Progress Promises?ldh.la.gov/assets/oph/pcrh/obesity/AFHK2008Report...Nick Drzal Nutrition Education Consultant, Michigan Department of Education; Michigan Action for Healthy Kids

ProgressPromises?

or

An Action for Healthy Kids Report Fall 2008

What’s Working For and Against Healthy Schools

Leon T. Andrews, Jr.Director, Youth Development,Institute for Youth, Education,and Families, National League of Cities

Jim BogdenCenter for Safe and Healthy SchoolsProject Director,National Association of State Boards of Education

Vanessa Cavallaro, MS, RD, LDNProject Manager, Blue Cross Blue Shield of Massachusetts;Massachusetts Action for Healthy Kids Team

Nick DrzalNutrition Education Consultant, Michigan Department of Education;Michigan Action for Healthy Kids Team

Tab Forgac, MS, RD, LD, SNSVice President, School NutritionMarketing, National Dairy Council

Diana FoxDirector, Cancer Control Programs, PA - American Cancer Society;Pennsylvania Action for Healthy Kids Team

Warren HaymanConsultant,Council of Urban Boards of Education

Madeleine LevinSenior Policy Analyst,Food Research and Action Center

Alicia Moag-Stahlberg, MS, RD, LDFounding Executive Director, Action for Healthy Kids; Principal, Ceres Connections, Ltd.

Erica OdomEducation Program Specialist,Division of Adolescent and SchoolHealth, Centers for Disease Control and Prevention

Terry O’Toole, PhDHealth Scientist, Division of Adolescent and School Health, Centers for Disease Control and Prevention

Jen RinehartVice President, Research and Policy, Afterschool Alliance

Rebecca RobertsProject Director,American Association of SchoolAdministrators

Francesca ZavackySenior Program Manager,National Association for Sport and Physical Education

About Action for Healthy KidsA public-private partnership of more than 60 national organizations and government agencies representing education, health, fitness, and nutrition, Action for Healthy Kids addresses the epidemic of overweight, sedentary, and undernourished youth by focusing on changes in schools to improve nutrition and increase physical activity. More than 10,000 volunteer educators, health professionals,school administrators, parents, and others take action at the national, state, school district, and school building levels through Action for Healthy Kids Teams in all 50 states and the District of Columbia.

AcknowledgmentsAction for Healthy Kids draws upon the expertise and contributions of numerous national organizations, government agencies, Action for Healthy Kids Teams, and individuals committed to creating schools that promote sound nutrition and physical activity. The following members of Action forHealthy Kids Partner organizations, Team leaders, and other experts provided valuable support and guidance, information, and critical review for this report:

>> Free PDF versions of this report are available at www.ActionForHealthyKids.org.

Action for Healthy Kids Staff

Rob BisceglieExecutive Director

Kristin AveryGrants Manager

Kim Blum, MS, RDResources Manager

Vanessa Cavallaro, MS, RD, LDNSenior Program Manager

Angela Forfia, MASenior Program Coordinator

Mary Haley Director of Partner Programs

Selena King Program Coordinator

Amy Moyer, MPH, RDProgram Manager

Renate Myler Senior Communications Manager

Joi-Anissa RussellDirector of Development

Sarah Titzer, MHADirector of Team Programs

Action for Healthy Kids National Office4711 Golf Road, Suite 625Skokie, IL 600761-800-416-5136www.ActionForHealthyKids.org

www.ActionForHealthyKids.org


ContentsExecutive Summary: Progress or Promises? 2

School Wellness and the Imperative of Leadership 8by David Satcher, MD, PhD

The Background: Why School Wellness Matters 11Poor classroom performance; a reduced ability to learn; chronic health conditions; social discrimination; and the cost-impact on society are but a few of the consequences of ignoring school wellness imperatives.

The Snapshot: The State of School Wellness Today 16Two years after the federal school wellness policy mandate, what are kids eating, what aren’t they eating, and why? What is happening with physical activity and physical education, and how must this change? What actions, on the part of states and others, has the federalmandate spurred? What are the hindrances?

The Stakeholders: Illuminating Research Findings 26Observations, opinions, insights, and recommendations from a wide range of participants across the board. Among them, there exist alignment and agreement that promise further progress, but also stark differences in perspective that hint at potential barriers.

The Successes: Good News 36Strides are being made — as constituencies get engaged... as Action for Healthy Kids Teams expand efforts... and as school districts take action.

The Hurdles: Remaining Challenges 42Schools are wrestling with competing priorities, fiscal limitations, and the challenge of providing youth-appealing healthy foods that kids will actually eat. Meanwhile, parents remain an under-utilized,under-accessed resource, and the question persists as to whetherthe real change agents are yet on board.

The Future: Within Our Reach 49Needed now: clarity and consistency. For its part, Action for Healthy Kids’ path is clear: a commitment to nutritional quality and physical activity in schools; a redoubled focus on underserved communities; enlisting parents as advocates; closer collaboration with school leaders; support for wellness policy implementation and evaluation; and stakeholder mobilization overall.

References 54

Action for Healthy Kids Board of Directors and Partner Organizations 56

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>> ACTION FOR HEALTHY KIDS REPORT: FALL 2008

Executive Summary: Progressor Promises?

EXECUTIVE SUMMARY: PROGRESS OR PROMISES?

3

School wellness — the belief that schools can andmust promote and encourage healthy eating, physical activity, and nutrition and physical education as partof the solution to the childhood obesity epidemic —is an issue that impacts and engages a variety ofstakeholders who have a role in leading, advocatingfor, and implementing wellness initiatives.

This report presents current perspec-tives of these stakeholder groups —school administrators, parents, edu-cators, nutrition and health profes-sionals, wellness advocates, federaland local government agencies, com-munity groups, school board mem-bers, students, and others — on theprogress that has been made and thegaps that still exist. It is being pub-lished to provide a snapshot of thestate of school wellness after morethan five years of work by Action forHealthy Kids, and others, at thenational, state, and grassroots levels.

In preparing this report, Action for Healthy Kids assessed on-the-ground achievements large andsmall; examined initiatives in placeand changes effected; and carefullyevaluated the tasks remaining. Wealso undertook two efforts to obtainnew information. First, we conductedresearch with stakeholders through-out the nation. And second, we conducted a series of in-depth inter-views with a group of authoritiesfrom the education and health fields— professionals whose experiencestouch on the complex issues involvedin achieving school wellness.

The situation.

A growing body of evidence indi-cates that poor nutrition, physicalinactivity, and obesity are associatedwith lower student achievement.These factors also contribute tomany health problems and set chil-

dren up for poor health throughouttheir lives — at a cost to them, theircommunities, and society.

Beyond the issue of excess calo-ries, concern exists about poor nutri-tional quality, which leads to nutrientdeficiencies that can affect learningand health and contribute to commonillnesses such as flu, not to mention a range of chronic diseases. Further-more, research indicates that physicaleducation and regular physical activitycan improve students’ ability to learnby enhancing concentration skills andclassroom behavior. Healthy kidsmake better students, and healthy kidsmake better communities. Bottom line:it is in schools’ interest to help providehealthy, active environments.

The good news.

Over the last five years, Action forHealthy Kids and many others haveelevated awareness at all levelsabout the importance of nutrition andphysical activity, and spearheadednew initiatives in schools and com-munities across the country. In con-cert with other organizations, wehave taken important steps — largeand small — toward addressing thechildhood obesity crisis.

From the innovative activities ofAction for Healthy Kids’ Teams to the fact that school wellness is now a subject of national dialogue andfocus, there is cause for optimism.And the passage of federal legislationmandating local wellness policies —

A growing body of evidence indicates that poor nutrition,physical inactivity, and obesity are associated with lowerstudent achievementand poorer health.


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a response by Congress to the alarm-ing surge in childhood obesity byidentifying a key role for schools in itsprevention — will be looked backupon as perhaps the launching padfor the school wellness movement.

Despite accomplishments and thewelcomed addition of school wellnesson the radar screen, troubling gapsexist. If the goal of creating a healthy,active environment at school for allAmerican children is indeed to becomereality, these gaps must be closed.

Gaps in perception.

Action for Healthy Kids’ researchshows that superintendents, schoolboard members, teachers, schoolnutrition personnel, parents, commu-nity health professionals, and evenstudents diverge significantly — notonly in how they view the issue ofschool wellness, but in how theyinterpret the effectiveness of effortsto address it. Those charged withschool governance and leadershiproles tend to be much more opti-mistic than those with day-to-dayschool wellness implementationresponsibilities. Until these stake-holder perceptions are more closelyaligned, supported by meaningfuldata from district- and statewidemonitoring efforts, progress inadvancing the current state of schoolwellness will likely be affected.

Gaps in attention and access

to healthy food choices — and

in improving nutritional quality.

Most of the attention to improvingschool nutrition has focused on foodsand beverages to avoid — that is,nutrients of which youth should haveless. This focus has left missedopportunities to improve the qualityof foods and beverages at school.Schools have achieved mixed results

in creating healthy, appealing schoolmeals, the source of most nutrition atschool. Recent data from the Centersfor Disease Control and Preventionand the U.S. Department ofAgriculture determined that schoolmeal programs had improved theirnutritional content since the mid-1990s, but many offerings still lacktasty, youth-appealing fruits and veg-etables, whole grains, and fat-freeand low-fat milk and milk products.

Add to this picture the availabilityof unhealthy food options throughvending machines, school stores,and snack bars, and there is littlewonder why youth continue to con-sume inadequate nutrients in theschool environment. As long asschools provide access to unhealthy,low-nutrient food options, kids arelikely to continue to choose them.

A further hurdle preventing youthfrom consuming nutrient-rich foods istheir simple lack of interest in doingso. This hurdle seems especiallychallenging given that many stake-holders, kids included, believe thatschools offer limited access to tastyand appealing healthful food options.

Removing high-density, low-nutri-ent foods from schools must be a con-tinuing priority; however, the nutrition-al quality of all foods in the overallschool environment — and the needto engage and educate youth in mak-ing better food choices — must alsobe key parts of the solution.

Gaps in physical education

and school-based physical

activity opportunities.

There is general consensus amongnational education, health, and med-ical organizations that quality, dailyphysical activity can be a beneficialcomponent in addressing childhoodoverweight and obesity. Moreover,

Despite accomplish-ments and the welcomed addition of school wellness on the radar screen, troubling gaps exist.


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evidence shows that children who arephysically active and fit tend to per-form better in the classroom, and thatdaily physical education does not neg-atively affect academic performance.

The National Association for Sportand Physical Education recommendsthat children engage in at least 60minutes of age-appropriate physicalactivity most or all days of the week,but few children meet these recom-mendations. Unfortunately, insuffi-cient funding and staffing for physi-cal education programs have cutphysical education from schoolschedules. Few schools provide dailyphysical education for all students,and only about seven in ten elemen-tary school children have recessevery day. Equally troubling, partici-pation in physical education declinesas students progress through school.

Gaps in policy implementation.

Although the federal wellness policymandate was an essential andpotent lever for engaging state edu-cation agencies and local districts, itrepresents just a first step. Manyschool districts across the nation doindeed have policies in place, andnearly 70 percent of those policiesdo meet the minimum federalrequirements. However, there aremany shortcomings in both policycontent and implementation. Forexample, fewer than half of localwellness policies have requirementsfor physical education staff certifica-tion or development. A similar gapexists in the food-service arena,where fewer than 30 percent ofstates offer school nutrition directorsand food service managers statelicensure, certification, or endorse-ment. Importantly, a review of localwellness policies by Action forHealthy Kids in fall of 2006 showed

that the majority did not fully addresspolicy implementation and evaluation.

Gaps in policy monitoring

and evaluation.

Tracking of local wellness policyimplementation is as important asdevelopment of the policy itself, yetmonitoring and evaluation are notgiven the attention necessary, and in many districts are virtually nonexist-ent. It is particularly telling that so faronly one state — Kansas — hasenacted ongoing monitoring of well-ness policies, reflecting a shortcomingin nationwide efforts to create healthylearning environments. Clearly, effec-tive systems for monitoring and evalu-ating policy implementation wouldenable stakeholders to more accu-rately assess progress, and, impor-tantly, develop and improve ongoing,targeted intervention strategies.

Gaps in interest and in

perceived responsibilities.

While there is broad agreement thatchildren’s physical inactivity and poornutrition are important public healthconcerns, many schools — andadministrators and educators withinthose schools — do not view stu-dents’ health and wellness as part oftheir core mission. Given the otherpressing priorities that schools mustaddress, not all educators see pro-moting students’ nutrition and physi-cal activity as part of their job. This isa disconnect that we must recognize,and continue to address.

One promising approach in schoolwellness is weaving physical activityand healthful eating into the fabric ofthe school culture — for students aswell as school staff. Wellness advo-cates agree that, to effect significantchange, wellness needs to be inte-grated within the overall school

Given the other pressing priorities that schools mustaddress, not all educators see promoting students’nutrition and physical activity as part of their job.


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improvement plan — and traditionally,it is not. Can schools ever be commu-nity centers for lifelong learning, inwhich lessons about and practicessupporting better nutrition and physi-cal activity are a key part? Someauthorities suggest they must.

Gaps in parent engagement.

Although there is growing concernamong many parents and adult caregivers about the effects of poornutrition, inactivity, and obesity, thisconcern has not consistently trans-lated into meaningful engagementwith schools.

Research indicates that schoolsare not getting much support fromparents when it comes to encourag-ing children to be physically activeevery day or to consume healthfulfoods and beverages. Potentially con-tributing to this situation is the factthat neither parents, nor school healthprofessionals, nor community healthproviders feel that schools are provid-ing adequate information to parentson the importance of daily physicalactivity or sound nutrition — even ifthey recognize that schools aloneshould not bear this responsibility.

Research further indicates thatalthough they care deeply about theirchildren’s health and well-being, par-ents often feel ill-equipped to supportschools’ wellness efforts. Evidencefurther suggests that parents, includ-ing those in underserved communi-ties, are interested in serving as well-ness advocates, but they often don’tknow enough about the wellness cli-mate and processes within theirschools to take specific actions.

We need more creative solutionsfor engaging parents in improvingschool wellness policies and practices— and for reinforcing healthy eatingand physical activity habits at home.

Gaps in addressing

underserved communities.

The environments in which manyAmerican children live do not make it easy for them to engage in healthybehaviors. This is especially true forchildren in underserved and high-risk areas who have been hit hardwith multiple health disparities. Poor nutrition and physical inactivityexact a disproportionate impact onlow-income communities, whichexperience a higher incidence ofundernourished, sedentary, andoverweight youth and over-burdenedschool systems.

Fueling the problem in disadvan-taged communities is that many chil-dren and stressed families face otherfactors that compound unhealthyenvironmental influences, such as alack of resources for both nutritiousfoods and physical activity; a lack ofnearby grocery stores where theycan buy fresh fruits and vegetables,whole-grain foods, fat-free and low-fat dairy products; outdoor environments that are unsafe forphysical activity; and a lack ofaccess to physical activity programsdue to both financial disparities andtransportation issues.

These are facts of concern to allAmericans, with their serious impli-cations relative to learning, health,productivity, economics, and equity.

Gaps in systemic support.

Authorities interviewed for this reportsuggest we are entering a phase ofthe school wellness journey wherethe more challenging systemic hur-dles now have to be surmounted —the resource-intensive ones that costmoney. For example, many schoolssimply are not equipped to encour-age or accommodate a commitmentto school wellness. School priorities

We are entering aphase of the schoolwellness journeywhere the more challenging systemichurdles now have to be surmounted — the resource-intensiveones that cost money.


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such as testing take precedenceover virtually every other concern.This is compounded by inadequatetime in the school day to addresscore wellness needs. Further, ashortage of physical educationteachers and lack of funding forbasic equipment pose significantbarriers for both physical educationclasses and other school-basedphysical activity programs.

