**The Childhood and Adolescent Obesity Epidemic Confronting Virginia
Schools**

**2007-2008**

**Environmental Public Health Leadership Institute**

**Werner von Kutzleben, MS/PHD**

*Environmental Health Supervisor*

*Virginia Department of Health*

*134 Peyton Street*

*Front Royal, VA 2263*

*(540) 635-3159*

[*Werner.Vonkutzleben@vdh.virginia.gov*](mailto:Werner.Vonkutzleben@vdh.virginia.gov)

**Mentor**

*Hank Topper*

*USEPA Headquarters*

*Ariel Rios Building*

*1200 Pennsylvania Avenue*

*Washington D.C.*

*(202) 564-8534*

**Acknowledgements**

I would like to thank the following individuals for the support and
assistance provided during my fellowship in the EPHLI

*Dr. D. Helentjaris*

*Lord Fairfax Health District*

*Virginia Department of Health*

*102 N. Kent Street, Ste 201*

*Winchester, VA 22601*

*April Jenkins*

*Nurse Manager*

*Lord Fairfax Health District*

*150 Commerce Street*

*Winchester, VA22601*

*Victor Voss*

*Oklahoma State Department of Health, Oklahoma Cit, Oklahoma*

*CDC and EPHLI Staff, Atlanta, Georgia*

![](media/image1.jpeg){width="1.2513888888888889in"
height="0.6354166666666666in"}

**[The Childhood and Adolescent Obesity Epidemic Confronting Virginia
Schools]{.underline}**

**[Executive Summary]{.underline}**

**General Text**

Virginia, which in 2007 had the distinction of being the 25^th^ heaviest
State in the nation with respect to childhood and adolescent obesity, is
far from being the only State dealing with this issue. Within the past
three decades the rate of overweight and obesity among young Virginian's
(aged 5 to 17 years old) has more than doubled. Not only are behavioral
and sedentary lifestyles, and the lack of physical inactivity at fault,
but also poor dietary habits. The magnitude of diet related chronic
diseases are enormous. In economic and financial terms Virginia ranked
14^th^ in healthcare costs, costing approximately \$1.6 billion or about
5.6% of the State's 2003 budget.

Consequently, the State has begun taking on an increasingly more active
and significant role in addressing the State's childhood and adolescent
obesity crisis. The lack of past policies have shown there have been
several mental models that reflected a shift in the burden that led to
short term fixes rather than prevention and long term solutions. The
far-reaching consequences have resulted in numerous resolutions and
Virginia House and Senate bills being introduced or passed that intend
to curb or combat obesity through enforcement of strict regulations or
gentle encouragement.

State agencies, schools and stakeholders are in a powerful position to
intervene by taking action in reversing the obesity trend using a
multi-pronged, comprehensive and ambitious approach in dealing with
childhood and adolescent obesity. They must be prepared to lead and
provide the necessary available funding and resources in fighting the
battle of the bulge through empowerment, education and information by
providing the supportive goals and efforts needed. Treatments designed
to reduce obesity must incorporate and promote standards linked to
health nutrition through reauthorization of Child Nutrition Programs
that include provisions to promote healthier nutrition choices,
nutrition standards, limit access to competitive foods, and physical
exercise programs in grades K through 12. They must also initiate
curricula that motivate, influence and encourage behavioral and
lifestyle changes by advocating programs that are attractive to young
people. Finally, they must encourage continued interest, and introduce a
referral system and wellness program that provides guidance and
counseling through encouragement and involvement at all levels resulting
in good life long habits and attitudes.

This project focuses on these goals by involving State agencies, schools
and stakeholders by addressing ways in dealing with the obesity dilemma
through the intervention and involvement of efforts by all.

**[Introduction/Background]{.underline}**

Worldwide childhood obesity is on the rise. In 2004 the *World Health
Organization (WHO*) estimated that one in ten children world wide was
overweight or more than 22 million children under the age of five. A
1980 study by the US Surgeon General found that the number of American
children who were overweight had more than doubled, and tripled for
adolescents, or an estimated 9 million youngsters. The *World Health
Organization (WHO*) considers obesity to be one of the ten causes of
preventable deaths, the result of the worldwide nutrition transition
that is driving the obesity epidemic which is reflected by profound
lifestyle and behavioral changes within society.

Overweight and obesity, which is characterized as abnormal or excessive
fat accumulations in the body, is measured by using the Body Mass Index
(BMI) which is a simple index of height for weight. Overweight as
defined by the BMI is equal to or more than 25, and obesity as a BMI
equal to or more than 30, providing a benchmark for individual
assessment.

  ----------------------------------- -----------------------------------
  Classes                             Body Mass Index (BMI)

  Underweight                         Less than18.5kg/m2

  Normal                              18.5 -- 24.9

  Overweight                          25 -- 29.9

  Obesity 1                           20 -- 34.9

  Obesity 2                           34.9 -- 39.9

  Morbid Obesity                      40

                                      
  ----------------------------------- -----------------------------------

Figure 1: Body Mass Index (BMI) as defined by height for weight

While genes and underlying medical problems are important variables in
considering and determining a person's susceptibility to weight gain,
the main causes of overweight and obesity are primarily associated with
complex interactions between poor dietary habits (an energy imbalance
between calories consumed verses calories expanded), a sedentary
lifestyle, behavior, cultural attitudes, the environment, and the
socioeconomic status of the individual.

