We Wonder Why Youth are Obese?

This week I heard two stories about active transport for school children that made me shake my head, one in a good way and one bad.

Graph from Huffpost.com 9/30/09 "Cycling or Walking to School Will Not Be Tolerated!"

First, it is no secret that an alarming (and perhaps increasing, although some data indicate the trend is flattening) number of children and youth are overweight or obese. Based on 2008 CDC data, about 33% of youth and children obese. Obese youth are more likely to be inactive, and inactivity in childhood leads to about a 90% likelihood of inactivity throughout the lifespan. Inactivity leads to increased likelihood of chronic and acute health conditions. Therefore it is critical to quality of life, health and well-being that children be physically active, are encouraged to do so, and like it.

So when I was talking to a relative, and she said her children (now 13 & 15) are FORBIDDEN by the school administration to bike to school even if she biked to/from school with her kids, I could not believe it! As someone who biked to school as a kid and currently bikes to work when weather permits, I cannot imagine being actively discouraged from biking. Shouldn’t one be able to bike to school/work if he/she chooses!? Isn’t this the parents’ decision, not school administrators?

I began asking other parents if this were true in their school districts–the answer was yes! I found a May 2, 2012 story on NPR titled “What’s Lost When Kids Don’t Ride Bikes To School” in which it was reported the number of students who walk or ride their bikes to school has dropped from 48% in 1969 to just 13% in 2009. The main reason stated for the rule is safety, which is outlined in a great book titled Free Range Kids: How to Raise Self-Reliant, Safe Kids.

The second story is from a conversation I had with a friend who teaches physical education in elementary school. I asked her about the “no biking to school rule” (confirmed), but she also told me about another active transport initiative. At her school every Friday she picks up about 30 kids on the “Walking School Bus. Brilliant! She said it is growing in popularity and the kids love it. What a simple way to solve the physical activity and safety issue.

In an era where childhood and youth obesity is an public health issue, daily required Physical Education in our schools is a rarity, yet data indicates physical activity increases cognitive function and therefore academic achievement, making it possible for children to actively transport themselves to school seems like a great solution to many issues.

To learn more, read the brief by the Active Living Research arm of the Robert Woods Johnson Foundation that summarizes the research and provides recommendations for policies that increase active transport–“A substantial body of research shows that certain aspects of the transportation infrastructure—public transit, greenways and trails, sidewalks and safe street crossings near schools, bicycle paths, traffic–calming devices, and sidewalks that connect schools and homes to destinations—are associated with more walking and bicycling, greater physical activity and lower obesity rates.”

CDC  Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.

Physical Activity in China

I was recently given the opportunity to travel to China for the inauguration of the American Cultural Center for Sport at Tianjin Sport University in Tianjin China. Having never been to China, I tried to learn about and make as many observations pertaining to physical activity, sport, health and well being as I could.

East Meets West, and not in a good way.
I asked if obesity is a public health issue in China, and the answer was “yes it is a growing problem.” This response surprised me. I have observed but one overweight/obese Chinese person in 8 days in three of the biggest cities in China (Shanghai, Tianjin & Beijing).

The reason why obesity is on the rise in China I was told is due to lifestyle changes associated with economic development (i.e. more people can afford cars & scooters, and therefore engage in less active transport like walking or biking) and the introduction of Western fast food, which I captured in an “East meets West” photo. The current US population is 312 million, and according the CDC more than one-third of U.S. adults (35.7%) are obese. The current Chinese population is 1.35 billion, and I found an article that stated obesity rates in China are soaring and more than 25% of Chinese adults are overweight or obese. This data and my observations while here in China are not congruent, so I’ll have to do some investigating and learning on the nature of this discrepancy.

What I did observe is active Chinese across the lifespan.

Tai Chi in the Temple of Heaven park at 7am
Public parks are used by older Chinese for many forms of physical activity, including walking, ballroom dance, tai chi, and many others.  The outdoor circuit training stations equipment is really interesting and I haven’t seen anything like it in the US. The machines don’t provide any resistance, but are great for range of motion and keeping

An outdoor elliptical in a Chinese park.
all body parts loose and working.  To that end, I saw many older Chinese using various park fixtures to stretch, massage or promote circulation, like the two women pictured here.

