Is school PE really the answer to “childhood obesity?”

Virtually every person who was a fat child recalls the humiliation and torment of school gym class. For fat children who may not enjoy or excel at athletics, PE class is a place to learn that their bodies are inadequate; bodies that are already subject to bullying and merciless ridicule in and out of school.

But this is more than about simply anecdotes and haunting childhood memories. There is evidence deserving of attention of why PE class is a miserable experience for many children.

The body of evidence has been growing for years, documenting the especially intense negative feelings towards fat children held by PE teachers. The latest study was just published in the International Journal of Obesity. Led by Dr. Kerry S. O’Brien, Ph.D., at the Department of Women’s and Children’s Health at the University of Otago, New Zealand, “measures of implicit and explicit anti-fat prejudice were administered to university health professional students” and found that PE student teachers displayed higher levels of anti-fat bias than any other group of health professional. Associating obesity with being bad, lazy and stupid increased during their years of university study — the longer they were immersed in the PE environment and came to adopt ideological beliefs, according to the researchers. As the Sunday Telegraph reported: “PE teachers harbour a deep dislike of fat pupils.”

Now, before my skeptic friends think me completely daft, let me note that I approach studies based on the recently popularized Implicit Association Test (as this one was, in part) with trepidation and skepticism, as they do. Anyone with a lick of sense who has ever taken these tests can quickly figure out how to manipulate their scores, and interpreting the findings to come up with meaningful and scientifically valid conclusions is fraught with difficulties and controversy. The concerns surrounding these psychological tests, which are purported to measure our unconscious attitudes and stereotypes, were reviewed in an excellent article recently published in Science News. [You can also follow the links to take some IAT tests.] Still, the findings of this latest study are not unusual and, in fact, support the dominant body of evidence on this issue.

Its results are nearly identical, for example, to those found several years ago by researchers at the Cooper Institute in Dallas, Texas, examining bias among university exercise science majors. Using not just the Implicit Association Test, but also a series of questionnaires designed to measure attitudes towards fat people, they found strong negative bias towards fat people and beliefs that fatness was the result of being lazy. The greatest negative feelings towards fat people were found among Caucasian women.

Research looking at junior and senior high school teachers and school health care workers, led by Dianne Neumark-Sztainer, Ph.D., M.P.H., R.D. at the University of Minnesota, found that more than one in four teachers believed fat people were untidy and went so far as to admit they believed being fat was one of the worst things that could ever happen to a person.

These more recent findings continue to support the 1994 Report on Discrimination Due to Physical Size by the National Education Association, which stated that “for fat students, the school experience is one of ongoing prejudice, unnoticed discrimination, and almost constant harassment [and that] from nursery school through college, fat students experience ostracism, discouragement, and sometimes violence.” According to Sondra Solovay, Oakland, California attorney and author of Tipping the Scales of Justice: Fighting Weight-Based Discrimination: “Many fat kids exist on a diet of shame and self-hatred fed to them by their teachers.”

Using other measures, Dr. Jennifer O’Dea, M.P.H, Ph.D., from the University of Sydney in Australia, examined beliefs and attitudes about obesity among university students majoring in physical education and home economics and found “a great deal of misinformation being conveyed from teacher to students” with nearly 90% advocating unsound weight loss advice and demonstrating a lack of nutritional education about weight control, adolescent nutritional needs, eating disorders and fad diets. Nearly all of the teachers were “recommending strict calorie-controlled diets to their fat students, many of whom were in the middle of their adolescent growth spurt,” she said. Most concerning was the high prevalence of eating disorders and dangerous weight control methods among the teachers themselves, which included 19% who abused laxatives and 10% inducing vomiting. The potential for transference of the teacher’s own beliefs, attitudes and prejudice as well as the delivery of ill-informed health education messages had clear potential for harmful outcomes for students.

In an acclaimed article published in Health Education Research, Dr. O’Dea cautioned:

Child obesity prevention programs and untested health education messages have the potential to further stigmatize fat children and perpetuate the current prejudicial beliefs well-documented among physicians and likely to exist among other health and education professionals, that fat people are ‘weak-willed, ugly and awkward’ and ‘gluttonous, lazy, bad, weak, stupid, worthless and lacking in self control’.

Coercing unwilling, body conscious, overweight children into sport or physical activity is likely to exacerbate these problems and further reduce their participation in physical activity...Conversely, involving children in physical activities that they enjoy is likely to boost their self-esteem, social interactions and friendships, and promote the very important and evidence-based philosophy that fat children can be fit and healthy.

The implications of such fat prejudices for our children are enormous. The most popular intervention proposed in response to beliefs about an epidemic of childhood obesity is to mandate more physical education in schools...exposing them to more of the same. Not only is there no evidence to support the effectiveness of such measures, anyway — in fact, every single school-based intervention has proven unable to change childhood obesity rates or actual health outcomes among children or teenagers — but it is especially concerning that the very premise behind such interventions is virtually never questioned. Nor is it recognized that supporting evidence is often of terribly poor quality and controvertible.

