Teaching Overweight Students in Physical Education

Comprehensive Strategies for Inclusion

Weidong Li

• Editorial: Routledge
• Año: 2016
• ISBN:
  9781317553670
• Edición: 1
• Categoría: Psicología
• Categoría: Historia y teoría en psicología

Overweight students often suffer negative consequences with regard to low physical ability, skills, and fitness; obesity-related health implications; teasing and exclusion from physical education by their peers; and psychosocial and emotional suffering as a result of weight stigma. Widespread obesity and its negative consequences have presented an unprecedented challenge for teachers, who must include overweight students in physical education activities while striving to provide individualized instruction for diverse learners and foster positive learning environments. Educators stand to benefit greatly from specific knowledge and skills for reducing bias and including overweight students.

Teaching Overweight Students in Physical Education offers a compact and easy-to-read take on this problem. It begins by summarizing information on the obesity trend, weight stigma, and coping mechanisms. Next, it introduces the Social Ecological Constraint Model, which casts the teacher as an agent of change who is aware of and manipulates a variety of factors from multiple levels for effective inclusion of overweight students in physical education. Finally, it provides detailed strategies guided by the conceptual model for instructors to implement into their physical education classes. In all, this book provides a map for successfully including overweight students and offers practical strategies to help physical education teachers create inclusive and safe climates, and design differentiated instruction to maximize overweight or obese students' engagement and learning.

Comprehensive, evidence-based, and timely, this book is tailored for physical education educators and practitioners, but will also benefit parents of overweight children by providing them with strategies for educating their children on how to cope with stigma and weight-related teasing.

1

Obesity and Obesity-Related Consequences

This chapter introduces the definition of obesity and prevalence of obesity, discusses the etiology of obesity, and describes physical, psychosocial, emotional, and behavioral consequences of obesity. The final section presents the benefits of physical activity. The information provided in this chapter will help physical education teachers understand the complexity of obesity, and equip them with knowledge and skills to raise awareness about obesity among their students. Instructors will be able to promote physical education in their school as well as obtain better resources and support from their administrators and colleagues.

Definition of Obesity

Obesity refers to a condition in which a person has excessive accumulation and storage of body fat (Merriam Webster’s Online Dictionary). The most commonly used measure of body fat is body mass index (BMI), which is calculated by a formula—dividing squared body height in meters by body weight in kilograms. According to the Centers for Disease Control and Prevention [CDC] (2015a), adults can be classified as being underweight, normal weight, overweight, or obese based on their BMI. A high BMI generally means high body fat.

• Underweight: BMI less than 18.5
• Normal or healthy weight: BMI from 18.5 to 24.9
• Overweight: BMI from 25.0 to 29.9
• Obese: BMI of 30.0 or higher

Children and adolescents’ BMI is compared to growth charts that are age and gender specific. Based on the growth charts, a child can be classified as underweight, normal or healthy weight, overweight, or obese (CDC, 2015a). A high percentile generally indicates high fat.

• Underweight: BMI-for-age less than 5th percentile
• Normal or healthy weight: BMI-for-age from 5th percentile to less than 85th percentile
• Overweight: BMI-for-age from 85th percentile to less than 95th percentile
• Obese: BMI-for-age of 95th percentile or higher

BMI is not a golden measurement of body fat, and there are many issues related to BMI such as inaccuracy. However, BMI screening is low cost and very practical as it can be administered to a large group of students in a short period of time in physical education classes. Many U.S. states have enacted legislation to require BMI screening in public schools: Arkansas, Florida, Maine, Massachusetts, Nevada, New Jersey, New York, Pennsylvania, Tennessee, and West Virginia. Many researchers and practitioners view BMI screening in public schools as one policy approach to addressing the problem of childhood obesity. However, this policy has created a lot of controversies. According to Ikeda, Crawford, and Woodward-Lopez (2006), BMI screening has many pros and cons. The pros are:

• It raises parental awareness of their child’s weight status after reviewing their child’s BMI screening results.
• It encourages parents to assess and potentially change the diet and activity patterns of their children as a means to treat or prevent overweight and obesity.
• This type of mandatory measurement of BMI allows for monitoring childhood obesity trends.
• It provides important information for the development and implementation of successful strategies and interventions aimed at obesity treatment and prevention.

The cons for conducting BMI screening at schools are:

• Children are labeled. This can increase weight-related teasing toward overweight or obese students.
• Children can potentially develop eating disorder symptoms as a result of becoming thin and slim (Cogan, Smith, & Maine, 2008; Ikeda et al., 2006).