Physical activity seems more playful, joyful and integrated into daily life for older Chinese. The park is a public place they go for spiritual, social and physical health. I saw nearly all the groups I watched, laugh and smile and genuinely interact with one another. I did not see ONE cell phone.

2 Chinese women stretching and massaging their legs
One game that I tried with some women, is Chinese Hacky Sack. I didn’t know what is was called, but with a quick use of The Google

Jianzi in the park
I discovered The Chinese Hacky Sack is called Jianzi. It is a special shuttlecock sport played with a colorful feathered article with a spring-loaded base that is kicked by feet with the goal of keeping it in the air for as long as possible. It was really fun, easier than hacky sack, and I worked up a sweat in 2-3 minutes.

The physical activities I saw appeared to be free and most had a peer leader/coach. Below right you can see a woman instructing another woman on how to do Taiji Rouliqiu move. This physical activity is a modern kind of internal martial art originating from China which follows the principles of Taijiquan in its philosophy and in the motion. The students I saw ranged in age, but most appeared to be middle age or older. Lesson: it is never too old to be physically active or learn a new physical skill. It left me wondering what children and adolescents do for physical activity and if they engage in the same forms.

Peer Taiji Rouliqiu Coaching in the Park
If you know the name of the physical activity this man is doing, please let me know. It looked very challenging but meditative, as the object he is spinning around on the rope makes a pleasant humming type noise. Thanks in advance!

I don't know what this is called but it looks fun!

In the US when I drive past parks, I rarely see ANYONE using them, let alone groups of older adults!  With an aging US population, growing obesity rates, and unused green space, it seems to me market and opportunity exist for someone to seize.

And We Wonder Why Some Girls Aren’t Physically Active?

This morning a colleague sent me this article from ESPN.com about another ban on head scarves for Muslim female athletes. When I see this and other  stories, it makes me recommit to the work I do at The Tucker Center.

It its well documented that females are less physically active than their male peers at all ages, and that girls of color are less physically active than their White counterparts. There are two great reports that summarize the plethora of research on girls, physical activity and health and developmental outcomes–The Tucker Center Research Report: Developing Physically Active Girls (2007), and The Women’s Sport Foundation’s Her Life Depends On It (2009).

Some of the work I do with my graduate student Chelsey Thul, examines the barriers to physical activity of East African girls here in the Twin Cities. We have the largest East African diaspora in the US, and the East African girls in our community find in very challenging to be as physically active as they’d like to be.  They talk about wanting to be physically active but also desire to remain true to religious and cultural norms. If you want to see a great film that documents the challenges Iranian Muslim women face who desire to compete in an international soccer match with a German team, be sure to watch Football Under Cover.

The ESPN.com story illustrates exactly how challenging it can be for Muslim girls and women to be physically active. When are leagues and sport organizations going to enact inclusive policies that encourage and facilitate physical activity and sport participation for EVERYONE?

Physical Activity, Organized Youth Sport & Youth Obesity

soda machineSome and colleagues and I are working on research pertaining to what is known (and mostly not known) about the role of youth sports in obesity prevention. Last week Toben Nelson, University of Minnesota’s School of Public Health, presented some of our work at the monthly Tucker Table. You can view his PowerPoint and see a small video clip. This work has made me think critically about how youth sports may not be the healthiest places for some children–including the ubiquitous presence of unhealthy snacks which I wrote about in an earlier blog. While physical activity and active living may help prevent childhood obesity, healthy eating is the other half of the equation. To highlight the relationship between physical activity and the presence of unhealthy food, this Village Voice post and picture showing how NYC playgrounds house soda machines says it all (via AN).

Helping Lead the U.S. to Better Health?

health appleFor those who may not know, here in the U.S. we have a President’s Council for Physical Fitness and Sport. This group according to the government website “is an advisory committee of volunteer citizens who advise the President through the Secretary of Health and Human Services about physical activity, fitness, and sports in America.” Many of my Kinesiology colleagues have served on the PCPFS council and its Science Board. It is an honor to be asked to serve this prestigious group. The PCPFS puts out many informative publications, research digests and other pieces that can be downloaded free on the PCPFS website.