In parallel, school food servicesare strained on multiple fronts. Food-service staff may not be adequatelytrained and often are poorly paid. Yetthey are charged with the responsi-bility of feeding thousands of childrenper meal with minimal budgets andlimited time and facilities — alldirectly impacting the quality ofmeals. Schools tend to make upbudgetary shortfalls by offering pop-ular but mostly low-nutrient competi-tive foods that do not meet USDAnutritional requirements. And as food prices continue to rise, the challenges are exacerbated.

The urgent need for change.

Action for Healthy Kids believes that a healthy future for America’sschoolchildren largely hinges onbridging these gaps. The challengesenumerated here represent anurgent “to do” list for the foreseeablefuture, not only for our organization,but for others who share in this com-mitment. Addressing these gaps ispart of the necessary process thatleads to progress.

Real change has begun, and moreis within reach. Short- and long-range realities alike demand policy,environmental, and behavioralchange, as well as expanded com-munication and outreach. But longer-term issues involve effecting sys-temic change — creating incentive

structures for school leaders, healthprofessionals, and states; re-thinkingthe funding and purchasing patternsof school meals; solving of complexissues of school-day scheduling; and,of course, working diligently touncover further funding to supportcritical school wellness efforts.

The bottom line is that, to fulfill themandate of school wellness, changeis still needed at all levels of the edu-cation system — building, district,state, national — and among a widerange of stakeholders — schooladministrators, educators, schoolstaff, parents, students, community,and other decision-makers. Schoolscannot do it alone, and, to tacklewellness, they need broad, specific,and continuing support from all sidesand all constituencies.

Action for Healthy Kids

as convener and catalyst.

Action for Healthy Kids realizes thatwe must also contribute more. Ournext five years will be marked byclose collaboration with stakeholdersin a committed effort to acceleratechange in American schools. Thatcommitment will take the form of aredoubled focus on schools in under-served communities; an emphasis on helping more parents becomewellness advocates; a commitmentto promoting nutritional quality; work-ing to ensure adequate physicalactivity opportunities for students;closer collaboration with schoolleaders; and support for wellnesspolicy monitoring and evaluation.

With clarity of vision and consis-tency of mission, Action for HealthyKids will continue to work to uncover,encourage, and channel the leader-ship necessary in effecting change— and support that leadership withvital information, tools, and insights.

Schools cannot do italone. To tackle well-ness, they need broad,specific, and continuingsupport from all sidesand all constituencies.

Research results, reports, and many other references touched on in this report can be accessed in greater detail at Action for Healthy Kids’ website,www.ActionForHealthyKids.org.


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School Wellness and theImperative of Leadershipby David Satcher, MD, PhD

SCHOOL WELLNESS AND THE IMPERATIVE OF LEADERSHIP

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It may sound simple, but schoolwellness is any-thing but. Yes,there has been a good deal ofprogress madeover the last fewyears. But it’s not

just progress we’re focusing on now.It’s the remainder of the journey.

Clearly, at a national level, asthis report is published, organiza-tions and individuals that work withschools have taken on school well-ness as a major topic of dialogue.Wellness has become a focus ofnational meetings. It is the subjectof articles in education journals.Undeniably, awareness of theimperatives of school wellness isthere, and building.

Today, we better understand theroles that modeling healthy eatingand encouraging regular physicalactivity play in reducing childhoodobesity. That’s a huge step forward.And it goes without saying that the2004 Congressional passage of amandate requiring local school well-ness policies was a major milestone.

We have asked schools to makesome major changes in the waythey do business, and this is not aneasy thing for schools to do.Resources are scarce; support isstretched; and the individuals “inthe trenches” are often fighting anuphill battle. But what I see outthere today is dedication, and I seeit building — committed educators

and school administrators deter-mined to help every child developlifelong habits of physical activityand balanced nutrition.

Are some districts, regions, andstates better able to do this thanothers? Of course. School wellnessas a way of educational life comesharder, and slower, to some schoolsthan others. But it’s coming.

Despite cause for optimism,though, the hurdles are substantial.Systemic challenges range frominsufficient resources to the problemof finding time in already overcrowd-ed school days. Equally troublesome“everyday” and human barriersinclude conflicting school priorities,general resistance to change, anabsence of creative thinking amongall the constituencies involved, achronic lack of planning, and the dif-ficulties of monitoring changes asthey happen.

Recent figures quantify theurgency. According to the NewEngland Journal of Medicine,* inour nation “average weight is pro-gressively increasing among chil-dren from all socioeconomic levels,racial, and ethnic groups, andregions of the country.” Today, one-third of all children and adolescentsare overweight or obese. To use theword epidemic is not to overstate.The implications are grave, but thetide can be turned.

The catalyst, from my observation,is leadership. Whether it’s a super-intendent, a principal, a motivatedschool board member, an active

and interested parent, or all of theabove, school wellness has to startwith one committed individual orconstituency. And the involvement,support, and partnership of thecommunity at large is crucial, some-thing that is especially challengingin underserved communities.

There’s also cause for celebra-tion now, though. I’m genuinelypleased with how U.S. educationleadership has responded in termsof programs and initiatives of whichschool wellness is the centerpiece.By doing so, they’re saying, “Weunderstand the problem. We ‘get’that school wellness is important.”Anyone who has worked in thearea of social and cultural changeknows that’s a huge step.

I’m pleased also with how clear-ly we have established that there’sa connection between health andlearning, and that supporting thegoal of better nutrition and physicalactivity means supporting betteracademic performance. The factthat they go hand in hand shouldhave been intuitive, but it wasn’t.Since the publication in 2004 ofAction for Healthy Kids’ own TheLearning Connection report, thelinks among nutrition, physicalactivity, and academic performanceare now becoming more widelyacknowledged and further bol-stered by new supporting data.

I’m equally gratified that someschool wellness advocates, includ-ing Action for Healthy Kids, arebeginning to increase the focus on

Imagine an American school environment in which every child has access toproper nutrition and regular physical activity. Think of all the positive benefitsfor student health, well-being, and classroom performance.

*David S. Ludwig, MD, PhD. “Childhood Obesity: The Shape of Things to Come,” New England Journal of Medicine, December 6, 2007, p. 2325.

David Satcher, MD, PhD


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disadvantaged communities. Theproblems of overweight and obesity,as well as undernourishment, areserious threats to the well-being ofunderserved communities, and to theindividual futures of children borninto them. And it is important to notethat, while the childhood obesity epi-demic affects children from all racialand ethnic groups, it isn’t uniform forall groups — this is an increasinglyurgent problem among AfricanAmerican and Hispanic youth partic-ularly. A nation like ours ignoressuch communities at its peril,because, apart from the humanprice, the healthcare costs of result-ing disease and disability in years tocome will be astronomical if we don’teffect change.

I salute the thousands of Action forHealthy Kids volunteers, as well asvolunteers and staff of other organi-zations working in this arena. Theyhave stimulated many of the substan-tive school wellness achievements todate. And all these same players areneeded to shoulder the myriad tasksinvolved in further advancing thecause of school wellness in themonths and years to come.

Going forward, we must acceler-ate change in every communityacross America by engaging moreschools, more parents, more stu-dents, and more community leaders.We must continue to collaborate withpartners to develop innovative solu-tions, especially in pushing for fullimplementation and monitoring oflocal wellness policies.

If we fail to act, we endanger thefuture well-being of America’s youth,and, I dare say, of America itself. Ourchildren deserve healthier learningenvironments — schools that pro-mote lifelong habits of healthful eat-ing and active lifestyles.

Is that too much to ask? Mostschool wellness advocates think not.Do policy-makers fully understand thebenefits of school wellness? I’d saythey certainly understand them betternow than they did five years ago.About that, I’m encouraged, but farfrom satisfied. To further the cause,communication with policy-makers —as well as with concerned leaders,interested lay people, the public healthcommunity, and current and would-bepartners — is a full-time job.

The urgency of making school well-ness a higher priority for our society islargely the rationale behind this wide-ranging, and I think important report. I urge you to read it in its entirety.

David Satcher, MD, PhD16th U.S. Surgeon General and Founding Chair of Action for Healthy Kids

Director of the Center of Excellence on Health Disparities at Morehouse School of Medicine

We must acceleratechange in every community acrossAmerica by engagingmore schools, more parents, more students,and more communityleaders.

THE BACKGROUND: WHY SCHOOL WELLNESS MATTERS

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TheBackground:Why SchoolWellness MattersPoor classroom performance; a reduced ability to learn;chronic health conditions; social discrimination; and thecost-impact on society are but a few of the consequences of ignoring school wellness imperatives.


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As recognized by the U.S. SurgeonGeneral, schools are one of the bestsettings in which to halt the alarmingimpacts and implications of poornutrition and physical inactivity onAmerican youth. These behaviorshave many harmful consequences tochildren’s short- and long-term healthand ability to learn.

It all comes back to learning.

A growing body of evidence indi-cates that poor nutrition, physicalinactivity, and obesity are directlyassociated with lower levels of student achievement. For example, a recently published article in theJournal of School Health (Florence,et al.) found that fifth-grade studentswith poor nutritional quality were significantly more likely to under-perform academically.

The Learning Connection: TheValue of Improving Nutrition andPhysical Activity in Our Schools, anAction for Healthy Kids report, sum-marized research that shows a directlink between academic achievementand nutrition, physical activity, andweight. Those findings include:> Well-nourished students tend to

be better students, while poorlynourished children exhibit weakeracademic performance, and score lower on standardizedachievement tests.

> Poor nutrition and hunger translateinto inadequate intake of essential

vitamins, minerals, fats, and proteins that are necessary for optimal cognitive function.

> Physical activity and physical fitness are associated withimproved cognitive function,stronger academic achievement,increased concentration, and better test scores.

> Obesity and poor nutrition are correlated with reduced academicachievement and a greater numberof behavioral problems, potentiallydue to a greater-than-average number of absences, social stigmatization, or poor self-esteem.

The Centers for Disease Controland Prevention (CDC) recognizes that“the academic success of America’syouth is strongly linked with theirhealth. In turn, academic success isan excellent indicator for the overallwell-being of youth, and is a primarypredictor and determinant of adulthealth outcomes.”*

What are kids up against?

The environments in which mostAmerican children live do not make it easy for them to engage in healthybehaviors.

High-calorie, low-nutrient foods —non-nutritious snacks, sweetened bev-erages and sodas, fried foods — arereadily available to most Americanchildren. As a result, most youth rou-tinely consume such unhealthy foods.

School wellness is important. But why? Simply put, student health and classroom performance suffer when students do not eat well or get enough physical activity; therefore it is in schools’ interest to help provide healthy, active environments.

*See “Student Health and Academic Achievement” at www.cdc.gov/HealthyYouth/health_and_academics/index.htm.

The environments inwhich most Americanchildren live do notmake it easy for them to engage in healthybehaviors.

www.cdc.gov/HealthyYouth/health_and_academics/index.htm


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Respondingto the Call Five years of steady progress.In 2001, the U.S. Surgeon General’sOffice released the landmark reportstating that the consequences ofoverweight and obesity couldreverse many of the health improve-ments that the nation had achievedin recent years. In outlining commu-nity-based strategies to address thisvital health problem, the report highlighted schools as one of fivekey settings where initiatives shouldbe focused. Action for Healthy Kidswas founded in 2002 in response to the Surgeon General’s imperativeto work with schools to fight child-hood obesity.

Since its inception, Action forHealthy Kids has brought togethermore than 60 organizations and gov-ernment agencies as well as 51Teams nationwide that have engagedmore than 10,000 volunteers. All of its initiatives are dedicated toimproving nutrition, increasing phys-ical activity, and reducing over-weight by changing school environ-ments. In 2007, for example, Actionfor Healthy Kids Teams reachedmore than 71% of the nation’s schooldistricts — representing nearly 37million K-12 students — with outreach, support, and informationrelated to school wellness.

Action for Healthy Kids and itsPartners have elevated local aware-ness about the importance of nutri-tion and physical activity, and spear-headed new initiatives in schools and

communities around the country. In concert with other organizations,Action for Healthy Kids has takenimportant steps toward addressingthe childhood obesity crisis — galvanizing invaluable support froma wide range of educational andcommunity constituencies.

Great strides, harsh realities.Despite progress in terms of awareness, commitment, and effec-tive initiatives large and small, morethan five years after the founding ofAction for Healthy Kids, poor nutri-tion and physical inactivity remain a serious threat. Under-funding ofschool wellness initiatives, alongwith sustainability issues and lack of accountability mechanisms, con-tinue to undermine the promise forhealthier learning environments.

Poor nutrition and physical inac-tivity exact a disproportionate impacton underserved communities, whichexperience a higher incidence ofundernourished, sedentary, and overweight youth and over-burdenedschool systems. This is a fact of concern to all Americans, with itsserious implications relative tolearning, health, productivity, eco-nomics, and equity.

All of these hurdles are surmount-able, and are recognized andembraced by Action for HealthyKids and its Partners merely as partof the process that leads to progress.For Action for Healthy Kids thatprogress will take the form of afocus on engaging all concerned con-stituencies by encouraging the mak-ing of better food choices, and creat-ing environments that get — andkeep — kids moving.


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This leads to excess calorie consump-tion and nutritional deficiencies.

How bad is the problem? Onenational health survey (NHANES III)reveals that almost one-third of calories consumed by children andadolescents aged 8 to 18 years comefrom foods with low nutrient density,such as saturated fats, added sugars,candy, sweetened beverages,desserts, and salty snacks.

Recent data from the Centers forDisease Control and Prevention(SHPPS 2006) indicate that nearly half (48 percent) of high schools,25 percent of middle schools, and 12 percent of elementary schoolsallow students to purchase foods and beverages high in saturated fat,sodium, or added sugars from vend-ing machines, school stores, or snackbars during lunch period. Additionally,54 percent of schools sell high calo-rie, high fat cookies, candy, or otherbaked goods as part of fundraisersfor school organizations.

Nor do most children routinelyconsume healthy foods recommend-ed by the Dietary Guidelines forAmericans. Only 2 percent of school-aged children consume the recom-mended daily number of servingsfrom all major food groups, accordingto the U.S. Department of Agriculture.According to the 2007 National YouthRisk Behavior Surveillance, only 14percent of adolescents in grades 9-12consume three servings of milk perday, while only 21 percent consumeat least five servings of fruits andvegetables per day.

Children living in low-income,minority, and urban communities areat particular risk of poor nutrition. TheYouth Risk Behavior Surveillance linksminority status to less healthy eatingpatterns. And another study, ofMinnesota urban youth, points out dis-

parities in obesity and eating patternsby ethnicity and socioeconomic status(Neumark-Sztainer, et al.). And anoverall relative lack of nutrition educa-tion compounds children’s inability tomake healthy food choices in general.

It’s not one problem. It’s two.

The negative effects of poor nutritionand excessive calorie intake arecompounded by the fact that themajority of American children do notengage in enough physical activity.Few meet the recommended 60 minutes of age-appropriate physicalactivity most or all days of the week.Specifically:> More than one-third of students in

grades 9-12 do not regularly engagein physical activity, according to theNational Association for Sport andPhysical Education (NASPE).

> According to the CDC, 62 percent of children aged 9-13 years do not participate in any organizedphysical activity during their non-school hours.

With competing priorities such astesting and tight budgets, schoolstoday are offering fewer and feweropportunities for physical activity. For example, NASPE reports that thepercentage of students who attend a daily physical education class inschool dropped to 28 percent in 2003,from 42 percent in 1991.

And as for physical education,NASPE recommends 150 minutes ofP.E. per week for elementary studentsand 225 minutes per week for middleand high school students. In reality,very few schools provide daily physicaleducation for all grades throughout theentire school year. According to 2006findings of a national survey on schoolhealth that the CDC conducts every sixyears (SHPPS) that figure is a stun-

Only 2 percent ofschool-aged childrenconsume the recom-mended daily number of servings from allmajor food groups,according to the U.S. Department ofAgriculture.


