Final Task Force Recommendations

Background and Overview of the Work of the Task Force

Citing an epidemic of obesity among children and youth, State Superintendent of Public Instruction Jack O'Connell established a task force on childhood obesity, type 2 diabetes, and cardiovascular disease to examine the factors that contribute to the increases in these diseases among California schoolchildren. Members of the task force included students, parents, public health experts, physicians, nutritionists, physical education specialists, school nurses, and other educators (see "Acknowledgments" for a complete list). The first meeting of the task force was held on March 26, 2004, with subsequent meetings in May, July, August, September, October, and December. All meetings were open to the public.

Many guest speakers were invited to share their expertise with the task force (see "Acknowledgments" for a complete listing). Task force members were presented with information about current data, research, programs, and initiatives related to the national and statewide obesity epidemic. Presentations were made at nearly every meeting, and there were opportunities for public input at every meeting as well. At the September 10, 2004 meeting, the task force approved the first draft of recommendations to the State Superintendent to be released for public comment. These recommendations included actions that schools and their partners should take to address the epidemic trends facing California schools.

The public comment period ran from September 15, 2004, through October 6, 2004. Comments from 126 individuals were received. A summary of the comments received was discussed at the task force meeting on October 29, 2004. A public hearing was also held at this meeting. Task force members reviewed public comments and finalized their recommendations, incorporating recommendations as appropriate. The final recommendations were presented to State Superintendent Jack O'Connell on December 10, 2004.

Acknowledgments

Superintendent Jack O'Connell extends special thanks to the following individuals for their participation as members of the Task Force for Childhood Obesity, Type 2 Diabetes, and Cardiovascular Disease. These individuals provided valuable expertise and displayed serious commitment to this effort. Their service is deeply appreciated.

Members of the Task Force

• Barry Coughlin, M.D., F.A.C.C., Cardiovascular Center of Lompoc, Inc., Task Force Chair
• Nancy Adalian, Vice President, Health Commission, California PTA
• Ted Barone, Principal, Burlingame Intermediate School
• Stanley Bassin, Ed.D., Clinical Professor of Cardiology, UC Irvine
• William Bommer, M.D., Professor of Medicine, American College of Cardiology, California Chapter Representative
• Melinda Bossenmeyer, Ph.D., California Association for Health, Physical Education, Recreation, and Dance
• Maria Casey, Executive Director, Partnership for the Public's Health
• Rob Challinor, Chair, Child Nutrition and Physical Activity Advisory Council, Assistant Superintendent—Educational Services, Hesperia Unified School District
• Dan Cooper, M.D., Professor of Pediatrics, Vice Chair of Program Development, Department of Pediatrics, UC Irvine
• Stephanie Davila, Youth Board Nominee, California Center for Civic Participation and Youth Development
• Harold Goldstein, DrPH, Executive Director, California Center for Public Health Advocacy
• Martin Gonzalez, Assistant Executive Director, Policy Services, California School Boards Association
• Cary Hart, M.D., Department of Pediatrics, Kaiser Permanente, Sacramento
• Ruby Hennessey, RN, Professional Standards Chairperson, California School Nurses Organization
• Francine Kaufman, M.D., Professor of Pediatrics, USC School of Medicine
• Andy Megaw, Teacher, Upland Unified School District
• Ed Moreno, M.D., F.A.A.P., California Council of Local Health Officers
• Gregory Payne, P.E.D., California Medical Association, San Jose State University
• James Sallis, Jr., Ph.D., Professor, Department of Psychology, San Diego State University
• Selinda Shontz, R.D., Senior Director of Stroke Programs, American Heart Association
• Terri Soares, R.D., Nutrition Education Coordinator, Fresno County Office of Education
• Robert Wilkins, President and CEO, YMCA of the East Bay

Presenters

Superintendent O'Connell and task force members wish to thank the following individuals who shared their expertise through presentations at task force meetings:

March 26

• Dan Cooper, M.D., Professor of Pediatrics, Vice Chair of Program Development, Department of Pediatrics, UC Irvine, Data and Research Documenting the Crisis
• Phyllis Bramson-Paul, Director and Assistant Superintendent, California Department of Education (CDE) Nutrition Services Division, Nutrition in Schools
• Dianne Wilson-Graham, Physical Education Specialist, CDE Curriculum Leadership Office, Physical Education and Activity in Schools
• Caroline Roberts, Administrator, CDE School Health Connections/Healthy Start, Coordinated School Health and the Health Framework for California Public Schools

May 7

• Nancy Spradling, Executive Director, California School Nurses Organization School Nursing: Reductions in Force but Increases in Need
• David Saunders, Director, Mission Delivery, American Cancer Society—California Division, School Health Councils
• Nancy Gelbard, MS, RD, Chief, California Obesity Prevention Initiative, California Department of Health Services, Nutrition, Physical Activity, and Obesity Prevention Efforts at the Department of Health Services
• Joanne Ikeda, MA, RD, Co-Director, Center for Weight and Health, U.C. Berkeley How to Become An Overnight Expert on Childhood Obesity
• William Bommer, Team for Life