Historically, the Executive Director is someone who is well respected and academically trained in sport science yet understands how to apply and implement research-based best practices to improve the health, nutrition and well being. President Obama has recently named the new Executive Director: Sergio Rojas (for his bio click here and here). No disrespect to Mr. Rojas, but is he qualified? With a BA in Psychology from Loyola, I couldn’t help but think this rings of Chicago-based nepotism.

With the health of US citizens in the forefront of the national debate on health care reform, the alarming incidence of childhood obesity in US children, low rates of physical activity, and the fact that pressure to meet No Child Left Behind standards has basically ensured that physical education is stripped from school curricula despite rising evidence that physical activity increases cognitive functioning and classroom achievement, some of many health issues that face our nation, the PCPFS needs a strong and informed leader. I doubt that Rojas is the guy to help move these issues in the right direction, I hope I’m wrong.

picture from Institute of Health Economics

Clarifying “The Myth About Exercise”

TIME Cover_myth about exercise Every Saturday I look forward to the TIME magazine in my mail. I know I can read it all online, but there is something satisfying about print media. As someone trained in sport science (aka, Kinesiology) this week’s cover story by John Cloud “The Myth About Exercise” intrigued me. After reading it, I was more than surprised, a bit irritated, and wondered if this wasn’t just more sensationalistic journalism. The premise of the article was based on “some recent studies” that found exercise does not help one lose weight or isn’t as important as we’ve been led to believe.

What?! Have we been lied to all these years? A friend who regularly works out read the article and promptly said, “THAT was depressing and made me never want to work out again.” I wondered how many others were thinking similar thoughts.

The TIME article, based in part on the findings of ONE clinical trial, found that in a group of 464 overweight women assigned to four conditions—women who exercised did not lose significantly more weight than those who did not exercise…and some women in each of the four conditions gained weight.

Dr. Timothy Church, Chair of Health Wisdom at LSU and lead author of the clinical trial, outlines the process of exactly how exercise might psychologically work against us:
1. exercise stimulates hunger
2. when we exercise we often “reward” ourselves with food [see my blog post about this issue in youth sport]
…or both. My astute friend mentioned previously, pointed out this premise assumes that those who don’t exercise don’t reward themselves with food.

Cloud offers an additional explanation based on another study with UK children he’d written about earlier this year
3. One might be more sedentary during non-exercise times than if one didn’t exercise at all

At first read, these findings and the TIME article may be perceived as a green light to bolster couch potato status, and only pay attention to what you eat–and this is dangerous. Exercise matters…but more importantly researchers have demonstrated movement matters!

Weight management is a simple energy equation: energy in (food) < energy out (exercise + energy expended daily to move about, live, & breathe) = maintain or lose weight.

If you take in more than you expend, you gain weight. Given that our metabolism slows 10% every decade (i.e., meaning you burn 10% less calories/energy), even if you ate exactly the same as you did as a teenager…you’d gain weight. True, exercise is only HALF of the equation, but a still needed half.

With billions of dollars tied up in the health and diet industry and new products and advice generated daily, I’ve joked for years that I’m going to write a one-page best seller—Move More, Eat in Moderation (© 2009 nmlavoi). Alas, I fear this would not be a best-seller nor make me enough money to become a full time blogger….Americans want the easy route, the quick fix, and watching what you eat and factoring movement into one’s daily plan takes a bit of effort.

TAKE HOME: The research cited in the TIME article is mostly one-sided, although it does raise some interesting questions. Many other researchers have found that exercise/movement IS important, can lead to a host of positive outcomes, and can provide a buffer to chronic diseases associated with obesity. This is a perfect example of why a critical perspective can be valuable….so…off the couch!

To promote healthy eating, and active living in a society in which obesity rates continue to grow, attention to both is critical. This well-placed article in a well known weekly magazine may do more fan the flame of weight loss mythology, than help.

p.s. The tired gendered cliché of “woman running for something sweet” on the cover did not escape notice

UPDATE 8/10/2009: To prove my point about sensationalist health journalism, today a University of Minnesota colleague Gary Schwitzer, a longtime health journalist “sounded the alarm this week after analyzing hundreds of medical news reports from the past three years” in an article in The New York Post.

