Running head: CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 1

Childhood Obesity and School Absenteeism

Courtney Lantz and Heather Saindon-Kaneen

PPE 310

Arizona State University

December 5, 2017
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 2

Childhood Obesity and School Absenteeism

Introduction

Childhood obesity is a rapidly growing issue in the United States and around the world.

Since the 1970s, the obesity rates for children aged 2-19 years has more than tripled. The Centers

for Disease Control and Prevention breaks the numbers down by age ranges, with the prevalence

of obesity of 2- to 5-year-olds being 8.9%, 6- to 11-year-olds being 17.5%, and 12- to 19-year-

olds being 20.5% (Childhood Obesity Facts, 2017, para. 2). Although obesity rates are much

lower in early childhood, they increase significantly into middle childhood and adolescence.

Even the seemingly low rates are extremely alarming. As the World Health Organization

describes, intervention is essential. Without it, these obese infants and toddlers will likely

become obese adolescents and adults (Facts and Figures on Childhood Obesity, 2017, para. 4).

With the high obesity rates, they will face many health issues throughout their lifetime that will

prevent them from accomplishing what they are capable of. There is also concern that these

health issues will lead to higher absentee rates for school-aged children. Children need to be in

the classroom to get an adequate education. It is essential that parents and schools work together

to combat the issue and make a true impact on the obesity epidemic. This paper investigates the

topic of childhood obesity as it relates to school attendance and overall health of the child by

looking at the literature related to the topic and proposing a plan of action through practical

implications.

For more information about healthy learning communities or for contact information,

please visit:

www.courtneylantzppe310.weebly.com

www.heatherkaneen.weebly.com
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 3

Literature Review

Although it is evident that childhood obesity is a growing concern in the United States, it

is important to understand the effects of childhood obesity on school attendance, performance,

and overall health. By looking at the current literature, these relationships become evident.

Pan, Sherry, Park, and Blanck, 2013. With the rising childhood obesity rates, many

researchers wanted to investigate the effects of childhood obesity on school attendance and

performance. Pan et al. (2013) conducted a study that attempted to determine the relationship

between obesity and school absences that were due specifically to illness or injury in adolescents

ranging in age from 12- to 17-years-old. The study analyzed data from the National Health

Interview Survey (NHIS) from 2009 of 3,470 adolescents. The researchers also asked follow-up

questions from the parents about their children, which included the number of school absences

due to illness or injury and their childs body mass index (BMI) based on reported heights and

weights (Pan et al., 2013). Through their research, investigators determined that overweight and

obese children took an average of one more day per year than their normal weight peers. When

researchers added in factors of socioeconomic status and disease, overweight and obese students

had more than one-third more absences related to illness or injury than their normal-weight peers

(Pan et al., 2013).

Carey, Singh, Brown III, and Wilkinson, 2015. Although school attendance is

important, some researchers looked at the effects of childhood obesity on both absenteeism as

well as school performance. A study conducted by Carey et al. (2015) investigated in detail the

poor school performance exhibited by obese children ages 10- to 17-years old. It sought to

determine if the poor performance was related to their higher prevalence of health conditions and

utilization of health services (Carey, Singh, Brown III, & Wilkinson, 2015). The study analyzed
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 4

data from the National Survey of Childrens Health (NSCH) from 2011 to 2012 of 45,255

children. The survey was conducted over the phone, asking parents questions related to their

childs health and well-being. The data was compared along six educational and health outcomes

which included school absences, problems at school, repeating a grade, school engagement,

overall health, and utilization of health services (Carey et al., 2015). The researchers found that

each of the four educational outcomes exhibited a strong relationship with childhood obesity. For

school absences specifically, obese children had a higher rate of missing more than two weeks of

school than their normal-weight peers, while overweight children had the lowest rates of school

absences (Carey et al., 2015). Obese and overweight children had a higher prevalence of poor

overall health and poor overall health was strongly related to all four of the educational

outcomes.