What is more, obesity increases the risk of about 30 serious medical
conditions and is the second cause of death, 2^nd^ only to smoking. Not
only do overweight and obese young people face major health consequences
in diet-related chronic diseases such as type 2 diabetes, cardiovascular
disease, hypertension, high blood pressure and cholesterol levels, sleep
apnea and premature death, but also must cope with a reduction in the
quality of life as well as experiencing social stigmatization and
discrimination. Approximately 300,000 overweight and obese related
deaths occur annually within the U.S. *(CDC)*.

Globally the United States continues to lead the way. All regions of the
nation have seen sharp increases in pediatric obesity and respective
body mass indexes (BMI) within the past three decades *(Centers for
Disease Control and Prevention CDC), Trust for America's Health (THAH),
National Health and Nutrition Examination Survey (NHANES), World Health
Organization (WHO).*Whilst *Centers for Disease Control and Prevention*
(*CDC)* data showed an upsurge in pediatric obesity between the 1960's
to 2002, statistically it remained the same for both sexes. In 1982, 4%
of the U.S. juvenile population was found to be overweight; in 1994 it
increased to 16% and by 2002 it stood at about 33% *(National Health and
Nutritional Examination Survey).* At the same time, 2003-2004 data from
the *National Health and Nutrition Examination Survey (NHANES)* found
that among pre-school children, aged 2-5 years old, overweight
prevalence increased from 5% to 13.9%; school aged children aged 6 - 11
years of age it swelled from 4% to 18.8%, and for adolescent, those aged
12 -19 years it soared from 6.1% to approximately 18%. Experts estimate
that by 2010 one in five U.S. children will be obese which is three
times the target of 5% set for *Healthy People 2010.*

  ----------------- ----------------- ----------------- -----------------
  Prevalence of                                         
  Overweight Among                                      
  U.S Children and                                      
  Adolescents (Ages                                     
  2 -- 19 Years)                                        

                    NHANES 1971 -     NHANES 1988 -     NHANES 2003 -
                    1974              1994              2004

  Ages 2 through 5  5%                7.2%              13.9%

  Ages 6 through 11 4%                11.3%             18.8%

  Ages 12 through   6.1%              10.5%             17.4%
  19                                                    
  ----------------- ----------------- ----------------- -----------------

Figure 2: Prevalence of overweight among children and adolescents

In addition, significant differences exist between the various ethnic
and racial groups. Data from the *Centers for Disease Control and
Prevention* (*CDC)* and *National* *Health and Nutrition Examination
Survey (NHANES)* found that among boys and adolescent young men of
Mexican American descent, the risk of being overweight or obese is
particularly prevalent with 41.5% either being overweight or obese
compared to Native Americans with 39%, African Americans 37.5%, and
approximately 28% for Caucasian juveniles. Similarly the percentile for
Mexican American girls is approximately 40%, 38% for Native American
juvenile females, 36% for African American girls and 27% for Caucasians
young females.

+-----------------+----------------+----------------+-----------------+
|                 | Non-Hispanic   | Non-Hispanic   | Mexican         |
|                 |                |                | Americans       |
|                 | Whites (%)     | Blacks (%)     |                 |
|                 |                |                | (%)             |
+-----------------+----------------+----------------+-----------------+
| Preschoolers    | 8.6            | 8.8            | 13.1            |
+-----------------+----------------+----------------+-----------------+
| Ages 6-11       | 13.5           | 19.8           | 21.8            |
+-----------------+----------------+----------------+-----------------+
| Ages 13-19      | 13.7           | 21.1           | 22.5            |
+-----------------+----------------+----------------+-----------------+

Figure 3: Disparities in Prevalence of Overweight among Children in the
United States

Education is also a factor. The prevalence of overweight and obesity in
juveniles has increased across all educational levels, and is higher for
adolescents with less education.

2007 -- 2008 Fellow Project National Environmental Public Health
Leadership Institute

According to the *CDC* and *Behavioral Risk Factor Surveillance*
*System* those with less than a high school degree the incidence for
overweight and obesity is approximately 30%, with a high school diploma
25%, some college education 21% and a college degree around 17%.

**Virginia**

Virginia is far from being the only State in the nation having to deal
with pediatric obesity. According to 2004 *CDC* data overweight and
obesity in Virginia (adolescents and adults) is similar among the
different regions within the State, ranging from 56% in the North,
Southwest, Valley and Central Regions to about 61% in the Southside.
Virginia is not one State where obesity rates are on the rise,
statistically remaining the same as the previous year, 2006. However,
every State still exceeds the federal government's national goal to
reduce obesity rates to 5% by the year 2010 (*Healthy People 2010*).