The Social Construction of Fatness and Femininity

Two things happened in last 24hrs which inspired this blog. First, last night I was watching a PBS show (yes..nerdery abounds!) called Make ‘Em Laugh which featured Joan Rivers claiming (this isn’t verbatim but close), “We should all stop pretending that beauty doesn’t matter. It does. So let’s just tell young girls ‘beauty matters’ so try to make yourselves look good.” (You can see part of her interview about “fat” Elizabeth Taylor here.) Second, I read a blog “Fat Pedagogy: On Gluttonous Enterprise and the Exercise-Industrial-Complex” which inspired this blog. I’ve read some about the critical perspective of obesity, overweight, and fatness which I find fascinating (See for example the special issue of Sociology of Sport Journal Special Issue: The Social Construction of Fat—“The Personal is the Political” edited by Margaret Duncan). I’ve thought about this issue and its intersection with gender…here is an excerpt I wrote with graduate student Chelsey Thul for a paper on underserved girls and physical activity:

Some scholars argue that a public focus on inactivity, the obesity “epidemic,” and assertion that the nation’s future is tied to its citizens’ body shape, athleticism, cardiovascular fitness, and vitality (Gard, 2004), contribute to the development of eating disorders, unhealthy body scrutiny, and anxieties in young women. Messages about health and physical activity, constructed by experts and reinforced by the media, tell girls what a “normal” and “desirable” body should look like, which is unobtainable for a vast majority of girls. Achievement of this kind of body within “a cult of slenderness” (Rich et al., 2004) signals worth, discipline, virtue, status, and emotional stability but leaves little room for acceptance of bodies outside the norm or for different perspectives about the role of physical activity in girls’ health and well-being.

This narrow standard of “acceptable bodies” was a theme in my blog about Jason Whitlock’s sexist column about Serena Williams’ backside and his assessment that she wasn’t disciplined enough to be “really good”. Neuman writes about this point, “More importantly, that ‘fixed standard’ is a socially-constructed sensibility grafted to the cultural politics of the ‘Right body,’ one less rooted in scientific nuance than in cultural norms shared by mostly white, upper-middle class, (mostly) masculine, (almost exclusively) Western scientists (Atkinson, 2006).” Neuman goes onto to assert that, “Herein lies the exercise-industrial complex paradox: the more money invested into ‘fixing’ the ‘problem’ of obesity, the more convinced we as a consuming public become of the stakes and consequences—and yet, those investments and moral imperatives have only resulted in higher rates of ‘obesity.’ ”

This got me thinking as well about the female athlete-sexy babe paradox (for more on this click here, and here): the more the media focuses on femininity and sexiness of female athletes, the more convinced the public becomes that femininity is “important” and the only way to market and consume women’s athletics—, and yet, selling sexy female athletes has not resulted in higher rates of popularity and attendance…nor does help challenge narrowly constructed ideas of healthy female bodies—particularly for girls and women.

A Good Built Environment Increases Children’s Physical Activity

baseball in a small townThe American Academy of Pediatrics recently released a policy statement about the role of the built environment on children’s health. The built environment is overall structure of the physical environment of a child’s community (e.g., safe sidewalks, accessible parks, existence of bike paths) including spaces such as buildings and streets that are deliberately constructed as well as outdoor spaces that are altered in some way by human activity.

Emerging research indicates that the built environment limits or promotes opportunities for physical activity, in turn affecting child health—including obesity. A July 2009 report “F is for Fat: How Obesity Policies are Failing in America” released by the Robert Wood Johnson Foundation and the Trust for America’s Health indicated that in 30 states the percentage of obese and overweight children is at or above 30 percent. Obesity is a gendered and racialized issue as it is more prevalent in girls than boys, and girls of color have higher rates of overweight and obesity than do their White peers. (Note that the sign indicates “baseball diamond”… a game that girls have historically been excluded from. The sign does not say “ball fields” which could perhaps include softball assuming a softball field exists. To read more about girls and baseball read Jennifer Ring’s 2009 book Stolen Bases: Why American Girls Don’t Play Baseball)

In many communities across the US, the built environment unfortunately does not reflect the image depicted here…the existence of a safe community baseball field that youth can easily find, have access to, and may perhaps walk or bike to and from. The American Academy of Pediatrics report published in Pediatrics outlines a number of policies that can help create and increase the existence of health-promoting built environments.