1. Coming to the Aid of Overweight Youth Robert P. Pangrazi

2. The Fattening of America One in three Americans are overweight or obese Fat free and/or sugar free foods are in abundant supply yet weight continues to increase Fitness push by the President’s Council has not slowed the obesity epidemic among youth

3. A View of Physically At-Risk Children* Data on school age youth in each country Pedometer step counts and BMI Data gathered using the same protocol Data gathered during the fall season in each country *Vincent, Pangrazi, Raustorp, Tomson, & Cuddihy. (August, 2003). Activity levels and BMI of children in the U.S., Sweden, & Australia. Medicine & Science in Sports & Exercise.

4. Number of Participants MalesFemales Australia281285 U.S.325386 Sweden461440

5. How Many Steps – BMI Referenced Standards* How much activity separates normal weight from overweight/obese children 12,000 steps for girls 15,000 steps for boys Converted to time… –107 minutes for girls –137 minutes for boys *Tudor-Locke, C., et.al. (2004). BMI-referenced standards for recommended pedometer- determined steps/day in children. Preventative Medicine, in press.

6. Step Counts - Girls Most (MA) and Least (LA) Active Tertiles

7. Step Counts - Boys Most (MA) and Least (LA) Active Tertiles

8. Girls - % Overweight/Obese* CountryLeast Active More Active Most Active Total U.S.48.0%35.9%22.8%35.6% Sweden23.3%20.5%6.5%16.8% Australia20.7%12.5%10.4%14.4% *Using International standards from Cole, et al., Br. Med. J. 320:1-6, 2000.

9. Boys - % Overweight/Obese* CountryLeast Active More Active Most Active Total U.S.46.7%24.5%18.8%33.5% Sweden22.9%18.0%17.7%16.6% Australia18.8%17.7%10.9%15.8% *Using International standards from Cole, et al., Br. Med. J. 320:1-6, 2000.

10. BMI (kg/m 2 ) - Girls Means for Most Active Tertile

11. BMI (kg/m 2 ) - Girls Means for Least Active Tertile

12. BMI (kg/m 2 ) - Boys Means for Most Active Tertile

13. BMI (kg/m 2 ) - Boys Means for Least Active Tertile

14. “The Fitness Push” It failed obese kids… For the last 45 years, the U.S. has emphasized fitness as a way to fight obesity However, obesity continues to increase in the U.S. This approach has failed in the U.S. because children and most adults do not “buy in” to fitness

15. Why Doesn’t Fitness Work for the Youth Who Need It Most? It has been forced on youth creating a backlash and dislike when kids become adults – no locus of control It has created a hierarchy of “good” to “poor” activity Teachers and students haven’t understood the genetic limitations of participants Unrealistic standards were set – “One for all”

16. Mass Prescription It Fails the Majority of Youth Assumes all people need the same workload Assumes a small set of exercises is appropriate for many different sizes and shapes of people Assumes we know the correct workload for all students Takes away exercise independence – the intrinsic motivation to keep active

17. Philosophy Statement Helping Obese Youngsters It takes a village to succeed Overweight children can be served by physical education Obese youngsters may be better left to health experts Screening is the most important phase of the program It is better to “not try” than to “try and fail”

18. Screening Potential Participants Initial screen by classroom teacher Discuss with classroom teacher the potential for success –Are parents supportive? –Does the child perceive a problem? –Is the youngster motivated? –Would the teacher support the youngster?

19. Screening Potential Candidates Hold a conference with each of the possible candidates Select students for further evaluation based on the comments of classroom teacher, student comments and the feelings of the physical education teacher

20. Checking Parental Support Explain program to parents –Objectives, selection process, parent responsibilities Give parents a handout explaining program for discussion at home Possible termination for non- support Permission form and return within specified time

21. Selection of Participants “Success Profiling” Baseline Activity Level –Activity surveillance using pedometers –Baseline activity level for 4 days BMI Children’s Attraction to Physical Activity Scale (CAPA) Parent, teacher, student and P.E. specialist “chance for success” rating (1-7 pts.)

22. Where Students Accumulate Activity Morgan, C. F., Pangrazi, R. P., & Beighle, A. (2003). Using pedometers to promote physical activity in physical education. Journal of Physical Education Recreation and Dance, 74(7), 33- 38.

23. Activity Time, Distance, or Step Counts? Distance – least accurate due to stride variations and directionality Step Counts – shows variation based on the physical (genetic) traits of each individual Activity Time – most accurate and meaningful to kids and parents

24. Why Use Activity Time? Vast majority of activity recommendations are based on time Least variation between individuals – reduces comparative differences Allows teachers to see how much activity students are receiving in class

25. Introducing Pedometers Let students shake and look; walk and look; reset and clear many times Explain placement of the pedometer – over the kneecap on the waistline –Vertical plane –Clothing or belt that is relatively snug “You shake it, we take it”

26. Finding Baseline Activity Level Gather 4 days of 24 hr activity time for elementary school youth Gather 8 days of 24 hr activity for middle/secondary school youth Find average daily activity time

27. Calculating Baseline Activity Day 1 Activity Time_______________ Day 2 Activity Time_______________ Day 3 Activity Time_______________ Day 4 Activity Time_______________ Add all 4 days to determine your total activity time Total Activity Time________________ Use whole minutes only & divide Total by 4 for baseline Baseline Activity Time______________

28. Activity Goal Setting Increase baseline activity by 10% Record physical activity each day for two weeks If goal reached majority of days, increase by another 10% of baseline If goal not reached, continue present level

29. Personal Activity Time Goal Week #Baseline Activity Time Goal= Baseline + 10% Total TimeMade Goal Sample50 minutes +5 minutes 55 minutes 1 & 2 3 & 4

30. Implementation of Activity Program Meet with selected students at least once a week Meet in small groups or individually Create a personalized log book for each student Include physical activities Include parental weekly progress check form

31. Assigning Out of School Activity Each student is unique Locus of control belongs to participant Offer suggestions not mandates Try to identify activities the student enjoys Encourage large muscle activity

32. Monitor Progress As a general rule, redo complete evaluation each quarter (9 wks) Don’t concentrate on weight loss Primary focus on the activity process Secondary focus on BMI Minimal focus on weight Share positive results with others – parents and teacher