Another current intervention is to reduce the amount of time that a child spends in front of a screen of some sort. Screens, whether computer screens, video game screens, or television screens all encourage children to be passive recipients of entertainment, rather than active players in a game of some sort. What is fascinating is that merely aiming to reduce screen time seems to be sufficient to help increase child health. The Stanford Student Media Awareness to Reduce Television (SMART) classroom program aimed at reducing children's screen time, but did not promote a substitute physical activity for that reduced screen time (Robinson, 1999). Simply reducing screen time was linked to reduced BMI, reduced body fat, and reduced waist circumference (Robinson, 1999). Presumably, this positive impact of reduced screen time comes as the result of two factors. First, screen time is often linked to mindless eating, which increases calorie consumption. Second, kids who are not in front of a screen are going to be more likely to engage in some physical activity, even if not specifically directed to substitute physical activity for the screen-watching activity.

Proposed interventions

One proposed intervention is active transport to and from school. Depending on how far from school a student lives, a child could get several minutes of activity if using a physical means of self-transport to and from school. However, this easy, inexpensive option is largely ignored. At this point in time:

Little is known about the contribution of active transport to school to overall physical activity. Trips to school by walking and biking have decreased in recent years, and most studies of walking to school have been based on parent reports. A recent study used direct observation to determine the prevalence of walking and biking to school at 8 urban and suburban schools in 1 city. The vast majority of students rode a school bus or were driven to school; only 5% walked or rode a bike to school. A small number of interventions have been designed to increase the prevalence of walking to school (Pate et al., 2011).

These studies have not always demonstrated a strong impact on childhood obesity rates, but the fact is that a child who is moving is a child who is moving. It seems beyond unlikely that a child who begins to take an active means of transport to and from school is going to face negative health consequences from that choice.

This intervention would propose that all parents begin to be involved in active transport to the child's school. The goal would be that three days out of the week, the child would take an active means of transport both to and from school. Some parents are unable to do so because the child must be at before-school or after school care, but, in those scenarios, the parent can make active transport part of the student's transportation to day-care. Even children who live an unreasonable distance from school could be involved in active transport. A parent who needs to drive a child to school could stop, park, and walk with the child or allow the child to bike ride the last 1/2-mile to the school. Likewise, some children may need to take a bus to get to school. Parents could accompany their children to a distant bus stop, so that the entire trip was not passive. There is no reason that parents could not increase the activity in their children's commutes to and from school.

The benefit of this proposed intervention is that it would have the parents actively involved in the children's active transport to and from school. The intervention is not to have children walk or bike ride to school without adult supervision, a scenario that is simply impermissibly dangerous in many parts of the country. Instead, the intervention is to have parents walk their children to school. The most positive aspect of this interaction is that, by showing the parent participating in regular physical activity with the child, the child learns that physical activity is an appropriate part of the day. The parent can take that opportunity to talk about the school day with the child, review facts for tests or quizzes that will be given that day, discuss hopes and fears for the day, and otherwise engage in bonding with the child. Using the shared exercising time as a way of increasing parental bonding and parent-child communication will reinforce the notion that exercise is a positive, not only physically, but also emotionally.

Expected Outcomes

The problem with requiring active transport to and from school is that it is time consuming. Many people already...

Even those who do regularly carve out time for exercise in their personal lives may not want to give time to active transport for the child to and from school because walking with a child to school rarely gives an adult the type of high intensity workout that one might seek to achieve. In other words, fit parents cannot substitute 20 minutes of walking to and from school for 20 minutes on the Stairmaster, and they have to find that 20 minutes somewhere. Likewise, particularly for working parents, the evening rush to get children home, fed, homework done, and bathed by bedtime will make it seem impossible for many of them to commit to actively transporting their children to and from school. Therefore, one expects a high drop-out rate among the program.
However, among the parents who continue participation in the program, the expected outcomes are very positive. One would expect that the children being actively transported to school would have positive health changes in BMI, body fat percentage, and waist circumference as compared with a control-group of students who are passively transported to school. Moreover, one would expect children who are actively transported to school to experience positives that, while not overtly related to childhood obesity, are likely to increase their overall mental and physical health. For example, one would anticipate that children who are actively transported to school with a parent's assistance would have a closer relationship and better communication with the parent as compared to children in the control group. Therefore, even if the activity does not have a positive impact on the child's weight, one would expect that child to suffer from fewer of the negative psychological health consequences that are attendant to childhood obesity. Finally, parents who walk their children to school have a greater opportunity to observe their child's interactions with peers, teachers, and other adults at school. Does the child appear to have friends, do other children pick on the child, and do teachers seem happy to see the child? A parent walking a kid to the schoolhouse door has many more opportunities to notice these interactions than a parent dropping off a child in a carpool lane.

Conclusion

Because childhood obesity is a multi-layered problem, no single intervention is going to be enough to fix the problem for all children or to fix the entire problem for a single child. A child who is already struggling with childhood obesity is not going to suddenly have an acceptable BMI simply because his parents have started walking him to and from school. However, the reality is that a single intervention, on its own, should not be expected to fix the problem. If the intervention helps alleviate the problem, then it should be considered successful. If a ten-minute walk to and from school increases a child's daily activity from 20 minutes per day to 40 minutes per day, even though the child is still 20 minutes short of the recommended activity guidelines, few people could suggest that the intervention was not successful. Moreover, by getting parents involved in the exercise program, one would hope to see some spillover effect into other parts of the child's life. Maybe the parent and child will come to value their walks together, and institute walks during the weekend or increase the frequency or duration of their walks to and from school. Perhaps the parent will see the positive impact of exercise and try to make small dietary changes. The important thing to keep in mind is that even small positive changes are still positive, and that it is easier to get people to commit to small changes and keep those commitments than it is to get people to make radical overnight changes.

References

Ara, I., Vincente-Rodriguez, G., Jimenez-Ramirez, J., Dorado, C., Serrano-Sanchez, J.A., & Calbet, J.A. (2004). Regular participation in sports is associated with enhanced physical fitness and lower fat mass in prepubetral boys. Int. J. Obes Relat Metab Disord, 28, 1585-1593.

LaFontaine, T. (2008). Physical activity: The epidemic of obesity and overweight among youth:

trends, consequences, and interventions. American Journal of Lifestyle Medicine, 2(1), 30-36. doi: 10.1177/1559827607309688.

Nettlefold, L., McKay, H.A., Warburton, D.E.R., McGuire, K.A., Bredin, S.S.D., & Naylor, P.J.

(2011). The challenge of low physical activity during the school day: at recess, lunch, and in physical education. Br…