Is Obesity an Educational Issue?

Antonella Dagostino The Open University

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EDUCATIONAL ENQUIRY E891 End of Course Assessment (ECA) IS OBESITY AN EDUCATIONAL ISSUE?

Focus and Rationale Traditionally, child obesity has always been identified as a health issue, however recent studies have shown that there is a strong link between educational outcomes and health. The focus of this paper is to highlight two aspects of child obesity which are strongly related to educational issues. The first refers to schools responsibility in promoting healthy eating habits in children and adolescents. The second, which could be considered as a consequence to the first, concerns a statistical analysis illustrating that healthier children appear to perform better at school and have less social and behavioural problems compared to their overweight peers. While there is a vast selection of literature available about child obesity mainly coming from health-related studies, finding articles whose focus revealed a strong connection with education has been a rather challenging task. For this reason, I have decided to restrict my review to articles whose claims seemed to be relevant to support the idea that obesity is indeed an educational issue. Teaching nutrition as a school subject is not, per se, sufficient to tackle child obesity; a problem which has reached alarming proportions worldwide (Jenvey, 2007). It is necessary to carefully monitor the food which schools have provided through cafeterias, canteens and so on, to ensure that the department of Education proactively contributes to putting a cap on the disastrous consequences of child obesity which include poor school performance as well as social behavioural problems. Reviewing Process Methodology The present review has been approached from an interpretive perspective as it seemed the most appropriate choice “to reveal something surprising, startling, or new...” (Eisenhart, 1998). In fact, as Swandht (1998), eloquently explains while discussing in favour of the interpretive review “...education is interpretation, it involves self-understanding and its purpose is to make us more human”. As a matter of fact, the aim of this review is to interpret data which are normally associated to health issues and attempt to prove, its intrinsic value in the field of education. For this reason, other types of reviews have been discarded as unfit for the purpose. Articles Selection Process & Rationale After having read a good deal of literature related to child obesity, my tutor pointed out to me that perhaps the subject I was interested in was more related to a health issue rather than an educational one. All of a sudden, I realised that what was missing in my search was the connection between the two fields. I then switched my focus towards some articles which could bridge the gap between health and education in child obesity. The first article that grasped my attention was Nutrition education: towards a whole-school approach (Rowe et


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all, 2010). While reading the abstract, I came across a sentence which reported exactly what I wanted to demonstrate: “The study also illustrates the centrality of educational leadership in the school context, even in an area typically identified as a ‘health’ issue” (p.197). The second article was selected based on its inherent relevance to education: Association of Overweight With Academic Performance and Social and Behavioral Problems: An Update From the Early Childhood Longitudinal Study (Judge and Nahns, 2007). From an interpretive point of view, what has emerged from these articles is that it is fundamental to involve both students and school staff to prevent child obesity which, if ignored, has serious consequences in terms of performance and social and behavioural problems at school. In brief, both articles identified child obesity as an educational issue and not just as a health one. IS OBESITY AN EDUCATIONAL ISSUE?

An Interpretive review According to a recent systematic review conducted in England on the relationship between childhood obesity and educational attainment, the most important implication which emerged from the study was that “...obesity should not be understood solely as a health issue” (Caird et all, p.14, 2011). The question we should ask ourselves arises spontaneously: Should we consider obesity as an educational issue? Absolutely yes! To support this claim, the following is a review of two articles from an interpretive point of view which have been selected based on their inherent relevance to the field of education. The case study presented in the first article titled Nutrition education: towards a whole-school approach (Rowe et al., 2010), is an extract from a broader research that assessed “Western Gateway Health Promoting Schools Grant Scheme” whose aim is to promote health in the school environment by applying a Health Promoting School (HPS) approach. The study was sponsored by Queensland Health, a public health agency in Australia which provided financial support to ten school communities for a period of three years. The school selected for the study was chosen because of the actualisation of a “Kids Café” where students were able to prepare, serve and sell nutritious food to other students (p.199). The study was undertaken in a relatively small primary school of about 230 students and staff (p.205). The most important fact which emerged from this research was that the “Kids Café” became so successful in selling nutritious meal deal items for AU$ 2,00 each that it forced the school tuck shop to eventually introduce a similar menu as it was starting to lose profits (p.202). It should be noted that the Kids Café was part of the curriculum hence students were in charge of promoting the menu, gathering orders, preparing and serving the food as well as doing the cleaning up chores. The Kids Café had an “internal champion” identified as a senior teacher who followed its implementation throughout its development stages. This person demonstrated that it was possible to include HPS activities in the curriculum because they could contribute to learning outcomes (p. 203). The meaning of learning outcomes here is intended in its broader sense. In fact, if we think of educational outcomes in terms of test results and grades, it may be hard to fully understand the type of skills that a whole-school approach is likely to provide. As mentioned earlier, teaching nutrition as a school subject may not be


