Involving children and adolescents in a healthy diet and regular physical activity can reduce the risk of obesity and related chronic diseases (7,8). The school environment can also influence the physical activity of children and adolescents. Healthy People 2020 includes targets related to physical activity and healthy eating among children and adolescents and in schools (Annex B) (10).
This report provides nine general guidelines for school health programs to promote healthy eating and physical activity.
Use a Coordinated Approach to Develop,
Schools and school districts can refer to the School Health Index for a complete list of policies and practices that promote healthy eating and physical activity in schools. The School Health Index guides schools through developing an action plan to improve their school health policies and practices (199,200). Completing the School Health Index can lead to positive changes in the health environment of the school.
Have schools established a school health council and conducted an assessment of their existing healthy eating and physical activity policies and practices.
Establish School Environments that Support
Explicit safety rules should be taught to and followed by students in physical education, out-of-school physical activity programs, and community sports and recreation programs. Trained staff or volunteers, including coaches, teachers, parents, paraprofessionals, and community members, should supervise all physical activity programs. Employees should be aware of the potential for physical activity-related injuries and illnesses among students, so that the risk and consequences of these injuries and illnesses can be minimized.
Nationwide in 2006, in 32% of schools, school staff members were allowed to use physical activity (eg, lap running or push-ups) to punish students for physical education misbehavior.
Provide a Quality School Meal Program and
In addition, regular participation in the School Morning Program is associated with lower BMI among students (309). Ensure that all foods and beverages sold or served outside of school meal programs are nutritious and appealing. Offer breakfast to all students at no cost to increase overall participation in the school breakfast program (315).
Ensure that all food and drink sold or served outside of school meals is nutritious and attractive.
Implement a Comprehensive Physical Activity
Sports plans should thus also include the development of safe and effective individualized physical activity plans. Following the review, the task force strongly recommended enhanced school-based physical activity as an intervention strategy to increase youth physical activity (378). Indicate a significant percentage of each student's recommended daily amount of physical activity in PE class.
Incorporate instructional strategies into physical education to improve students' confidence in their ability to be physically active and maintain physical activity behaviors. Giving students choices during PE lessons can increase students' confidence in their ability to participate in physical activity in general (414-416). Incorporate instructional strategies in physical training and physical activity programs that lead to positive attitudes and perceptions of physical activity.
The influence of students' attitudes toward and perceptions of physical activity can influence their engagement in physical activity outside of physical education class (417,418). Provide sufficient opportunities for all students to engage in physical activity outside of Physical Education class. The school setting can provide multiple opportunities for students to enjoy physical activity outside of physical education class and increase daily amounts of physical activity, including (377,419).
Ensure that physical education and other physical activity programs meet the needs and interests of all students. Often, students who have disabilities or chronic health conditions are discouraged from participating in physical education classes and other forms of physical activity.
Implement Health Education that Provides Students
Nutrition and physical activity topics can also be incorporated into other academic disciplines to complement comprehensive health education and physical education programs (456,457). Implement a planned and sequenced health education curriculum that is culturally and developmentally appropriate, addresses a clear set of behavioral outcomes that promote healthy eating and physical activity, and is based on national standards. Assessment protocols for quality health education include criteria for checking student work (such as a rubric) and incorporate multiple criteria over time.
As a result of participating in a primary and secondary school health education curriculum that includes nutrition, students should have the knowledge and skills to do the following. Health education curricula should reinforce the information taught in physical education classes and provide opportunities for students to apply physical activity knowledge and skills. The National Health Education Standards and Performance Indicators outline the health-related concepts, skills, and healthy beliefs, values, and norms students need for healthy behaviors (453).
A national health goal seeks to increase the proportion of elementary, middle, and senior high schools that have health education goals or objectives that address the knowledge and skills in the National Health Education Standards (high school, middle school, and elementary school) (goal ECBP 3) (10 ). The National Health Education Standards emphasize the development of skills and specify that, as a result of health education, students should be able to 1) understand concepts related to health promotion and disease prevention;. CDC's Health Education Curriculum Analysis Tool (HECAT) helps school districts conduct clear, complete, and consistent analyzes of written health education curricula based on the National Health Education Standards and research-based attributes of effectiveness.