In a 2007 legislative summary by then Governor Kaine, Virginia's
overweight and obesity rate climbed 154%, tripling between 1990 and 2004
making Virginia the 25^th^ heaviest State in the nation for adolescent
obesity in 2007 (*Trust for America's Health).* Moreover, a 2003 report
by the *Annie E. Casey Foundation* estimated that approximately 30% of
Virginia's youth is either overweight or obese which is comparable to
Maryland (30%) and lower than North Carolina (34%) and is just under the
national average of 31% *(Trust for Americas Health-TFAH)*. Washington
D.C has the highest adolescent obesity rate of approximately 23%,
followed by West Virginia and Kentucky, while Utah has the lowest of
about 8%.

The economic costs of overweight and obesity to the State have been well
documented and include both direct and indirect costs in the form of
increased expenses in prevention, diagnosis and treatment services as
well as the value of income lost due to decreased productivity.

In a first time, State level, obesity-related health care study
*Research Triangle Institute Internationa*l and the *CDC* estimated that
Virginia's direct obesity attributable health care costs exceeded \$1.6
billion in 2003, or about 5.7% of Virginia's total medical expenditures,
, or approximately \$222 per person. Between 1998 and 2000,
approximately 5% of Virginia's population (young and old) was considered
to be obese accounting for 6.7% of Medicare related obesity costs (\$320
million) and approximately 13% of Medicaid related expenses
(\$374million). A 2005 study published in the journal *Health Affairs*,
the per capita health care spending for obesity was 56% higher than that
for a normal weight person. Nationally, hospital costs for diseases
related to childhood obesity increased from \$35 million in 1979 to
\$127 million in 1999 and included treatments for type 2 diabetes,
cardiovascular disease, respiratory problems and high blood pressure.

**Schools**

Outside of home, children and adolescents spent the majority of time in
school. They eat a large share of their food while there. The *United
States Department of Agriculture (USDA)* is responsible for providing
school meals which must meet federally defined guidelines and standards
to be eligible for federal subsidies. School breakfasts and lunches
provide approximately one-third of the recommended daily dietary
allowances. That being said, schools are in an excellent position to
promote and provide health nutrition and physical exercise programs that
encourages good lifelong habits and behavior.

In a 2000 survey done by *School Health Policies and Programs Study
(SHPPS)* found that Virginia, like 87.8% of other schools districts
nationwide, participated in the *USDA* school lunch program, and 63% in
the breakfast program. All 132 of Virginia's public schools participated
in the lunch program, serving approximately 619,000 lunches and 162,000
breakfasts daily which is equal to about 112 million school lunches and
30 million breakfasts annually.

Likewise 81% of schools, including Virginia, prepare and cook food at
school, while 16.6% have contracted an outside food service management
company, and 20% of schools offer brand name fast foods to students.
About half the schools do menu or food based planning, and approximately
21% of the school districts use Nutrient Standard Menu Planning. Sixty
six percent of schools offer a choice of two or more entrees and about
62% offer a choice between two or more vegetables or fruits daily.
Conversely, a *Virginia Department of* *Health* study found that when
given the choice Virginia fourth graders consciously made the decision
of selecting the less nutritious of food items less than 50% of the time
while recognizing the healthier option 71% of the time.

In a 2007 report by the *Trust for America's Health* found that Virginia
met only two of the five categories aimed at reducing or preventing
pediatric obesity in schools. It is not one of the 17 States that
require meeting higher dietary guidelines and school nutritional
standards

for breakfasts or lunches as set forth by the *U.S Department of
Agriculture (USDA)*; it is not one of the 22 States requiring
nutritional standards for competitive foods sold in vending machines; it
is not one of the 26 States that limit when and where these foods may be
sold on school property, nor is it one of the 16 States that screens for
body mass index or fitness status. However, Virginia did meet standards
for health nutrition education and physical exercise programs.

That being said, most school meal programs still focus on delivering
minimum versus maximum nutrition. In a mid 1990's survey conducted by
the *USDA* concluded that only 2% of school aged children met the Food
Guide Pyramid serving recommendation's for all five food groups. Schools
too are to blame and can be a barrier to healthy eating. Many schools
serve lunch as early as 10.00 a.m. and as late as 1.30 p.m. resulting in
insufficient time for eating, long cafeteria lines, and unattractive
lunch rooms thus promoting the use of vending machines and competitive
foods. What is more, health education and elementary school teachers
provide nutrition education a median of five hours per school year, four
hours in middle schools and five hours in high school respectively.

Many of the poor eating habits of young Virginians manifest themselves
through the over-consumption of processed energy dense foods that are
high in calories, sugars and saturated fats, but low in nutritional
value. A 2002 *Women, children and infants (WIC)* report by the
*Virginia Department of Health* found that 61% of the children enrolled
in the program had bad eating habits. About 3.3% of infants, 18.7% of
children, and 28% of fourth grades, were classified as being obese. This
alarming trend suggests that parents must take responsibility in
installing good eating habits early in the lives of their children, and
that schools continue to give, ensure the provide the necessary support
by promoting health nutrition, healthier food choices and proper eating
patterns.

Adding insult to injury in the obesity epidemic dilemma are school
vending machines.

Ninety-eight percent of public high schools, 74% of middle schools and
43% elementary schools either have vending machines or a school store
where students can purchase sweets, salty snack foods and soda beverages
that are all high in caloric value *(CDC.)* More than half the vending
machines operate in direct competition with the school lunch hour.

