Healthy Eating & Fitness Are a Top Priority
Over the past 30 years, the percentage of children and youth in California who are overweight or obese has increased dramatically. Unless they develop healthy eating and fitness habits, and have access to healthy food and activity environments, children and adolescents are at greater risk of developing the many health problems associated with overweight and obesity. These problems include a wide range of chronic diseases, including type 2 diabetes, hypertension, many forms of cancer, and respiratory problems.
Although exact estimates vary, it is clear that overweight and obesity rates are very high. According to the 2007 California Health Interview Survey, 12% of children between 5 and 11–and 15% of those living in poverty–are overweight for their age.1 Among adolescents aged 12-17, 13% are overweight or obese, with this figure climbing to 23% among those in living in poverty.2 A report from the California Center for Public Health Advocacy and the UCLA Center for Health Policy Research notes that, while the trend may be slowing or even reversing, major problems and disparities remain.
A Nation at Risk: Obesity in the United States Statistical Sourcebook, from the American Heart Association and the Robert Wood Johnson Foundation, contains data on the prevalence and possible causes of obesity, and highlights the inequalities that are central to understanding this issue.
School-based health centers (SBHCs) deliver both clinical and non-clinical services to reduce overweight and obesity and prevent type 2 diabetes. Recent research shows that adolescent SBHC users get more physical activity and eat more healthy foods than do SBHC non-users.3 Our fact sheet, Improving Nutrition and Physical Activity, describes model program components, staffing, keys to success, and evaluation measures, as well as profiles of eight innovative programs addressing the health needs of students all over California in fun and creative ways.
SBHCs can play a key role in schoolwide wellness efforts. With funding from the S.D. Bechtel Jr. Foundation, five Oakland schools identified “Wellness Champions,” many of whom are SBHC staff, and are now working to increase healthy eating and physical activity on campus. To learn more about these schools’ approaches and successes, see case studies focused on school wellness councils, healthy eating, and youth leadership.
Diabetes is a life-changing chronic disease that affects one in 100 California adolescents.4 Among adolescents living in poverty, the rate is much higher: three in 100 have been diagnosed with diabetes.5
Type 1 diabetes, formerly known as juvenile diabetes, makes up 5% of diabetes cases in the United States. Type 1 diabetes cannot be prevented and is typically diagnosed in children and young adults. Type 2 diabetes, formerly known as adult onset diabetes, has become increasingly common among children and adolescents because of rising obesity rates. Unfortunately, too many of California’s children and youth are overweight or obese: in fact, among those living in poverty, 15% of children and 23% of adolescents are overweight or obese.6
Eating healthfully, exercising regularly, and maintaining a healthy weight are critical to preventing the onset of Type 2 diabetes. Children and youth with both types of diabetes need support from families and schools in treating and managing their chronic disease, particularly if insulin therapy is needed.
To learn more, visit the American Diabetes Association webpage.
School-Based Health Centers Help Prevent & Manage Diabetes
School-based health centers (SBHCs) deliver both clinical and non-clinical services to reduce overweight and obesity and prevent the onset of type 2 diabetes. They also help students manage type 1 and 2 diabetes to minimize its impact.
More specifically, recent research shows that:
- SBHCs can effectively screen students for important diabetes risk factors.7
- Adolescents who use SBHCs get more physical activity and eat more healthy foods than do SBHC non-users.8
- School-based telemedicine programs can provide effective diabetes management care.9
Addressing Diabetes Risk Factors in School-Aged Children
Helping the Student with Diabetes Succeed
The American Diabetes Association offers a wealth of information for schools, school health providers, parents, students, and teachers related to understanding diabetes and school-based diabetes management. They also offer a free resource titled Helping the Student with Diabetes Succeed: A Guide for School Personnel. This comprehensive guide empowers school personnel, parents, and students to create a safe learning environment and equal access to educational opportunities for all children with diabetes.
Center for Health and Health Care in Schools
With new research and medical advances, young people with diabetes have a brighter and healthier future. School staff and students can help prevent or delay diabetes-related complications with the correct information and tools. The Center for Health and Health Care in Schools has many useful resources for preventing and managing diabetes.
