Coming to the Aid of Overweight Youth Robert P. Pangrazi.

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