School Health Guidelines to Promote Healthy Eating and Physical Activity

Recommendations and Reports

September 16, 2011 / 60(RR05);1-71

Prepared by

Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion

The material in this report originated in the National Center for Chronic Disease Prevention and Health Promotion, Ursula E. Bauer, PhD, Director

Corresponding preparer: Sarah M. Lee, PhD, CDC, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Hwy NE, MS K-12, Atlanta, GA 30341. Telephone: 770-488-6126; Fax: 770-488-5771; E-mail: skeuplee@cdc.gov.

Summary

During the last 3 decades, the prevalence of obesity has tripled among persons aged 6--19 years. Multiple chronic disease risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose levels are related to obesity. Schools have a responsibility to help prevent obesity and promote physical activity and healthy eating through policies, practices, and supportive environments.
This report describes school health guidelines for promoting healthy eating and physical activity, including coordination of school policies and practices; supportive environments; school nutrition services; physical education and physical activity programs; health education; health, mental health, and social services; family and community involvement; school employee wellness; and professional development for school staff members. These guidelines, developed in collaboration with specialists from universities and from national, federal, state, local, and voluntary agencies and organizations, are based on an in-depth review of research, theory, and best practices in healthy eating and physical activity promotion in school health, public health, and education. Because every guideline might not be appropriate or feasible for every school to implement, individual schools should determine which guidelines have the highest priority based on the needs of the school and available resources.

Background

Healthy eating and regular physical activity play a substantial role in preventing chronic diseases, including heart disease, cancer, and stroke, the three leading causes of death among adults aged >18 years (1--5). Poor diet and physical inactivity among younger persons can lead to an increased risk for certain chronic health conditions, including high blood pressure, type 2 diabetes, and obesity (1). During 2007--2008, 20% of U.S. children aged 6--11 years and 18% of persons aged 12--19 years were obese, percentages that have tripled since 1980 (6). Engaging children and adolescents in healthy eating and regular physical activity can lower their risk for obesity and related chronic diseases (7,8).
The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society, including families, communities, schools, child care settings, health-care providers, faith-based institutions, government agencies, the media, and the food and beverage industries and entertainment industry. Each of these sectors has an important, independent role to play in improving the dietary and physical activity behaviors of young persons. Schools play a particularly critical role by establishing a safe and supportive environment with policies and practices that support healthy behaviors. Schools also provide opportunities for students to learn about and practice healthy eating and physical activity behaviors.

Introduction

In response to the childhood obesity epidemic, much research has been conducted on school-based obesity prevention and healthy eating and physical activity promotion and intervention since the last publication of the Guidelines for School and Community Programs to Promote Lifelong Physical Activity Among Young People (1997) and the Guidelines for School Health Programs to Promote Lifelong Healthy Eating (1996). The new guidelines in this report synthesize the scientific evidence and best practices during 1995--2009 and combine healthy eating and physical activity into one set of evidence-based guidelines for schools serving students in kindergarten through 12th grade (grades K--12); other educational programs within schools, such as prekindergarten, might also be able to apply these guidelines in their settings. These guidelines support the 2010 Dietary Guidelines for Americans (5), the 2008 Physical Activity Guidelines for Americans (9), and the Healthy People 2020 objectives related to healthy eating and physical activity among children and adolescents and schools (10). The guidelines establish a foundation for developing, implementing, and evaluating school-based healthy eating and physical activity policies and practices for students (Appendix A). Each of the nine guidelines is accompanied by a series of strategies for schools to implement.
The primary audience for this report includes state and local education and health agencies, federal agencies, and national nongovernmental organizations that focus on the health of students in school. Agencies can use these guidelines to establish professional development materials, programs, and resources for partners and constituents. Locally, physical education and health education teachers, school nutrition directors, school health councils, and other school staff members; health-care providers; community members; policy makers; parents; and students can use these guidelines to establish, implement, and assess healthy eating and physical activity policies and practices in schools. Finally, faculty members in institutions of higher education can use these guidelines to teach students of school health, public health, physical education, health education, exercise and wellness, physical activity, dietetics, nutrition education, nursing, elementary and secondary education, and other health- and education-related disciplines.

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