15

ningly low 4 percent of elementaryschools, 8 percent of middle schools,and 2 percent of high schools.

Here again, children living in low-income, minority, urban communitiesare also at higher risk for inadequatephysical activity. Data from the U.S.Department of Health and HumanServices show children’s participa-tion in physical activity decreaseswith family income, and that Hispanicand African American children partic-ularly are the least likely to exercise.

Alarming numbers.

Today, more than one-third of ourchildren and adolescents fall into thetop two categories for weight thatthe CDC has defined. For children,these categories are defined as“overweight” and “obese.”

Levels of overweight among chil-dren have risen rapidly. In the last 30 years, according to the CDC, thepercentage of overweight childrenaged 6 to 11 has nearly tripled, andthe percentage of overweight ado-lescents aged 12 to 19 has more thantripled. The results of a study summa-rized in the Journal of the AmericanMedical Association (Ogden, et al.)indicate that more recently, rates ofchildhood obesity have remainedlevel. However, although the resultsshow promise, they do not indicate a reversal of the obesity trend, asmore than one-third of the childrenand youth in the study were consid-ered overweight.

Given their higher risk for poornutrition and physical inactivity, it is not surprising that children inlow-income minority and urban communities are at greatest risk foroverweight. Numerous analyses haveconfirmed that the prevalence ofoverweight is higher in these areas.

Poor nutrition, physical inactivity,

and overweight among Americanchildren contribute to many healthproblems and set children up for poorhealth throughout their lives — at a cost to them, their communities,and our society. Underscoring thispoint, a report from the ConferenceBoard suggests that obesity is costing U.S. businesses $45 billionannually in medical expenses andlost productivity. Moreover, otherserious illnesses that are becomingmore prevalent among children —including heart disease, Type 2 diabetes, and asthma — are alsoassociated with obesity.

Yet more health consequences.

Beyond excess calories, poor nutri-tion can lead to nutrient deficienciesin children. Such deficiencies cancontribute to a number of chronicdiseases, or leave children withoutprotection from various conditions.

For example, a child’s failure toconsume the recommended intake of calcium can increase his or herrisk of fractures and osteoporosis asan adult. Adequate calcium intakeplays a beneficial role in reducing the risk and/or consequences of anumber of other conditions as well,including colon, breast, and ovariancancers, hypertension, lead poison-ing, and obesity.

Overweight itself frequentlybecomes a chronic condition.Overweight children tend to stayoverweight through adolescence andbecome obese adults.

In the end, though, perhaps themost immediate consequence ofoverweight that children feel is socialdiscrimination, according to the U.S.Surgeon General in a 2001 report onchildhood obesity. This, in turn, hasbeen linked with poor self-esteemand depression.

Children living in low-income, minority,and urban communitiesare at particular risk of poor nutrition, physical inactivity, and obesity.

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The Snapshot:The State ofSchool WellnessTodayTwo years after the federal school wellness policy mandate, what are kids eating, what aren’t they eating, and why? What is happening with physical activity and physical education, and how must this change? What actions, on the part of statesand others, has the federal mandate spurred? What are the hindrances?

THE SNAPSHOT: THE STATE OF SCHOOL WELLNESS TODAY

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What are kids eating at school?

Recent research in peer-reviewedjournals, including the AmericanJournal of Preventive Medicine andthe Journal of School Health, as wellas findings from the Centers forDisease Control and Prevention’s2006 School Health Policy andPrograms Study (SHPPS, releasedevery six years) and the UnitedStates Department of Agriculture’sSchool Nutrition Dietary Assessment(SNDA-III), paint a picture of theschool food environment.

Over the past five years, most ofthe efforts to improve school nutritionhave focused on limiting or restrict-ing competitive foods, and for goodreason. Unhealthy temptations —cookies, soda, chips, and other low-nutrient foods — abound. The2006 SHPPS survey revealed thatabout 45 percent of elementaryschools, over 56 percent of middleschools, and some two-thirds of highschools offer such choices. And

almost 60 percent of high school students can buy soda in the cafeteriaat lunch (Johnston, et al.).

The SNDA-III study determinedthat students who participated in theschool lunch program were less likelyto consume competitive foods thanthose students who did not partici-pate. For elementary, middle, andhigh schools, most of the competitivefoods were eaten at lunch. The mostcommon choices were candy, bakedgoods, soda, and chips — all low innutrition and high in calories.Students consuming competitivefoods had more than 150 caloriesfrom these low-nutrient foods on anygiven day.

Students have many options to buyfood during the school day. Accordingto the U.S. Government AccountabilityOffice, almost 90 percent of highschools, over two-thirds of middleschools, and almost one-third of elementary schools sell competitivefoods through vending machines,

It is impossible to assess the state of school wellness today without acknowl-edging the landmark federal legislation known as the U.S. Child Nutritionand WIC Reauthorization Act of 2004. In this act, Congress responded to thealarming surge in childhood obesity by identifying a key role for schools inits prevention. The act called for development of a local wellness policy inmost school districts in America. School districts had until July 2006 to puttheir policies in place. These policies are to include:> Goals to promote student wellness, nutrition education, and physical activity. > Nutrition guidelines for school meals and for other foods available at school. > A plan and a person responsible for monitoring the policy. > Creation of a local guidelines committee, which would include not only rep-

resentatives of local schools but also parents and other community members.Despite its sweep and specificity, the act has serious limitations. It lacks funding and requirements for local accountability, standards and guidelinesfor implementation, and systems and standards for monitoring and evaluationto consistently track and measure progress. For more information, visitwww.ActionForHealthyKids.org.

A Genuine Milestone

Children who partici-pate in the school lunch program are less likely to consumecompetitive foods.



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Voices: A Wealth of Perspectives, Opinions

In preparing this report, Action for Healthy Kids identified a number of individuals whose expertise spans the fields of child health and schoolwellness, and talked with them to gain their insights about the state of school wellness today. During extensive interviews, these authoritiesreflected upon progress in school wellness thus far; on continued challenges in the advance of school wellness; and on what remains to be done by stakeholders at the local, state, and national levels. Thethoughts of the individuals at right are shared throughout the report. >>

school stores, or snack bars.Nevertheless, schools are makingefforts to provide healthy optionsamong competitive foods sold. Forexample, the 2006 SHPPS surveyfound more schools offering milk as abeverage in vending machines,school stores, and snack bars (28percent of middle and 51 percent ofhigh schools), while water sales invending machines increased to 46percent from 30 percent in 2000.

Another study found that 63 per-cent of middle and high school stu-dents attend schools that offer sometype of fruit and/or vegetable fromvending machines, school stores, or snack bars and carts (Delva, et al.).The same study found that studentsin low-income communities haveless access to healthier snacks, as do African American middleschool students.

A more complex challenge.

According to the 2005 DietaryGuidelines for Americans, childrenand adolescents continue to con-sume less than the recommendedamount of critical nutrients like calci-um, magnesium, and Vitamin E, toname a few. However, students whodo participate in the school lunchprogram have better nutrient intakethan those not participating.

The great majority of students (87percent) attend schools that partici-pate in the USDA-reimbursable

National School Lunch Program,according to data reported in theAmerican Journal of PreventiveMedicine (Delva, et al.). USDA dataindicated that in 2007 the averagedaily participation rate for schoollunch was 30 million students.

Schools appear to have achievedmixed results in creating healthierschool meals. A recent review (Leviton)found school meal programs haveimproved their nutritional content sincethe mid 1990s. SNDA-III found thatmore than two-thirds of school mealsexamined met standards for vitamins,minerals, protein, and fiber. However,most lunches did not meet standardsfor fat, saturated fat, or sodium.Notably, only 6 percent to 7 percent ofschools had lunches that met all theUSDA set standards; clearly, muchmore work is needed before we haveall schools offering meals that meetboth nutritional and taste standards.

Getting youth to eat healthieroptions at school has several chal-lenges. Qualitative research done byAction for Healthy Kids with minorityyouth in 7th and 8th grade uncovereda major barrier to students makinghealthy choices at school: access totasty, appealing, healthier options.School nutrition professionals aretrying to provide healthful and tastystudent-appealing products (e.g., cutfruit, fresh salads, or cold fat-free flavored milk in plastic containers),but cost is a major barrier. Also, stu-

Cost is a major barrierto providing healthy,tasty, youth-appealingitems such as cutfruit, fresh salads, or flavored milk inplastic containers.


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Katherine Kaufer Christoffel, MD, MPH, director of the Center on Obesity Management and Prevention at Children's Memorial Hospital, professor at Northwestern University's Feinberg School of Medicine, and Action for Healthy Kids board member. Guillermo Gomez, Chicagodirector for the Healthy Schools Campaign. Julia Graham Lear, PhD, research professor in prevention and community medicine at GeorgeWashington University and director of the Center for Health and Health Care in Schools. Madeleine Levin, MPH, senior policy analyst for theFood Research and Action Center in Washington, D.C. Robert Murray, MD, director of the Center for Healthy Weight and Nutrition at NationwideChildren's Hospital in Columbus, Ohio, pediatrics professor at Ohio State University’s school of medicine, and chair of the Council on SchoolHealth for the American Academy of Pediatrics. Howell Wechsler, EdD, MPH, director of the Division of Adolescent and School Health of theCenters for Disease Control and Prevention (CDC). Gene Wilhoit, executive director of the Council of Chief State School Officers (CCSSO); for-merly director of the Arkansas Department of Education and commissioner of the Kentucky Department of Education.

dents are accustomed to eatinglow-nutrient, high-calorie competi-tive foods and fast foods, whichmakes introducing healthier itemsmore challenging.

Schools have generally madeefforts to offer more healthful choic-es as part of school meal offerings.According to 2006 SHPPS data:> About two-thirds of schools offer

students a daily choice betweentwo or more types of fruit or 100percent fruit juice and betweentwo or more vegetables.

> Most schools offer a choice ofeither low-fat or fat-free milk, anda third of schools offer both ofthese healthy choices, as well aswhole-grain foods.

> Significantly more schools usedhealthy food preparation prac-tices in 2006 than in 2000.

What about daily physical

education and school-based

physical activity programs?

Research has shown that dailyphysical education does not detractfrom academic performance.* Still,as revealed by the 2006 SHPPS sur-vey, surprisingly few schools pro-vide daily physical education for theentire school year for all students.Just as alarming, studies show thatparticipation in physical educationactually declines as students go

through school (Johnston, et al.). > Physical education requirements,

as well as actual student partici-pation rates, decline substantiallybetween 8th and 12th grades.

> Principals participating in onesurvey estimated that over 90 per-cent of 8th graders actually tookphysical education, compared toonly 34 percent of 12th graders.

SHPPS also found 32 percent ofelementary schools do not offerdaily recess for all students and 52percent do not offer intramuralactivities or physical activity clubsfor students. Also notable is thatparticipation in varsity sports waslower among students from low-income families and AfricanAmerican and Hispanic students.

*See “Active Education: Physical Education, Physical Activity and Academic Performance,” a fall 2007 Active Living Research Brief, available atwww.activelivingresearch.org/alr/alr/files/Active_Ed.pdfbrief.

Physical Education vs. Physical ActivityPhysical education is a planned, sequential program of curricula and instruc-tion that helps to equip students with the knowledge, skills, capacities, val-ues, and enthusiasm to maintain a healthy lifestyle into adulthood. Physicaleducation is designed to promote physical fitness, develop motor skills, andprepare students to participate confidently in team and individual activities.

By comparison, physical activity is bodily movement of any type; productive physical activity is the product of a quality physical educationprogram. Opportunities for physical activity during the school day includetime spent in physical education class, classroom-based movement,recess, walking or biking to school, and recreational sport and play thatoccurs before, during, and after school.

Physical education should not be compared to or confused with otherphysical activity experiences such as recess, intramurals, or recreationalendeavors. The unique goals of physical education are the development ofphysical competence, health-related fitness, cognitive understanding, and a positive attitude toward physical activity so that individuals can adoptand maintain a physically active and healthy lifestyle.

Source: National Association for Sport and Physical Education

www.activelivingresearch.org/alr/alr/files/Active_Ed.pdfbrief


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The SHPPS survey does docu-ment progress, however. Statesthat require elementary schools toprovide students with regularlyscheduled recess increased to 12percent in 2006 from 4 percent in2000. Among school districts, thepercentage with this requirementrose to 57 percent from 46 percent.

Growing public awareness.

In general, public awareness hassubstantially shifted toward recogni-tion of the dangers of obesity and thehealth benefits of balanced nutritionand adequate physical activity forchildren, according to the authoritiesinterviewed in preparing this report(see page 19).

“There’s awareness that the nextgeneration may even have a short-er life span because of obesity —and people are passionate aboutnot letting this happen,” maintainsMadeleine Levin of the FoodResearch and Action Center, anonprofit organization working toeliminate hunger and malnutritionin the United States.

Interestingly, awareness of theproblem of childhood obesity existseven among communities whereresidents may otherwise lackaccess to health information.Guillermo Gomez, Chicago directorfor the Healthy Schools Campaign,which works to create healthyschool environments, says that par-

ents in low-income minority com-munities increasingly understandthat obesity is a dangerous and dis-proportionate burden on their com-munities. Importantly, they seethese health disparities as a socialjustice issue, according to Gomez.

Federal mandate spurs action.

Regardless of limitations, many ofthe experts interviewed considerthe federal mandate to implementlocal wellness policies in the fightagainst obesity (see sidebar, p. 17)an essential and potent lever forengagement and action at the levelof both state education agencies and local districts.

Madeleine Levin of the FoodResearch and Action Centerbelieves that many superintendentshave moved to implement localwellness policies precisely becausethey realize the policies can guidethe way to promoting healthy envi-ronments in the schools.

Howell Wechsler, director of theDivision of Adolescent and SchoolHealth at the Centers for DiseaseControl and Prevention (CDC), seesthe value of the wellness policythrough another lens. “Havingthese policies really speeds youthrough the innovation process in avery dramatic way,” he notes.

The local wellness policy man-date gave the Chicago HealthySchools Campaign a way to mobilize

Latino parents around school health.Guillermo Gomez reports that thecampaign translated the policy mandate not only into Spanish butalso into easily understandable lay-man’s terms for parents. Parents, in turn, came out by the thousandsto let the Chicago Public Schoolsknow that they expected the well-ness policy to be implemented.According to Gomez, “The policywas an opportunity because it said,essentially, ‘Establish school well-ness teams. It’s not a choice.’”

But how effective are local

wellness policies?

To find out how school districtsfared in the development of theirlocal wellness policies, at the timepolicies were due on July 1, 2006,Action for Healthy Kids assessed112 policies that had been approved.The sample included policies from42 states representing schools inrural, suburban, and urban settingsand from schools with medium andlarge student enrollments.

Action for Healthy Kids’researchers compared school poli-cies against two benchmarks — the federal guidelines and an Action for Healthy Kids tool to measurebest practices in school health asdetermined by an expert panel. The assessment uncovered thatonly 54 percent of district policiesmet the minimum federal require-

>> On progress thus far... “I would characterize the changes as fairly dramatic thus far. We had certainly neglected school health, gottenaway from good practices, but I see dramatic progress, with schools reinstituting physical activities, addingand expanding breaks, and many have instituted in-class activities. ‘Junk-food removal’ has been an area ofgreat improvement, as has the removal of carbonated soft drinks and candy vending machines. So I’d say in arelatively short time the changes have been dramatic — despite the huge changes still left to be effected.”

Gene Wilhoit


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ments. On a promising note, about80 percent of policies required com-munity and family involvement inschool health councils, bringingimportant support to schools.

Collecting additional local well-ness policies bolstered this earlysnapshot: these data are pendingpublication. However, study authorAlicia Moag-Stahlberg, MS, RD,founding executive director of Actionfor Healthy Kids, relays that schoolswill need considerable assistance todevelop, fully implement, and sustainthe wellness policies. Although inthe re-assessment 70 percent oflocal wellness policies met the federal mandate, most policies didnot fully address implementation andevaluation of the policies.