Most mainstream journalists, researchers, academics and healthcare professionals work from the notion that only one point of view exists: today’s generation of children are fat because they are inactive and that dire health consequences await them unless something is urgently done. It is taken as a proven fact, beyond dispute, and in almost all articles, the claim is made as if it were so obvious and intuitively correct that no evidence is even needed.

According to Michael Gard, a physical and health educator at Charles Sturt University’s Bathurst campus, and co-author of The Obesity Epidemic:

[M]any teachers and student teachers see fighting the ‘war on obesity’ as physical education’s most important duty....many schools have adopted a variety of ‘anti-obesity’ programs and that these range from the innovative to the radical, and from the drastic to the downright dangerous. Perhaps more than anything else, what has struck me is the passion with which some educators have taken up obesity as a cause. In fact, it is this passion which has probably lead to some of the more dubious school programs.

...Amidst all this talk of ‘couch potatoes’ there is the unmistakable refrain of adults lamenting how the children of today are less physically active than in ‘their day.’ ...In fact, some members of the medical profession have gone as far as calling today’s children ‘Generation O.’‘O’ being for obesity...The image of a fat, lazy and physically feeble generation...There is more than a hint of disgust in these words; a sense that today’s children are not only fat, lazy and weak, but also stupid as they passively ‘soak up’ whatever television serves up. I have a great deal of trouble matching this image with the children I know, most of whom are busy, active, lively young people.

Noting that the significance of the obesity epidemic for PE is not at all a straightforward matter, Gard and others call for thinking carefully, beyond the sensationalism, because, surprisingly, alternative points of view really do exist:

[T]here now exists a body of research which questions the medical consequences of overweight and obesity...that body weight by itself has virtually no effect on people’s medical health except in cases of extreme obesity. There is also a quite mainstream body of scientific evidence to suggest that people who are slightly underweight may be at greater health risk than people who are overweight or moderately obese...Some researchers also make the widely acknowledged (though rarely publicised) observation that there is almost no evidence of any kind to show that losing weight is good for your life expectancy. In fact, they argue that there is evidence that dieting in order to lose weight can have significant negative health effects...

The belief that an entire generation of children, and that all fat children, are inactive betrays more than innate prejudice, but a lack of understanding of the nature of children’s physiology. It is not comfortable to be truly sedentary; virtually all people have a natural inclination to move their bodies, and especially children. They are, by nature, extremely active little creatures. Anyone who’s tried to keep a child sitting still for long will recognize the truth to this. It’s more amazing that when it comes to fat children so many don’t stop to think about this reality. Children are also not little adults and they are active in very different ways from adults, yet a surprising number of adults and professionals continue to measure children’s activities by their own concepts of what it means to be active. Most children’s activity does not come in structured and organized activities, “exercise” or sports with sustained durations (i.e. “60-90 minutes a day”). Kids accumulate a greater volume of activity in intense spurts followed by periods of rest.

It’s called play.

Walking and playing is still the main ways kids get exercise. And, despite popular notions of kids being shuttled around in cars and spending their days plopped in front of a screen, children’s play experiences and the amount of physical activity they derive from it and walking and biking, appear to have changed very little since the 1940s. For example, research led by Colin Pooley, Ph.D. at Lancaster University in England, for the Economic & Social Research Council, followed over 895,000 individual trips and collected 160 hours of taped interviews and data among four age groups of children and found that walking still accounted for about two-thirds of their means of transport and that their actual movements and play activities had changed very little in the past 60 years, despite greater affluence, media and car ownership.

In examining the quality of the evidence claiming less physical activity among children, one of the most egregious errors is found, for example, in reports acknowledging that in the U.S. and England there has been a decline in calories consumed among teens and children since the 1930s but which go on to conclude — without any real measures at all — that since body weights haven’t concurrently reduced that it “must be” because of reduced energy expenditure. Another common problem in studies is to find an association between a certain group of fat children and less involvement in some sort of physical activity and then to reverse causation. Noting reduced participation or time spent in school athletics or physical education classes, even the American Heart Association cautioned, does not translate into significant differences in daily energy expenditures among children, fat or lean. Children have never gotten most of their physical activity in school and in the average gym class kids are aerobically active for an average of 3 1/2 minutes — a statistic that hasn’t changed in decades.

Data from the Youth Risk Behavioral Surveillance System of the U.S. Centers for Disease Control and Prevention, and a review of some of the available evidence were discussed in a recent post, Telly Tubby Myths. While early data going back beyond recent decades is sparse, a review of the evidence for children’s physical activity in the U.S. and internationally, conducted by Adelaide, Australian researchers and published in a recent issue of the British Journal of Sports Medicine, concluded that overall, the data does not support the view that today’s generation of young people is less active. Population survey data mostly shows little, if any, change for decades. But trend data also suggests dramatic increases since the 1960s in extracurricular sports and physical activities, according to a recent review in the Annual Review of Public Health by researchers at the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis. The most recent Child Trends Data from the U.S. Department of Education, National Center for Education Statistics, reported that although socioeconomic disparities were evident, between 2001 and 2005, the percentage of students participating in after-school sports has increased to the highest levels ever, with 31% of K through 8th graders participating in one or more regular activities at least once a week.