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sufficient to promote healthy eating habits in children and adolescents. As a matter of fact, as reported in the case study, the implementation of a Kids Café provided students with the opportunity to have a concrete experience in dealing with their own food choice. The learning outcomes which are expected to be achieved in this case can be identified, for instance, as becoming responsible, developing organisational skills, cooperating with peers and gaining self-respect. Such skills are not commonly assessed in standard school tests and this could explain why so far, obesity has been considered as a mere health issue. As a consequence, to demonstrate that obesity is indeed an educational issue even in its traditional sense, some researchers have attempted to prove its relationship to educational outcomes beyond any doubts. The second article, Association of Overweight With Academic Performance and Social and Behavioural Problems: Un Update From the Early Childhood Longitudinal Study (Judge and Jahns, 2007), is a statistical study on a sample of 13,680 third grade children designed and performed by the US Department of Education. According to the study, math and reading test scores achieved by overweight children were significantly lower than non-overweight children (p.672). It should be noted though, that after introducing variables such as socioeconomics, for instance, only overweight girls appeared to confirm similar results while differences among boys became insignificant. However, even if obesity may not be proven to be strictly related to poor educational attainment, there are still fundamental negative socio-behavioural aspects which are connected to child obesity. According to the article, overweight children are potentially more likely to become victims of bullying behaviours as well as experiencing social isolation and stigmatisation compared to their normal-weight peers (p.673). In addition, the study illustrated that overweight children were more likely to have mothers with less than a high school diploma (p.675). In this case too we can assume that education does matter when discussing child obesity. In the conclusion, the authors point out that the way educators deal with children’s overweight in school may have implications for the educational consequences of a significant proportion of children (p.677). Why is the school crucial in dealing with child obesity? As illustrated in a recent study about obesity prevention in schools, Bucher Della Torre et al. concluded that school participants unanimously agreed that schools are a crucial environment to carry out child obesity prevention strategies (p.233, 2010). The study was based on the responses of school stakeholders such as school staff members, adolescent students and their parents. It appears rather plausible to think that nobody, children included, wants to be obese. Adopting a whole-school approach as suggested earlier in this paper, is not only a good idea but rather a necessity. As Lee et al., emphasise, the school is an ideal environment for the promotion of health for the purpose of relieving the increasing burdens caused by unhealthy lifestyles (p.49, 2010). In the first article selected for this review, there is a reference to some activities which are suggested to improve availability, affordability and accessibility of nutritious food in the school settings (p.205). Such initiatives are likely to be linked to school curricula, in particular, the authors refer to school-based food gardens which, according to McAleese and Rankin (2007) have demonstrated to improve children eating habits. Making connections between the curriculum and learning imperatives in the school settings is at the core of a


