Combatting Obesity: After-School Programs Promote Healthy Eating and Physical Activity

Robert Hill knows firsthand what it’s like to be an overweight child. “I grew up hating physical activity and only eating foods that tasted good to me,” he said. With no one to guide him about healthy food choices, Hill became morbidly obese by the time he was a teenager. Like many overweight young people, he was shunned by his classmates and bullied.

Hill is now healthy and fit, having had gastric bypass surgery when he was 19. But his early experiences have stayed with him, informing the way he works to prevent childhood obesity today. In his current job as the director of youth wellness programs at the YMCA of South Florida, Hill incorporates exercise and good nutrition standards into after-school and summer programs.

“There was a girl, 8 years old, named Marie. She was obese and had just been diagnosed as pre-diabetic,” recalled Hill. Marie’s mother was desperate for solutions, so Hill helped her enrolled in an exercise and nutrition program called YFit. Weight is never measured in Hill’s programs, but Marie’s mother reported that her daughter quickly made progress. “She lost two pounds in a week, just getting the recommended 60 minutes of physical activity every day,” said Hill.

A national epidemic

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A 30-year trend in rising rates of childhood obesity in the United States shows no signs of slowing. One in three children aged 2 to 19 in the U.S. is currently overweight, and 17 percent are obese, according to findings published in May in the journal Obesity.  The study, led by researchers from Duke University, found little to applaud in the data: “There is no evidence of a decline in obesity prevalence in any age group, despite substantial clinical and policy efforts targeting the issue,” concluded the researchers.

The Duke study noted that the biggest, and perhaps most discouraging, increase occurred in the rate of what is classified as “severe obesity” — children who have a body mass index of 35 or more. The Duke team called for urgent action on a population-wide basis to stem the advance of obesity during childhood, noting that it is associated with “worse health and shortened lifespans as adults.”

OST commits to healthy living

In the past decade, leading youth development agencies such as the YMCA and the Boys & Girls Clubs of America have heeded the call, making obesity prevention a priority.

“As one of the largest youth-serving organizations in the country and a leading community-based network committed to improving the nation’s health, the Y is determined to play a significant role in reducing childhood obesity,” said Kevin Washington, president and CEO of YMCA of the USA.

Many after-school programs are joining the cause. “Because childhood obesity has become a national epidemic, we must find ways to fight it across all childcare settings,” said Tierney Lloyd, director of health and wellness initiatives at the Afterschool Alliance, a Washington, D.C.-based advocacy group.

According to the Alliance, more than 10 million kids in the U.S. take part in after-school programs, where they are a “captive audience” for anti-obesity messages. “Children may be in OST programs for 15 or more hours per week during the school year and sometimes all day during the summer,” said Lloyd, “so OST providers are uniquely positioned to be an important part of childhood obesity solutions.”

In 2011 the National AfterSchool Association adopted science-based standards (see Sidebar) for what is known as HEPA — Healthy Eating and Physical Activity — to promote the best obesity prevention outcomes for K-12 children.

For the first time, said LLoyd, HEPA standards are mentioned in the 21st Century Community Learning Centers (21st CCLC) program guidance, which covers about one in 10 mostly rural and inner-city OST programs. Under the 2015 Elementary & Secondary Education Act, CCLC programs are now allowed to use their federal funds to support a healthy and active lifestyle programming, including nutrition education and structured physical activity programs.

Some form of the HEPA standards have since been included in the OST guidelines of about half the states, but Lloyd estimates that only about 10 percent of the nation’s programs have adopted the standards. The HEPA standards restrict the types of foods provided in after-school programs, limit children’s screen time and promote at least 30 minutes of moderate to vigorous physical activity each day.

Healthy snacks & drinks

In programs that have taken the pledge, gone are the sugary fruit cups, chocolate milk, and fried foods that were popular after-school snacks a few decades ago. “We would get tater tots and mini corndog nuggets,” recalled Hill. “Now we make sure that any grain we offer is whole-grain and milk is 1 percent or nonfat. We always make sure there is fruit or a vegetable, and instead of 5 percent juice, you would get an orange,” he said.