States are stepping up.

Given the lack of funds with which to implement the federal legislation,most individual school districts grap-ple on their own as best they can. Asmajor school district funders, stateshave perhaps the most powerfulleverage with which to encouragethe creation of strong policies to pro-mote school wellness and to encour-age their adoption by school districts.

Indeed, states are beginning tostep up and assume important rolesin helping school districts develop,implement, and monitor their newlocal wellness policies. An October2007 issue brief by the National

Association of State Boards ofEducation (NASBE) revealed somewidespread efforts by states. As offourth-quarter 2007:> At least 48 states had developed

guidance materials or adoptednew laws, regulations, or policiesthat specifically address the fed-eral legislation mandating school

wellness policies. > At least 40 states had produced

state-specific policy guidancedocuments and resources to helplocal school districts create wellness policies.

> At least 19 state legislatures, stateboards of education, and stateagencies had adopted require-

>> On the growing awareness of school wellness... “There’s a definite awareness now that the next generation may have a shorter lifespan because of obesity – and people are passionate about not letting this happen.” Madeleine Levin

“Many parents in low-income minority communities now understand that obesity is a dangerous and disproportionate burden on their communities. They see these health disparities as nothing less than a social justice issue.” Guillermo Gomez

Aligned with Other InitiativesSchool wellness relates to and benefits from other comprehensive initiativesand approaches to improving students’ health and well-being, including:

The Whole ChildThe current direction in educational practice and policy focuses over-whelmingly on academic achievement. However, academic achievement ismerely one element of student learning and development, and only a partof any system of educational accountability. The Whole Child is a publicengagement and advocacy campaign launched by the Association forSupervision and Curriculum Development (ASCD), an Action for HealthyKids Partner organization. The initiative encourages schools and commu-nities to work together to ensure that each student has access to a challeng-ing curriculum in a healthy and supportive climate. For more information,visit www.wholechildeducation.org.

Coordinated School HealthMany communities in the U.S. are pursuing a coordinated approach toschool health — designed to improve students’ health and their capacity to learn through the support of families, schools, and communities working together. The Coordinated School Health (CSH) model has eight interactive components, which include: Health Education; PhysicalEducation; Health Services; Nutrition Services; Counseling andPsychological Services; Healthy School Environment; Health Promotionfor Staff; and Family/Community Involvement. For more information, go to www.cdc.gov/HealthyYouth/CSHP/.

www.wholechildeducation.org

www.cdc.gov/HealthyYouth/CSHP/


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ments intended to strengthenlocal wellness policy evaluationand school district accountabilityto the state or local level.

Numerous states have alsopassed laws or adopted regulationsto establish wellness policy contentregarding nutrition, physical activi-ty, or both; have implemented inno-vative or systematic approaches tochecking school district compli-ance with policies; have acted toencourage local districts to adopt astrong wellness policy; or haveestablished statewide workgroupswith the specific task of providingguidance on implementing federallymandated local wellness policies.

NASBE singles out Arkansas,Rhode Island, and South Carolinafor adopting comprehensive strate-gies to promote school wellness by:> Integrating local wellness poli-

cies into the general educationaccountability system.

> Adopting provisions to strengthenschool district accountability tothe community.

> Establishing additional wellnesspolicy content requirementsbeyond the minimum federalrequirements.

It is notable, however, that so far only one state — Kansas — hasenacted ongoing monitoring ofschool wellness policies. The lack

of such monitoring may well impedewidespread implementation ofthese policies in the 49 other states.

Substantial change

not yet widespread.

Although states are getting onboard and some districts are gain-ing traction with their wellness poli-cies, real, substantial change is notyet widespread.

The CDC’s Howell Wechslersays, “We were dealing with inno-vators at the turn of the millennium,and now we’re deep into the earlyadopters.” In other words, in 2001school wellness was a pioneeringinnovation; now, seven years later,it’s progressed to the stage of bud-ding acceptance.

Other experts interviewed uni-versally agreed that getting to thenext level of change requires moving beyond simple awareness.The current need is to create wideavailability of healthful foods anddaily opportunities for physicalactivity in all schools — assuredly, a challenge.

Julia Graham Lear, director of theCenter for Health and Health Care inSchools at George WashingtonUniversity, has real concerns aboutprogress at the school district level,where, she feels, it must happenfirst. Says Lear, cutting to the bot-tom line, “The work now is aboutwhere the real barriers are — the

ones that cost money.” Howell Wechsler echoes a

similar assessment. “The relativelycheap fixes,” he says, “are done.We are starting to make goodprogress on them already. Takingout the high-fat chips and puttingthe baked chips in. It’s gettingdone in many schools. But over-hauling physical education andschool lunches — fixing these ismuch more resource-intensive.”

From his perspective workingwith a large urban district, GuillermoGomez also perceives that overallprogress has been slow. He lamentshow long it has taken for the infor-mation to filter down from the dis-trict level to the individual schoolsin the city of Chicago, and reportsthat, after being sent information,many principals, when telephoned,couldn’t remember receiving it.

Robert Murray, chair of theCouncil on School Health for theAmerican Academy of Pediatricsand a professor of pediatrics at OhioState University, points out an addi-tional challenge beyond the initialstep of implementing a policy.

“The mandate to create a policy,”he claims, “forced a national discus-sion about what we want for ourchildren in schools in terms of nutri-tion and physical activity. And that’sgood. But the second wave of well-ness activity is making those policieswork toward a continuous improve-

>> On the relationship of wellness to learning... “Educators themselves often don’t make the link between health and education. They see their role as producing kids who are excited about learning, and giving them strong academic and life skills. But educators sometimes don’t make the connection that health is a huge contributor to success in life. The irony is that as we’ve increased academic expectations, we’ve neglected the health and wellness side of things — which is a total contradiction.” Gene Wilhoit


23

ment process in the schools. And thatstep is proving to be more difficult.”

Katherine Kaufer Christoffel, pedi-atrics professor at NorthwesternUniversity, director of the Center onObesity Management and Preventionat Children’s Memorial Hospital inChicago, and an Action for HealthyKids board member, voices some opti-mism. She notes how changes cantake time to occur because schooldistrict leaders balance so many chal-lenging priorities. Still, she points out,“When time forces them [schools andschool districts] to focus, I think thediscussions are likely to be in the rightdirection — because there are moreand more options for them to choosefrom that are on the healthier sides ofthe equation, and because there’scontinuing pressure from some par-ents, and expectations.”

A bigger-picture, long-range per-spective is offered by Gene Wilhoit,executive director of the Council ofChief State School Officers, who says,both directly and encouragingly, “It’snot easy to redesign learning process-es to fit in new and emerging priori-ties, but it can be done. We can startto view schools as community cen-ters for lifelong learning, in which les-sons about better nutrition and physi-cal activity are a key part. I’m opti-mistic that those kinds of new visionsare being received more openly bythe education community than theywere just a few years ago.”

>> On the federal school wellness policy mandate... “Having these policies really speeds you through the innovation process in a very dramatic way.”

Howell Wechsler

“Translated into Spanish, the wellness policy has given the Chicago Healthy Schools Campaign a way to mobilize Latino parents around school health.” Guillermo Gomez

“It all started with the acceptance thathealth and wellness are part of learning,”says Audrey Satterblom, wellness coordinator for the Indianapolis PublicSchools and a member of the IndianaAction for Healthy Kids SteeringCommittee. She’s explaining her district’sestablishment of a coordinated schoolhealth program, largely in response to thefederal local wellness policy mandate.

“For the first year after we developeda local wellness policy,” says Satterblom,“it frankly just sat there,” and implemen-tation languished. Satterblom, as a for-mer P.E. teacher and administrator with apassionate interest in wellness, advocat-ed for an umbrella program that wouldallow development in Indianapolis of awellness “curriculum” that wouldaddress everything from mental healthchallenges to sexual-ity to obesity. Hersuperintendentresponded positively,as did the federal PEP (PhysicalEducation for Progress) program, whichprovided a needed grant.

“When advocating for the establish-ment of this type of program,” Satterblomsays, “an educator needs to becometotally involved, and needs to say, ‘This is important, and I’m going to stand forthis, and my school has to improve.’”And improve Satterblom’s district has.Just one example?

“In the obesity area, as part of effortsto ramp up physical activity, our middleschool now has moved to daily year-round P.E., which is a huge change fromthe old perfunctory nine-week course.That was a big move, especially in a timeof budget cuts in other areas.”

School District in Action: IndianapolisSo how does Satterblom get

kids motivated and excited about partici-pating in the wellness curriculum?

“Well, it helps that it’s mandatory,”she responds, half-jokingly. “But as a for-mer P.E. teacher, even before the days ofwellness policies, my motivations werealways academic ones. I knew that if mykids were healthy and active, they weregoing to read better. They were going todo math better. ‘Action-based learning,’as I call it, just works,” she says defini-tively. And more than 36,000 kids inSatterblom’s district are the beneficiariesof her optimism and vision.

Dr. Eugene White, superintendent ofschools in Indianapolis, is philosophicaland realistic about the issues with whichhis district wrestles.

“Schools are facing more and more

social challenges each decade, and a lotof responsibility has been shifted to us,things that weren’t traditionally educa-tion’s responsibility. But the fact is,schools are the American institution thathas ‘public’ above the front door, and wehave to take it on.”

But White points to Satterblom's own-ership of the wellness issue in Indian-apolis as one reason for its success.

“You have to have someone who priori-tizes wellness, and is given the ability todrive it. Any time someone asks me aboutthe success of what we’re doing, I justkeep going back to the ownership thatAudrey took of the initiative. We would bedragging our feet like many other districtsif she hadn’t taken it upon herself to lead.”

“You have to have someone who prioritizes wellness, and is given the ability to drive it.”

In 2000, the number of schoolsmaking exclusive deals with softdrink companies was exploding.Today, these exclusive deals arenearly nonexistent and the soft drinkindustry has begun to regulate itselfwhen it comes to products in theschool environment. The Centers forDisease Control and Prevention’s2006 School Health Policies andPrograms Study (SHPPS) datareported that the number of schoolsthat sold carbonated soft drinks,sports drinks, and fruit drinks duringlunch period decreased from 68 per-cent in 2000 to 48 percent in 2006.And nationwide, in 2006 more thanhalf of states required or recom-mended that schools prohibit theselling of junk foods à la carte, invending machines, and in schoolstores and canteens.

As noted above, less attentionand change has been seen relativeto the quality of diets for all youth.Less than 2 percent of children andadolescents currently consume theminimum number of recommendedservings from all food groups.

This has led to low dietary intakeof calcium, potassium, fiber, mag-nesium, and Vitamin E. The U.S.Departments of Agriculture andHealth and Human Services’ 2005Dietary Guidelines for Americansinclude guidance about “FoodGroups to Encourage,” stating thatyouth need to consume more fruits,vegetables, whole grains, and fat-free and low-fat milk and milkproducts to meet recommendedminimums for good health.

Broader NutritionalChallengeMoreover, a recent study of low-socioeconomic urban youth aged 7-13 years examined diet quality, andfound that the diets of more than75 percent of participants failed tomeet recommended servings forgrains, vegetables, dairy, and fruitgroups – with mean intake beingsignificantly lower than recommen-dations. Twenty-five percent ormore of the youth studied did notmeet recommended amounts foriron, folate, and calcium. Ninety-

three percent of children aged 9-13did not meet Adequate Intake forcalcium, nor did 76 percent of chil-dren aged 7-8 years.

Strategies to eliminate junk foodhave involved replacing high fat,high sugar, and/or high calorieitems with lower-calorie fat andsugar counterparts, such as switch-ing baked chips for regular. Thisdoes begin to address obesity bylowering calorie content. However,it does not address the broadernutritional challenge. Thesechanges will allow for competitivefoods to be available, which canlead to youth using them as analternative to school meals, andcontinuing to consume inadequatenutrients. This strategy alone isinsufficient to meet the imperativesof local wellness policies.

To that end, the Institute ofMedicine released a report in 2007about appropriate nutritional stan-dards for the availability, sale, andconsumption of foods at school.The report concluded that the feder-ally reimbursable school nutrition

The Changing Food Environment Much of the attention and work over the last five years in school wellness has been focused on the “wipe out junk food” strategy. And there has been someprogress made. However, much less attention, and change, has been seen relative to the quality of diets for all youth.

>> On policy/legislative solutions... “You have to be able to get at the state level enough legislators to focus and say, ‘Look, how are we going to get more physical education in when we don’t have enough hours of instruction in academic courses? But it’s not a matter of sending out a curriculum and exhorting people any more.” Julia Graham Lear


24


25

programs should be the main sourceof nutrition at school and that com-petitive foods, if available, shouldconsist of nutritious fruits, vegeta-bles, whole grains, and fat-free orlow-fat milk and milk products.

Nutritional Quality: The Logical Next StepJennifer Weber is the manager of national nutrition policy for theAmerican Dietetic Association. Shedescribes the move to a focus on nutri-tional quality as a natural evolution –indeed the logical next step – in thefield of school wellness.

“Obviously,” Weber acknowl-edges, “we need to continue takingthe least nutritious foods out ofschools. Refocusing on raising nutri-tional quality can happen simultane-ously to that. Yet we need toacknowledge that these tasks poseunique challenges. Getting people tounderstand and care about the nutri-tional quality of the foods kids eat inschools requires different strategiesthan simply educating them aboutfoods to avoid.”

Weber says that a principal hurdleis the belief on the part of manyadministrators and parents alike that

once we’ve conquered junk food thejob is done.

“Although it’s a vital, even critical,topic,” says Weber, “nutritional qualitydoesn’t quite ‘resonate’ with educators,administrators, even parents in the sim-ple, understandable way that ‘eliminat-ing junk food’ does. Addressing over-consumption of ‘junk food’ isperceived as more urgent, and moredirectly related to childhood obesity,than overall diet quality. So overcom-ing that perception is an important hur-dle. Kids’ health, even more than thatof adults, is dependent on consumingadequate nutrients. Nutritional qualityis needed for proper growth, physi-cal/mental development, and the prevention of chronic disease.”

Weber says that it will be crucialin the coming months and years forschool wellness advocates from everystakeholder group to remember, andconstantly try to reinforce, thatschool wellness isn’t just a matterof shifting the emphasis off the leastnutritious foods; it’s about shiftingthe emphasis onto healthier foods toreach the point where the foods thatkids want to consume are the onesthat they should consume.

“To me,” Weber maintains, “that’sthe most valuable conversation thatwe can have, going forward.”

School wellness isn’tjust a matter of shiftingthe emphasis off theleast nutritious foods;it’s about shifting theemphasis onto healthier foods.

>> On urgency... “If there were ever some loud sirens out there, they’re there now, when you begin to talk about the conditionof our children and the rapid pace at which our health is declining.” Gene Wilhoit

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TheStakeholders:IlluminatingResearchFindingsObservations, opinions, insights, and recommendations from a wide range of participants across the board. Among them, there exist alignment and agreement that promise further progress, but also stark differences in perspective that hint at potential barriers.

THE STAKEHOLDERS: ILLUMINATING RESEARCH FINDINGS

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Eleven national education and healthorganizations* participated in theresearch, surveying their membersand constituents. Action for HealthyKids also invited its own Team mem-bers to respond.

In total, some 2,400 individualsresponded, from all 50 states, a groupthat included school leaders (super-intendents, principals, school boardmembers); school personnel (schoolnutrition and food service staff, physical education and classroomteachers, and others); public healthprofessionals; school wellness

advocates; and parents, students,and community members.

The respondents — who includedthose with the job of developing andimplementing wellness policies, andthose whose children and/or clientswould be expected to benefit fromsuch policies — offered their impres-sions not only of the state of schoolwellness today, but also of what thebarriers are, who can move schoolwellness forward, and what it willtake to do so.

What follows is a brief summary ofselected research findings.

