 816 years watch three to five hours of television daily. Extreme cases of obesity are generally contributed to inactive children, eating too many snacks with a high fat content. (Blasi, 2003) Possible Causes The simple answer to the problem of childhood obesity is more calories are taken in than are expended in a day, which when accumulates results in obesity. However there are a variety of factors that affect and may contribute to obesity and the solution may be as complex. Increasing physical activity to meet or exceed daily dietary intake is something that people can control and therefore have an impact. This study will focus on the increase in physical activity for students and monitor their progress throughout the duration of the study. There is no longer a question about whether or not childhood obesity exists. It does. Environmental conditions, such as television, video games, and computers can have an influence if children don’t take part in other physical activities. Certainly, the increase in fast food diets and the intake of sugar has an impact on a child’s weight, particularly if not balanced with other foods and activities. Soft drinks have become a mainstay in the daily diet of American children. A recent longterm research study examined soda consumption and its effect on children’s body weight. The study found that “for each additional daily serving of a sugarsweetened soft drink, the incidence of obesity was significantly increased. Researchers also discovered that the odds of becoming obese increased 1. 6 times for each additional glass of sugarsweetened soft drink consumed above the daily average. ” (Blasi, 2003) In 1998, The National Association for Sport and Physical Education issued guidelines stating that young children should strive for 60 minutes of physical activity each day to promote health and wellbeing. Clearly, this is a valuable goal for both children and adults, but may not be the only contributing factor for obesity. The factors that contributing to obesity are complex, and can include economic, social, cultural, behavioral, nutritional, psychological, and genetic factors. However, individual differences make it unclear the extent to which each of these factors contributes to obesity. An individual’s genetic makeup combined with the environment in which the person lives may have an impact. Eating and activity patterns have been shown to be consistently related to obesity. These are also the two factors that we can most readily have an impact on. (Blasi, 2003) Most states require students to participate in some type of physical education program, the time spent in physical education declines with each subsequent grade. “About one third (39. 7 percent) of elementary schools require physical education in kindergarten, one half (50 percent) of elementary schools require physical education in grades 1 through 5, one fourth (25 percent) in grade 8, and only 5 percent in grade 12. ” (Garbe & Hoote, 2004) This is in conflict with recommendations made by the American Academy of Pediatrics (AAP). The AAP recommends that K12 students have daily opportunities for physical education. The National Association of State Boards of Education (NASBE) backed this notion with the development of guidelines, stating that elementary school students should have at least 150 minutes per week of physical education and at least 225 minutes per week when they reach middle/ junior and senior high school. The School Health Policies and Programs Study (SHPPS), conducted in 2000, found that only 8 percent of elementary schools, 6. 4 percent of middle/junior high schools, and 5. percent of senior high schools provide daily physical education for the entire school year for all grades. (Garbe & Hoote, 2004) Both the school environment and the family environment must absorb the responsibility for childhood obesity. While the school cafeteria provides food choices, the physical education program determines the time allocated to physical activity, and the school curriculum controls opportunities to learn about the relationship between personal behaviors and health. Away from school, the family environment strongly influences child health. Chapter Two Literature Review According to the Centers for Disease Control and Prevention, 15 percent of young people in the United States are overweight, defined as a body weight at or above the 95th percentile on Body Mass Indexforage percentiles. An additional 15 percent of children (those above the 85th percentile) are classified as being “at risk of overweight. ” The health risks of obese children cannot be overstated. The risks in terms of physical health include hypertension, heart disease, diabetes, and increased risk of obesity in adulthood. The cumulative effects of obesity don’t stop there. “Obesity also exerts a heavy psychological toll on children: the likelihood of impaired quality of life for obese children is 5. 