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Coming to the Coming to the Aid of Aid of
Overweight Overweight YouthYouth
Robert P. PangraziRobert P. Pangrazi
The Fattening of AmericaThe Fattening of America• One in three Americans are
overweight or obese• Fat free and/or sugar free foods
are in abundant supply yet weight continues to increase
• Fitness push by the President’s Council has not slowed the obesity epidemic among youth
A View of Physically A View of Physically At-Risk Children*At-Risk Children*
• Data on school age youth in each country
• Pedometer step counts and BMI• Data gathered using the same
protocol• Data gathered during the fall
season in each country*Vincent, Pangrazi, Raustorp, Tomson, & Cuddihy. (August,
2003). Activity levels and BMI of children in the U.S., Sweden, & Australia. Medicine & Science in Sports & Exercise.
Number of ParticipantsNumber of Participants
Males Females
Australia 281 285
U.S. 325 386
Sweden 461 440
How Many Steps – BMI How Many Steps – BMI Referenced Standards*Referenced Standards*
• How much activity separates normal weight from overweight/obese children
• 12,000 steps for girls• 15,000 steps for boys• Converted to time…
– 107 minutes for girls– 137 minutes for boys
*Tudor-Locke, C., et.al. (2004). BMI-referenced standards for recommended pedometer-determined steps/day in children. Preventative Medicine, in press.
Step Counts - GirlsStep Counts - Girls Most (MA) and Least (LA) Active TertilesMost (MA) and Least (LA) Active Tertiles
6000
8000
10000
12000
14000
16000
18000
20000
6 7 8 9 10 11 12
Australia MAU.S. - MASweden - MAAustralia - LAU.S. - LASweden - LA
Step Counts - BoysStep Counts - Boys Most (MA) and Least (LA) Active TertilesMost (MA) and Least (LA) Active Tertiles
9000
11000
13000
15000
17000
19000
21000
6 7 8 9 10 11 12
Australia - MAU.S. - MASweden - MAAustralia - LAU.S. - LASweden - LA
Girls - % Overweight/Obese*Girls - % Overweight/Obese*Country Least
ActiveMore Active
Most Active
Total
U.S. 48.0% 35.9% 22.8% 35.6%
Sweden 23.3% 20.5% 6.5% 16.8%
Australia 20.7% 12.5% 10.4% 14.4%
*Using International standards from Cole, et al., Br. Med. J. 320:1-6, 2000.
Boys - % Overweight/Obese*Boys - % Overweight/Obese*Country Least
ActiveMore Active
Most Active
Total
U.S. 46.7% 24.5% 18.8% 33.5%
Sweden 22.9% 18.0% 17.7% 16.6%
Australia 18.8% 17.7% 10.9% 15.8%
*Using International standards from Cole, et al., Br. Med. J. 320:1-6, 2000.
BMI (kg/mBMI (kg/m22) - Girls ) - Girls Means for Most Active TertileMeans for Most Active Tertile
15
16
17
18
19
20
21
22
23
24
6 7 8 9 10 11 12
AustraliaU.S.Sweden
BMI (kg/mBMI (kg/m22) - Girls ) - Girls Means for Least Active TertileMeans for Least Active Tertile
15
16
17
18
19
20
21
22
23
24
6 7 8 9 10 11 12
AustraliaU.S.Sweden
BMI (kg/mBMI (kg/m22) - Boys) - BoysMeans for Most Active TertileMeans for Most Active Tertile
1516171819202122232425
6 7 8 9 10 11 12
AustraliaU.S.Sweden
BMI (kg/mBMI (kg/m22) - Boys) - BoysMeans for Least Active TertileMeans for Least Active Tertile
1516171819202122232425
6 7 8 9 10 11 12
AustraliaU.S.Sweden
““The Fitness Push”The Fitness Push”It failed obese kids…It failed obese kids…
• For the last 45 years, the U.S. has emphasized fitness as a way to fight obesity
• However, obesity continues to increase in the U.S.
• This approach has failed in the U.S. because children and most adults do not “buy in” to fitness
Why Doesn’t Fitness Work for Why Doesn’t Fitness Work for the Youth Who Need It Most?the Youth Who Need It Most?