*Action for Healthy Kids Partners and other organizations participating in the research included: Afterschool Alliance; American Association of School Administrators; Centerfor Health and Health Care in Schools; Family, Career and Community Leaders of America; National Association for Sport and Physical Education; National Association ofElementary School Principals; National Association of Secondary School Principals; National Association of State Boards of Education; National Association of StudentCouncils; National PTA; National School Boards Association.

Some see progress, some are not sure. In October andNovember of 2007, Action for Healthy Kids conductedresearch with education stakeholders to gain insights and perspectives on efforts to meet the nutritional andphysical activity needs of schoolchildren.

Do schools have effective wellness policies...

Respondents differ in their opinions about the existence ofeffective policies to encourage proper nutrition. Seventy-twopercent of superintendents (and 61 percent of principals) saythat schools have effective policies to encourage proper nutri-tion. Seventy-nine percent of community health professionalsfeel the opposite. School health professionals and school nutrition/food service professionals are split — about half feelthat schools have effective policies, and half don’t.

72% SUPERINTENDENTS

50% SCHOOL HEALTH PROFESSIONALS

21% COMMUNITY HEALTH PROFESSIONALS

68% SUPERINTENDENTS

45% SCHOOL HEALTH PROFESSIONALS


Opinions similarly diverge regarding policies to encourage daily physical activity. Sixty-eight percent of superintendents (and 59percent of principals) believe schools have effective policies in place.Eighty-three percent of community health professionals do not.Almost half of school health professionals feel good about whether policies encourage daily physical activity. But only 35 percent of physical education teachers agree.

...encouraging daily physical activity?

35% PHYSICAL EDUCATION TEACHERS

...encouraging proper nutrition?

53% SCHOOL NUTRITION/FOOD SERVICE PROFESSIONALS


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>> On the next wave of wellness activity... “The federal mandate to create a policy forced a national discussion about what we want for our children in schools in terms of nutrition and physical activity. And that’s good. But the second wave of wellness activity is making those policies work toward a continuous improvement process in the schools. And that step is proving to be more difficult.” Robert Murray

“The relatively cheap fixes are done. We are starting to make progress on them already. But overhaulingphysical education and school lunches — fixing these is much more resource-intensive.” Howell Wechsler

More information about the research results presented on these pages is available in “The State of School Wellness: Action for Healthy KidsStakeholder Research”at www.ActionForHealthyKids.org.

Are schools implementing their wellness policies?

It depends on who is responding. Seventy-seven percent of superintendents and 54 percent ofprincipals feel that most schools are doing an adequate job implementing their wellness policies.Half of school nutrition/food service professionals agree. But at least 72 percent of communityhealth professionals and physical education teachers say no.

77% SUPERINTENDENTS



Are schools monitoring implementation and evaluating results?

Superintendents — many of whom may not be close to day-to-day aspects of implementation —are alone in largely feeling (60 percent) that most schools effectively monitor local wellness policyimplementation and evaluate results. Most respondents in other groups disagree. Notably, over 65 percent of school nutrition/food service professionals say the job isn’t getting done. More than80 percent of physical education teachers and community health professionals concur.

60% SUPERINTENDENTS




54% PRINCIPALS




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As vice president forprograms at theAmericanAlliance forHealth, PhysicalEducation,Recreation, andDance (AAH-

PERD), Judith Young — thechair of Action for Healthy Kids’Board of Directors — has a bird’s-eye view of the crucial roles thatphysical education and physicalactivity play in school wellness.

Young is careful to point outthat “it’s how we use the time thathas been dedicated to physicaleducation and physical activitythat’s important. And all of ourguidance in school,” she remindsus, “is preparatory to childrenleading a physically active lifeoutside of school. Teachers, schoolboards, and other stakeholdersneed to keep that in mind as theymake plans and shape policies.”

Young maintains that currentresearch data is more than strongenough to support increased atten-tion to physical activity, in terms ofits contribution to child develop-ment and academic performance.

“Kids who demonstrate higherlevels of fitness are doing betteracademically,” she asserts. “Theevidence is increasingly there.And knowing that, an awful lotcan be accomplished, even withinthe constraints we are all facingnow — although heaven knows itcould happen faster with moremoney available.”

So what, in Young’s view, isneeded to propel us toward ramp-ing up physical education andschool-based physical activityprograms?

“Obviously, the traditionalthings that have motivatedschools have been both federalmandates and grant programs ofvarious kinds. So the absolutelyideal incentive is something thatcombines both those things. Thisis as true in the P.E. and physicalactivity areas as on the nutritionside. However, the reality is thatlawmakers on a local level aregenerally reluctant to imposerequirements of any kind onschools — especially unfundedrequirements. So as a result, itfalls to activism and advocacy.”

Young herself is one suchadvocate. At AAHPERD, she isaggressively working on federallegislation that ensures the worka-bility of incentives like the U.S.Department of Education’s CarolM. White Physical EducationProgram grants, as well as modifi-cations to the reauthorization ofthe Elementary and SecondaryEducation (“No Child LeftBehind”) Act that would incorpo-rate more supports for P.E. andphysical activity in schools.

Young is convinced thatchanges in the school day itselfare inevitable, given the evolvingrequirements for physical educa-tion and/or physical activity inschools.

“You can’t do something in theschool day if there’s no time dedi-

cated to it. Those 30 minutes, thequalified, certified instructor, it all has to happen somehow. Andfrankly, up to now it’s all beenneglected as the acknowledgmentof the importance of physicalactivity in our society has waned;we’ve got to replace it with some-thing systematic. And no, everykid doesn’t need to be an athlete,or spend time doing tedious calis-thenics – they just have to under-stand the things they have to doto keep themselves healthy. Thebest part is that we can have aripple effect on families by teach-ing kids these things.”

Young is careful to stress thatstakeholders’ focus has to be on“both sides of the coin” — betternutrition plus physical activity and physical education.

“It can’t be one without theother,” she says. “They’re mutual-ly supporting. Kids learn quicklythat healthier eating supports theirinvolvement in exercise and activ-ity, and vice-versa. It’s really acomplex of interacting variables.

“To P.E. teachers out there trying to make progress,” shesays, “my advice is do your job.Teach as if it’s life-and-death,because it is. Kids have to under-stand how to get healthy, andkeep themselves healthy as theygrow. Period. As for parents, they have to think about physicalactivity, and getting their kidseating better and moving moresystematically than they perhapsever thought they had to. Supporthas to come from all sides.”

Physical Education and Physical Activity: Vital Variables in the School Wellness Equation

Judith Young, PhD


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Most school superin-tendents and schoolnutrition professionalsfeel that schools provide healthy, youth-appealing foodsand beverages, while two-thirds of teachers, parents, and community health professionals disagree.

What about nutritioneducation?When asked whether they agree thatmost schools are doing a good job ofeducating students about the impor-tance of sound nutrition, 83 percent of superintendents and 64 percent ofprincipals feel that they are. However,fewer than half of school nutrition/food service professionals (45 percent),school health professionals (43 per-cent), physical education teachersand parents (both 42 percent) agree.And only 34 percent of students and26 percent of community health pro-fessionals feel schools are providingadequate nutrition education.

Are schools providinghealthy foods andbeverages thatappeal to kids, andlimiting access tothose that are highin calories and lowin nutrients?Over 80 percent of superintendents say yes, as do 90 percent of schoolnutrition and food service profession-als. But only about a third of teachers, parents, and community health professionals agree. About half ofschool health professionals, schoolboard members, and principals thinkthat schools are doing a good job.

What about physicaleducation and physical activity?About half of school board members,superintendents, and principals agreethat most schools provide quality dailyphysical education programs for allstudents. Other groups disagree.Nearly 80 percent of physical educa-tion teachers feel that improvement isneeded, as do at least 70 percent ofparents and students, and 87 percentof community health professionals.

Similarly, over half of school admin-istrators (superintendents and princi-pals) and board members believeschools have effective policies toencourage daily physical activity,while two-thirds or more of P.E. teachers, parents, students, and community and state education and health professionals disagree.

Respondents give schools some-what more credit for doing a good jobof educating students about theimportance of daily physical activity.Some 40 percent of parents and physical education teachers think that schools are doing a good job.Community health professionals aremost doubtful, with only 20 percentsaying an adequate job of educatingstudents about the importance of daily physical activity is being done.(See page 19 for information about the distinction between physical education and physical activity.)

>> On barriers to advancing school wellness... “Finding time to insert wellness-related activities such as nutrition education and physical activity into the calendar is challenging. You can’t blame teachers and districts for wanting to spend more time on math and science.” Howell Wechsler


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Working on the front lines of bothschool nutrition policy and dailyschool food service operation,Wilson has an unusually clearview of possibilities, challenges,and frustrations on the nutritionside of the wellness equation.

“There is indeed frustration outthere,” she says. “Parents are try-ing to do the things, nutritionally,that we’re advising, and then theschool sends home a flyer about apizza fundraiser, and the parentsget totally confused with, andangry about, the mixed messages.

“Kids, meanwhile, are saying,‘Look, you’re restricting all thesefoods, and encouraging us to eatcertain other foods, but you’re notsaying why.’ They’re telling us inso many words that the nutritioneducation component is lacking.And I couldn’t agree more.”

Wilson says the kids have really hit the nail on the head.Nutrition education is absolutely a missing link. Everything fromcomprehending labeling to under-standing food-related terminologylike “whole grain” is part of thenutrition education that should be happening, but largely isn’t, shesays. To critics who say there’s no proof that nutrition educationworks, Wilson argues that com-mon sense dictates it can andshould be tried.

Meanwhile, as a food servicedirector, Wilson’s biggest chal-lenges are fiscal, plain and simple.It’s the sheer difficulty of conceiv-ing and executing genuinelyhealthy school lunches within thebudget available.

“I’m getting $2.57 to workwith,” says Wilson. “You go toStarbucks and show me what youcan get for $2.57! Would I like toparticipate in ‘Farm-to-School’?Absolutely. I know a baby carrotfrom the farm tastes completelydifferent from the one I buy froma vendor. But show me the localfarmer who’ll bring me enoughgreen beans daily for 6,000 kids.”

“Meanwhile,” she continues, “a local private school is doingorganic lunches for students —and I have to explain to my par-ents who come to me that (a)they’re independently funded, (b)the parents themselves volunteerto prepare and serve the lunches,and (c) the kids there have anhour for lunch compared to my 20minutes. The limitations we areworking under are substantial.”

As for healthy, kid-appealingfoods, Wilson says she has a 100percent-healthful brown-rice stir-fry that’s made from scratch and,as she herself says, “tastes awe-some.” But she notes, “I have 200kids sign up for lunch that day, as

opposed to 500 on a chicken-nugget or pizza day. I can’t do it very often because my reim-bursement is made on the basis of total meals served, and it bringsdown my numbers. I’m trying, but the cards are really stackedagainst food service professionalsat this point.”

On the professional front,Wilson’s biggest focus right nowis on credentialing —standardiz-ing requirements for food servicepersonnel. “There are, right now,”she reports, “no nationwide stan-dard requirements regarding edu-cation, experience, or expertise forrunning a food service program.And most states have no stan-dards, either. For goodness sake,even instructional aides andschool bus drivers are licensed!”

The School NutritionAssociation has a national certifi-cation that it offers, requiring anexam and minimum hours oftraining. “We can’t mandate it,”Wilson says, “but we can talk tolegislators about it, which we’redoing vigorously.” She insists thatschool nutrition professionals are committed to contributing positively to student wellness.

“I don’t know a school nutri-tion professional who would notwant to do what’s best for kids. So many of us are in this busi-ness because that’s what we careabout, no matter what our train-ing level. We have some verydedicated and bright school nutrition directors in this countrywho have absolutely changed theway school lunch works.”

Front-Line School Nutrition WisdomKatie Wilson, SNS, is president of the School Nutrition Association,and works as the food services director of the Onalaska SchoolDistrict in Wisconsin. Asked what she would do if she had the powerand resources to make a single change to enhance the state of schoolwellness in America, she answers, “I’d institute a K-12 standardizednational curriculum in nutrition education.”


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Are schoolsengaging wellnessteams?The federal wellness policy mandaterequires schools to establish an advi-sory group of individuals includingparents, students, and representa-tives of the school food authority, theschool board, school administrators,and the public to serve as a wellnesspolicy team. Well over 60 percent ofschool nutrition and health profes-sionals, physical education teachers,other teachers, community healthprofessionals, and parents feel thatmost schools are not effectivelyengaging wellness teams. But almosthalf of school principals and two-thirds of superintendents say they are.

Do schools have adequate resourcesto improve schoolwellness?The majority of all stakeholdergroups that responded to the surveybelieve that schools are under-resourced to effectively strengthenschool wellness. Two-thirds or moreof school administrators, schoolboard members, school health andnutrition professionals, and P.E. andclassroom teachers say schools donot have adequate resources.Interestingly, respondents “outside”the school system perceive the lackof resources even more acutely than

do those who are “inside.” Over 75percent of community health profes-sionals feel that schools do not have adequate resources, and 85 percentof state health professionals agree.

As noted below (see page 35),respondents feel resources are neededfor more staff, equipment, materials,improved school food, and training.

Are parents supporting schoolwellness efforts?Schools do not appear to be gettingmuch support from parents when itcomes to encouraging children to bephysically active every day. Over 70percent of every group responding —including 73 percent of parents them-selves — disagree that parents do agood job of encouraging their kids tobe physically active every day.

Respondents are also not con-vinced that most parents encouragetheir children to consume healthfulfoods and beverages. Over 60 per-cent of all groups responding —including 72 percent of parents them-selves — contend that improvementis needed.

Conversely, areschools supportingparents’ efforts?Neither parents, nor school healthprofessionals, nor community healthproviders feel that schools are pro-

The majority of allstakeholder groups that responded to thesurvey believe thatschools are under-resourced to effectivelystrengthen school wellness.

>> On the power of sharing information... “Educate the public about the fact that policy tools exist for them to participate in policy-making and decision-making. Once parents in a local school district get hold of the policy and create some goals aroundit, they take ownership of implementing it and start influencing others – the principal, athletes and coaches,PTA members. They think, ‘Hey, we don’t have to have a fundraiser with jelly doughnuts!’ Once parents realize what the policy is, and that they can actually do something, they tend to go off and do it.”

Robert Murray


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viding adequate information to par-ents on the importance of daily physical activity or nutritious eatinghabits. At least three out of four P.E.teachers, other classroom teachers,school health professionals, andcommunity and state health profes-sionals feel schools are not providingadequate information to parents onthe importance of daily physicalactivity. The numbers are similar

when it comes to schools providingguidance to parents on sound nutri-tion: 69 percent of parents, 72 per-cent of school health professionals,61 percent of school nutrition/foodservice professionals, and 81 percentof community health professionalssay schools are missing the opportu-nity to do more, as do half of schooladministrators and two-thirds ormore of educators and school staff.

> Physical education teachers are judged most supportive overall, with 67 percent of all survey respondents rating them as “very supportive” and 27 percent as “somewhat supportive.”

> School health professionals come next, with 64 percent of respondents rating them as “very supportive” and 27 percent as “somewhat supportive.”School administrators and school board members are also perceived as supportive but less so: about a quarter of respondents rate both groups as“very supportive” and just over one-half of respondents rate them as “somewhat supportive.”

> Respondents perceive people outside the school system as less supportive of the advancement of school wellness. Community leaders, government leaders, and business and industry leaders are rated as “not supportive” of the advancement of school wellness by 19, 26, and 30 percent of respondents, respectively. Respondents also have some reservations aboutsupport for school wellness among students, parents, and other caregivers.Sixteen percent of respondents view students and parents/caregivers alike as “not supportive” of school wellness in general.

> And while some two-thirds of respondents rate students and parents/caregivers as “somewhat supportive,” only small percentages of respondentsrate each group as “very supportive” of the advancement of school wellness.

So who, exactly, supportsschool wellness?