Given the potential negative unintended consequences of BMI screening, physical education teachers should take precautions before conducting BMI screening at their schools, including checking out their own state legislation and school district policies, gaining approval and support from school principals, collaborating with school counselors and nurses, and surveying parents to get their perspectives on BMI screening.

The Prevalence of Obesity in the United States

Since 1985, the obesity rate has increased dramatically in the United States. Even today, obesity is still widespread and at the forefront of the public health crisis in the United States (Ogden et al., 2014; Ogden et al., 2015). It is estimated that 69% of adults are overweight or obese, and 35% of adults are obese. Among children and adolescents, over 30% are overweight or obese. Seventeen percent of children and adolescents are obese (Ogden et al., 2015).

Many racial-ethnic and geographic disparities exist in the rates of overweight or obesity among adults and children (Ogden et al., 2014). In general, African-American and Hispanic women have higher rates of overweight or obesity than Caucasian women. Hispanic men have higher rates of overweight or obesity than African-American and Caucasian men. The overweight and obesity rates are higher in the South and Midwest regions (Gregg et al., 2009; Ogden et al., 2014; Sherry et al., 2010). Among children, African-American and Hispanic children tend to have higher rates of overweight or obesity than Caucasian children (Freedman et al., 2006; Ogden et al., 2014). The rates of overweight or obesity tend to be higher among children from families with a lower social economic class (Ogden et al., 2014; Wang & Zhang, 2006) and living in the Southern region of the United States (Singh et al., 2008).

Etiology of Obesity

The etiology of obesity is complicated. Numerous factors can contribute to obesity, including individual lifestyle behaviors, genetic makeups, medical conditions, prescription medication side effects, social and cultural norms, and environments (Anderson & Butcher, 2006). Other factors contributing to obesity include the following:

• Medical conditions such as polycystic ovary syndrome can cause obesity.
• Some prescription drugs such as steroids and antidepressants can lead to obesity.
• Environmental factors: Physical activity and food environments can also contribute to obesity (Sallis & Glanz, 2009). An overabundance of fast food choices (high fat and junk food), a dangerous neighborhood, lack of access to physical activity in the community, and an increasing availability of television and video games all can contribute to obesity.
• Social and cultural factors: Poor, less educated Americans are more likely to be overweight or obese than those who are wealthy and more educated. Individuals from a low socioeconomic class may not have enough money to purchase healthy foods to eat. Less educated Americans may not receive adequate education on how to cook healthy meals. African-Americans and Hispanic-Americans are more likely to accept a larger body size than others (Haytko, Parker, Motley, & Torres, 2014).
• Psychological factors: Individuals are likely to gain weight from excess calories in response to emotional stress such as loneliness, pain, rejection, anxiety, or anger (Gundersen, Mahatmya, Garasky, & Lohman, 2011).
• Genetics: Obesity runs in families. Children with one obese parent or two parents who are overweight or obese are more likely to become overweight or obese than those whose parents have normal weight (Choquet & Meyre, 2011).
• Individuals’ lifestyle behaviors: An individual who does not get enough sleep or sleeps too much can gain an appetite as a result of changes in hormones (Knutson, 2012). One can crave foods high in calories and carbohydrates. Consequently, he or she can gain body weight. An individual who lives a sedentary lifestyle is more likely to gain body weight as he or she takes in more calories than he or she burns. Eating an unhealthy diet high in calories can also contribute to an increase in a person’s body weight.

Among all these factors, individual lifestyle behaviors such as lack of physical activity and unhealthy diet are the leading causes of overweight and obesity. Therefore, lifestyle interventions play a critical role in decreasing the overweight and obesity rates in the United States.

Consequences of Obesity

Childhood obesity is associated with serious physiological consequences (Daniels, 2009; Ebbeling et al., 2002; Franks et al., 2010; Olshansky et al., 2005; Papoutsakis et al., 2013; Tsiros et al., 2009; Visness et al., 2009), psychosocial consequences (Anderson et al., 2007; BeLue et al., 2009; Boutelle et al., 2010; Carey et al., 2015; Haines & Neumark-Sztainer, 2006; Li & Rukavina, 2012; Neumark-Sztainer et al., 2002; Puhl & Latner, 2007; Shore et al., 2008), and economic consequences (Cawley, 2010; Cawley & Meyerhoefer, 2012; Finkelstein, Ruhm, & Kosa, 2005). This is very alarming since many of these consequences will manifest later in life, and children who are overweight or obese are more likely to become more overweight or obese as adults (Freedman et al., 2005). The physiological consequences of childhood obesity follow:

