School obesity programs may promote worrisome eating behaviors and physical activity in kids

January 24, 2012 Volume 14 Issue 2
  • 82% of parents report at least one school-based intervention aimed at preventing childhood obesity within their children’s schools.
  • 30% of parents of children age 6-14 report worrisome eating behaviors and physical activity in their children.
  • 7% of parents say that their children have been made to feel bad at school about what or how much they were eating.

In recent years, childhood obesity has consistently ranked among the top concerns that parents and the public have regarding the health of children in the U.S. There have been a variety of prevention efforts, many of them school-based, aimed at childhood nutrition and obesity.

Meanwhile, there has also been a steady increase in the prevalence of eating disorders, especially among children and pre-teens. Reasons for this increase are not clear, but there is concern that interventions to prevent obesity—however well-intentioned—may play a role.

In September 2011, the C.S. Mott Children’s Hospital National Poll on Children’s Health asked parents about obesity prevention programs in their children’s schools and about food-related behaviors and physical activity that may be worrisome.

School-Based Interventions

Parents of children age 6 to 14 report a variety of interventions aimed at obesity prevention at their children’s schools:

  • 37% say height/weight measurements are taken at school
  • 40% report incentives for children to increase physical activity
  • 42% say there is nutrition education in school
  • 59% say there are limits on sweets or “junk food” in the classroom

Overall, 82% of parents report at least one of these obesity prevention programs in their children’s schools.In addition, 7% of parents say that their children have been made to feel bad at school about what or how much they were eating.  

Worrisome Behaviors

Overall, 30% of parents report at least one worrisome behavior in their children that could be associated with the development of eating disorders (Figure 1).

School programs that provide incentives for children to increase physical activity are associated with an increase in parents’ reporting their children have too much physical activity. Parents that report incentive programs at their children’s school are more likely to say their children are “too physically active” (11%) compared with parents who do not report incentives for physical activity at their child’s school (4%). Otherwise, we did not find school-based obesity-prevention programs to be associated with the other worrisome eating and physical activity behaviors among children that parents reported.

Potentially Worrisome Behaviors

Parents’ report of other behaviors in their children that are potentially worrisome for the development of eating disorders were also quite common.  These include:

  • Worried about weight, 17%
  • Worried about body image or shape, 16%
  • Avoiding sweets or junk food, 10%
  • Sudden interest in vegetarianism, 3%

There was no association between school-based programs and these ‘potentially worrisome’ behaviors.

Implications 

Given the lifelong health risks that result from childhood obesity, school-based obesity prevention initiatives make good sense. At the same time, the rising prevalence of eating disorders—and the trend of seeing these disorders more often among younger children—raises concerns that some obesity prevention initiatives may inadvertently promote an unhealthy anxiety about eating or weight among certain children.

The level of worrisome eating and activity behaviors in this Poll (nearly 1 of every 3 households with kids) underscores how important it is for parents to be aware of and discuss nutrition messages presented to their children. Parents should also be alert to sudden changes in their children’s eating behaviors, and to the possibility of food- or weight-related teasing or bullying.

In this study, we found only one worrisome weight-related behavior to be associated with school-based nutrition interventions:  Where there were school-based incentives for physical activity, more parents reported their kids to be “too physically active.”  Our study was not designed to quantify the actual level of physical activity nor to understand what aspects of “too much” activity parents found most worrisome.

Overall, further study is required to determine whether school nutrition interventions are associated with an increased risk of disordered eating in school-age children.  Nevertheless, the twin dilemmas of obesity and eating disorders will continue to challenge parents, schools, and healthcare providers to present a carefully balanced view of healthy eating behaviors and physical activity.

Data Source

This report presents findings from a nationally representative household survey conducted exclusively by Knowledge Networks, Inc. (KN), for C.S. Mott Children’s Hospital via a method used in many published studies.  The survey was administered in September 2011 to a randomly selected, stratified group of parents age 18 and older (n=976) with a child age 6-14 from the KN standing panel that closely resembles the U.S. population.  The sample was subsequently weighted to reflect population figures from the Census Bureau.  The survey completion rate was 58% among parent panel members contacted to participate.  The margin of error is ± 1 to 5 percentage points.

Director: Matthew M. Davis, MD, MAPP
Faculty Collaborators: David Rosen, MD, MPH & Jennifer Christner, MD
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Amy T. Butchart, MPH
Web Editor: Anna Daly Kauffman, BA

Findings from the C.S. Mott Children's Hospital National Poll on Children's Health do not represent the opinions of the investigators or the opinions of the University of Michigan.  The University of Michigan reserves all rights over this material.

[Parent of children age 6 to 14]
This next set of questions is about physical activity and eating. Please answer questions for each child between the age of 6 and 14.

Q1.  Please describe your child[ren]’s current level of physical activity.
(Select one response for each child.)

  Not enough About right Too much
Your [x]-year-old      
Your [y]-year-old      
Your [z]-year-old      

Q2. Have you observed any of the following changes in your child[ren]’s eating behavior over the past year?  (Select all that apply.)
 

  Avoids sweets or junk food Excessive worry about fat in food Sudden interest in vegetarianism Inappropriate dieting Have NOT observed any of these
Your [x]-year-old          
Your [y]-year-old          
Your [z]-year-old          

Q3. Have you observed any of the following changes in your child[ren]’s behavior over the past year?  (Select all that apply.)

  Preoccupied with food content or labels Worried about weight Refusing family meals (wants different food) Worried about body size or shape Have NOT observed any of these
Your [x]-year-old          
Your[y[-year-old          
Your [z]-year-old          

Q4.  Has/Have your child[ren] had any formal or structured nutrition education at school?
(Select one response for each child.)

  Yes No Unsure
Your [x]-year-old      
Your [y]-year-old      
Your [z]-year-old      

Q5.    Are there programs at your child[ren]’s school related to the following:
(Select one response for each program.)

  Measurement of height and weight at school Incentives for physical activity Limits on sweets or junk food in the classroom
Your [x]-year-old Yes/No/Don't Know Yes/No/Don't Know Yes/No/Don't Know
Your [y]-year-old Yes/No/Don't Know Yes/No/Don't Know Yes/No/Don't Know
Your [z]-year-old Yes/No/Don't Know Yes/No/Don't Know Yes/No/Don't Know

Q6.  Has/Have your child[ren] been made to feel bad about what or how much they are eating at school?
(Select all that apply.)

  Yes, by a teacher Yes, by another parent or other adult Yes, by another student or peer Yes, because of a school program or policy No Don't Know
Your [x]-year-old            
Your [y]-year-old            
Your [z]-year-old            

Participants were also asked demographic questions on gender, race/ethnicity, annual household income, education and insurance status.

All information is the sole property of the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health.  It can only be used if there is an acknowledgment that "The information came from, is copyright by and is owned by and belongs to the Regents of the University of Michigan and their C.S. Mott Children's Hospital National Poll on Children's Health. It cannot be republished or used in any format without prior written permission from the University."
 

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Faculty Collaborators: David Rosen, MD, MPH and Jennifer Christner, MD
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Amy T. Butchart, MPH
Web Editor: Anna Daly Kauffman, BA

Click on an image to download the full-size version

Parent report of worrisome behaviors in children age 6-14