>> On documenting and disseminating best practices... “What people don’t realize is that there’s a very strong and growing minority of schools where they are getting their act together in terms of wellness, and we need to do a better job of informing people about that.”

Howell Wechsler

“We need to extend the reach of the information that’s available and has been produced. Reports need to go to every superintendent in the country; webinars have to include school leaders and PTA leaders nationwide; podcasts should be used to reach stakeholders we’re not reaching; we really need to amplify the force withwhich we’re putting information out there.” Katherine Kaufer Christoffel

Physical educationteachers are judgedmost supportive ofschool wellness overall,with 94 percent of allrespondents ratingthem as “very” or“somewhat” supportive.


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What are the principal barriers to school wellness?From a list of eight potential barriers to school wellness, respondents rate the following as the most significant:

63% COMPETITION FROM OTHER SCHOOL PRIORITIES

46% RESOURCES AVAILABLE TO IMPLEMENT SCHOOL WELLNESS POLICIES

54% LACK OF TIME IN A SCHOOL DAY

42% TRACKING AND MONITORING OF POLICY IMPLEMENTATION

Respondents rate other barriers, listed below in order of significance from most to least:> Inadequate tools and “know-how.”> Difficulty implementing existing school wellness policies.> Lack of effective, evidence-based interventions.> Insufficient quality of existing school wellness policies.

>> On the speed of change... “Overall progress has been slow. It’s taken a long time for information to filter down from the district level to the individual schools in the city of Chicago.” Guillermo Gomez

“Change takes time — simply because school district leaders balance so many challenging priorities.”Katherine Kaufer Christoffel

Closing Perception GapsGaps in perception exist among school leaders (superintendents, principals,board members) and educators/staff who must implement policies forimproved nutrition and physical activities. Specifically, those with school governance and leadership roles are more optimistic than those with implemen-tation roles. Those “inside” the school system are generally more optimisticthan those “outside” the system. Also notable is that parents are not alignedwith school leaders in their perceptions of the state of school wellness.

Better systems for monitoring and tracking policy implementation wouldenable stakeholders to more accurately assess progress with school wellnessand also aid in developing targeted intervention strategies and building thecase for adequate resources.

School administratorsby far are the best positioned to move local school wellnessforward, according to survey respondents.Parents and other caregivers come in second, with schoolboard members closebehind.


35

>> On advocating for change... “There is strength in the combination of the federal local wellness policy and community members advocating for it. You have your nutrition and physical activity advocates in every school community, and you empower them with the fact that state laws say certain things are allowable and certain things are not.” Howell Wechsler

In addition to moneyand resources, stakeholders believethat changes toschool menus, increased physical education, increasedparental involvement,and better leadership support are the bestways to improve schoolwellness.

Who can move schoolwellness forward?From among a list of 11 stakeholdergroups, respondents ranked those theyperceive as best positioned to movelocal school wellness forward.Respondents indicated that schooladministrators by far are the best posi-tioned to move local school wellnessforward. Parents and other caregiverscome in second, with school boardmembers close behind parents. Schoolnutrition and food service profession-als, teachers, physical educationteachers and professionals, govern-ment leaders, and school health pro-fessionals are also ranked as well posi-tioned, but trail the top three groups.

Notably, few respondents rank stu-dents, community leaders, or busi-ness and industry leaders as being inthe strongest position to move schoolwellness forward.

What is the best wayto achieve positivechanges in wellness?This open-ended question generatedalmost 2,300 answers. In order, themost frequent responses from allstakeholder groups include:> The need for more money and

resources, including time, staff, and materials.

> Changes to school menus — high-er-quality foods, more local fruitsand vegetables, more low-fat dairyitems, fewer processed foods.

> The need to improve and increasephysical education — more teach-ers, classes, and equipment.

> Increased parental involvement onwellness teams and via at-homesupport for sound nutrition andphysical activity practices.

> Better leadership support at all levels — from the school building tonationally elected officials.

> Coherent, effective school- and district-based teams, featuring col-laboration among school administra-tors, boards, and staff, and involvingparents and community members.

> More communication and outreach,based on strategies to raise aware-ness, and support and educatestakeholders at all levels.

> Legislation mandating changes at national, state, and local levels.

> The need to better plan, implement,and evaluate policies and resultingprogress.

Also frequently cited were respons-es concerning: shared and supportedvision at all levels; making health andwellness a higher priority of equalimportance to the mandates under NoChild Left Behind; integrating nutritionand physical activity education andexperiences into the curriculum; hold-ing schools and states accountable forimplementation of plans that get results;placing legal limits on foods sold out-side of school meals; and the need formore and better adult role modelsinside and outside of school.


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The Successes:Good NewsStrides are being made — as constituencies get engaged... as Action for Healthy Kids Teamsexpand efforts... and as school districts take action.

THE SUCCESSES: GOOD NEWS

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For more than five years, Action forHealthy Kids Teams across the coun-try have been working to promoteschool wellness, shoulder-to-shoul-der with the entire range of stake-holders that must be engaged inorder to make further progress. Thesevolunteers — school administrators,teachers, community leaders, publichealth professionals, and parents —have applied their energy, creativity,and commitment to supportingschools in their efforts to offer stu-dents healthy food choices andopportunities for physical activity.

The case studies summarized brieflyhere — all of which are available asmore detailed narratives in the form ofAction for Healthy Kids field reports —illustrate what is possible in schools,as well as some of the lessons thatAction for Healthy Kids Teams and vol-unteers have learned as they haveworked with schools to test new ideasto promote school wellness. The stories share a common theme: how to engage the stakeholders mostessential to creating and sustainingchange in the schools — be theyschool leaders, parents, or students.

There are positives when it comes to school wellness. In fact, there are many stories of promise and evenbreakthroughs — and countless lessons learned inthe field to date.

Engaging ParentsMichigan Makes Parents Part of a Comprehensive StrategyMichigan Action for Healthy Kids helped the state’s Department of Educationset up “Parent Champions for School Wellness” to bring parents into a com-prehensive, statewide initiative to promote school wellness. The effort providedvaluable information to parents about the federal school wellness legislation.

Colorado Creates Effective Parent AdvocatesA grant award from Action for Healthy Kids made possible by Kellogg’sCorporate Citizenship Fund enabled advocacy training via an original “ParentsAre the Power” toolkit developed by the Colorado Action for Healthy Kids Team.

LESSONS LEARNED > Remind parents that there is no one person or institution solely responsible

for the childhood obesity crisis. Invite them to work together with schoolsand other community institutions.

> Ask parents to commit to a specific action, even if it’s a small one. Give thema role and acknowledge their contributions.

> Do not preach; it is far more effective to ask parents to partner with you toovercome challenges, and to involve them in creative ways.

> Share responsibility with parents. A relationship of mutual respect will drawparents in and make them want to reinforce at home what kids are learningat school.

> Appreciate all parent contributions, even those that may seem minor.

Ask parents to committo a specific action, even if it’s a small one.Give them a role andacknowledge their contributions.


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>> On committed school leadership... “Most change happens because of the impassioned leadership of one individual. We’re going to have to tap into those superintendents at the state and district level who ‘get’ it, and perhaps even the retired ones who ‘get’ it. They can help their peers understand that all superintendents will eventuallybe held accountable for school wellness.” Howell Wechsler

Engaging School LeadersIndiana Rewards Active, Healthy Schools with the “Healthy Hoosier School Award”The Indiana Action for Healthy Kids Team devised the “Healthy Hoosier School Award” to recognize schools that have put policies and programs in place to help create healthy students. To apply for the award, school principals must submit an application that requires extensive information regarding their school’s food and physical activity environment including details on school lunch policies, whether the school has on-campus health personnel, and whether vending machines are turned on during classroom hours.

LESSONS LEARNED > Understand that recognition is important to school leaders. School

administrators appreciate acknowledgment for good policies and programs.> Engage district leaders with the outcome that’s important to them:

improved academic achievement. Show them the links between academic performance and good nutrition and physical activity.

> Acknowledge the time constraints and competing priorities that district administrators face.

> Solicit leaders’ opinions and feedback each time they’re presented with a new concept or tool. Ask them how they think they’ll apply it in their own settings.

Engaging Students

The case studies summarizedhere — and others — fromAction for Healthy Kids Teams'work in the field, along withadditional “What's Working”models, are available atwww.ActionForHealthyKids.org.

Massachusetts Lets Students Take ChargeIn the fall of 2004, the Massachusetts Action for Healthy Kids Team launched“Students Taking Charge,” an initiative to engage students in creating healthyschool environments. The Team awarded six grants of up to $1,000 to help stu-dents develop, evaluate, and refine a toolkit about nutrition and physical activityin the school environment. The Massachusetts Department of Education helpedget the call for applications out to student governments throughout the state.Student council members reviewed and made suggestions to improve the toolkit.

Texas Students Take Charge, TooUtilizing the “Students Taking Charge” toolkit developed by the MassachusettsTeam, Texas Action for Healthy Kids launched an initiative that was funded bythe 2007-2008 Action for Healthy Kids Team Grant Program made possible by

Ask students to identify the problemsand to create solutionsthat make sense to them. Ownershipmatters.



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Kellogg’s Corporate Citizenship Fund that would create student advocates in the following school districts: GrandPrairie, Alamo Heights, Irving, and Pasadena. The programkicked off with a student summit in August of 2007 that trainedstudents in creating a healthier school environment.

Iowa’s Student Wellness SummitIn the summer of 2007, Iowa Action for Healthy Kids held its second annual Student Wellness Summit, titled YEAH! (Youth Empowered Ambassadors for Health). Over 150 partici-pants representing 25 school districts throughout the stateattended the summit. All student-led teams that included at least one staff member were given the opportunity to apply for a $500 mini-grant to help implement student-led wellness initia-tives. To date 30 grants have been given out to schools toincrease the health literacy of Iowa youth and empower them to advocate for healthier school environments. The project was funded by local organizations including the WellmarkFoundation, the Iowa Medical Society Alliance, and the Midwest Dairy Council.

LESSONS LEARNED > Trust students to take school policies on and empower them

to do so — don’t just pretend they are in charge. > Connect with student councils and student governments to

find the “do-ers” in the student body. > Realize that students will be more honest, frank, and matter-

of-fact about their school environment than adults will. Adultsmay “edit” or be more polite about answers to questions.

> Ask students to identify the problems and to create solutionsthat make sense to them. Ownership matters.

> Ask students what they're willing to do. Enlist them in the discussions of how to implement behavior change. After all,they are the ultimate stakeholders.

Teams at WorkA majority of Action for Healthy KidsTeams work directly on local wellnesspolicies, and: > 76% focus on helping districts develop,

implement, and monitor local wellnesspolicies.

> 4% have developed wellness policyguidelines and/or made recommenda-tions for local districts.

> 82% have conducted training workshopsfor key stakeholders including schooladministrators, educators, and parents.

> 71% have published a toolkit, policymodel, and/or how-to information.

> 92% report that districts in their statesdeveloped local wellness policies based in part on action undertaken by Teamsand on materials and support provided by Action for Healthy Kids.

Teams have engaged on the local, state,and national levels:> 50% have offered mini-grants to school

buildings and/or districts to assist withimplementation of local wellness policies.

> 90% have implemented strategies enactedat the state level; 82% at the districtlevel; 59% at the school building level.

> 84% have had a representative whoserved on and/or provided input to keystate advisory committees or commissions.

> 100% have contributed resources to the Action for Healthy Kids nationalresource database for use by otherTeams and the public.

Data above were gathered during the 2006-07 school year.

>> On monitoring... “In order to achieve continuous quality improvement in school wellness – the next step after policy implementation – states will likely have to mandate monitoring. Without a mandate to monitor progress, my fear is that schools just won’t do it.” Robert Murray


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>> On school breakfast... “Making breakfast part of the school day would be on the top of the list of strategies I would undertake first and foremost to help school wellness. It’s very, very doable to serve breakfast in the classroom; there are schools that are doing it all over the country right now. Little ones, rural ones, urban ones. We don’t have to say we have to change the whole system – we can do that one thing right now and it would make a huge difference.” Madeleine Levin

Pinellas County, Florida is rapidly becominga “poster child” for school wellness innova-tion. The Pinellas County Schools FoodService “Salad Program” was recognizedby the U.S. Centers for Disease Control andPrevention and the U.S. Department ofAgriculture. Pinellas public school luncheswere ranked first in the state and tied forsecond in the country in promoting thehealth of children.

Meanwhile, Pinellas County’s TeenCuisine “Quick Bites” video was honoredwith a Telly Award, which honors excellencein local, regional, and cable TV commercials,and non-broadcast video. The “Quick Bites”video series promotes healthy eating habitsusing middle school students and profes-sional chefs in a cooking-show format.

Peggy Johns is supervisor of pre-K to 12health education in Pinellas and a memberof the Florida Action for Healthy Kids Team.

“Nutrition education is really workinghere,” she says, “but it’s because with us it’sfor the long haul. You just can’t go in, give acouple of lessons, and boom, it’s done. Youhave to have support and education Kthrough 12. It takes a number of years toreally establish the groundwork for healthiereating and behaviors. Gradual steps aremore sustainable than looking for drasticchange overnight.”

That gradual approach to change is applied even in the cafeteria, Johns says.

“We didn’t completely eliminate friedFrench fries in the high schools. What wedid was say, okay, we’re going to controlportion size — no more than 4.5 ounces. And students can only have one serving —no more of this à la carte stuff where theybuy three servings of French fries and that’stheir lunch.

“Same with vending machines. If we

have a contract with a vendor, we’re notgoing to eliminate all sugared sodas. Wenegotiate a smaller percentage, maybe 30%,of sodas. But again, we limit the serving size— it can’t be over 12 ounces. No more ofthose 20 ounce cans and bottles. So we’retaking baby steps to ‘wean’ students intowellness, and get them where they need tobe little by little.”

Dr. Clayton Wilcox, Pinellas County’ssuperintendent of schools, says that admin-istrators are “driven by the tyranny of the

urgent.” In other words, putting out fires. He maintains that, in his opinion, having afull-time staff member like Peggy Johns tofocus on health and wellness issues is, for larger districts, essential.

“If you don’t have somebody whose soleor principal responsibility is wellness, I thinkit becomes difficult. From a superintendent’sperspective, you need a champion, and youneed to support that person. Doing so is really a way to make a huge wellnessimpact in your district.”

Is Wilcox optimistic about the future ofschool wellness?

“Absolutely,” he responds. “There’s no institution that is so uniquely positionedto make an influence on the future as thoseof us who are charged with, and challengedto, educate kids. Education has risen to the occasion every single time it’s beenasked to. I don’t think school wellness willbe an exception.”

“Administrators are driven by the tyranny of the urgent.”Take baby steps to

“wean” students intowellness and get themwhere they need to belittle by little.

School District in Action: Pinellas County, Florida

“There is no one-stop solution to the enor-mous problem of childhood obesity. Schoolsclearly have the ability to help kids developpositive health habits. But the city, mean-while, has the ability to improve the builtenvironment — for instance, by making thecommunity more walkable. Neither side hasthe resources to get the job done workingindependently.”

Yvonne Garrett, director of communityservices for the city of La Mesa, California,is providing a vivid example of how manysolutions to tackling the school wellnessissue are joint ones — in this case, a tan-dem effort between the city and La MesaSpring Valley School District.

La Mesa is just one of the cities nation-wide receiving support from a partnershipbetween the American Association ofSchool Administrators and National Leagueof Cities’ Institute for Youth, Education, andFamilies, with support from the RobertWood Johnson Foundation. The aim is forcities and school districts to partner todevelop local overarching wellness plans— plans that are the deliberate product ofclose collaboration between senior-levelstaff from the municipality, the school district, and other community partners. Othercities competitively selected for this initia-tive include: Charleston, South Carolina;Jackson, Tennessee; Oakland, California;San Antonio, Texas; and Savannah, Georgia.

To La Mesa’s Garrett, it makes all thesense in the world.