![](media/image2.jpeg){width="4.333333333333333in"
height="2.176388888888889in"}

Figure 6: Trends in child and adolescent obesity, girls and boys aged 6
through 19 years.

Source: Ogden et al

In addition to the thousands of dollars profit made from junk food
vending machines sales in schools, daily intake of high calorie soda
beverages has increased by 500% since the 1950's *(Senior
Journal-Dr.D.Ludwig)* giving way to consumption of milk depriving
youngsters of the needed calcium for growth and development. Children
now drink twice as much soda as milk. What is more, Fairfax County, the
States largest school division, soda vending machine profits for the
2002-2003 school year was approximately \$913,000, Chesterfield

2007 -- 2008 Fellow Project National Environmental Public Health
Leadership Institute

County, the fourth largest system had profits of about \$550,000, and
Prince William

County, number 3 in enrollment, reported profits of \$173,000.

The fact that only 12% of schools nation wide prohibit or restrict these
types of competitive foods on their premises, and include Mississippi,
Louisiana, West Virginia and Georgia where school meal participation
exceeds the national average, most school districts rely on vending
machines to subsidize the cost of school meal programs and other school
activities.

Virginia schools, staff, parents need to be more involved in assessment
of the school lunch environment and programs, and take steps through
integration and implementation of a more extensive health nutrition
curriculum from grades 1 through 12, feature active learning strategies
that follow National Health Education and USDA Standards, provide
choices of healthy foods that meet the taste preferences of diverse
student populations, that foods served will meet the five food groups of
the Food Pyramid, and help students develop the

knowledge, attitudes and skills they need to adopt and maintain for a
healthy lifestyle.

Gradual implementation is the key to this philosophy, and could be
achieved in a multitude

of ways including, for example, healthy food preparation and cooking
classes by all students, learn about healthy verses unhealthy
food-selection, a greater awareness of the food pyramid and awareness of
daily calorie intake.

Physical exercise programs as mandated by law require youngsters
participate in physical activity until eighth grade, after which it
becomes an elective rather than a requirement. The lack of importance of
a physical exercise program has been compounded by the declining
importance of physical education, the result of greater importance on
academic performance

More than half the States (61%), including Virginia, require schools or
school districts to follow national or State education guidelines for
physical exercise programs. Nationally about 96% of elementary and
middle schools require that students are enrolled in physical education
classes, with about 71% providing regular scheduled recess. According to
a *CDC* survey about 84% of elementary schools and 77% of middle schools
follow the national or State education standards or guidelines.

On average schools provide daily physical education or its equivalent
about 150 minutes per week in elementary schools, and 225 minutes per
week for middle school students the entire school year. That being said,
17% to 25% of schools exempt students from required physical activity
courses because of high physical competency tests, participation in
other school activities, enrollment in other school courses or community
service.

To counter the decreased trends of physical exercise programs, and as
recommendation by the U.S. Surgeon General, schools must engage in
providing at least 30 minutes of moderate to vigorous physical activity
on a daily basis in grades 1 -12. That being said, the risk of obesity
for childhood obesity decreases by about 10% per hour of exercise
*(Senior Journal)* for each student's height, weight, and body mass
index annually.

Until recently though the percentage of students attending physical
education classes fell from 42% to 29% in 1991 to 1999. However, with
the recent introduction by legislators (Virginia Code section 22.1-207
and House and Senate bill 1130) Virginia schools are now required to
provide physical and health education by lessons, drills and physical
exercise. It also mandates that all Virginia students receive health
instruction and physical training as part of the educational program.

Physical Education Standards of Learning in Virginia schools must
continue to emphasize and identify concepts, knowledge, processes and
skills needed to maintain a physically active lifestyle and to help
students perform the necessary skills from grades K -- 12 in achieving
skilful movement, personal fitness and responsible behavior through the
understanding of the benefits of physical activity and exercises. It is
an integral part of the curriculum and its primary goal is in developing
total physical fitness in the development of an individual's maximum
physical potential, acquire movement abilities, safety awareness and an
appreciation and understanding of specific sports. Its goal is for
students to acquire the desire to retain and remain physically fit and
active throughout their life time.

Schools should not use withholding of physical activity as a punishment
but rather provide access to school facilities that encourage physical
activity. In addition, schools should incorporate group bus stop pickup
and drop-off sites rather than providing door-to-door service, thus
encouraging students to walk. In addition, funding must be made
available to provide adequate and sustained resources needed for
implementing relevant changes in school environments that encourage a
willingness of students to participate in physical activity throughout
the school year.

Virginia schools also need to consider establishing and incorporate a
local wellness program and policies that include goals for physical
exercise, as well as other school based activities designed to promote
student wellness. This can be achieved through an effective weight
management program for groups and individual who are at risk of
developing obesity by measuring each student's height, weight, and body
mass index annually, developing long term strategies that support
healthy diets and regular physical activity, and mount clinical
responses dealing with obesity through clinical programs and staff
training to ensure support for those affected to lose weight or avoid
further weight gain.