Rapport, Daskalakis, and Andrel, 2010. The study conducted by Rapport et al. (2010)

was trying to research the reasons why obese children were missing from school more than the

children of normal weight. They were looking into one of the main issues minority and youth at

increased risk for obesity. (Rappaport, Daskalakis, & Andrel, 2010). According to the article on

Philadelphia school children, 291,040 records were analyzed which represented 165,056

students, grades 1-12. Body mass index was determined using age- and sex-specific percentiles

from the Centers for Disease Control and Prevention. (Rappaport et al., 2010). After conducting

the research, obesity was not a large reason for absence. The researchers concluded that the rates

for overweight and obesity were between 17% and 20%. An estimated rate of 17 absences per

180 students were recorded. Only those children that were severely obese had significantly

higher rates of absences (Rappaport et al., 2010). White students, as well as other races besides
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 5

Asians, had higher rates of school absences. However, students eligible for free or reduced-cost

meals had 24% higher rates of absenteeism. (Rappaport et al., 2010).

Echeverra, Vlez-Valle, Janevic, and Prystowsky, 2014. The study conducted by

Echeverria et al. (2014) was about obesity and poverty, and investigated the rates of absences in

schools in the United States. Obesity is still among one of the school challenges teens are facing.

Researchers determined body mass index (BMI) by separating it into three categories (normal,

overweight, and obese) using age- and sex-specific criteria. They analyzed data from the 2007

National Survey of Childrens Health (NSCH) which included 91,642 participants, with a 46.7%

weighted response rate among households with children (Echeverra, Vlez-Valle, Janevic, &

Prystowsky, 2014). This survey was conducted between April 2007 and July 2007. The

dependent variable was the number of school days missed and the main independent variables

included BMI and poverty status (Echeverra et al., 2014). The data revealed that those children

living in high poverty (<200% FLP) had the greatest percentage of school absences. When

considering obesity, those in poverty also had higher than the average rates of obesity.

Researchers determined that the likeliness of missing 11 or more days of school was 1.5 times

higher for overweight children and 1.9 times higher for obese children (Echeverra et al., 2014).

Synthesis of Information

Research Overview. The research articles each found an association between childhood

obesity and school absence rates. This correlation was typically strong (Pan et al., 2013; Carey et

al., 2015; Echeverra et al., 2014), although one article found a weak association (Rappaport et

al., 2010). All of the research articles found a similar association between obesity rates and

poverty status, which one suggesting poverty as the contributor to increased absence rates

(Rappaport, Daskalakis, & Andrel, 2010). When looking at associations between poverty and
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 6

obesity, it was found that obesity rates were higher in higher income areas than in lower income

areas (Rappaport et al., 2010) which suggests that poverty is not contributing to obesity rates and

should be considered separately.

Research Themes. There were several consistent themes throughout the articles. When

calculating childrens BMI, each of the researchers used age- and sex-specific percentiles set up

by the Centers for Disease Control and Prevention. This helps to maintain consistency

throughout the studies, so that the same children are considered obese, overweight, normal-

weight, or underweight, respectively. Another consistent theme throughout the articles was

investigating the effects of poverty in the research in addition to obesity. Poverty has been

suspected to impact school attendance, and therefore, it was important for researchers to analyze

the data with and without controlling for poverty to check for noticeable differences.

There were also some themes that were different in the articles. For example, one article

looked specifically into several different educational outcomes, one of which was school

attendance (Carey et al., 2015). These researchers also investigated the association between

obesity and utilization of health care services. Another theme included comparing school

attendance with the development of certain diseases (Pan et al., 2013). Some of those selected

were directly associated with obesity while others were not.

Overall Conclusions. Overall, the conclusion was that children who are obese end to

miss more days of school than their normal weight peers. This leads to additional educational

issues, such as lower engagement and repeating a grade. Poverty has also been found to also

have a relationship with school attendance, often adding to the absenteeism rates of obese

students.
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 7

This research highlights the importance of addressing childhood obesity through

improved fitness and nutrition. Childhood obesity rates are on the rise, and implementing

physical activity and nutrition with our children can help reduce the continued growth of obese

children. Resolving issues with obesity will have positive implications on their school attendance

rates, which can help school performance improve. More importantly, addressing childhood

obesity will benefit childrens overall health and wellbeing.

Practical Implications

To help lower childhood obesity rates and improve school attendance and performance,

schools should implement the EatSmart program. The EatSmart program is a weekly afterschool

program for students, with an event held every month for students, their families, and the

community (See Appendix A for a calendar of events). The focus at EatSmart is on promoting

healthy eating, while partnering with schools to encourage adequate physical activity.

