PHYSICAL EDUCATION

Jennifer Menon, MD, PGY1 Advocacy Presentation 10/26/2012

MT

12 year old male with no PMH comes in for WCC No changes in history, getting As and Bs in school, has a few close friends. After school activities include homework, tv, and video games. He doesnt like to go outside much because theres nothing to do outside. He lives with his parents in an apartment building. Both parents are obese. Mom is a diabetic, diagnosed at age 34, and Dad has been treated for high cholesterol for many years. Friends come over occasionally, and when they do they usually just play video games or watch TV. Parents bought him a Wii for Christmas, and he enjoys games like Mario Kart and Zelda. Diet consists of fast food once to twice per week (both parents work full time, its just easier to drive through and grab something quick) . When his parents do cook, its usually a meat with either pasta or rice and occasionally a vegetable.

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PE:

Vitals: HR 91, RR 20, BP 100/73, BMI 28 General: Obese appearing young male, NAD HEENT: NC/AT, MMM, OP and TMs clear Neck: Supple, no LAD, no rashes, no thyromegaly CVS: RRR, no murmurs Resp: CTAB Abd: NT/ND, normoactive bowel sounds Extr: MAEW, PPP Skin: No rashes

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Go through your anticipatory guidance Congratulate him on his As and Bs in school What else do you want to do?

Addressing Obesity

One study looking at PCPs addressing childhood overweight and obesity in Southern Appalachia
71% spoke about diet and physical activity 17% provided parents with tools for intervention

One study surveyed pediatricians and family practitioners listed in the AMA database
Less than 50% routinely used BMI as a screening tool 18% referred overweight or obese patients for further management 58% either never, rarely, or sometimes tracked patients over time for concern about weight issues

Some National Facts on Obesity

1 in 3 children in low-income households are obese or overweight before their 5th birthday
Highest

rates in Native American, Hispanic, and Alaskan Native children

National Youth Risk Behavior Survey of high school students (2011):

No

daily PE classes for 69% of students Increased sedentary lifestyle behaviors

Childhood obesity rates tripled since 1980

http://www.cdc.gov

So why is this an issue?

Overweight and obese children and adolescents become overweight and obese adults Earlier onset of complications of obesity Hospitalization associated issues:
Increased

length of stay by 0.85 day $1,634 increase in charges $727 increase in costs

How Utah Ranks vs. Nationally

Utah
Overweig ht Children 12% Adolescent 12.2% s Obese 8.7% 8.6% Children (age 2-19 yrs) Adolescen ts

National Statistics
Overweig ht 31% Obese 17%

15.2%

13%

Congratualtions, Utah! You are the least overweight/ obese state in the US! But its still 1 in 5

2011 Youth Risk Behavior Survey. http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Where the Burden Falls

Whose job is it to address obesity and inactivity? Is it the physician taking care of the patient who spends about 15 minutes per year with them? Is it the schools role to promote good health?

Food for Thought

How many of you think

How many parents think it:

regular daily physical activity helps children do better academically and should be part of a school curriculum for all students in grades K-12? that more school physical education could help control or prevent childhood obesity? that physical education is at least as important as other academic subjects? that there should be more physical education in schools, particularly for fighting obesity?

95% of parents

76% of parents 54% - 85% of parents, depending on subject 91% of parents

http://www.aahperd.org/naspe/publications/upload/Executive-Summary.pdf

National Association for Sports and Physical Education

Mission: enhance knowledge, improve professional practice, and increase support for high quality physical education, sports and physical activity programs

Promote physical education to children Encourage lifelong commitment to physical activity Not trying to make athletes out of all children

National Recommendations for Physical Activity and Education:

150 minutes/ wk for elementary school students 225 minutes/ wk for middle and high school students At least 60 minutes per day Avoid prolonged periods of inactivity

On Physical Activity:

Physical Activity: What Counts?

Vigorous backyard play School recess

Some

PE teachers organize activities during recess to get kids involved and physically active by licensed professionals

Physical Education classes

Taught

School and community sponsored sports teams

Utah Physical Education Laws

PE classes must be offered in grades K-6, but it does not require daily recess. Minimum of 225+ minutes per week of physical education in grades 7-8 and a for three years in high school. PE must be taught by a certified instructor PE must be open to all students Must be co-educational

Utahs CORE Curriculum Standards for PE

1)

2)

3) 4)

5)

6)

Students will demonstrate competency in motor skills and movement patterns needed to perform a variety of physical activities. Students will demonstrate understanding of movement concepts, principles, strategies and tactics as they apply to the learning and performance of physical activities. Students will participate regularly in physical activity. Students will achieve and maintain a health-enhancing level of physical fitness. Students will exhibit responsible personal and social behavior that respects self and others in physical activity settings. Students will value physical activity for health, enjoyment, challenge, self-expression, and/or social interaction.

Action for Healthy Kids Utah

Mission: reduce and prevent childhood obesity and undernourishment Work with legislators for passing laws for providing appropriate nutrition and opportunities for physical activity in school

Action for Healthy Kids Utah: Recommendations

Elementary School

Secondary School

Implement Core Curriculum Goal: 150 minutes/week of physical education and instruction 2 recess periods per day Recess is not a reward Discourage withholding recess as punishment or for remediation Establish safe walking/ biking routes and encourage use Allow recess before lunch

Implement Core Curriculum Instruction should emphasize activities, knowledge, and skills for lifelong physical fitness Include and promote intramural sports and fitness activities in addition to formal athletic programs Establish safe walking/ biking routes and encourage use

http://choosehealth.utah.gov/documents/AFHKPApolicyrecommendations.pd

Where Can We Advocate?

School boards Legislators and policy makers Community based organizations

Action

For Healthy Kids: Utah

References

http://www.aahperd.org/naspe/ http://www.diabetes.org/diabetes-basics/diabetesstatistics/ http://www.schools.utah.gov/curr/healthpe/ http://dx.doi.org/10.1016/j.amepre.2011.03.016, Holt N. et al, Primary Care Practice Addressing Child Overweight and Obesity: A Survey of Primary Care Physicians at Four Clinics in Southern Appalachia. South Med J. 2011 January; 104(1): 14-19.