What is more, behavioral and lifestyle changes in the past three decades
within American culture and society have further exacerbated the
problem. While children tend to be physically more active, the level of
physical activity decreases through adolescents. Both encounter many
modern day distractions that discourage physical activity leading to
behavioral changes and an increasingly sedentary life style. About 95%
of Virginia's school aged children report watching television daily with
54% watching one or two hours a day, while about 40% indicated that they
watch 3 or more hours daily. About 74% reported playing video or
computer games a couple of hours a day, while 21% said that they play
three hours or more. In addition many of Virginia's youngsters spend
many hours regularly searching the worldwide web.

Also on any given day (outside of school premises) approximately 30% of
children consume unhealthy fast foods that are high in calories and
saturated in fat. (*Senior Journal-Dr.D.Ludwig*). The number of food
related advertisements (approximately 10,000 per year) aimed at children
and adolescents using Value marketing (providing more food for less
money), which is a technique that food related industries use (and is
extremely profitable) promotes larger portion sizes with disregard to
the respective health consequences that result in over the
overconsumption of foods that contribute to childhood and adolescent
obesity.

**[Problem Statement]{.underline}**

Childhood and adolescent obesity is a growing problem within the State
of Virginia. Associated diet-related medical conditions and increasing
obesity healthcare costs are unnecessarily taxing the State to address
and deal with the epidemic. *Why despite the best efforts and intentions
have school administrators and staff not able to arrive at innovative
strategies and solutions to mitigate childhood and adolescent obesity
confronting Virginia schools.*

**Behavior over Time Graph** ![](media/image3.wmf){width="5.5in"
height="4.688888888888889in"}

Figure 8: Behavior over time graph indicating the ability of the State,
schools and local communities to respond to funding inconsistencies in
the State's economy, and its impact in on mitigating the childhood and
adolescent's obesity epidemic confronting Virginia schools.

***Casual Loop Diagram and applicable archetypes:***

![](media/image4.wmf){width="7.248611111111111in"
height="5.093055555555556in"}

**Figure 9: Fixes that Backfire**

***Casual Loop Diagram and applicable archetypes***:

![](media/image5.wmf){width="6.988888888888889in"
height="5.221527777777778in"}

**Figure 10: Shifting the Burden**

***10 Essential Environmental Health Services***

> ![](media/image6.png){width="4.375694444444444in"
> height="4.178472222222222in"}

**Figure 11: Ten Essential Environmental Services as outlined by Carl S.
Osaki , University of Washington School of Public Health and Community
Medicine, Seattle, WA**

1\. Monitor -- Monitor diet related chronic diseases and conditions, and
psychological disorders associated with childhood and adolescent
obesity.

2\. Diagnose and Investigate -- Virginia school districts should utilize
their position to enhance awareness of childhood and adolescent obesity
in schools through expansion of surveillance programs, evaluation , data
sharing and commitment.

3\. Inform, Educate and Empower -- Provide necessary resources needed to
educate, inform and empower healthcare providers and care givers to
mitigate childhood and adolescent obesity through effective lifestyle
and behavioral changes early in life.

4\. Mobilize Community and Partners -- Encourage family and community
involvement at all levels through integration of physical exercise and
health nutrition education on a continuous basis in the school
environment.

5\. Develop Policies and Plans -- Develop and implement an effective
referral system and wellness program that promotes and provides guidance
and counseling through encouragement and involvement.

7\. Link to provide care -- Provide links to healthcare providers,
schools and caregivers to that offer guidance, information and
assistance in obesity related issues through effective programs.

9\. Evaluate -- Survey partners on annual basis on effectiveness of
success of programs

10\. Research -- Increase research on behavioral and biological causes
of obesity, prevention and treatment.

***National Goals Supported***

1\. This project supports one of the core Environmental Health
objectives of *Healthy People 2010* in finding solutions through
integration of the ten Environmental Health Services by providing
guidelines to develop public health strategies in the abatement of
childhood and adolescent obesity confronting schools.

This project also supports *Healthy People in Healthy Places* through
schools that protect and promote the health, safety and development of
all students, and to protect and promote health nutrition and physical
activity programs.

2\. This project supports the following goals and objectives in the
CDC's *National Strategy to Revitalize Environmental Public Health
Services.*

**Goal I: Build Capacity** -- Strengthen and support environmental
public health services at state, tribal, territorial and local levels.

**Goal II: Research Support** -- Support research to define the
effective approaches to enhance environmental public health services.

**Goal III: Foster Leadership --** Foster leadership to enhance
environmental public health service.

**Goal IV: Communicate and Market:** Improve communication and
information sharing among environmental public health agencies,
communities, strategic partners and other stakeholders and better market
environmental health services to policymakers and the public.