July 16

• Lucinda Mejdell-Awbrey, PHN, MA, Coordinator, Student Support Services, Visalia Unified School District (USD), Addressing Student Health Issues Using the Coordinated School Health Model
• Enid Hohn, RD, Director, Nutrition Services, Vista USD, Partnerships for Healthy Schools
• Phyllis Bramson-Paul, Director, California Department of Education (CDE) Nutrition Services Division, What Californians Should Know About School Lunches
• Robin Jones, Supervisor, Child Nutrition Services, Folsom-Cordova USD, Eating Healthy, It's Your Choice
• Andrew Glazier, Chief of Staff to LAUSD Board Member Marlene Canter, Seceding from Candyland: How We Kicked the Soda and Junk Food Habit at LAUSD
• Sarah Samuels, DrPH, Changing Nutrition and Physical Activity Environments
• Caroline Grannan, Executive Vice President, San Francisco USD PTA, member of SFUSD Student Nutrition and Physical Activity Committee, and parent, Healthy Food, Healthy Schoolchildren
• Marjorie Freedman, Ph.D., Chair, School Nutrition Advisory Council, Bret Harte Middle School, San Jose USD, and parent advocate, Creating Healthier School Environments: One Orange at a Time

August 13

• James F. Sallis, Ph.D., Professor of Psychology, San Diego State University; Director, Active Living Research Program, School and Community-Based Prevention of Overweight in Youth: Promoting Physical Activity

September 10

• Dr. Richard Jackson, MD, MPH, State Public Health Officer, California Department of Health Services, Childhood Obesity, Schools, and Public Health

Superintendent O'Connell and task force members thank the many individuals and organizations that reviewed and commented on the draft recommendations during the public review process and all who provided comments at task force meetings.

Many staff members from the California Department of Education had vital roles in the task force efforts. Their support is gratefully acknowledged:

California Department of Education Staff

• Sue Stickel, Deputy Superintendent, Curriculum and Instruction Branch
• Margaret Aumann, Nutrition Education Consultant, Nutrition Services Division, Program Resources, Education, and Policy Unit
• Donna Bezdecheck, School Health Education Assistant, Learning Support and Partnerships Division, School Health Connections/Healthy Start Office
• Phyllis Bramson-Paul, Director, Nutrition Services Division
• Linda Davis-Alldritt, School Nurse Consultant, Learning Support and Partnerships Division, School Health Connections/Healthy Start Office
• Jeri Day, Health Education Consultant, Learning Support and Partnerships Division, School Health Connections/Healthy Start Office
• Craig Gifford, Analyst, Nutrition Services Division, Administrative Management Unit
• Kelly Haarmeyer, Analyst, Learning Support and Partnerships Division
• Joanna Knieriem, Office Technician, Learning Support and Partnerships Division, School Health Connections/Healthy Start Office
• Sam Lam, Web Developer, Technology Services Division, Application Development and Maintenance Office
• Rebecca Larsen, Project Management Office Analyst, Technology Services Division, Project Management Office
• Karissa Lujan, Office Technician, Learning Support and Partnerships Division, School Health Connections/Healthy Start
• Helen Ostapeck, Associate Government Program Analyst, School Health Connections/Healthy Start
• Alberto Rivera, Office Technician, Learning Support and Partnerships Division, School Health Connections/Healthy Start
• Caroline Roberts, Administrator, Learning Support and Partnerships Division, School Health Connections/Healthy Start
• Lila Rose-Skates, Retired Annuitant, Learning Support and Partnerships Division, School Health Connections/Healthy Start Office
• Deborah Tamannaie, Nutrition Education Consultant, Nutrition Services Division, Program Resources , Education, and Policy Unit,
• Gwyneth Tracy, Education Program Consultant, Education Data Office
• Cindy Villines, Manager, Technology Services Division, Application Development and Maintenance Office
• Dianne Wilson-Graham, Physical Education Consultant, Curriculum Leadership Office
• Michelle Zumot, Associate Government Program Analyst, Executive Office

Problem Statement

The percentage of children and adults who are overweight and obese has reached epidemic proportions nationally and in California. Nationwide, the proportion of young people who are overweight has tripled since 1980. Of U.S. children and adolescents aged 6 to 19 years, 15 percent—almost 9 million young people—are considered overweight 1, and in California the situation is worse. According to an analysis of the 2004 FITNESSSGRAM data by the California Department of Education, over 32 percent of youth are overweight, and close to 74 percent are unfit. 2 America's children and youth are less active, consume more fat and sweetened beverages, and eat fewer healthy foods, especially fruits and vegetables, than children of previous generations. Alarmingly, only 51 percent of today's children and youth eat even one serving of a fruit or vegetable each day. 3