But if children were truly less active today, then their physical fitness would reflect that. Here again, despite popular beliefs, a review of U.S. studies examining actual peak oxygen consumption measurements indicated that there has been little change in absolute and relative peak V-O2 levels in children from the 1930s through the 1990s. The only notable decrease, in recent decades, was among teenage girls; a group shown to be increasingly more body consciousness and engaging in dieting behaviors. As Dr. O’Dea wrote, studies of teenagers have clearly identified body consciousness and weight concerns as major barriers to participation in sports and physical activities.

As Gard cautioned, midst all of the talk about childhood obesity, there has not been enough careful thinking.

There are already more than enough people ready to demonise today’s children as ‘couch potatoes’ without any evidence to substantiate their opinions. As teachers, I am inclined to argue that we have a special duty to be careful in what we think and say about children and that little will be gained by adding our voices to the chorus of insults directed at children. We should be well informed, skeptical of generalizations and open to a variety of perspectives. But at the same time, I believe we should at least be suspicious when interest groups outside the teaching profession assume the right to tell us how we should teach and what our roles as teachers should be.

...remind those who enthusiastically sign up to the ‘war on obesity’ that many young people generally do not like repetitive, overly strenuous and excessively competitive physical activity. If children get a whiff that they are being made to do physical activity because it is ‘good for them’ or because they are being punished for being part of a ‘couch potato’ generation, it may not seem quite as much fun as it would otherwise have been....children’s physical education will begin to look more and more like the physical activity that weight-obsessed adults do, such as aerobics classes, circuits and laps around the oval.

Sucking the fun out of activity was exactly the concerns written by one parent about the PE her daughter was experiencing in school. Her LiveJournal post is worth reading in its entirety. It offers the human side of the science that may be helpful for PE teachers, school administrators, legislators and healthcare professionals who are quick to support physical education as a means to address obesity. Here is just part of what she writes:

Riding a bike is fun. Taking a walk is enjoyable. Playing tag, kick the can, kickball, 4-square — it's all a blast. Playing tennis, golf, lacrosse, basketball, volleyball — so much fun! Skating is fun. Swimming is fun. There are so many activities, games and sports that are fun, fun, fun! that we all could be having a great time every day. Except that somewhere along the line, for some reason, many of these things stop being fun. And I'm not just talking about they stop being fun because people get old and creaky and it gets difficult and even painful to participate. I'm talking about they stop being fun even for kids! Because somehow the fun is being sucked out of games, sports and activities — and what was once a natural source of enjoyment for all of us has become unappealing, work, un-fun.

The fun-suckers have ruined gym class (which should be every kid's favorite class and loads of fun!) ... I can tell you (at least in my community) exactly when gym class stops being fun. It is when children go to middle school. In elementary school, we had the BEST gym teacher in the world. She played games with the children, laughed, ran, danced — activity was boisterous and exhilarating — and the teacher had a ready smile for the children and the whole focus of the class was having fun. While having fun, the kids got lots of exercise — because, you know what? Exercise is inherently fun. You have to purposely and cruelly mess with exercise to make it not fun. Which is what happens when you go to middle school. Then the focus turns from fun to "fitness" — and the teachers are no longer kind or fun at all. They bark orders. They teach "skills." They act like they expect the children would rather not be there — like they don't expect the kids to have fun, but to be miserable — and guess what? That is exactly what they create.... They teach the kids how to take their pulse and time their running and measure their exercise — and the carefree, laughing, enjoyable days of gym class are over. In fact, with my daughter, gym went from being her favorite class to her least favorite and most dreaded class in the blink of an eye....

It seems to me that teaching children enjoyable activities and games, laughing and having fun with them — creating in them a lifelong desire to play and enjoy being active would be the priority....Dance, run, play! And it could be like that their entire lives. But it's not. The fun gets sucked away and children start avoiding things that it is natural to love. Children love to pick up a rope and jump ... until somebody starts counting the jumps or the minutes and equates it with "exercise" or even worse, "weight control" — and it stops being fun....There has got to be a way that we can stop sucking the fun out of physical activity — and stop the emotional, psychological and physical damage that we are doing to millions of children each year....We need to stop piling humiliation, "fitness," weight obsession, and all of the other crap on top of the natural joy of playing and moving — and stop sucking the fun out of being active!

Sadly, that’s not likely to happen if year after year, the evidence that counters popular beliefs about "fat, slovenly children" continues to be ignored, while the prejudices that condemn and ridicule, medicalize, and work to “shape up” an entire generation of lovely, healthy and once happy children are allowed to continue.

© 2007 Sandy Szwarc. All rights reserved.