Also gone are the hated dodgeball games that traumatized many a child in the name of physical fitness. Hill said that instead of relying on games that target the least athletic kids, he creates programs that involve everyone having fun while they are being active.

“We focus on achievement, not competition” said Hill. “Children can learn to run, throw a ball, catch and move in different patterns. They are able to establish a sense of belonging and build relationships” — all while getting fit, he said. He has also charted progress in their flexibility, speed in a one-mile run, and how many pushups or crunches they can do.

According to Hill, since the games are enjoyable, the kids are more likely to incorporate physical activity into other parts of their lives. “When we give surveys to parents and ask if their kids continue to play [outside of the program], the answer is always yes,” said Hill.

Parents seem to have noticed the changes in the after-school curriculum nationwide, and there’s evidence that they approve. According to the Afterschool Alliance’s “America After 3PM” report, more than 70 percent of parents were satisfied that their children’s after-school programs were offering healthy snacks and beverages.

Low-income, African-American and Hispanic parents were especially likely to agree that after-school programs have a responsibility to provide good food choices for their kids. More than two-thirds of parents surveyed also reported that their child gets at least 30 minutes of physical activity per day.
Studies of the effects of after-school obesity prevention programs show they can have an effect, although it’s not easy holding on to the benefits. A 2011 study of elementary-school children in the southeastern U.S. found that adding 80 minutes per day of physical activity each school day reduced the children’s percentage of body fat and raised their cardiovascular fitness.  The only problem? The benefits were lost during the summer.

Standards for healthy eating & physical activity in OST

In 2011, the National AfterSchool Association adopted standards for healthy eating and physical activity (HEPA) in out-of-school time.

Far from simply outlawing candy or soda, the standards comprise a comprehensive approach to instilling lifelong healthy habits by addressing everything from staff modeling and curriculum to social supports. Among the best practices outlined in the guidelines:

• Programs will not serve fried, sweetened or salty foods, or those containing trans fat; no posters or advertisements promoting unhealthy foods are allowed.
• Food is not used as a reward or a punishment; holiday and birthday celebrations do not include unhealthy foods.
• Staff are trained in good nutrition; they eat the daily program snack or meal with the children and discuss the benefits of healthy food choices.
• Parents are educated about healthy eating and receive guidelines about good food choices their kids may bring to the program; they are encouraged to support healthy eating habits at home.
• Programs do not allow access to movies or television, and limit digital devices to those used for homework, used less than one hour per day.
• Programs spend at least 20 percent of their time (typically 30 to 60 minutes) in moderate to vigorous physical activity, outdoors whenever possible, including aerobic, bone- and muscle-strengthening exercises.
  

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California’s national model

Now, in an effort that could become a legislative model, California has launched a recognition program called DASH (Distinguished After School Health) to encourage the state’s 4,400 publicly funded OST programs to voluntarily adopt HEPA standards. Applications have been reviewed by the California Department of Education (CDE), and certifications will be issued this summer.

More than 200 schools applied for recognition, according to assistant communications director Robert Oakes. “As far as CDE can determine, if this is not the first such program nationally, it’s certainly a pioneering effort,” said Oakes.

DASH is the result of legislation authored by Sen. Hannah-Beth Jackson, who said “good eating and exercise habits, when established early, help prevent childhood obesity and make a difference in a child’s health.” Besides recognizing programs that are taking “that extra step,” DASH will also inform parents about local afterschool programs so they can make the most informed choices about where to enroll their kids.

The California Alliance of YMCAs participated on the advisory committee to finetune the DASH program. Kris Levi-Twombly, executive director of the Alliance, said while it is built around the HEPA standards, the new state program is more accessible and creates a pathway for after-school programs to ease into HEPA. “It meets programs where they are,” he said. “DASH is incentive-based and, given the financial constraints that after-school programs are facing right now, this is something that is within reach.”

DASH certification is new for the Y, according to Levi-Twombly. Not all of the state’s 33 associations applied for recognition, but he believes in time they will, driven by the fact that in California, one out of three children is now obese or overweight.

“We really have a public health crisis on our hands,” said Levi-Twombly.

By Elaine Korry
Photos courtesy of YMCA of South Florida