**Goal V**: **Develop the Workforce** -- Promote the development of a
competent and effective environmental public health service workforce

**Goal VI: Create Strategic Partnerships** -- Foster interactions among
agencies, organizations and interests that influence environmental
public health services

![](media/image1.wmf)

![](media/image2.wmf){width="8.499305555555555in"
height="10.50763888888889in"}

> **[Methodology:]{.underline}**
>
> Events and activities.
>
> **Event:**
>
> 1: Set goals and objectives that meet *Healthy People 2010*
> requirements for health nutrition curricula and physical exercise
> programs in Virginia schools.
>
> **Activities:** Collaborate with State, schools and communities
> through establishment of meetings, data sharing, evaluation and
> dissemination of information related to childhood and adolescent
> obesity issues, risks and health consequences.
>
> **Event**:
>
> 2: Establish an effective surveillance, monitoring systems and
> programs that will provide the necessary activities designed to
> promote student wellness through weight management, health nutrition
> and physical exercise programs
>
> **Activities:** Provide funding and resources needed for incorporation
> and implementation wellness policies and programs that meet Healthy
> People 2010 and Healthy People in Healthy Places requirements in
> Virginia schools
>
> **Event:**
>
> 3: By 2020 school administrators and staff will have implemented a
> health nutrition curriculum and physical exercise program that meets
> or exceeds State and Federal guidelines using innovative and improved
> application methods for the entire academic.
>
> **Activities:** Make fun filled educational health nutrition, physical
> exercise programs and activities available and mandatory throughout
> the academic year for all grades by maintaining interest and
> enthusiasm for the program .
>
> **[Results]{.underline}**
>
> In a 2007 study done by the *Trust For America's Health* ( *TFAH* ),
> the report "F *as in Fat; How Obesity Policies Are Failing in
> America"* found that Federal Government and State policy efforts have
> consistently failed to provide viable solutions to the growing obesity
> crisis. The impact of the "no child left behind" directive for
> education reform and signed into law in 2002 by the federal
> administration, has resulted in a decrease in importance and emphasis
> in health nutrition and physical exercise programs. Schools are
> putting greater emphasis on improving reading skills and math test
> scores to comply with the directive and abide by Virginia's "Standards
> in Learning" initiative and requirement.
>
> Unfortunately, the directives have shown that there have been lapses
> in mental policy models and reflect a mind set which has led to
> damaging results with regards to health nutrition and physical
> exercise programs in schools. Progress in academics can only be as
> fast as the slowest student within the group, depriving youngsters of
> wellness programs that encourage healthy lifestyles, behavior, habits
> and physical exercise activities that carry over into adulthood.
>
> Many States are now conscientiously making efforts to take the
> necessary steps to mitigate the obesity epidemic. Virginia is one of
> them. A 2005 research paper done by the University of Baltimore (2005)
> concluded that Virginia's efforts to control childhood obesity
> improved from a "D" to a "C". The report examined the State's capacity
> to combat obesity in eight different categories, including significant
> steps via legislation, regulation and education.
>
> Regretably however, legislative mind sets in State policies and
> actions aimed at reducing childhood and adolescent obesity frequently
> tend to be fragmented and inadequate. That being said, Virginia
> legislators have within the past several years been active in
> considering policy options that address the issue of child hood
> obesity. Aiming to prevent the onset of diet-related health
> conditions, policy makers are considering a variety of options and
> approaches to facilitate opportunities for health nutrition and
> physical exercise programs in Virginia schools. Numerous papers,
> resolutions and bills are either under consideration or have been
> passed in the House and Senate.
>
> Included are the following resolutions, House and Senate bills that
> have been considered, are under consideration or have been passed by
> Virginia legislators.
>
> **State legislation on Childhood Obesity policy 2005**
>
> **Physical Activity or Education in Schools 2005**
>
> **[Virginia SB 1130 (enacted), Act 350]{.underline}** Requires
> physical education to be taught in the elementary grades of every
> public school including activities such as, but not limited to,
> cardiovascular, muscle building or stretching exercises, as
> appropriate.
>
> **Legislation concerning obesity related issues as of August 20,
> 2007**
>
> **[School Based Restrictions and Regulations]{.underline}**
>
> **[Virginia (HB 2214) Combating Childhood Obesity]{.underline}**
>
> Requires the Superintendent of Public Instruction and the State Health
> Commissioner to work together to combat childhood obesity and other
> chronic health conditions that affect school-age children.
>
> **[Virginia (HJR 637) Joint Subcommittee to Study Childhood
> Obesity]{.underline}**
>
> Establishes a joint subcommittee to study childhood obesity in
> Virginia\'s public schools. The joint subcommittee shall ascertain
> methods of combating childhood obesity in Virginia public schools and
> examine the relationship between the health and physical education
> curriculum; public health policies; social, economic, and cultural
> influences; and media messages; and the incidence of overweight and
> obese students in the public schools
>