5 times greater than for healthy children. ” (Anderson & Butcher) Increasing childhood obesity is related to increasing adult obesity. Although the obese share of the population is expected to increase with age, obesity today is increasing with age more quickly than it did thirty years ago. (Anderson & Butcher, 2006) Although a public school cafeteria has not traditionally provided the healthiest of meals, the problems continue to grow with the introduction of fast foods, such as McDonalds, Taco Belle and Pizza Hut, to the lunch offerings. “In addition, hundreds of underfunded school districts have negotiated “pouring rights” contracts to sell brands of soda and allow young people easy access to vending machines during recess breaks. Soda consumption among adolescents has nearly tripled between 197778 and 1994. ” A 12ounce serving of carbonated soda contains the equivalent of 10 teaspoons of sugar. Soda consumption has been shown to be an independent risk factor for obesity in children. In addition to sodas becoming readily available during school time, vending machines are present in a majority of schools. (Staveren & Dale, 2004) Currently, there are minimal opportunities for children to be physically active during school time. Recent budget cuts have resulted in cuts to physical education. Physical Education is necessary if children are going to maintain a healthy body weight and good health. Children should receive at least 60 minutes, and up to several hours, of ageappropriate exercise on all or most days of the week. Few schools offer any structured physical activity outside of the physical education classes. (Staveren & Dale, 2004) Simply adding physical education opportunities may not be enough to make significant impact or reduction in childhood obesity. Children who are obese are not comfortable in the physical education class. Not only is it physically challenging, but embarrassing as well. Obese children may feel more vulnerable in the physical education class than they do anywhere else in the school. Due to the number of overweight and obese children, it is obvious that physical education programming needs to be restructured and adapted to suit this population. An obese child is not going to benefit from being made to run laps that they are not physically capable of doing. Physical Education may have to take more of an individual approach with students, helping them to identify goals, and then designing a fitness plan to meet those goals. More wellness information should be incorporated into the curriculum, benefiting all children. The competitive nature of physical education needs to be reevaluated in order to meet the needs of obese children. Focus should be place on health. Physical education instructors will also need to motivate children, and finding activities that they enjoy and then building on those may provide the motivation necessary. (Irwin, et. Al. , 2003) Physical educators are confronting a growing need for developmentally appropriate movement education among very young children. Children are more sedentary and more obese, on average than their counterparts 20 years ago, and they need to develop. movement skills and habits for healthy, active lifestyles. (Helm & Boos, 1996) Researchers at the University of California at San Diego tried to determine how excess weight affects obese children and their ability to perform normal activities. The study, surveyed 106 obese children (57 boys and 49 girls; average BMI of 34. 7) between the ages of 5 and 18 years. They were asked questions such as whether they ever experienced problems due to participating in physical activities, bathing themselves, other kids not wanting to be their friends, or being unable to pay attention during class. The interview also asked how often they felt depressed or worried and whether they ever missed school because they did not feel well. The results of each interview were graded on a scale of 100 and then compared to the published data on healthy children and children with cancer who were receiving chemotherapy or had chemotherapy recently. The average score for obese children (67) was drastically lower than healthy children (83) and even slightly less than children with cancer (69). The biggest difference in the scores between the obese children and the other two groups was related to their social functioning–20 points lower than the healthy group and 9 points lower than the children with cancer. One major reason obese children had lower scores in this area is because they get picked on and teased at school, while children with cancer usually receive sympathy. More often than not, the obese children had a physical or emotional problem: 65 percent had at least one medical condition, 37 percent had high cholesterol or a similar condition, 13 percent had either depression or anxiety, and 4 percent had diabetes. It may be due to these complications that obese children are on average absent from school four days a month, while healthier children miss on average less than a day a month. (JOPERD, 2003) A growing need in physical education is to help young people enjoy the rewards of exercise through participation. This need could be addressed by teaching students the health benefits derived from maintaining active lifestyles. Additionally, physical educators could emphasize the results of exercise which appeal to young people, such as improved physical appearance. For example, improved physical appearance can be included in a discussion of body fat reduction. This exercise benefit should not be the only focus of the discussion, but could certainly be a part of it. (Douthitt & Harvey, 1995)
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