“Up to this point, our community has notlooked at childhood obesity as a ‘global’issue — that is, as everyone’s concern. Yetit’s obviously a multi-pronged problem — sobringing all the key players to the table andtrying to identify mutual solutions is just anefficient use of resources.”

In La Mesa, municipal leaders andschool administrators alike are receivingthe benefit of consultation with nationalexperts in the areas of local wellness policies, childhood obesity, healthy eating,active living, and school health councils.

One possible action-step is the estab-lishment of a “walking-to-school” culture in La Mesa. For their part, city officials willbe looking at improving sidewalks to ensurestudent safety along the routes. To recipro-cate, the school district is supporting thecity’s own wellness-encouraging efforts byopening up schools to be used as communi-ty centers to promote higher levels of

physical activity across the community. It’swin-win for both sides.

“Cities can’t attack the wellness problemalone,” Garrett says, “but neither canschools. What we’re establishing here istruly a local partnership with a single visionof how we can share expertise andresources to tackle school wellness andcity wellness as one.”

School District in Action: La Mesa, California

“What we’re establishing here istruly a local partnership with

a single vision of how we can share expertise and resources to tackle school

wellness and city wellness as one.”


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>> On community involvement... “I have never seen a community that demands high expectations of a school and have that school not deliver on it. I have seen some enlightened superintendents and educators bring about excellence despite a community, but it’s very hard. It’s so much easier to bring about changes if the community understands and is committed to making a difference in the lives of children. It gives the superintendent a clear message, and it gives the teachers direction and excitement.” Gene Wilhoit


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The Hurdles:RemainingChallengesSchools are wrestling with competing priorities, fiscal limitations, and the challenge of providing youth-appealing healthy foods that kids will actually eat. Meanwhile, parents remain an under-utilized, under-accessed resource, and the question persists as to whether the real changeagents are yet on board.

THE HURDLES: REMAINING CHALLENGES

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Wellness advocates agree that, toeffect whole change, wellness needsto be an element within any overallschool improvement plan. And in theend, it is this approach that, giventhe link between health and learning,will help schools reach their aca-demic goals.

It is happening in some states andsome districts. But given the impor-tance of nutrient-rich foods and dailyphysical activity to children’s healthand academic achievement, whyhasn’t change swept through schoolsthroughout America? Why aren’t ourchildren healthier and more fit?

“Schools have regrettably ignoredhealth and wellness issues in manycases,” says Gene Wilhoit, executivedirector of the Council of Chief StateSchool Officers, “while at the sametime putting greater emphasis oncore content areas like math and sci-ence, and of course demandingaccountable academic performance.

“We have to get schools to thepoint where they understand a child’ssuccess will not be achieved in thesetraditional areas without good health,and that means nutrition and physicalactivity. Period.”

Schools face many challenges, butthe consensus of the education andhealth authorities consulted for thisreport points to one important reality:schools cannot alone improve stu-dent health. Over and over, theseexperts emphasize that schools donot operate in isolation from theircommunity environments.

“School is simply where we seebroader community things playing out,and it is really important to keep that

in mind — to act on that and not thinkschools are on their own,” warnsJulia Graham Lear of the Center forHealth and Health Care in Schools.

Katherine Kaufer Christoffel, pedia-trician and Action for Healthy Kidsboard member, concurs. “You can'tcreate an impervious bubble withinthe schools,” she asserts, “becausethey exist in communities, the childrenlive in the communities, the teacherslive in the communities… so in orderto have integrated change acrossthese different sectors, we have to beworking within and across sectors."

The sentiment is echoed byMadeleine Levin of the FoodResearch and Action Center.“Schools can only influence the com-munity so much,” she asserts. “Ittakes the involvement of parents,community leaders, and governmentagencies — they too are a huge partof the solution.”

Problem is compounded

for low-income, underserved

populations.

Schools in disadvantaged communi-ties face factors that compoundunhealthy environmental influences:a lack of resources and stressedfamilies. Levin observes that in low-income neighborhoods, even if par-ents want to pack a healthy schoollunch for their children, there oftenare not grocery stores nearby wherethey can buy fresh fruits and vegeta-bles, whole-grain foods, low-fat dairyproducts, or other healthy foods.

Christoffel points to other environ-mental influences, too: “You can’tignore the immediate environments

School wellness should be “built in.” The central challenge in school wellness is making it part of theschool culture and the overall school environment.

We have to get schoolsto the point where they understand that achild’s success will notbe achieved withoutgood health, and thatmeans nutrition andphysical activity.


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of the schools. There’s more andmore research about how many fastfood restaurants there are within ahundred yards of many schools, andit’s sobering.”

It bears repeating. Average andlow-income families are under par-ticular stress. Madeleine Levin noteshow many Americans are workinglonger and longer hours just to keeptheir income stable. This, sheexplains, invariably affects what hap-pens to children before and afterschool. Kids are not coming to schoolhaving eaten a nutritious breakfast, ameal that research shows particular-ly enhances learning.

“The majority of American fami-lies,” Levin observes, “just do nothave schedules that allow them to allsit around the table together and eatbreakfast. This is true,” she says,“even where the cost of a healthybreakfast isn’t a barrier — which it isfor millions of poor families.”

Parents and schools: mutual

reinforcement is crucial.

Recognizing parents’ primary role intheir children’s health, Action forHealthy Kids’ stakeholder researchquestions probed parents’ role inencouraging healthy habits in theirchildren.

Schools are not getting much sup-port from parents, according to thesurvey respondents, among whomseveral hundred were parents. As

noted earlier in this report (see page32) the vast majority of respondents,including parents themselves, feelthat most parents do not do a goodjob of encouraging their children tobe physically active every day orencouraging their children to con-sume healthful foods and beverages.

Research respondents suggestthat parents need help to supportschools’ efforts. Neither parents, norschool health professionals, norcommunity health providers feel thatschools are doing enough to provideinformation to parents on the impor-tance of daily physical activity orsound nutrition — even if they recog-nize that schools alone should notbear this responsibility.

Obviously parents in all communi-ties, including underserved communi-ties, care deeply about their chil-dren’s health and well-being. A sepa-rate, recent Action for Healthy Kidsresearch study* found that AfricanAmerican and Hispanic parents inlow-income, urban settings feel thatlocal schools and parents have ajoint responsibility to influence chil-dren’s eating and physical activityattitudes and behaviors.

Further, and more importantly,these parents are interested in serv-ing as wellness advocates. Theresearch indicates, however, thatparents are looking for more informa-tion and education about schoolwellness. Most parents simply don’t

>> On the food environment at school... “Why should there be any unhealthy foods and beverages in schools? Surround kids with healthy foods and healthy food choices, making them easy for children to get; create an environment where the choices at school are all healthy. If you really listen to kids, there are healthy foods they like.” Madeleine Levin

Most parents simplydon’t know enoughabout the wellness climate and processes in their schools to take specific actions.


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>> On school food service hurdles... “The fundamental structural issue we’ve got to deal with is how to make fruits and vegetables, whole grain products, and low-fat and fat-free dairy more economically attractive.” Howell Wechsler

“School meal programs face many barriers to offering healthy foods. Ultimately they bear the responsibility, yet policymakers need to be realistic about the costs of providing healthy, high-quality food.”

Madeleine Levin

Even school districts with strong wellnessprograms and policies, like JeffersonCounty Public Schools in Kentucky, needparent involvement and advocacy tomake them even stronger.

In 2006, Anita McLaughlin, in additionto being a registered dietitian, was theofficial parent representative on the com-mittee assigned to develop the local well-ness policy for the Jefferson Countyschools, as well as a member and formerco-chair of the Kentucky Action forHealthy Kids Steering Committee. Whilethe Kentucky legislature had recentlymandated a clear andeffective law thataddressed the schoolday, it was McLaughlin’sdesire that the policy also be extended toafter-school hours — specifically asregards snacks and beverages offered invending machines.

“My experience,” McLaughlin reports,“is that, while schools certainly careabout wellness, they also desperatelywant the revenue they gain from vendingmachines that sell soft drinks and ‘junkfood.’ That revenue can be significant,and I understand it often pays for thingslike sports equipment. But my contentionis that wellness policies should apply toschools 24/7, not just during the schoolday. I just didn’t want them turning on the vending machines after school, and‘undoing’ all the good they did in keepingjunk food and sugar drinks out duringthe school day. And I wanted the policyto reflect that.”

When the provision that would havecovered after-school hours was removedfrom Jefferson County’s draft policy priorto its approval, McLaughlin got angry.

Parents in Action: Jefferson County, KentuckyHer subsequent advocacy took the formof everything from a letter-writing cam-paign to speaking at school board meet-ings at which the wellness policy wasbeing reviewed.

“I encountered resistance and push-back,” McLaughlin says. “But I was per-sistent. Some called me relentless anddogged. But I felt it was a very importantprovision, and somebody had to fight tokeep it.” McLaughlin’s persistence paidoff. The after-school vending-machineprovision was restored to the final draft of Jefferson County’s policy, and the

policy has since been implemented. She points out that the support of otherhealth professionals, particularly threephysicians who spoke at the final schoolboard meeting, was vital.

The lesson? Simply that schools maynot always welcome parent engagementon issues of substantive change — and yet determined parents can make a difference.

“You know,” McLaughlin observes, “if you have one set of standards for theschool day, and then as soon as the bellrings you’re selling soft drinks and candy,what kind of message does that send tokids themselves? It doesn’t make sense.Somebody had to get that across.”

“I encountered resistance and pushback. But I was persistent.”

know enough about the wellness climate and processes in theirschools to take specific actions.

This knowledge gap also was evi-dent in a nationwide poll conductedby Action for Healthy Kids,** show-ing that parents from all areas of thecountry are unaware of local well-ness policies. Many wrongly assumethat schools are providing adequatenutrition and quality physical activityopportunities to students every day.

Schools have competing

priorities and mandates.

School districts must contend withmultiple pressures and priorities. Infact, competition from other schoolpriorities is ranked the top barrier toimplementing school wellness bystakeholder research respondents,over 60 percent of whom termed it a“significant” hurdle.

Superintendents, in particular,have difficult jobs. They face the chal-lenge of preparing students to per-form well on standardized achieve-ment tests mandated by No Child LeftBehind legislation; fitting more andmore educational content into schooldays of finite length; and above all,meeting ever-tighter budgets.

With district — and public —attention focused on test scores,

*Action for Healthy Kids focus group study withminority parents in low-income, urban communities,conducted with MEE Productions in 2006-2007.

**See Parents’ Views on School Wellness Policies, at www.ActionForHealthyKids.org.



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school leaders find it difficult to justi-fy time to add, or even keep, existingactivities such as health and physicaleducation in the schedule.

With this pressure for test scores,the CDC’s Howell Wechsler pointsout, “You can’t blame [educators] forwanting to spend more time on mathand science.” In general, partici-pants in Action for Healthy Kids’stakeholder research (see page 34)feel the same way: over half statethat the lack of time in a school dayis a significant barrier to school wellness implementation.

Small steps despite

ever-present fiscal challenges.

School districts need motivation tomake school wellness a priority.Katherine Kaufer Christoffel warns,however, that “the incentives are notlined up so that putting wellness onthe front burner makes businesssense to school districts or schools…The real master is their bottom line.”

But things can be done. Schooladministrators can take relativelyeasy steps such as negotiating with abottling or vending machine contrac-tor to switch from soda to water andlow-fat milk, or from salty snacks toless salty. But other types of changesthat schools might need to make topromote wellness bump up againsthard district realities.

Julia Graham Lear reminds us, forexample, that many schools don’t

have the extra money for somethingas basic as on-site facilities forpreparing fresh foods for school mealprograms. And such essentials tohigh-quality programming as creden-tialed staff cost even more.

Robert Murray, of the AmericanAcademy of Pediatrics, questionswhether organizations concernedwith improving school wellness havedone an adequate job figuring outhow schools can make changes,given their financial constraints andconcerns about efficiency.

“Once the superintendent and theboard acknowledge the fact thatschool has to play a role and thatsteps need to be taken to help theirstudents, it then becomes the finan-cial officer of the district who reallybecomes the key player. I don’t knowthat we’ve done a good job nationallyof engaging financial officers,” hemaintains.

School food services

are strained.

Tight budgets have an obviousimpact on school meals. School foodservices must be self-supporting, andin 2000 the U.S. Department ofAgriculture reimbursed only 51 per-cent of the cost of a meal. One wayschool food service operations haveoffset this cost has been by sellingpopular competitive foods. As thenutrition criteria for these foodschange, school food service must

>> On progress in stages... “With school wellness, you have to pick your shots; get some wins; look for other small victories. Even if it doesn’t lead to change right now, you’re laying real groundwork. The big issues don’t get resolved even in a decade. With tobacco, we’re talking 20 years to effect real change, and with childhood obesity it will be even longer. It’s hard to change the culture.” Julia Graham Lear

Incentives are notlined up so that putting wellness onthe front burnermakes business senseto school districts. The real master is the bottom line.


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sell more healthful options thatoften cost more and may not haveas much student appeal as what isin the vending machines. Manyschool food service operationshave become dependent on thesesales in order to stay out of the red.

Further, school food service staffmembers need more training andoften higher wages, several of ourinterviewees noted. This fact com-pounds the challenge of feedinghealthy meals to thousands of chil-dren per meal with minimal budgetsand limited facilities. HowellWechsler points out that in moststates there currently exist no certification requirements forschool food service managers.

Impediments to

nutritional quality.

There are numerous hurdles andchallenges that must be addressedin order to meet goals connected togetting students to make betterfood choices.

School meals have evolved to use processed, prepared food items.Preparing higher quality, tasty, nutri-tious meals that would require moreon-site production presents a needfor training, higher skilled staff, andpossibly new equipment.

Budgets for school food serviceare often inadequate for the rising

costs of food and labor. A studypublished in the Review ofAgricultural Economics (Wagner, et al.) documents that indirect costspaid by school food services toschool districts negatively affectmeal quality by decreasing funds to upgrade kitchens and train staff.

Action for Healthy Kids’ focusgroups with minority middle schoolstudents in urban communities*found that the largest barrier to mak-ing better food choices at schools issimply the poor quality and unappe-tizing nature of the options served,not their healthfulness.

As well, students and teachershave not always been receptive tomany changes to improve schoolmeals. School nutrition profession-als have concerns that this willnegatively affect participation ratesand budgets further. And higherquality food products that are tastyand prepared and served in anappealing manner just cost morethan current alternatives.

Augmenting these realities, nutri-tion and public health profession-als** feel the biggest barriers keep-ing youth from consuming nutrient-rich foods are their lack of interestin doing so, since the status quo isseen as no problem. These profes-sionals cite additional barriers: thelack of access to tasty and appeal-

ing healthful food options; the lackof support from parents; and aschool environment that’s generallynot conducive to healthy eating.

Importantly, blame is not beingplaced on any group. A good dealof the challenge rests in the simplefinancial reality of how much fund-ing schools receive versus theever-rising costs of food. But thereare clearly crucial barriers thataffect the goal of getting studentsto make better food choices — and,by implication, impact the largergoal of school wellness overall.

Health: A new part

of schools’ mission?

It is a simple and understandablefact that not all educators see pro-moting students’ health as part oftheir mission. Or their job.

“Our number one hurdle is over-coming the school’s feeling thattheir sole mission is education —and that health is a backwater issuefor most of them,” claims RobertMurray. “Getting education leaderssuch as superintendents and princi-pals to turn their attention from stricteducational outcomes to the well-being of the whole child remains achallenge. It will be greatly facilitat-ed by offering to help school admin-istrators accomplish these goals.”