Resources for Practice
Body Basics: A Toolkit for Adolescent Providers
The fifth module of the Adolescent Health Working Group‘s Provider Toolkit Series, Body Basics is designed for busy providers. It includes materials that you are free to copy and distribute to your adolescent patients and their families or to hang in waiting and exam rooms. Body Basics takes a closer look at the specifics of nutrition, physical activity, body image, obesity, and eating disorders among teenagers. It includes many resources, including:
- Screening and assessment tools
- Brief office interventions and counseling guidelines
- Information and tip sheets
- Health education materials for teens and their adult caregivers
- Resources and referrals
California Power Play! Campaign Resources
The California Power Play! Campaign provides a variety of resources to help educate, motivate, and empower 9- to 11- year-old children to eat fruits and vegetables and be physically active. The materials are research-based, educator-friendly, and appealing to children.
Changing Lives, Saving Lives
Changing Lives, Saving Lives: A Step-by-Step Guide to Developing Exemplary Practices in Healthy Eating, Physical Activity and Food Security in Afterschool Programs is available from After School Solutions’ Healthy Behaviors Initiative. The guide is designed to help afterschool programs and their community and educational partners in systematically and intentionally strengthening their nutrition, physical activity and food security practices.
Establishing School-Based Best Practices in Nutrition and Physical Activity
Criteria for Evaluating School-Based Approaches to Increasing Good Nutrition and Physical Activity is a comprehensive tool for evaluating school-based approaches to increasing children’s physical activity and improving nutrition. The criteria were developed by Action for Healthy Kids (AFHK) in response to the Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. The report is intended for use by policymakers, educators, researchers, and others. An Executive Summary of the report is also available.
Food on the Run
Food on the Run: Lessons from a Youth Nutrition and Physical Activity Campaign describes how this California-based project mobilized youth advocates to promote healthy eating and physical activity. It outlines how to implement a nutrition and physical activity youth advocacy program. Plus it provides educational materials for youth and adolescents, including lesson plans, academic achievement facts, public service announcements, and tip sheets.
Jump Start Teens
This interactive cross-curricular set of lessons for high school teachers and school nutrition staff. Lessons, worksheets, and stand-alone activities support team building among teachers, coaches and nutritional staff, as well as parents, local business, and the greater community.
Taking Action for Healthy School Environments
Through case studies featuring 18 California school districts, Taking Action for Healthy School Environments: Linking Education, Activity, and Food in California Secondary Schools illustrates promising practices and provides recommendations for improving student health and thus academic potential through policy action and environmental change in the following four areas: 1) adopt local school wellness policies that institutionalize links between education, physical activity, and food; 2) increase nutrition education opportunities for students; 3) increase physical activity for students and the community; and 4) implement nutrition standards for all food and beverages offered at school.
California Project LEAN and the California School Boards Association
California Project LEAN has put together a series of free, online videos that demonstrate how schools can have an even greater impact on the health, wellness, and success of all students. In addition to an introductory video, there are videos covering: 1) the implementation of moderate-to-vigorous physical activity in PE; 2) physical activity during the school day; 3) safe routes to school; 4) joint use of school facilities; and 5) increasing consumption of healthy beverages. In addition, California Project LEAN and the California School Boards Association have developed Student Wellness: A Healthy Food and Physical Activity Policy Resource Guide for school governance leaders. The guide provides school governance leaders with a step-by-step approach to enhance the school environment so students can develop and practice healthy eating habits. It outlines the link between nutrition, physical activity and learning; highlights school districts that successfully offer healthy foods and beverages; offers recommendations for developing comprehensive nutrition and physical activity policies; and provides sample policies from which schools can draw. The California School Board Association also has a Sample CSBA Board Policy: Student Wellness and a Development of Physical Activity Policy.
School Food and Beverage Marketing Assessment Tool
This tool can be used to assess food and beverage marketing on school campuses, providing results that are useful to health professionals and educators concerned with children’s health and the types of food messages in schools.
The Center for School, Health and Education
The Center for School, Health and Education, at the American Public Health Association, advances school-based health care as a comprehensive strategy for preventing school dropout and improving graduation rates for K-12 students. One of the Center’s key issues is hunger and obesity, and their website provides useful links and information for health providers seeking to address these issues in the school environment.
Healthy School Food Policies
The Center for Food and Justice, a division of the Urban and Environmental Policy Institute, has created Healthy School Food Policies: A Checklist. The Checklist contains 65 policy ideas for improving school food, with legislative language for each idea drawn from policies that have been enacted or proposed at the state or school district levels. This updated version contains dozens of new policies drawn from a much wider range of sources than the original 2002 release.
Sample School Wellness Policies
The U.S. Department of Agriculture’s (USDA) Team Nutrition website serves as a clearinghouse of information on the components that should be considered when establishing a school wellness policy. Examples of policies already developed by schools and state agencies are provided as resources and references. These policies are not endorsed by USDA nor do they represent a comprehensive list; they are simply a set of examples to help schools.