Overweight children and youths are more prone to developing serious health problems now and in the future. The U.S. Surgeon General states that children who have an unhealthy diet and low levels of physical activity are at a greater risk for developing chronic health problems, including type 2 diabetes, high blood pressure, asthma, and heart disease. 4 Centers for Disease Control and Prevention (CDC) scientists recently predicted that 30 percent of U.S. children born in 2000 will develop type 2 diabetes in their lifetimes. 5 If left unchecked, diabetes can lead to complications such as kidney failure, blindness, heart attack, and amputations. It is feared that overweight and obesity may erase the last century's victories over heart disease and stroke, and that the rates of breast, prostate, and colon cancer will increase. 6

The economic burden of so many children and adolescents being overweight is high. The CDC reports that in one two-year period, U.S. taxpayers spent $127 million on hospital costs associated with caring for overweight children and adolescents. 5 This represents almost a four-fold increase in two decades. Across all ages, California paid nearly $25 billion in health care costs and lost productivity in 2000 due to overweight, obesity, and physical inactivity. 6 The social stigmatization and low self-esteem often associated with being an overweight child or adolescent may lead to even higher costs in future years. 7

The epidemic of childhood overweight is a complex, multi-faceted problem that requires a multi-level state and community response to reverse the upward trend. 4 When addressing this problem, however, care must be taken so that other eating disorders, specifically anorexia nervosa and bulimia nervosa are not perpetuated. Anorexia nervosa typically appears in early to mid adolescence. In the United States, as many as ten million females and one million males are fighting a life and death battle with an eating disorder such as anorexia nervosa. Schools are an important venue for addressing all eating disorder issues.

The CDC has identified effective strategies for schools that promote lifelong healthy eating and prepare children and youth for physically active lifestyles. 8 Its recommendations emphasize comprehensive nutrition education and quality physical education programs that are supported across all settings—at home, at school, and in the community. The Surgeon General calls for improving the school environment through approaches that extend beyond nutrition and physical education programs to include school policy, the school physical and social environment, and links among schools, families, and communities. 9

Using strategies from these documents in conjunction with California-specific data and objectives, the California Department of Education can play an important role in addressing the poor eating patterns and inadequate physical activity exhibited by students and adults during the school day.

Task Force Recommendations

Preamble   

The members of the Superintendent's Task Force on Childhood Obesity, Type 2 Diabetes, and Cardiovascular Disease, 

Recognizing that the number of overweight children in California and the nation has reached epidemic levels,

Concerned that childhood obesity increases the risk of serious medical conditions, such as diabetes and cardiovascular disease, resulting in tremendous human and economic cost, excess personal tragedy, and daily suffering,

Recognizing that along with the physical consequences of obesity, there are serious psychological and social consequences as well,

Recognizing also that healthy, well-nourished children are better able to learn,

Affirming that families, schools, and communities must all work together to resolve the problem of childhood obesity,

Acknowledging that approaches to obesity prevention and weight management must include the promotion of self esteem and body satisfaction, along with respect for individual and cultural differences,

Convinced that addressing the problem of childhood obesity will require ensuring that schools have adequate funding to support physical education, health, and nutrition programs,

Set forth the following recommendations to build on Building Infrastructure for Coordinated School Health: California's Blueprint:

1. Increase the quality and quantity of instruction in physical education to provide more physical activity and enhance student achievement of California's Physical Education Model Content Standards.
   
   
   1. Include physical education as core curriculum and treat physical activity as essential to all students' education and health.
   2. Maintain and enforce the required 200 minutes of physical education in kindergarten and grades one through five, with a recommended additional 100 minutes of physical education each 10 school days, exclusive of recesses and the lunch period.
   3. Maintain and enforce the required 400 minutes of physical education in grades six through twelve, with a recommended additional 100 minutes of physical education each 10 school days, exclusive of recesses and the lunch period.
   4. Do not grant exemptions to these minimum requirements to any school or class. However, individual student exemptions could be made based on documented medical or hardship reasons and for eleventh and twelfth grade students in approved athletic programs with daily physical activity of 40 minutes or more. (Repeal Education Code sections 51241[c][1] and 51242.)
   5. Ensure that at least 50 percent of physical education time is spent doing moderate to vigorous physical activity. Encourage and provide funds for physical education class size to be similar to core curriculum courses.
   6. Strongly encourage implementation of evidence-based programs and practices with demonstrated impact on physical activity.
   7. Provide funding for on-site instruction, evaluation, and ongoing support to implement evidence-based physical education programs and practices conducted by certified master physical education teachers.
   8. Strengthen mechanisms (e.g. coordinated compliance reviews and visits conducted as part of the Distinguished School Award Program) for monitoring and enforcing physical education requirements.
   9. Improve assessment and public reporting procedures for effectiveness of school-based physical education programs (report in School Accountability Report Card).
   10. Conduct periodic coordinated statewide monitoring of school-based physical education based on progress toward physical education content standards and physical activity programs, using the highest quality available measures to evaluate progress in providing more physical activity for California youth (FITNESSSGRAM).
   11. Provide monetary support to encourage schools to use school facilities and resources to provide opportunities for physical activity throughout the school day.
   12. Provide funding and encouragement for supervision and equipment for physical activity before and after school and after lunch (if lunch period is more than 30 minutes).
   13. Provide funding and encourage the use of safe school facilities as community wellness and activity centers available during non-school hours.
   14. Collaborate with physical activity-providing agencies for wellness center programs.
   15. Fund and encourage schools to provide, maintain, and remodel facilities needed to implement quality physical education and physical activity programs.
   16. Require that schools provide students in kindergarten and grades one through six with opportunities for physical activity breaks (recess) at least once per 120 minutes of instruction.
   17. When possible, build schools within neighborhoods for easy and safe access, and plan physically active modes of commuting.
       