> **[Virginia (HJR 727) Childhood Obesity.]{.underline}**
>
> Encourages local school divisions to continue efforts to address
> childhood obesity.
>
> **[Virginia (SB 744) Placing School Boards in Charge of Obesity
> Regulations]{.underline}**
>
> Requires the Board of Education to establish regulations to prevent
> and reduce childhood obesity in the public schools. Requires local
> school boards to include nutrition and physical education in its
> professional development programs and requires that a body mass index
> (BMI) measurement be taken for every student entering a public
> kindergarten or elementary school for the first time. The bill also
> allows school boards to continue to annually monitor student BMIs,
> with regulations developed by the Board of Education.
>
> **[Virginia (SB 974) Childhood Obesity.]{.underline}**
>
> Requires the Superintendent of Public Instruction and the State Health
> Commissioner to work together to combat childhood obesity and other
> chronic health conditions that affect school-age children.
>
> **[Virginia (SB 1197) Eliminating Trans Fats in Public
> Schools.]{.underline}**
>
> Requires the Board of Education to promulgate regulations for the
> elimination of foods containing trans fatty acids from public schools
> by the beginning of the 2010-2011 school year. The gradual elimination
> shall begin with their elimination from vegetable oils used in school
> cafeterias by the beginning of the 2008-2009 school year. The final
> ban shall extend to all (i) foods sold as part of the official school
> breakfast and lunch programs, (ii) foods sold in vending machines on
> school grounds, and (iii) competitive foods sold during school hours.
>
> **[Virginia (SJR 374) Schools Commitment to Preventing Childhood
> Obesity]{.underline}**
>
> The resolution encourages the school divisions of the Commonwealth to
> strengthen their commitment to childhood obesity prevention by
> increasing opportunities for participation in healthy activities and
> emphasizing good nutrition in the public schools.
>
> **[Virginia (SB-88) Diabetes Care Legislation]{.underline}**
>
> The law, which took effect July 1, 1999, requires all Virginia public
> schools attended by a student with diabetes to have employees who have
> been trained by a licensed medical professional to administer glucagon
> and insulin. Schools with an instructional and administrative staff of
> ten or more people must have two such full time employees; smaller
> schools are required to have at least one trained employee. Training
> guidelines issued by the
>
> Virginia Board of Nursing require all Virginia school districts to
> provide designated staff members with a four-hour diabetes training
> workshop conducted by a diabetes health care professional
>
> **[Virginia HJR 637 Study: Childhood Obesity Report]{.underline}**
>
> Establishes a joint subcommittee to study obesity in Virginia's public
> schools. The joint subcommittee shall ascertain methods of combating
> childhood obesity in Virginia public school and examine the
> relationship between health and physical education curriculum; public
> health policies; social, economic, and cultural influences; and media
> messages: and the incidence of overweight and obese students in public
> schools. This joint subcommittee shall also examine methods to
> increase parental involvement and education to ensure proper nutrition
> of children, and survey other states to determine practices that have
> been useful in combating childhood obesity.
>
> **[Virginia HJR 726 Healthy Virginians/healthy Student
> Week]{.underline}**
>
> Designates the third week in September, in 2007 and each succeeding
> year, as Healthy Virginians/Healthy Students Week in Virginia.
>
> Even though there has been legislative movement in the right
> direction, the State needs to demonstrate leadership for childhood
> obesity prevention by committing reliable and adequate resources,
> funding, and policy developments that lead to changes supporting
> comprehensive health nutrition curriculum and a more intensive
> physical exercise activity program throughout the year in grades K
> through 12.
>
> **[Next Steps and Conclusion:]{.underline}**
>
> Establishing mind set changes that require behavioral and lifestyle
> changes will be a daunting task requiring significant policy
> initiatives that address the goals and objectives as set forth by the
> CDC *Healthy People 2010* and beyond, finding solutions through
> integration of the Ten Essential Environmental Health Services as
> outlined by Carl Osaki, and the Core Competencies for Environmental
> Health Professionals. Government, industry, communities, schools and
> families need to display guidance and commitment by mobilizing the
> resources necessary needed to implement, evaluate, monitor and
> disseminate effective policies and interventions that support
> childhood obesity prevention goals.
>
> It takes a "whole village" to come together and not just the
> individual. Prevention of pediatric obesity must be a national and
> State priority that engages several sectors of society. All must come
> together to meet the challenge and responsibility, be prepared to
> handle the burden of dealing with overweight and obesity by supporting
> the required processes and legislative initiatives that sustain the
> necessary programs through funding, recommendations and unique
> approaches in dealing with this issue. Federal, State, local
> governments and schools must provide an opportunity for serving
> healthier food choices, teaching children about health nutrition and
> education through introduction of a wellness curriculum that is of the
> highest quality, provide more accessible, uniform and constructive
> information, and provide physical exercise and activity programs that
> are attractive to youngsters. Parents and primary care givers can play