Water Access in Schools
The Centers for Disease Control and Prevention created this website to help schools ensure that students have access to free drinking water. A requirement of the Healthy, Hunger-Free Kids Act of 2010 is that all schools participating in the National School Lunch Program make free water available to students during mealtimes.
Breakfast and the Achievement Gap Among Urban Minority Youth
This article, Healthier Students Are Better Learners by Charles E. Basch, includes a chapter on how lowered rates of breakfast eating among urban minority youth contribute to the achievement gap. It highlights the extent of the problem and outlines ways schools can help to prevent and address it.
Comprehensive School Physical Activity Program
The major goal of the Comprehensive School Physical Activity Program (CSPAP) is to provide students with as many opportunities as possible to engage in physical activity (PA) before, during, and after school. CSPAP supports student participation in at least 60 minutes of PA each day, which includes PA performed outside of school time, as recommended by the Centers for Disease Control and Prevention (CDC). The cornerstone of CSPAP is physical education (PE). The other four core components of CSPAP are: 1) PA at school, 2) PA before and after school, 3) Staff involvement, and 4) Family and community involvement. You can download a PDF summary of the five CSPAP elements. The CDC also has a no-cost CSPAP Guide, a 70-page comprehensive overview of CSPAP that describes in detail the step-by-step strategies to develop, implement, and evaluate CSPAP. CSPAP focuses on PE/PA overarching concepts and the basic elements that schools need to consider as they seek to provide more PA opportunities for their students. SHAPE America, in collaboration with the CDC, produced the guide in 2013.
Physical Education: Age Appropriate Practices for Schools
The National Association of School Physical Education has created booklets outlining Appropriate Practices for Preschool, Elementary, Middle, and High School. They include guidelines for designing curricula and learning experiences, suggested fitness activities, strategies for effective assessment, and best practices on forming groups, maximizing participation, and the appropriate incorporation of competition.
SPARK – School-Based Sports, Play, and Active Recreation for Kids
Dedicated to improving the quantity and quality of physical activity for children and teachers, SPARK creates, implements, and evaluates programs that promote lifelong wellness. The SPARK program offers six evaluated curricula available to engage students in developmentally appropriate physical activity. They provide schools and agencies with curriculum, training, on-going support, and equipment.
Physical Activity and the Achievement Gap Among Urban Minority Youth
This article, by Charles E. Basch, describes how low rates of physical activity among urban minority youth contribute to the achievement gap. It highlights the extent of the problem and outlines ways schools can help to prevent and address it. (The article is part of a series titled Healthier Students Are Better Learners, published as a special edition of the Journal of School Health and available for free online.)
Many students are at school during breakfast, lunch, and even at dinnertime. School meals have a real and lasting influence on student health. These examples show how school communities, with school-based health centers (SBHCs) as key contributors, can make significant, positive changes to school food environments.
Innovative Eating With Grab-N-Go Breakfasts: Fremont High School
In 2010, Fremont High School began offering a free, hot breakfast to any student who showed up to the cafeteria between 7:45 a.m. and 8:10 a.m. Unfortunately, few students arrived at school early enough to eat.
Fremont’s Youth Wellness Advisory Board is a diverse group of students with a shared commitment to advocating for positive policy change and advancing school wellness. With encouragement from the health educator from the Tiger Clinic SBHC, the Advisory Board was eager to improve students’ eating habits. They invited the Director of Nutrition Services for Oakland Unified School District to talk with them about possible changes to Fremont’s meal program. The Director was impressed by the Advisory Board’s enthusiasm and organization and proposed piloting a new way of serving breakfast: the Grab-N-Go Breakfast. With the Grab-N-Go Break- fast, students could pick up a bagged meal at the school gate and bring it to class, increasing participation in the program, bringing in more federal funding, and ultimately improving food quality.
Over the next four months, the Advisory Board, with the support of the SBHC, the School Wellness Committee, and the school’s cafeteria staff, advocated for Grab-N-Go with administrators and teachers. They had one-on-one conversations. They created PowerPoint presentations, using data from the statewide Breakfast First coalition. They attended staff meetings to make their case. Some adults were immediately receptive, while others needed convincing. Ultimately, though, everyone agreed to a trial run.
Today, Grab-N-Go Breakfast is well-established and increasingly well-used. Many more Fremont students are eating breakfast – sometimes it’s a bagel, sometimes granola, sometimes another entrée, as well as juice and, if they want it, milk. (The Advisory Board gave feedback on the menu, even taste-testing the meals.) The system is efficient and simple: as students walk onto campus, they pick up a meal and bring it to class. Meanwhile, a cafeteria worker makes a tally mark for another well-fed student!