       
2. Increase the quality and quantity of health education to promote healthful eating and physical activity.

   Build Health Education Infrastructure

   1. Enact legislation to create preschool and kindergarten through grade twelve health education standards by 2006.
   2. Obtain State Board of Education approval of health standards by 2007.
   3. Establish health education, including an emphasis on nutrition and physical activity, as a separate core curriculum topic based on the Health Framework for California Public Schools.
   4. Ensure that the health education curriculum follows the Health Framework for California Public Schools.
   5. Provide adequate and reliable funding sources for health education, emphasizing nutrition and physical activity.

   Build Health Education Program

   6. Provide adequate and reliable funding sources to ensure credentialed school nursing services at every school, with a goal of one school nurse for every school site or cluster of schools with a student population of 1,000 by the year 2014.
   7. Utilize school nurses, registered dietitians, and health education specialists to coordinate and help provide health education.
   8. Provide training in health, nutrition, and physical activity for parents, teachers, administrators, and other school staff.
   9. Train health education providers to use instructional strategies that affect student behavior (reference: Health Framework for California Public Schools).
   10. Foster collaboration between schools (including students, families, teachers, and staff) and the public, private, and nonprofit sectors to support health education, nutrition, and physical activity.
   11. Ensure consistency between health education in the classroom and the school environment.
   12. Provide students opportunities to practice learned behaviors in a variety of home, school, and community settings.
       
       
3. Ensure the availability and quality of healthy foods and beverages served and sold at and by schools.
   
   School Meals
   
   
   1. Provide additional funding for school districts to increase the availability and ensure the quality of school meals in order to reduce dependence on revenue from competitive food sales.
   2. Require professional education standards for food service directors/managers.
   3. Provide funding and adequate staffing for the California Department of Education to provide training and technical assistance to support school districts in meeting state and federal nutrition requirements.
   4. Eliminate, over a reasonable period of time, the marketing on campus of all foods/beverages that do not meet established nutritional standards.
   5.  Work with the Legislature and the State Allocation Board to identify and make available funds to establish and modernize school cafeterias, kitchen facilities, and other eating areas.
   6. Prohibit high fat, high sugar foods and beverages from (1) being sold or served on K-12 campuses outside the school meal program; or (2) being sold as fundraisers. Nutritional standards shall (1) be developmentally appropriate and based on a review of Senate Bill (SB) 19, SB 677, and federal and state guidelines; (2) be established and enforced by state statute and/or regulation; and (3) not apply to foods/beverages brought from home for personal consumption. This requirement should be phased in over a reasonable period of time. A committee should be established by the California Department of Education to develop strategies for implementing these recommendations.

1 Centers for Disease Control and Prevention. Obesity Still on the Rise, New Data Show . National Center of Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity. Accessed on February 23, 2004.

2 California Department of Education. California Physical Fitness Testing 2004: Report to the Governor and Legislature, Sacramento, CA 2003.

3 Krebs-Smith, Susan, et al. Fruit and vegetable intakes of children and adolescents in the United States. Archives of Pediatric and Adolescent Medicine 1996; 150: 81-6.

4 U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

5 Centers for Disease Control and Prevention. Preventing Obesity and Chronic Diseases Through Good Nutrition and Physical Activity .

6 California Department of Health Services, Strategies to Reduce Obesity and Overweight, 2004.

7 American Academy of Pediatrics, Prevention of Pediatric Overweight and Obesity, 2003.

8 Centers for Disease Control and Prevention, Guidelines for School Health Programs to Promote Lifelong Healthy Eating, 1997.

9 Centers for Disease Control and Prevention, Promoting Better Health for Young People through Physical Activity and Sports, 2000.