Whipping kids into shape

In the fight against childhood obesity, Texas legislators have proposed spending between $5 and $8 million to require schools to measure kids’ fitness. The legislation happens to precisely describe a tool, at a cost of $230 per child, developed by a vendor who could receive $30 from the sale of each tool, the Star Telegraph reported:

Legislature looks at curbing child obesity

Many Texas students are too fat, experts say, and face future health problems because of their poor fitness. This week, the Legislature may weigh whether a new annual fitness test can help whip them into better shape. Fitness guru Dr. Kenneth Cooper of Dallas teamed up with Sen. Jane Nelson, R-Lewisville, to author legislation that would require schools to monitor students' health to prevent childhood obesity....

According to the bill, students in kindergarten through fifth grade must have “moderate or vigorous" activity for 30 minutes each day. Students in grades six, seven and eight must have physical activity 30 minutes a day for four semesters. Additionally, schools must annually assess the physical fitness of students in grades three through eight. Under the legislation, the Texas Education Agency would be asked to adopt a testing tool that measures aerobic capacity, body composition, muscular strength, endurance and flexibility.

According to the bill, the TEA must also analyze the data for a correlation between physical fitness and academic achievement, attendance, disciplinary problems and obesity....

The wording in the bill that describes the required testing tool mirrors language on the Web site for Cooper's FitnessGram, developed in 1982 to measure health and fitness levels of children.... The FitnessGram would cost about $230 for each child when purchased from its distributor, Human Kinetics. The nonprofit Cooper Institute receives $30 from each sale.

What this proposed legislation will actually cost is unclear. According to the Susan Coombs Texas Comptroller of Public Records website, the legislation is actually verbatim from an April 2007 report from the Cooper Institute, titled “Texas Youth Fitness Evaluation Project.” It states that there are 4.2 million kids in grades K-12 in over 8,000 Texas schools. If the $230 per child price cited in the Star Telegraph is correct, this project would cost considerably more than $8 million. It’s also unclear if these expenses include the software (at $250-1500 apiece), the costs of staff training, and costs to administer, score, analyze, and report results. The article also doesn’t mention the costs of responding to the FitnessGram scores when they measure large numbers of children as “underfit.” The Cooper report says that after California evaluated its students using their FitnessGram, only 25% passed all of the FitnessGram tests and the state was “doing something about it” and increased the state budget in 2006 to $40 million for gym teachers and $500 million for fitness supplies and PE teachers training.

Expenses aside, educators worry that classroom hours for fitness will take away from other academic subjects and electives, according to the newspaper:

Richard Floyd, executive director of the Texas Music Educators Association said...classes like foreign language, career and technology courses, and fine arts are suffering. Floyd added that while studies show a correlation between physical activity and improved academics, there are studies showing the same correlation with music education. “I haven't found one district that doesn't have some kind of requirement for physical activity in middle school," Floyd said. “We don't even mandate, in law, how much time they spend on math or English. School districts will determine what's best based on the needs of their students."

Parents of naturally heavier children may be shuddering that this is another way to target their kids for BMI measures in the name of fitness. The mandate to collect data to find correlations between obesity, fitness, academic achievement and disciplinary problems also seems little more than a hunting expedition to find more “proof” of fault with their children.

While it may seem intuitive to the legislators to equate fitness scores with children’s “obesity,” it appears they haven’t read the research which doesn’t support such popular assumptions.

Researchers at Harvard School of Public Health in Boston, MA, recently used the FitnessGram to learn if there was a relationship between overweight among schoolchildren and their level of physical fitness. Examining the scores for 6,297 kindergarten through eighth grade children in 15 public schools, through the Cambridge Public School Health Surveillance System, they did not find fitness scores to be predictive of overweight.

About 68% of all of the kids were “underfit,” according to the FitnessGram — defined as failing at least one of the five tests — yet only 17.5% and 19.8% of the girls and boys, respectively, were classified as “overweight.” Clearly, “underfit” kids were both fat and thin. Without adjusting for contributing factors, heavier kids didn’t do as well on upper body strength measures or endurance runs. Still, after controlling for baseline BMIs, an association between fitness scores and incidences of overweight was insignificant. Only one test (the endurance run) among girls had a notably higher odds ratio for overweight — at 96%, an untenable correlation. But the most glaring problem with the fitness scoring, noted these researchers, was that it didn’t take into consideration maturation, and fitness naturally varies by degree of maturation in children. Kids who mature earlier are naturally heavier and, especially girls, will score lower on certain tests. Interestingly, the heaviest girls in this study had higher odds for scoring well on abdominal strength. Another surprising finding was that the overweight kids scored better on flexibility than even the underweight kids.

The bottom line was that the researchers were not able to clearly establish a direction between fitness and overweight. Meaning, the slightly lower levels of athleticism among heavier children didn’t necessarily point to that as being the cause for their size, nor that trying to turn them into better athletes will make them slimmer.

There is no credible evidence that the levels of physical activity and fitness among fat children are less than thinner kids to explain their diversity in sizes. There is no credible evidence that school or after-school physical activity programs reduce obesity among children. The medical evidence long ago demonstrated that heredity and genes account for aerobic capacity, upper body strength and athletic prowess. Researchers have also found that different children have different physical aptitudes, just like academic and artistic abilities. Research, for example, in the journal of the North Association for the Study of Obesity, Obesity Research, found that “obese” and nonobese school kids had similar levels of physical activity, while nonobese boys engaged in more sports. The fat children did poorer on propulsion tasks, but showed greater grip strength and similar scores with the other kids on overall fitness.

Whether government and school officials will concern themselves with the facts is yet to be seen, but parents may find it helpful to know, when they receive a FitnessGram report on their child, that it also appears the FitnessGram may overrate more children as “underfit,” compared to other measures of fitness. For example, the study published last fall, led by Dr. Russell R. Pate, a researcher at the University of South Carolina’s Arnold School of Public Health, and colleagues from the Centers for Centers for Disease Control and Prevention and The Cooper Institute assessed the physical fitness of 3,287 kids aged 12 to 19 in the National Health and Nutrition Examination Survey between 1999 and 2002. It included clinical measures of their cardiovascular fitness on treadmill exercise tests and measures of blood pressure, heart rate and rate of perceived exertion, and estimated maximal oxygen uptake (the amount of oxygen consumed by the body during maximum exertion). While they found lower fitness levels among the largest teens and among girls compared to the boys, overall they found one-third of the kids didn’t meet government fitness standards — half the numbers identified using the FitnessGram in the Massachusetts children and even fewer than among the California children.

While fitness tests are unlikely to trim children, there is every indication they'll likely plump up some budgets.