Healthier Foods at School and at Home: Urban Promise Academy (UPA)
Over the past few years, UPA – led by Wellness Champions from both the SBHC (called the Hawthorne Clinic) and its Family Resource Center – have made great strides in improving the school’s food offerings and overall school food environment.
At UPA, every student participates in a morning “crew,” an enhanced homeroom experience that includes time for students to eat a relaxed breakfast. The health educator from the Hawthorne Clinic and the school nurse co-lead a “crew,” giving them the opportunity to engage directly with a small group of students. The breakfasts themselves have evolved to include more fruit and whole grains. And, working closely with the cafeteria manager, who is a strong advocate for children’s nutrition, parents have the opportunity to give input into the breakfast menus, improving appeal and quality.
Lunch choices have also gotten tastier. Students advocated for improvements to the school’s salad bar, which resulted in parent volunteers from the Family Resource Center preparing the salad bar each morning to make sure students get what they want. And, at honor roll celebrations, students enjoy healthy smoothies rather than ice cream sundaes.
With leadership from the Wellness Champions and Physical Education teacher, UPA started growing its own food on campus. The Family Resource Center engages students and families in regular gardening programs and in deciding what to grow. Volunteers range from early morning helpers who plant, weed, water, and harvest, as well a more intensive gardening during the summer. The space draws in the entire UPA community.
Finally, UPA is working to improve food choices not just on campus but also in homes. The school collaborates with the Alameda County Food Bank to deliver food to families and the Family Resource Center has convinced local fruit stands to donate to UPA.
From the Garden to the Kitchen: West Oakland Middle School (WOMS)
WOMS is deeply engaged in making the campus and community healthier places for students to live, work, and play. The SBHC’s leaders are focusing on primary prevention to complement the much-needed medical care. New efforts to promote healthy eating are bringing many stakeholders – including students, parents, community members, and others – together.
The school garden has been a huge success, providing students with experiential environmental and nutrition education. Groups of students, including the boys’ basket- ball team, tend the garden from planting to harvesting – and then eat their results. For many, the garden provides an opportunity for a new, deeply engaging and rewarding school experience. This experience has also influence families’ food choices and habits, with students prompting new meal and snack ideas. Recently, OBUGS, which coordinates the garden program, merged with LifeLong Medical Care (the SBHC’s lead agency) creating an even stronger partnership for health and facilitating better integration between clinical and non-clinical care, between prevention and treatment.
In addition, WOMS families are engaging in a community-based, community-driven series of cooking classes. Organized jointly by SBHC leaders and other neighborhood groups, the classes include an introductory eight-week series as well as specific classes focused on particular health issues. Every session, attendance grows.
Finally, the SBHC facilitates a weekly back pack food program in collaboration with Alameda County that serves 50 WOMS families to help improve their healthy eating habits.
About These Case Studies
These case studies highlight the contributions that SBHCs and their partners have made to the Bechtel Oakland Wellness Champion Initiative, which aimed to reduce obesity among Oakland youth by creating school environments that promote healthy eating , physical activity, and wellness. This Initiative served as a model for implementing wellness policies at the school level.
(1) California Health Interview Survey, 2007.
(2) California Health Interview Survey, 2007.
(3) McNall, M.A., Lichty, L.F., & Mavis, B. (2010). Impact of School-Based Health Centers on the Health Outcomes of Middle School and High School Students. American Journal of Public Health. 100(9): 1604-1610.
(4) California Health Interview Survey, 2007.
(5) California Health Interview Survey, 2007.
(6) California Health Interview Survey, 2007.
(7) Rafalson, L., J. Eysaman, and T. Quattrin. “Screening Obese Students for Acanthosis Nigricans and Other Diabetes Risk Factors in the Urban School-Based Health Center.” Clinical Pediatrics 50.8 (2011): 747-52.
(8) Mcnall, Miles A., Lauren F. Lichty, and Brian Mavis. “The Impact of School-Based Health Centers on the Health Outcomes of Middle School and High School Students.” Am J Public Health American Journal of Public Health 100.9 (2010): 1604-610.
(9) Izquierdo, Roberto, Philip C. Morin, Kathleen Bratt, Zoryana Moreau, Suzanne Meyer, Robert Ploutz-Snyder, Michael Wade, and Ruth S. Weinstock. “School-Centered Telemedicine for Children with Type 1 Diabetes Mellitus.” The Journal of Pediatrics 155.3 (2009): 374-79.