Marketing. Marketing the weekly afterschool program to students will take place at the

school level. Large hand-made posters will be distributed around the school during the first week

of school. Computer generated flyers will then be distributed in the common areas, such as the

cafeteria, classrooms, library, and office (See Appendix B for an example flyer). Many offices

keep brochures on file for students looking to join a club. Therefore, a brochure for the club will

be provided to the office, as well as to all the teachers to help market through word of mouth

(See Appendix C). Schools also have daily announcements, and therefore, an announcement will

be made weekly to remind students of the meetings, which will encourage student attendance.

To market the EatSmart monthly community event, flyers will be sent home with

students to make parents aware and encourage their attendance (See Appendix B). These same

flyers will be distributed at local businesses with their approval. Flyers will also be posted on
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 8

community bulletin boards. Reminders will be made through the schools social media page, as

well as information posted to local community pages. These flyers point out that

accommodations are available for people with disabilities so that all community members are

encouraged and welcome to attend.

Funding. The primary source of funding for the monthly EatSmart community events

will be through fundraisers completed by club participants and their sponsors. Fundraisers will

include things such as carwashes, restaurant nights, and donations. These fundraising options are

purely profit and will generate the funds for all necessary components of the events, including

prizes, game and activity supplies, and security. The more money generated through fundraisers,

the higher quality and quantity of prizes that will be available.

Each year, a new shirt will also be designed and available for sale (See Appendix D).

These high-quality shirts cost approximately $10.00 each to design and print in larger quantities.

They will initially be sold to students, parents, teachers, and other community members for

$20.00 to make nearly a 50% profit. To have the appropriate sizes, pre-orders will be accepted.

Extra shirts will be ordered with the additional funds from pre-ordered shirts and will then to be

sold at future community events. Because the poverty rate around the school is high, the price of

shirts will be placed on sale at all events after December. They will be sold for $15.00 to help

generate extra sales from those that cannot afford the price of $20.00. This price may be further

lowered if supplies are still available towards the end of the year.

Scheduling. Throughout the school year, EatSmart will become an event that all children

will want to attend. EatSmart meetings will be taking place every Wednesday from 2:30-3:30

p.m. in room 458. Once monthly on Saturdays, EatSmart will have a special community event

open to the public for all ages (See Appendix A for schedule and Appendix B for flyer example).
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 9

This community event will take place at Westview High School Performing Arts Center in

Avondale Arizona. This building was selected because of the accessibility, including wheelchair

ramps and wheelchair accessible restrooms. Both the academic calendar and the monthly flyers

will be handed out to all children to present to their families. These will also be distributed

throughout the community. The calendar shows when the meetings are as well as the Saturday

events that are open to the public.

Committee. To ensure a successful community event every month, a wellness committee

will be established. The committee will serve for the entire school year. Each year a new

committee will be selected. This committee will consist of five teachers, other than the sponsors.

To select committee members, the sponsors send out an email and flyer requesting volunteers. If

more than five teachers volunteer, than the club and sponsors select the committee based on

experience and qualifications. Each year, at least one teacher from the special education

department will serve on the committee. They will be able to provide extensive information and

input about appropriate accommodations for people with disabilities so that the program can

better assist all community members.

The committee is in charge of making sure that everything for the event is successful

from start to finish. They are also in charge of set up and take down, making sure there is

security to maintain community safety, and that they have prior administrator approval of all

curriculum and activities. In addition, they are responsible for helping to plan and design

activities, games, presenters, handouts, etc. It is their responsibility to develop nutrition

curriculum for each of the nine total events. The entire committee comes to the after-school club

meetings at least once a month prior to the monthly events to share their progress and gather
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 10

input and advice from the students. This helps ensure that the students are directly involved with

the information that is provided to their community.

Recognition. It is important that positive recognition is received about the EatSmart

community events. This will help ensure the events are able to continue in the future. It is

essential that the school does their part in distributing flyers (See Appendix B) and brochures

(See Appendix C). Posting information to the school and community social media pages will

also help to get the word out about when these will occur each month. It is also important,

however, that these events continue to provide diverse information and activities to keep

participants coming back and sharing positive words to others. These events have the potential to

change the entire community, improving the health and wellness of all involved.

Engagement. Engagement is imperative to the continued success of the community event

as well as the after-school club meetings. If the community is not engaged in the event, they will

not continue to attend. Without appropriate attendance, the benefits will no longer be worth the

cost. Successful fundraising and donations will help with continued engagement. The funds will

ensure that better prizes are able to be purchased, which will encourage more people to attend.

