Recommendations for Nashville’s Road to

Success

Obesity/Diabetes subcommittee report

Alignment Nashville Health Committee

Jan. 25, 2006

Health Warning: Obesity

Unhealthy diet and lack of physical activity can be a contributing factor in many chronic diseases, including Type 2 Diabetes

Nashville Youth Risk Behavior Survey* (YBRS) found 13% of Nashville youth are obese, based on body mass index (BMI)

Healthy People 2010 target for adolescent obesity is 6%

*Based on 2003 Metro Public Health Department survey of 15 public high schools and 5 private high schools. Margin of error +/- 2.3 percent.

Health Warning: Obesity

YRBS also found a physical activity rate (vigorous activity 3 of the last 7 days) among Nashville youth of 61%

16% of Nashville youth surveyed (21% of African-American youth) are at risk of becoming overweight based on BMI

Health People 2010 target for adolescent physical activity is 85%

Only 32% of Nashville youth surveyed attend Physical Education classes daily

Why worry?

Obesity correlates with blood pressure Obesity correlates with lipid levels Obesity correlates with insulin levels Diabetes rates among school-age children

are on the rise Diabetes can lead to serious health

complications over time, including heart disease, kidney disease, blindness, stroke and amputations

Our Proposal

Raise awareness of the problem and the relationship between obesity and diabetes.

Increase activity levels during school to the minimum 30-minute standard, beginning with pilot programs at the elementary school level.

Reduce obesity rates, a leading indicator of health risk, among Nashville youth to Healthy People 2010 goal of 6 percent.

Our Proposal

In Nashville’s public schools, the focus on academic performance has resulted in a decreased focus on PE and its relevance to academic performance. Our committee proposes to reverse that trend with the introduction of a scalable pilot program in which a standard of at least 30 minutes a day of physical activity is established for all children.

Goals Raise awareness of the problem and the relationship between obesity and

diabetes. Reduce the prevalence of obesity among children in the schools targeted for

the program. Increase activity levels during school to the minimum 30-minute standard. Incorporate exercise into children’s daily routine as a core part of the

curriculum. Ensure minimum exercise requirements are met for overweight and obese

children. Establish a program that is budget neutral after start-up costs. Ensure that time devoted to exercise does not have an adverse impact on

academic performance (we suspect the opposite). Have a program that is scalable to all elementary schools and can be

incorporated into the daily routine, including after-school programs. Include consideration of children with physical or mental handicaps, if

possible.

Proposed Intervention Start with elementary schools, and later address middle and high

schools. Principals in the pilot schools will agree to establish a minimum

standard of 30 minutes each day of physical activity. There will be buy-in from the central administration on the minimum

standard concept. Within each school, program will be coordinated by PE teachers and

managed by school principals. The minimum standard will be met during regular PE for at least 3 days

and by classroom teachers during the other days. The program will be coordinated by a consulting agency, offering

guidance and measuring impact. Performance rewards should be a part of the program, making sure that

principals, PE teachers, classroom teachers and children all have their incentives to participate in the program in alignment.

Proposed Intervention (cont.) Actual exercise programs will be developed by the consulting

agency in coordination with the health and wellness coordinator and the pilot schools. The consulting agency would either develop the program in-house or use an established concept such as SPARK (www.sparkpe.org), MarathonKids (www.marathonkids.com), or a variant of the STEPS program. Programs that meet minimum daily exercise requirements and are self-sustaining over many years would be favored.

The consulting agency would be engaged in a start-up fashion and be contracted over a 2-3 year period. Excluding potential start-up costs, the program would be budget neutral.

Successful pilots would be expanded to all elementary schools and simultaneously piloted in middle schools. Successful pilots could also be expanded to after-school programs.

Measuring Results

Evaluation would have two components: Measure the general impact on all children. Measure the impact on children who are overweight or

obese at the beginning of the program.

Measures would include: BMI measures of all children in the pilot schools and

activity assessments at various points in the program. Academic performance in the pilot schools would also

be measured. Special precautions would be made to insure the program does not stigmatize any child.

Funding

Funding would be sought to cover the costs of the consulting agency and/or of any trademarked programs used.