It is Julia Graham Lear’s con-

>> On compromise... “Sometimes health and wellness-focused people come into the school environment with a powerful and well-intentioned commitment, but with a no-compromise kind of mentality, and maybe a lack of empathy for the conditions that exist in schools. Health advocates have to keep up the strong message and interest in wellness, but they have to do it in a way that recognizes the shortfalls and the realities of schools’ ability to implement.” Gene Wilhoit

*Action for Healthy Kids’ qualitative research with minority middle school students in low-income, urban communities, conducted with MEE Productions in 2006-07. ** See Helping Youth Make Better Food Choices: Perceptions, Barriers, and Promising Approaches among Nutrition, Health, and Public Health Professionals,

available at www.ActionForHealthyKids.org.



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School administratorsand teachers are themore powerful andinfluential groups, but are viewed as lesssupportive than others.

tention that the problem is not lack ofknowledge. “I think people in the[education] field understand theissue; they just don't see a role forthemselves. Teachers worry aboutthe tests, and school boards worryabout budgets,” she says.

Lear notes that individuals from the health world may need to betterunderstand the culture of educationto create change. Public health professionals “have not immersedthemselves in a really fine-grainedunderstanding of what makes schoolsand school buildings and school districts and education policy andstate operations tick,” she observes.

In her view, public health worksfrom the top down, where, when adirective is given, things happen. But— with the exception of the federalNo Child Left Behind legislation,where schools are held accountablefor test scores — education is differ-ent; things tend to happen from thebottom up. You can’t rely on top-down directives as much as you haveto build bottom-up support.

Are the real change agents

on board?

Could it be that the individuals bestpositioned to move school wellnessforward are often the least support-ive of school wellness?

Participants in Action for HealthyKids’ stakeholder research give highest marks to physical educationteachers and school health profes-sionals in their support of advancingschool wellness in general.Respondents judge some two-thirdsof both groups as “very supportive”of school wellness. School nutritionand food service professionals comenext, and are judged “very support-ive” by 46 percent of respondents.

However, school administrators,school board members, and class-room teachers — arguably the morepowerful and influential groups, andlabeled so by research respondents— are viewed as less supportive.Only 28 percent of school administra-tors are ranked as “very supportive”of school wellness. Similarly, veryfew respondents (7 percent) rankparents as “very supportive.” In fact,16 percent of respondents view par-ents as not supporting the advanceof school wellness at all.

A national study with school boardmembers and superintendents, pro-duced by California School BoardsAssociation and California ProjectLEAN in 2007, shows that these school governance team members understandand support school wellness in princi-ple. However, their support does notnecessarily translate into actionbecause of a myriad of barriers, mostnotably lack of adequate funding andcompeting priorities they must address.

The bottom line: until those individuals who are most influentialare also among the most activelycommitted to school wellness, hurdles will remain.

THE FUTURE: WITHIN OUR REACH

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The Future:Within OurReachNeeded now: clarity and consistency. For its part, Action for Healthy Kids’ path is clear: a commitment to nutritional quality and physical activity in schools; a redoubled focus on underserved communities; enlisting parents as advocates; closer collaboration with school leaders; support for wellness policy implementation and evaluation; and stakeholder mobilization overall.


50

That is, in large part, precisely whythis report has sought the input of,and is addressed to, such a broadarray of stakeholders. Action forHealthy Kids’ next five years will bemarked by close collaboration withexactly those stakeholders in a joint,committed effort to acceleratechange in American schools.

That effort is fueled by the knowl-edge that only by positively impactingthe school environment as regardsbetter nutrition and increased physi-cal activity will we impact students’ability to reach their potential — andafford American youth the healthyadulthoods they deserve.

Where is Action for

Healthy Kids headed?

A commitment to nutritional quality and physical activity.The natural evolution beyond the“wipe out junk food” strategyrequires turning the focus towardgetting kids to make more intelligentchoices about the foods they do eat. In getting kids to make betterfood choices — especially fromamong the Dietary Guidelines for Americans’ “Food Groups toEncourage,” including fruits, vegeta-bles, whole grains, and low-fat and fat-free milk and milk products —Action for Healthy Kids will be: > Engaging youth in developing

approaches for improving nutrition-al quality in their school.

> Motivating youth to make betterfood choices at school by improv-

ing access to quality, healthfulfoods that are tasty and appealingin school meals and in all othervenues.

> Utilizing social marketing strategies to promote and market allkey “Food Groups to Encourage”that youth need to consume more of.

> Encouraging participation in schoolmeal programs through the use oftaste tests, special menus, improvedfood choices, and incentives and contests.

> Partnering with school administra-tors and industry to provide fundingnecessary for improvements.

> Engaging parents, families, commu-nities, students, and schools inactivities and events focusing onwellness at home and school.

For optimal health and wellness, children and youth must move more.Schools can help by providing systematic opportunities for physicalactivity and physical education.

Toward this end, Action forHealthy Kids will help schools to:> Instill regular physical activity into

the culture, attitudes, and behav-iors of students, staff, families, andlocal communities.

> Reinforce the importance of regular, quality physical educationclasses for all K-12 students.

> Engage youth in motivating their peers to become, and stay,physically active.

> Optimize the hours before schoolbegins by using the time to help

Schools simply cannot do it alone. If there is onetheme that emerges from this report above all others,it is that to tackle school wellness, schools needbroad, specific, and continuing support — from allsides, and from all constituencies.


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When parents areinformed, mobilized,and properly equipped,they can greatly influ-ence school wellnesspolicies and practices.

>> On the future... “We’ve set some lofty goals for education in the future; we’re not only to educate children to higher levels,but we’re to educate every one of them. We have a growing number of children with great needs. Childrenwill not reach academic standards without a strong and supportive environment around them, whichincludes health and nutrition programs and physical activity. We need to do everything in our power toorganize our communities and to marshal all the resources of parents and school personnel to come up withcreative and exciting solutions. Our children will respond to these kinds of new emphases – and I thinkthey will surprise some of us with what they’ll be able to achieve if we meet their basic needs.” Gene Wilhoit

kids get a healthy start to their daywith physical activity, such aswalk-to-school programs and otherage- and site-appropriate activities.

> Increase opportunities for childrenand youth to be physically activeduring the school day, working withschool administrators, teachers, andstudents to add brief periods ofphysical activity in ways that supportstudents’ crucial academic studies.

> Raise awareness of the importanceof being active after school — and provide activities and resourcesto help kids move more during thistime of day.

Mobilizing key stakeholders.A redoubled focus on underserved

communities. Action for Healthy Kidsplaces a high priority on supportingchildren in underserved communitieswho have been affected dispropor-tionately by health disparities. Aspart of our multi-year Campaign forSchool Wellness, Action for HealthyKids is working to create robustschool-family-community partnershipsto advocate for effective and sustain-able wellness policies and practicesin underserved communities andschools. Already, Action for HealthyKids’ pilot projects in Philadelphia,New York City, and Battle Creek,Michigan, involve Teams, representa-tives of our national Partner organiza-tions, and grassroots community lead-ers who are working side-by-side with

targeted schools and local organiza-tions in creating best practice well-ness interventions. This model can beexpanded on, and adopted, in othercommunities through Action forHealthy Kids Teams.

Enlisting parents as wellness advocates. Action for Healthy Kids willcontinue to bring parents — especial-ly parents in those same underservedcommunities — into the process toadvocate on behalf of their children.When parents are informed, mobi-lized, and properly equipped, theycan greatly influence school well-ness policies and practices. ParentsAdvocating for School Wellness is anew Action for Healthy Kids resourceto help motivate and assist parents tomove from awareness and caring tohands-on advocacy. This toolkit ofinformation (see sidebar on page 53) isdesigned to help recruit, cultivate, andtrain parents to connect with commu-nity partners and schools to makepositive contributions to the health ofstudents.

Closer collaboration with schoolleaders. Action for Healthy Kids willcontinue to reach out to school lead-ers because of their high-leveragevalue in bringing about change inschools. Every school leader has theability and the responsibility tostrengthen school wellness. Actionfor Healthy Kids will work with theseadministrators and educators to craftinnovative, yet practical, solutions


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to enhance school wellness — whilehighlighting as role models the out-standing leaders who are doing itsuccessfully.

Replicating best practices ofAction for Healthy Kids Teams. Inaddition to — and often integratedwith — the priority areas outlinedabove, Action for Healthy Kids Teamsnationwide will continue their criticalon-the-ground efforts to improve thenutrition and physical activity environ-ment in schools, working in ways thatbest address the needs in their localcommunities and states. Action forHealthy Kids is committed to captur-ing and sharing these activities andinnovations through the regular con-vening of key stakeholders for dia-logue, collaboration, and replication ofbest practice strategies for solutions.

Support for local wellness policy monitoring and evaluation.Better systems for monitoring andtracking wellness policy implementa-tion will enable stakeholders to moreaccurately assess progress withschool wellness and also aid in devel-oping targeted intervention strate-gies. Action for Healthy Kids is work-ing at the grassroots level to helpschool administrators, staff, and well-ness advocates monitor the effective-ness of their wellness policy imple-mentation efforts. This wellness poli-cy monitoring tool will help districtsanswer important questions relatedto the impact of their local wellnesspolicies, including:> What are the contents of the policy? > To what extent is the policy being

implemented? > What could facilitate the implemen-

tation of components of the policy? > What outcome(s) has the policy

produced?

This online self-assessment tool,available in the 2008-2009 schoolyear, helps districts look at theresults that are reasonable to themgiven the timing of implementationand contents of their policy. They canuse the tool to monitor the results oftheir wellness policy activities, or tokeep track of their wellness policygoals moving forward.

Clarity of vision,

consistency of mission.

As David Satcher notes in his pref-ace to this report, strong leadershipis the key to improving school well-ness. Action for Healthy Kids haslearned that leadership that results inchange can come from any corner —and often emerges in its most effec-tive form from unexpected places: a committed parent, an impassionedphysical education teacher, a for-ward-thinking superintendent with a “whole child” mindset.

One of Action for Healthy Kids’most valuable functions is igniting,uncovering, and channeling that kindof leadership — and supporting itwith valuable information, tools, andinsights vital to effecting change.

It is notable that, in the sea of opin-ions, research, and field knowledgegathered and assessed for this report,while there are countless perspec-tives and sometimes contradictory orconflicting findings and points of view,there is virtually no difference of opin-ion on the belief that school wellnessis both vitally necessary and a reach-able goal.

The certainty of this belief hasalways been a central tenet underly-ing Action for Healthy Kids’ mission,and will remain so.

There is virtually nodifference of opinion onthe belief that schoolwellness is both vitallynecessary and a reach-able goal.


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National Resources to Promote School Wellness

Game On! The UltimateWellness Challenge™

Developed by Action for Healthy Kids incooperation with the U.S. Department ofAgriculture and the U.S. Department ofHealth and Human Services, Game On!The Ultimate Wellness Challenge is part

of a continuing initiative to encourage our children and youth — and thosewho support them — to make better food choices and move more. GameOn! The Ultimate Wellness Challenge draws upon existing free and low-costresources from federal agencies and other leading organizations. The programfeatures four challenges, each of which emphasizes healthy eating and physicalactivity. The challenges are spaced throughout the school year — and theChallenge Course is a special event that can be used to kick off and/or concludethe program or used midway through the year to add momentum.

Parents Advocating for School Wellness Recognizing parents as a largely untapped force forchange in school wellness, Action for Healthy Kidsand MEE Productions — an organization widelyregarded for its success in mobilizing parents in low-income, urban communities — have produced thistoolkit to help Action for Healthy Kids Teams andother school wellness advocates unlock the enormous

potential of parents as change agents, to engage them as partners in supportof healthier schools for their children.

ReCharge! Energizing After-School™

In partnership with the National Football League,Action for Healthy Kids developed ReCharge!Energizing After-School, the first nationally distributed after-school program that fully inte-grates nutrition and physical activity throughteamwork-based strategies for youth in grades

3-6. ReCharge! Energizing After-School focuses on four concepts — “EnergyIn” (nutrition), “Energy Out” (physical activity), Teamwork, and Goal-setting.An online ReCharge! resource center provides valuable technical assistance to after-school program staff and educators who implement the program.

For more information on the programs listed on this page, visitwww.ActionForHealthyKids.org.



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Metos J and Nanney MS. “The Strength of School Wellness Policies: One State’s Experience.” Journal of School Health 77: 367-372, 2007.

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Strategic Advisory CommitteeAmerican Academy of Family

PhysiciansAmerican Academy of PediatricsAmerican Association of School

AdministratorsAmerican Public Health AssociationAmerican School Health AssociationAssociation for Supervision and

Curriculum DevelopmentAssociation of School Business

Officials InternationalCenters for Disease Control and

PreventionCouncil of Chief State School OfficersFood Research and Action CenterNational Association for Sport and

Physical EducationNational Association of Elementary

School PrincipalsNational Association of Secondary

School PrincipalsNational Association of State Boards

of EducationNational Association of Student

CouncilsNational Dairy CouncilNational Education Association –

Health Information NetworkNational Middle School AssociationNational Parent Teacher AssociationNational School Boards AssociationSchool Nutrition AssociationSociety for Nutrition EducationU.S. Department of Agriculture –

Food and Nutrition ServiceU.S. Department of Education – Office

of Safe and Drug-free SchoolsU.S. Department of Health and Human

Services – Office of DiseasePrevention and Health Promotion

PartnersAfterschool AllianceAmerican Association for Health

EducationAmerican Association of Clinical

EndocrinologistsAmerican Association of Family

& Consumer SciencesAmerican Cancer SocietyAmerican College of Sports MedicineAmerican Diabetes AssociationAmerican Dietetic AssociationAmerican Federation of TeachersAmerican Heart AssociationAmerican Medical Student Association

– Child & Adolescent HealthAssociation of State & Territorial

Health OfficialsAssociation of State & Territorial

Public Health Nutrition DirectorsDirectors of Health Promotion

and EducationThe Eunice Kennedy Shriver National

Institute of Child Health and Human Development

Family, Career & CommunityLeaders of America

Health Occupations Students ofAmerica

National AfterSchool AssociationNational Assembly on School-Based

Health CareNational Association of Chronic

Disease DirectorsNational Association of Health

Education CentersNational Association of Pediatric

Nurse PractitionersNational Association of School NursesNational Coalition for Parent

Involvement in EducationNational Coalition for Promoting

Physical ActivityNational Future Farmers of America

Organization/FoundationNational Medical AssociationPrevent Cancer FoundationThe President’s Council on Physical

Fitness and SportsThe Robert Wood Johnson FoundationSociety for Public Health EducationSociety of State Directors of Health,

Physical Education and RecreationYMCA of the USA

Action for Healthy Kids Board of Directors

Dr. David Satcher, MD, PhD – Founding ChairDirector, Center of Excellence on Health Disparities;Poussaint-Satcher-Cosby Chair in MentalHealth, Morehouse School of Medicine;16th United States Surgeon General

Judith Young, PhD – ChairVice President for Programs,American Alliance for Health, PhysicalEducation, Recreation and Dance

Reginald L. Washington, MD – Vice ChairMedical Director, Rocky Mountain Pediatric Cardiology; Professor of PediatricCardiology, University of Colorado Health Sciences Center

Jean Ragalie, RD – Secretary and TreasurerExecutive Vice President, Nutrition Corporate and Public Affairs,National Dairy Council

Kimberley GoodeVice President of Communications,Northwestern Mutual

Roger GoodellCommissioner, National Football League

Katherine Kaufer Christoffel, MD, MPHProfessor of Pediatrics and PreventiveMedicine, Northwestern University, Feinberg School of Medicine;Director, Center on Obesity Management and Prevention, Children’s Memorial Hospital

Vicki PerkinsIndiana State Director, The LEAGUE

John W. Rowe, MDProfessor, Health Policy and Management,Columbia University

Nicholas J. ValerianiExecutive Committee, Worldwide Chairman,Cardiovascular Devices & Diagnostics,Johnson & Johnson

Action for Healthy Kids Partner Organizations



Documents

Progress Promises?ldh.la.gov/assets/oph/pcrh/obesity/AFHK2008Report...Nick Drzal Nutrition Education Consultant, Michigan Department of Education; Michigan Action for Healthy Kids