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socio-ecological, whole-school approach, as highlighted in the case of the primary school in Queensland (p.206). From what we have read so far, it can easily be assumed that the function of schools should not be confined to just teaching a series of instructions out of their contexts. To maximize learning outcomes, it is necessary to link theoretical learning with practical skills such as those developed by the children involved in the implementation of the Kids Café. In general, people think that obesity is associated to countries whose local culinary culture may not be particularly popular (i.e.: the U.K.). However, recent studies have shown that obesity is becoming a serious problem even in countries such as Italy and China. In a survey published in Italy by the International Association for the Study of Obesity (www.iaso.org/) between 2001-2002, it resulted that the percentage of children considered overweight or obese has reached an alarming proportion: 32.4% for boys and 30.9% for girls. Such figures should help us comprehend to which extent the cost of obesity weighs on governments’ budgets. Just to mention an example, an estimate indicated that the direct and indirect cost of obesity in the US in 2003 was about $139 billion (Finkelstein et al., 2005). Of course, we cannot expect schools to be held solely responsible for implementing preventative measures to develop healthy eating habits in children. Promoting healthier lifestyles to adults and banning the targeting of children in unhealthy food advertising would obviously contribute to achieve better results. But in order to discourage harmful eating habits in children, it is fundamental to intervene as early as possible and schools are the place where children spend most of their time. It is for this reason that schools should be considered crucial for the development of a successful obesity preventative scheme. Discussion The idea that schools play a crucial role in preventing child obesity is not a startling one as we have seen from the various studies illustrated in this paper. What is surprising though is that despite the sound evidence demonstrating successful projects such as the Kids Café in Queensland, child obesity is still treated as a health issue. So far, schools have failed to integrate curricula with initiatives aimed at encouraging healthy eating habits in children which in turn, contribute to improve social and behavioural integration. According to what has been illustrated in the articles presented here, it can be assumed that traditional subjects which are normally included in standard school curricula to promote health such as physical education, for instance, are not enough to tackle an issue of such proportion and gravity. The whole-school approach vision proposed by Rowe et al. (2010) is an outstanding example of how a school with a relatively small budget could contribute to effectively tackle the issue of obesity in a small community by implementing projects such as the Kids Café. The successfulness of such a project is supported by the fact that it seems easily replicable on a vast scale. The positive aspects which a whole-school approach is likely to provide range from health to educational attainments even if the existence of a link between obesity and educational outcomes is still a controversial issue as clearly stated in the report conducted by Caird et al. (p.10, 2011). Yet, there are some functional outcomes such as becoming responsible (self-reliant), developing organisational abilities, cooperating with peers and enhancing self-esteem which are hardly ever assessed in standard tests. Perhaps the first step which each school should follow, once


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acknowledged that obesity is indeed an educational issue, is to upgrade the current curriculum by including activities and assessment tests based on the implementation of a whole-school approach. What is implied here, is that the creation of school-based food gardens, Kids Cafés or similar practical projects are likely to greatly contribute to the creation of a new culture which places health, in its holistic sense, as one of its main priorities. The importance of recognising schools as ideal environments to implement obesity prevention schemes is highlighted by Lee and Hooker who straightforwardly assert that “fighting childhood obesity should be a school-wide campaign” (p.7, 2010). They stress the crucial role of teachers in both public and private schools for the promotion of healthy lifestyles through innovative curriculum developments. In addition, they believe that teachers should also set a good example for children by following a proper diet and doing regular physical exercise themselves. Policy makers and school management are also mentioned as key figures to implement a strategic obesity prevention plan but most importantly, Lee and Hooker emphasise the essential combined efforts of schools, families and communities to reverse obesity trends. Conclusion In educational research, each study is normally assessed according to two main factors: validity and relevance. Validity is determined by measuring how accurately and truthfully a phenomena can be represented (Study Guide, p.192). Relevance, on the other hand, establishes to which extent the topic is considered relevant to issue of public concern or interest (Study Guide, p.194). The purpose of this review was attempting to explain that obesity, particularly child obesity, is undoubtedly an issue of public concern which is directly linked to scholastic education. The level of validity provided to support this idea mainly comes from the two articles selected for the purpose which include both quantitative and qualitative data. As proving validity is normally more challenging than other tasks in educational enquiry, other research papers have been used to supplement this review with the aim of supporting the growing idea that obesity is indeed an educational issue. As implied earlier, fighting child obesity concerns the upgrading of schools curriculum with the inclusion of initiatives strictly related to improving healthy eating habits in children and adolescents. Public schools in particular, should implement what has been referred to as a whole-school approach to ensure that today’s children will be less likely to become obese and consequently develop social behavioural problems. It has been suggested that perhaps, traditional testing systems may need to be adapted to emerging school trends to assess abilities which have not been given appropriate consideration in test scores so far despite their positive appraisal in adult society (i.e.: organisational skills). As it has been illustrated, the role of teachers and school staff members in general, is fundamental to set an example for the children thus it must be based on their own behaviour and awareness of the subject. For this reason, the creation of a successful whole-school approach needs the support of all of the people involved in school policy and practice and ideally, also that of parents and community members. Another relevant aspect which should be taken into consideration is the cost that the implementation of a whole-school approach may have. The project in the Australian primary school was supported by a grant of AU$ 28,000 given over a period of three years by a public health agency (p.199). As mentioned