Offering free food and other small handouts, such as water bottles, pencils, and pens will also

help engage the community.

Appropriate modifications will be present throughout the monthly event to encourage

attendance of all community members, including families of people with disabilities. The

Westview Performing Arts Center was selected because of its wheelchair accessibility to allow

comfort and ease for individuals with physical disabilities. In addition, all printed documents and

handouts will be available in large print for individuals with visual impairments. There will be a

volunteer sign language interpreter available at all presentations to assist individuals with hearing
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 11

impairments. If there is no volunteer, funds will be set aside to hire one for each monthly

meeting, as it is imperative that we have the accommodations available for those individuals. All

games and activities will have a set of modifications for anyone with disabilities so that everyone

has the chance to participate. The special education teacher on the committee will help ensure

that every aspect of the event is accommodating to persons with disabilities.

In order to have an official club, it is required that there is a sponsor and at least five

members. Therefore, engagement is imperative during club attendance as well. Without an

official after school club, there would be no opportunities for fundraising that are tied to the

school, making it more difficult to have a variety of fundraising opportunities. All club members

will receive a t-shirt (See Appendix D) free of charge. They will also receive community service

opportunities through volunteering at the community events and other school functions.

Conclusion

With the rates of childhood obesity growing increasingly fast, it is important that we

address nutrition and physical activity to help promote health and wellbeing for children.

Lowering the rates of obesity can lead to a happier and healthier life for those individuals. It will

also lead to enhanced school performance, which will provide for a more successful life.

The first year of the EatSmart program will include a huge learning curve. The committee

will help develop the lessons and activities that take place during the monthly community event.

It will be important to gauge the popularity and success of these lessons and activities. Based on

the successes and struggles of the first year, we will be able to make changes for the program

going forward. Within three years, we anticipate that EatSmart will have gained popularity

within the community, which will allow us to gain funding by public and private donors. Our

hopes are that students will join the club early on in their high school careers, so that by the time
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 12

they are juniors and seniors, they will be able to volunteer at the community events and put on

their own presentations. By five years after the start of EatSmart, we envision having regular

community partners that will help put on these community events. They will provide volunteers,

presenters, and goods in exchange for advertisement for their business. We also hope to grow

EatSmart from a focus on only nutritional health to including physical health components as

well.

There are many issues that need to be addressed to lower the rates of childhood obesity.

Parents, schools, and communities must come together and work as one. This program is just a

small step in the right direction. EatSmart provides an opportunity for children to take control of

their nutritional health and wellbeing. It also brings them together with parents and community

members to help make a bigger impact. By raising awareness about the importance of physical

activity and balanced nutritional health, we can encourage a healthier community.

CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 13

Appendix A
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 14

Appendix B
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 15

Appendix C
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 16

Appendix D
CHILDHOOD OBESITY AND SCHOOL ABSENTEEISM 17

References

Carey, F. R., Singh, G. K., Brown, H. S., III, & Wilkinson, A. V. (2015). Educational outcomes

associated with childhood obesity in the United States: cross-sectional results from the

2011-2012 National Survey of Childrens Health. The International Journal of

Behavioral Nutrition and Physical Activity, 12(1), 1-11. doi: 10.1186/1479-5868-12-S1-

S3

Childhood obesity facts. (2017, April 10). Retrieved October 22, 2017, from

https://www.cdc.gov/obesity/data/childhood.html

Echeverra, S. E., Vlez-Valle, E., Janevic, T., & Prystowsky, A. (2014). The role of poverty

status and obesity on school attendance in the United States. Journal of Adolescent

Health, 55(3), 402-407. doi: 10.1016/j.jadohealth.2014.03.012

Facts and figures on childhood obesity. (2017). Retrieved October 30, 2017, from

http://www.who.int/end-childhood-obesity/facts/en/

Pan, L., Sherry, B., Park, S., & Blanck, H. M. (2013). The association of obesity and school

absenteeism attributed to illness or injury among adolescents in the United States, 2009.

Journal of Adolescent Health, 52(1), 64-69. doi: 10.1016/j.jadohealth.2012.04.003

Rappaport, E. B., Daskalakis, C., & Andrel, J. (2011). Obesity and other predictors of

absenteeism in Philadelphia school children. Journal of School Health, 81(6), 341-344.

doi: 10.1111/j.1746-1561.2011.00599.x