Alignment Nashville Special Grant Funding Task Force should pursue grant funding for pilot programs. The SPARK program, for example, qualifies for funding under the Carol M. White Physical Education Program.

Funding collaborations should be explored via private/corporate donors, local and state grants, academic research institutions, etc.

Pilot School Selection

Focus on those schools already being monitored for BMI and blood pressure by the Health Department’s OOPS program.

Focus on schools with greatest health disparities as identified by the 2005 YRBS (results pending).

Timeline

Potential pilot schools and consulting agencies identified prior to the March 2006 Mayor’s Summit on Children and Youth.

Detailed implementation work begins in March, following the Mayor’s Summit.

School Board approval by Fall 2006 Program implementation begins Fall 2006 or

as soon as grants/funding are in place.

Mayor’s Challenge

Draft “A Challenge from the Mayor” that Mayor Purcell can issue at the Mayor’s Summit on Children and Youth in March as a way to draw attention to the issue and what Nashville is doing to address it.

Committee Research

Best Practices

Metro PE Requirement

After-school programs

Metro Schools PE requirements

High school: 1 year (can be taken anytime during grades 9-12)

Lifetime wellness: 1 year (can be taken anytime during grades 9-12)

Middle school: PE is an elective. Most principals choose to offer physical education every other day or as part of a rotation (usually a 6 or 12 week rotation).

Elementary: Minimum of 2 days per week. Most students average 60 minutes or more per week.

Source: School Health division, Metro Public Health/Metro Schools

Best Practices

After-school Program Demographics

Boys & Girls Clubs of Middle Tennessee Members (930 total) generally participate in 60 minutes of

movement/exercise/sports & games daily (depending on pick-up times).

77% of K-12 club members are 6-12 years of age 23% are 13-17 years of age 51% are male, 49% are female 86% African-American, 4% Hispanic, 8% Caucasian, 2%

other 83% from single-parent households 82% are economically disadvantaged 77% attend 3 or more times per week

After-school Program Demographics

Pearl-Cohn H.S. (35) Park Avenue E.S. (30) Wharton M.S. (12) W. A. Bass M.S. (20) Rose Park M.S. West End M.S. West Meade E.S. Wright M.S. Stratford H.S. Maplewood H.S. (20) Glen E.S. (15) Schwab E. S. Bellshire E.S. Jere Baxter M.S.          Caldwell E.S. (10) Bailey M.S. East Literature Tom Joy E.S. Smithson Craighead E.S  Litton M.S. Hunter Lane H.S. Hillwood H.S.

NSA Cockrill E.S. (20) McKissack E.S. (50) Martha Vaught M.S. W.A. Bass M.S. Antioch H.S. Glencliff H.S. (25) Glenview E.S. (40) Glengarry E.S. (10) Mt. View E.S. (25) Edison E.S. Croft M.S. McGavock H.S. Wright M.S. (65) Whitsett E.S. Glencliff E.S. (30) Paragon Mills E.S. (30) Meigs M.S. Fall Hamilton E.S. (60) Carter Lawrence E.S. (10) Rose Park M.S. (10) Cameron M.S. (20)

Walk to the North Pole (Haynes Middle School) Initiative was part of the school’s 2004 Health and Medical Sciences Fall Health

Kickoff. Students were challenged to "Walk to the North Pole" with the ultimate goal of

encouraging adolescents to have an active lifestyle. Each student received a pedometer and encouraged to monitor their daily steps. Recommended number of steps per day was 10,000 (approximately 5 miles). During the school day classes would take turns walking accompanied by their

teacher. Collective goal was 4004 miles (the distance between Haynes Middle School and the

North Pole). A chart at the front of the school mapped progress and provided a visual incentive. At the end of the challenge, each student was rewarded with a ticket to see The Polar

Express. Movie tickets were provided by the Meharry-Vanderbilt Alliance, local churches and

individuals who sponsored students by buying a $6.50 movie ticket. Students sometimes would forget their pedometers, some pedometers were lost, and

a few students were caught shaking the pedometers to artificially increase their meter readings. Students caught shaking their pedometers had their steps disqualified and were at risk of being removed from the program.

Website research links

2003 Youth Risk Behavior Survey www. www.sparkpe.org www.MarathonKids.com www.obesity.org/subs/childhooh