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earlier, the annual cost of obesity amount to billions of dollars in the US so it can easily be assumed that by investing in obesity prevention schemes at school today, governments will save a huge amount of money tomorrow. To conclude, it should be reiterated the importance of considering obesity as an educational issue because, as long as we envision the role of the school as a mere place where children can learn sets of instructions which may prove useful later on in their working life, we are missing its crucial role as a fertile ground to seed fundamental values which will provide our children with the necessary tools to have a healthier and happier lifestyle.


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REFERENCES Buthcer Della Torre Sophie, Akre Christina, Suris Joan-Carles (2010) Obesity Prevention Opinions of School Stakeholders: A Qualitative Study, Journal of School Health, May 2010, Vol. 80, No. 5, American School Health Association Caird J, Kavanagh J, Oliver K, Oliver S, O’Mara A, Stansfield C, Thomas J (2011) Childhood obesity and educational attainment: a systematic review. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London Eisenhart Margaret (1998) On the Subject of Interpretive Reviews, Review of Educational Research, Vol. 68, No. 4, Winter, 1998, pp. 391-399 Finkelstein E, Ruhm C, Kosa K.(2005) Economic causes and consequences of obesity. The Annual Review of Public Health. 2005; 26:239-257 International Association for the Study of Obesity (IASO) Available from: http://www.iaso.org/?map=children (Accessed 29/08/2011) Jenvey Vickii B. (2007) The relationship between television viewing and obesity in young children: a review of existing explanations, Early Child Development and Care, Vol. 177, No. 8, November 2007, pp. 809–820 Judge Sharon, Jahns Lisa, (2007) Association of Overweight With Academic Performance and Social and Behavioral Problems: An Update From the Early Childhood Longitudinal Study, Journal of School Health, December 2007, Vol. 77, No.10, American School Health Association Lee Albert, Ho Mandy and Keung Vera (2010) Healthy School as an Ecological Model for Prevention of Childhood Obesity, Research in Sports Medicine, 18:49–61, 2010, Taylor & Francis Group, LLC Li Ji and Hooker Neal H. (2010) Childhood Obesity and Schools: Evidence From the National Survey of Children’s Health, Journal of School Health, February 2010, Vol. 80, No. 2, American School Health Association McAleese J. and Rankin L. (2007) Garden-based nutrition education affects fruit and vegetable consumption in sixth-grade adolescents, Journal of the American Dietetic Association, Vol. 107, No.4, pp. 662-5 Rowe Fiona, Stewart Donald and Somerset Shawn (2010), Nutrition education: towards a whole-school approach, Health Education, Vol. 110, No. 3, 2010, pp. 197-208 Schwandt Thomas A. (1998) The Interpretive Review of Educational Matters: Is There Any Other Kind? Review of Educational Research, Vol. 68, No. 4, Winter, 1998, pp. 409-412

Health & Medicine

Is Obesity an Educational Issue?