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Posted Tuesday, January 20, 2009 3:30 PM

Childhood Obesity and School Exercise Programs: Not So Fast

Sharon Begley

I hate to pour cold water on what seems like a surefire way to combat childhood obesity—namely, school-based health and exercise programs—so I’ll blame the Cochrane Collaboration for doing so. This non-profit group of scientists and physicians, based in England, regularly assesses the weight of the evidence on health and medical questions from whether St. John’s wort can alleviate depression (yes, sort of) to whether mouthwash can reduce bad breath (in some cases). Now the Cochrane team has weighed in on whether school programs can help kids lose weight and inspire them to exercise more. Answer: no, on both counts.

That’s a little discouraging, given the renewed emphasis on using schools to combat the growing incidence of childhood obesity and its attendant diabetes. Studies from Greece to England to Australia and beyond have looked for correlations between physical inactivity and obesity, or school-based exercise programs and health benefits, calling almost unanimously for (to pick just one) “necessary school interventions in order to encourage healthier behaviours and habits.” To be sure, school-based programs here and there have reported success in reducing obesity and fostering healthy habits, but the results tend to be equivocal, especially when it comes to getting kids to stick with the program.

Taken together, the 26 studies of school-based programs aimed at promoting physical activity in Australia, South America, Europe and North America which the Cochrane team examined increased how long children spend exercising and cut their TV-watching time. So far, so good. The programs also reduced blood cholesterol levels and improved lung capacity, a measure of fitness. But—now the bad news—the programs had little effect on weight or blood pressure or on what kids choose to do in their free time, the last being a crucial indication of whether the programs are likely to change lifestyle habits for the better.

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“Given that there are at least some beneficial effects, we would recommend that schools continue their health promotion programs,” said Maureen Dobbins of the School of Nursing at McMaster University in Ontario, who led the review.

But why didn’t the programs do what public health officials hope, namely take off pounds and instill lifelong healthy habits? “Physical activity classes may be too closely associated with school work, so for some students this makes them feel like they are being made to do more work,” says Dobbins. In that case, the last thing kids want to do is more such “work” on their own time, when a teacher isn’t making them. Kind of like if you make reading a chore for kids, they think of it that way—and never want to pick up another book unless they have to.

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Member Comments

Posted By: quiact (February 2, 2009 at 8:29 AM)

Thoughts about Obesity

Obesity has been defined as when excess body fat accumulates in one to where this overgrowth makes the person unhealthy to varying degrees. Obesity is different than being overweight, as it is of a more serious concern.  As measured by one’s body mass index (BMI), one’s BMI of 25 to 30 kg/m is considered overweight.  If their BMI is 30 to 35 kg/m, they are class I obese, 35 to 40 BMI would be class II obese, and any BMI above 40 is class III obesity.  Presently, with obesity affecting children progressively more, the issue of obesity has become a serious public health concern.

Approximately half of all children under the age of 12 are either obese are overweight.  About twenty percent of children ages 2 to 5 years old are either obese are overweight.  The consequences of these stats on our children are very concerning, considering the health issues they may or likely experience as they get older.

Worldwide, nearly one and a half billion people are either obese or overweight.  In the United States, about one third of adults are either obese or overweight.  It is now predicted that, for the first time in about 150 years, our life expectancy is suppose to decline because primarily of this obesity problem.

Morbid obesity is defined as one who has a body mass index of 30 kg/m or greater, and this surgery, along with the three other types of surgery for morbid obesity, should be considered a last resort after all other methods to reduce the patient’s weight have chronically failed.   Morbid obesity greatly affects the health of the patient in a very negative way.  It has about 10 co-morbidities that can develop if the situation is not corrected.  Some if not most of these co-morbidities are life-threatening.  

One solution beneficial in many cases of morbid obesity if one’s obesity is not eventually controlled or corrected is what is known as gastric bypass surgery.  This is a type of bariatric surgery that essentially reduces the volume of the human stomach in order to correct and treat morbid obesity by surgical re-construction of the stomach and small intestine.  

Patients for such surgeries are those with a BMI of greater than 40, or a BMI greater than 35 if the patient has co-morbidities aside from obesity.  This surgery should be considered for the severely obese when other treatment options have failed.  The standard of care illustrating as to whether this surgery is reasonable and necessary should be clarified.

There are three surgical variations of gastric bypass surgery, and one is chosen by the surgeon based on their experience and success from the variation they will utilize.  Generally, these surgeries are procedures related to gastric restrictive operations or mal-absorptive operations.  

Over 200,000 gastric bypass surgeries are performed each year, and this surgery being performed continues to progress as a suitable option for the morbidly obese.  There is evidence that this surgery is particularly beneficial for those obese patients that have non-insulin dependent Diabetes Mellitus as well.

It is believed that the results of this surgery to correct morbid obesity greatly limits or prevents such co-morbidities associated with those who are obese.  Yet about two percent of those who undergo this surgery die as a result from about a half a dozen complications that could occur.  However, the surgery reduces the overall mortality of the patient by 40 percent or so, yet this percentage is debatable due to conflicting clinical studies at times.

Age of the patient should be taken into consideration, as to whether or not the risks of this surgery outweigh any potential benefits for the patient who may have existing co-morbidities that have already caused physiological damage to the patient.  Also what should be determined by the surgeon is the amount of safety, effectiveness, and rationale for a particular patient regarding those patients who are elderly, for example.

Many feel bariatric surgery such as this should be considered as a last resort when exercise and diet have failed for a great length of time.

If a person or a doctor is considering this type of surgery, there is a website dedicated to bariatric surgery, which is:  www.asmbs.org,

Dan Abshear


Posted By: OhioGal (January 21, 2009 at 4:36 PM)

I live in Northern Ohio where we have a long, cold winter. The mandated PE classes use the gym nonstop so that it can't be used for recess with the result that when it is too cold to go outside or it's raining, the kids have recess in their classroom. If PE weren't mandated the kids could play in the gym everday and get exercise every day instead of twice a week. The other problem with PE is that it is often no fun and so kids begin to hate the idea of exercise. If kids choose what they will play they choose something that appeals to them. As it is now, my daughter has been spending recess this week sitting in her classroom watching movies.


Posted By: sieg6529 (January 21, 2009 at 3:33 PM)

The reason that lunchroom food is such crap is because it is legislated.  The food must contain a certain % of fat and calories to provide enough sustenance to those children for whom it is the only proper "meal" of the day.  It is an antiquated law based on conditions in the USA which scarcely exist anymore, but good luck seeing it updated anytime soon.