• Children who are overweight or obese are at a high risk of experiencing a potential decline in life expectancy. This generation of children may have a shorter longevity than their parents due to a high prevalence of obesity (Olshansky et al., 2005).
• Children who are overweight or obese are at a high risk of having diabetes, atherosclerosis, dyslipidemia (e.g., high blood triglycerides, high cholesterol), high blood pressure, metabolic syndrome, liver disease, sleep apnea, disordered breathing, and orthopedic complications (Daniels, 2009).
• Children who are overweight or obese are at a high risk of developing gall bladder disease (Ebbeling et al., 2002), asthma (Papoutsakis et al., 2013), and allergies (Visness et al., 2009).
• Children who are overweight or obese are associated with poor health-related life quality (Tsiros et al., 2009) and are more likely to have premature death later in life (Franks et al., 2010).
• Children who are overweight or obese are more likely to have bone and joint disorders (Marder & Chang, 2005).

The psychosocial consequences of childhood obesity follow:

• Children who are overweight or obese are more likely to develop depressive symptoms (Boutelle et al., 2010) and anxiety symptoms (Anderson et al., 2007).
• Children who are overweight or obese are more likely to display poor body image (Averett & Korenman, 1999), have low self-esteem (McClure et al., 2010), feel worthless and inferior to their peers (BeLue et al., 2009), and show body dissatisfaction (Neumark-Sztainer et al., 2002).
• Children who are overweight or obese are more likely to experience peer victimization and be stigmatized and teased (Eisenberg et al., 2003; Li & Rukavina, 2012; Puhl & Latner, 2007).
• Children who are overweight or obese are more likely to display disordered eating and unhealthy weight-control behaviors (Haines & Neumark-Sztainer, 2006; Neumark-Sztainer et al., 2002).
• Children who are overweight or obese are more likely to have more school absences and lower academic performance (Carey et al., 2015; Shore et al., 2008).
• Children who are overweight or obese are more likely to have mental health disorders (Marder & Chang, 2005).

In addition to serious physiological and psychosocial consequences, obesity has economic costs that can affect all of us. Obesity is costly both to the individual and to society. The annual health care expenditures for obesity-related illness are estimated at $190.2 billion in the United States (Cawley & Meyerhoefer, 2012). Obesity costs billions of dollars to businesses in the United States due to paid sick leave, life insurance, disability, lost work days, restricted activity days, bed days, and physician visits. The aggregate annual obesity-related medical costs contribute to 5% and 7% of total annual health care expenditures (Finkelstein et al., 2005). The cost for children with private insurance and children enrolled in Medicaid is $11 billion and $3 billion, respectively (Marder & Chang, 2005).

Benefits of Physical Activity

The 2008 Physical Activity Guidelines Advisory Committee recommends that individuals engage in at least 60 minutes of moderate to vigorous physical activity on a daily basis to obtain health benefits (U.S. Department of Health and Human Services [USDHHS], 2008). Individuals can gain not only physical and psychosocial health benefits, but also cognitive benefits from physical activity (American College of Sports Medicine, 2009; CDC, 2015b; Haskell et al., 2007; USDHHS, 2008). Given that approximately one-third of children and adolescents are overweight or obese, it is very important to educate students on these benefits. Knowledge of benefits of physical activity has great potential to motivate students to develop and maintain a healthy and physically active lifestyle. The physical and psychosocial benefits include:

• Lower mortality from all causes
• Lower blood pressure
• Better cardio-respiratory functioning
• Lower risk of heart disease and stroke
• Lower risk of cancer, especially colon cancer and breast cancer
• Lower risk of type 2 diabetes
• Lower risk of osteoporosis and related fractures
• Better bone density
• Lower risk of falls
• Lower risk of gall bladder disease
• Better body composition
• Prevention of unhealthy weight gain
• Better quality of sleep
• Higher self-esteem
• Better mood
• Lower risk of depression and anxiety
• Improved physical fitness
• Better performance in work, leisure, and sport activities
• Better life quality
• Better blood sugar and insulin levels
• Reduced risk for chronic diseases and disabilities
• Decreased behavioral problems
• Lower risk of obesity

In addition to physical and mental health benefits, individuals can gain cognitive benefits from physical activity. Ample evidence from research supports the conclusion that physical activity is positively linked to improved cognition and better academic performance (Sibley & Etnier, 2003; Singh et al., 2012; Tomporowski et al., 2008; USDHHS, 2008). Students who are physically active have better attention spans in the classroom and obtain better cognitive functions and academic performance than those who are inac...