Childhood obesity: School solutions

Fall. For children, it is the season that translates into new school semesters and new books -- a new start. For physicians and organized medicine, it is a fresh opportunity to improve the health of those young people.

Consider one critical public health issue worthy of such reinvigorated attention, including new ideas and a heightened commitment -- the obesity epidemic running rampant among America's youth.

The American Medical Association at its Annual Meeting in June took steps to address this problem by endorsing a report by its Council on Scientific Affairs calling on doctors to advocate for change by working locally to make their communities more conducive to healthier living.

As part of the document, special attention was directed to childhood obesity and ways to address it through school-based interventions. The bottom line: Children spend the bulk of their waking productive hours in the classroom. It should be a natural focus in the fight against obesity.

The nation's increasing heft, especially as it affects children and adolescents, long has been a concern for the AMA. Studies show that children who are overweight or obese are more likely to be obese as adults than are children who are normal weight. Additionally, physicians already are seeing increasing rates among obese children and adolescents of co-morbid conditions such as non-insulin-dependent diabetes and osteoarthritis. And for now, the trend lines are pointing in the wrong direction. According to the Centers for Disease Control and Prevention, the prevalence of overweight children ages 6 to 11 more than doubled in the past 20 years, from 7% in 1980 to 16% in 2002. The rate among adolescents ages 12 to 19 more than tripled, increasing from 5% to 16% during this period.

That's why this CSA report is especially timely and important.

The report builds on the range of policies the AMA already has in place to take a broader view of this difficult problem. Specifically, the report incorporates many approaches stemming from the AMA's National Summit on Obesity, convened last year to identify new ways to confront the epidemic.

One central recommendation of the report, of course, is its request to develop a comprehensive school health advocacy agenda -- a timely consideration now that the calendar is ticking through September.

The AMA will work with a broad partnership to implement this agenda, including advocating for more funding for school health programs, mandating school physical education programs, advancing policies that promote healthier options in vending machines and healthier standards for à la carte cafeteria food.

There are many examples in which states and local school districts have made progress toward these ends, according to the National Assn. of State Boards of Education. A 2004 Connecticut law requires schools to offer K-5 students a set period of physical exercise each day. Meanwhile, the North Carolina State Board of Education required in 2003 that school districts establish school health councils, include recess as part of the school day and encourage minimum physical education class times. Additionally, the Texas Dept. of Agriculture issued a policy in 2004 setting nutrition standards for foods and beverages available on school campuses and regulating portion sizes.

These initiatives clearly are worthwhile. But how do physicians fit into the fight?

The CSA report addresses that question. "The war on obesity cannot be fought only on the clinical front," the document notes. "It requires a collaborative and coordinated effort by many groups, and physicians are in the unique position of being able to negotiate many of those arenas."

It's a call to action, urging physicians to advocate for stepped-up attention to good health -- in their own communities and in their local schools. Physicians are recognized as leaders and bring significant credibility to such issues. Adding their voice will effectively buttress the work they do everyday in the exam room.

After all, the pervasiveness of the obesity epidemic in general, and its impact on children and adolescents -- and therefore, our future -- in particular, warrants community involvement. And the best results will occur when physicians, families and communities work together to support schools and children.