• It has been forced on youth creating a backlash and dislike when kids become adults – no locus of control
• It has created a hierarchy of “good” to “poor” activity
• Teachers and students haven’t understood the genetic limitations of participants
• Unrealistic standards were set – “One for all”
Mass Prescription Mass Prescription It Fails the Majority of YouthIt Fails the Majority of Youth
• Assumes all people need the same workload
• Assumes a small set of exercises is appropriate for many different sizes and shapes of people
• Assumes we know the correct workload for all students
• Takes away exercise independence – the intrinsic motivation to keep active
Philosophy StatementPhilosophy StatementHelping Obese YoungstersHelping Obese Youngsters
• It takes a village to succeed• Overweight children can be
served by physical education• Obese youngsters may be better
left to health experts• Screening is the most important
phase of the program• It is better to “not try” than to
“try and fail”
Screening Potential ParticipantsScreening Potential Participants
• Initial screen by classroom teacher
• Discuss with classroom teacher the potential for success– Are parents supportive?– Does the child perceive a problem?– Is the youngster motivated?– Would the teacher support the
youngster?
Screening Potential CandidatesScreening Potential Candidates
• Hold a conference with each of the possible candidates
• Select students for further evaluation based on the comments of classroom teacher, student comments and the feelings of the physical education teacher
Checking Parental SupportChecking Parental Support• Explain program to parents
– Objectives, selection process, parent responsibilities
• Give parents a handout explaining program for discussion at home
• Possible termination for non-support
• Permission form and return within specified time
Selection of ParticipantsSelection of Participants“Success Profiling”“Success Profiling”
• Baseline Activity Level– Activity surveillance using pedometers– Baseline activity level for 4 days
• BMI• Children’s Attraction to Physical
Activity Scale (CAPA)• Parent, teacher, student and P.E.
specialist “chance for success” rating (1-7 pts.)
0
1000
2000
3000
4000
5000
6000
7000
8000
P.E. School Day OutsideSchool
BoysGirls
Where Students Accumulate Activity
Morgan, C. F., Pangrazi, R. P., & Beighle, A. (2003). Using pedometers to promote physical activity in physical education. Journal of Physical Education Recreation and Dance, 74(7), 33-38.
Activity Time, Distance, Activity Time, Distance, or Step Counts?or Step Counts?
• Distance – least accurate due to stride variations and directionality
• Step Counts – shows variation based on the physical (genetic) traits of each individual
• Activity Time – most accurate and meaningful to kids and parents
Why Use Activity Time?Why Use Activity Time?
• Vast majority of activity recommendations are based on time
• Least variation between individuals – reduces comparative differences
• Allows teachers to see how much activity students are receiving in class
Introducing PedometersIntroducing Pedometers
• Let students shake and look; walk and look; reset and clear many times
• Explain placement of the pedometer – over the kneecap on the waistline– Vertical plane– Clothing or belt that is relatively snug
• “You shake it, we take it”
Finding Baseline Activity LevelFinding Baseline Activity Level
• Gather 4 days of 24 hr activity time for elementary school youth
• Gather 8 days of 24 hr activity for middle/secondary school youth
• Find average daily activity time
Calculating Baseline ActivityCalculating Baseline ActivityDay 1 Activity Time_______________
Day 2 Activity Time_______________
Day 3 Activity Time_______________
Day 4 Activity Time_______________
Add all 4 days to determine your total activity time
Total Activity Time________________
Use whole minutes only & divide Total by 4 for baseline
Baseline Activity Time______________
Activity Goal SettingActivity Goal Setting• Increase baseline activity by
10%• Record physical activity each
day for two weeks• If goal reached majority of days,
increase by another 10% of baseline
• If goal not reached, continue present level
Personal Activity Time GoalPersonal Activity Time Goal
Week # Baseline Activity
Time
Goal=Baseline +
10%
Total Time Made Goal
Sample 50 minutes 50 minutes+5 minutes
55 minutes
1 & 2
3 & 4
Implementation of Implementation of Activity ProgramActivity Program
• Meet with selected students at least once a week
• Meet in small groups or individually
• Create a personalized log book for each student
• Include physical activities• Include parental weekly
progress check form
Assigning Out of School ActivityAssigning Out of School Activity
• Each student is unique• Locus of control belongs to
participant• Offer suggestions not mandates• Try to identify activities the
student enjoys• Encourage large muscle activity
Monitor ProgressMonitor Progress• As a general rule, redo complete
evaluation each quarter (9 wks)• Don’t concentrate on weight loss• Primary focus on the activity
process• Secondary focus on BMI• Minimal focus on weight• Share positive results with others
– parents and teacher