> a significant role by providing and developing healthier lifestyles
> and habits in their children. Community-driven policy efforts that
> advocate and incorporate changes for zoning and capital improvement
> that increase access to parks, bike paths, sidewalks, recreational
> facilities, and stores in low income as well as urban areas need to be
> conducive so that the community setting is more conductive to physical
> activity.
>
> The State of Virginia recognizes that it still has a long way to go in
> implementing school programs that mitigate childhood obesity, but as
> Neil Armstrong so adequately phrased it "One step for man, a giant
> step for mankind".
>
> **[Leadership Development Opportunities]{.underline}**
>
> My association with the Environmental Public Health Leadership
> Institute program during the past year has had a tremendous positive
> impact on me. It was an incredible learning experience for personal
> growth and development. The knowledge gained has given me a new
> outlook on the importance of public health which I otherwise would not
> have had. Personally and professionally it has helped me develop new
> opportunities and interests and I feel humbled to be chosen by the CDC
> and EPHLI staff as a candidate for the program. Because of the
> positive experience and the efforts put forth by the staff, my
> mentors, coaches and fellows I would like to express my sincere
> gratitude for the opportunity, and to have been associated with the
> program for the year. Thank you.
>
> **[About the Fellow(s)]{.underline}**
>
> **Biographical Sketch -- Werner von Kutzleben (BS/MS/PHD)**
>
> Werner von Kutzleben has been employed by the Virginia Department of
> Health, in the Lord Fairfax Health District, since 2005 and is
> currently the supervisor with the Warren County Health Department. Mr.
> von Kutzleben is responsible for a variety of programs including Food
> Protection, Soils and Drainfield , rabies and other public health
> related issues.
>
> Werner von Kutzleben is a graduate from the Christian Albrecht's
> University, Kiel Germany with a BS in Biology and Chemistry, and the
> University of Helsinki, Helsinki, Finland with a MS in Environmental
> Sciences and Ph.D in Biomedicine.
>
> Upon graduation he was employed as a senior environmental consultant
> with Powell Business Opportunities, followed by employment with
> LabCorp of America, and Clarke Mosquito Control Company.
>
> I would like to thank my wonderful wife for the support she gave while
> I was burning the mid night oil during the year long EPHLI program in
> completing the required assignments and program.
>
> **[References]{.underline}**
>
> American Heart Association: Statistical Fact Sheet -- Risk factors.
> americanheart.org
>
> American Obesity Association: Childhood Obesity.
> [www.obesity.org/subs/childhood/prevention.shtml](http://www.obesity.org/subs/childhood/prevention.shtml)
>
> Centers for Disease Control and Prevention: Overweight and Obesity.
>
> [www.cdc.gov/nccdphp/dnpa/obesity/index.htm](http://www.cdc.gov/nccdphp/dnpa/obesity/index.htm).
>
> Centers for Health and Health Care in Schools. www.healthinschools.org
>
> Champion: Vahealth.org/wic/champion.htm
>
> Childhood Obesity: Obesity Statistics.
> www.childhood-obesity-help.com/obesity-statistics.php
>
> Fitness: Obesity Satatistics,www.Fitnessby.com/Obesitystats.htm
>
> Health Goods: Overweight and Obesity Fact Sheet.
> www.healthgoods.com/edu/nutrition_Information/Weight_Control/overweight
>
> Institute of Medicine: Progress in Preventing Childhood Obesity.
> [www.iom.edu/obesity](http://www.iom.edu/obesity).
>
> KET: Kid's health Specials- Childhood Obesity.
> [www.ket.org/kidshealth/wellness/obesity_statistics.htm](http://www.ket.org/kidshealth/wellness/obesity_statistics.htm)
>
> National Conferences of State Legislatures.
> www.ncls/programs/health/ChildhoodObesity -2005htm
>
> National Health and Nutritional Examination Survey:
> www.cdc.gov/nhanes.htm
>
> Prevention Institute: From wallet to waistline. The hidden cost of
> supersizing. [www.prevention](http://www.prevention/)
> institute.org.portionsizerept.html.
>
> National Youth Risk Behavior Survey -- www.cdc.gov/yrbss
>
> Robert Wood Johnson Foundation: What does America think about
> Childhood Obesity.
>
> School Health Policies and Programs Study (SHPPS) -- CDC-SHPPS Senior
> Journal: If Life Expectancy Starts to Drop, Blame obesity in Children.
> [www.seniorjournal.com/NEWS/SeniorStats/5-03-17/ObesityChildren.htm](http://www.seniorjournal.com/NEWS/SeniorStats/5-03-17/ObesityChildren.htm).
>
> Society for Research in Child Development. The Epidemic of Childhood
> Obesity -- Socila Policy Report. www.srcd.org/spr.html
>
> Trust for Ameicas Health: America's obesity is Getting Worse.
> [www.healthyamericans.org](http://www.healthyamericans.org/).
>
> United States Food and Drug Administration: Overweight, Obesity
> Threaten U.S Health Gains. www.fda.gov/fdac/features/2002/202_fat.html
>
> United Stated Department of Health and Human Services: Childhood
> Obesity.
>
> hhtm//aspe.hhs.gov/health/reports/child_obesity.
>
> World Health Organization (WHO): Global Strategy on Diet, Physical
> Activity and Health.
> [www.who.int/dietphysicalactivity/publications/obesity/en/](http://www.who.int/dietphysicalactivity/publications/obesity/en/)
>
> Virginia Centers for Healthy Communities. Virginia's Obesity Epidemic.
> www.vahealthycommunities.com
>
> Virginia Commission on Youth - Commonwealth of Virginia: Child Obesity
>
> Virginia Performs: Measuring Virginia's Obesity rates.
> www.vaperforms,virginia.gov/i.obesity.php
>
> Wikipedia: Obesity. http//en.wikipedia.org/Obesity
>
> WIN: Weight-Control Information Network. Statistics Related to
> Overweight and Obesity. http//win.niddk.gov/statistics/index.htm