The use of goal-setting skills can also be integrated into health education to help students identify personal goals for diet and exercise behaviors (488). Computer education on exercise and healthy eating offers opportunities for self-paced health education.
Provide Students with Health, Mental Health, and
School health, mental health, and social service personnel should collaborate with community health care providers to increase student access to care, coordinate care, and promote evidence-based physical activity and healthy eating initiatives (215). Health, mental health, and social service professionals should be alert to students with these conditions to ensure they are meeting healthy diet and activity recommendations (533–535). Health, mental and social services staff may request written permission from families to share confidential health information with student health care providers (515).
Health, mental health, and social services staff members serve as liaisons between school staff members, students, families, community programs, and health care providers (515). Health, mental health, and social service staff members should seek partnerships and serve on community health coalitions (515). Refer students to community-based health care providers and healthy eating and physical activity services.
Health, mental and social care staff play an important role in the development and marketing of a referral system for students and families. To establish a referral system, health, mental health, and social services workers should identify health services and school- or community-based programs that encourage healthy eating and physical activity and address obesity and eating disorders. Employees in health, mental health and social care can assess which services are available at the school and which require external referral (182).
Health, mental health, and social services staff members are ideally placed to engage community health care providers and organizations in supporting healthy eating and physical activity policies and practices within schools. Health, mental health, and social services staff members can advocate for schools to develop strong policies and practices that help students achieve healthy eating and physical activity recommendations.
Partner with Families and Community Members
School health advocacy raises awareness about the importance of health behaviors and can increase school and community support for instruction, programs, policies, and environmental changes that support healthy eating habits and physical activity (550). Encourage communication between schools, families and community members to promote the adoption of healthy eating habits and physical activity behaviors among students. Schools that communicate with families and community members about healthy eating and physical activity initiatives create a greater understanding of school activities, which can increase support and participation in school policies and practices from students and their families (188,557).
Strategies for Guideline 7: Partner with families and community members in the development and implementation of policies, practices, and programs for healthy eating and physical activity. Encourage communication between schools, families and community members to promote the adoption of healthy eating habits and physical activity behaviors among students. Develop and implement strategies to motivate families to participate in school-based programs and activities that promote healthy eating and physical activity.
Families and community members should be invited to provide input into the design and implementation of healthy eating and physical activity policies, programs and practices. Develop and implement strategies to motivate families to participate in school programs and activities that promote healthy eating and physical activity. Involve staff from universities, hospitals, health centers and other health organizations in school-based healthy eating and physical activity initiatives.
Recruit parents, family and community volunteers to help with healthy eating and physical activity initiatives. Extracurricular programs (eg, after-school and parks and recreation programs) provide additional opportunities to reinforce health promotion messages taught in schools and can engage students in healthy eating and physical activity (606).
Provide a School Employee Wellness Program
Assess the status of school employee wellness activities and identify school employee interests and needs in terms of nutrition and physical activity. Assessing the current status of school employee welfare activities provides a starting point for planning future programming (625). The CDC School Health Index provides a range of items to assess current policies, programs, and practices for school employee well-being.
Additionally, schools that establish and maintain wellness programs for school employees generally encourage their staff to request activities, courses, and information that are most personally relevant to them. Sharing information with school administrators about the benefits of employee wellness programs and the interests and needs of school staff members can increase their support and allocation of resources for such programs (628,629). Obtain administrative support for school employee wellness programs that include healthy eating and physical activity.
Develop and deliver a presentation that identifies the need for and benefits of a school employee wellness program in the context of coordinated school health. An existing committee, such as the school board of health or the health insurance advisory board, should have the necessary foundation and components to guide the process of developing a well-being program for school employees (628). The school employee well-being leader may be the school health coordinator or an employee who is committed to providing quality programs for all school staff.
A comprehensive wellness program for school employees includes goals, objectives, and activities to promote healthy eating and physical activity. Welfare programs for school employees should be evaluated to determine whether objectives have been achieved, whether employees are satisfied and what can be done to improve the program.
Employ Qualified Persons, and Provide
The effects of a 2-year physical education program (SPARK) on physical activity and fitness in primary school students. Coordinate policies and practices for healthy eating and physical activity through a school health board and school health coordinator.
