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Fitness Assessment Program Raises Health Awareness

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A recent survey conducted by The Cleveland Clinic revealed some interesting information about Americans. Most believe their health is good and that others are the ones with problems. In fact, 30 percent of the respondents gave themselves an A on personal health, while most of their doctors graded them a C or lower.

Self-recognizable or not, two-thirds of American adults are now obese or overweight according to reports. The number of children and teens who are obese and overweight is a smaller population, but one that is still alarming at 32 percent.

To determine whether your child is healthy, overweight or obese, you must use more than your eyes or a scale. Actual differences can only be determined by measuring various aspects of a person's physical condition – and that's exactly what the Austin Independent School District and the State of Texas are doing.

FitnessGram, a physical education assessment and reporting program developed by The Cooper Institute in 1982, is helping school districts nationwide determine students' physical fitness levels. The Cooper Institute is a worldwide leader in clinical studies focusing on the management of chronic conditions such as obesity, hypertension and diabetes. AISD uses the assessment tool to raise student and family awareness regarding the importance of healthy eating and exercise.

Aerobic capacity, muscular strength, muscular endurance, flexibility and body composition each contribute to a student's overall score. One size does not fit all - and this fact is recognized in the FitnessGram program. Differences in gender and age are also recognized. That means an eighth-grade football player will be judged separately from a third-grader. Scores are compared to standards and suggestions for improvement can then be made.

FitnessGram in Austin Schools

As required by state law, AISD begins assessing students in the third grade and continues through the 12th grade. During the 2007-08 school year, more than 45,000 students were assessed using the FitnessGram program. According to the AISD Web site, "Physical fitness was significantly associated with both TAKS (Texas Assessment of Knowledge and Skills) performance and student attendance during the 2007-08 school year. Students with better physical fitness, including lower Body Mass Index, generally had higher scores on reading/ELA, math and science TAKS and were absent fewer days."

Michele Rusnak, AISD's Physical Education coordinator, has noticed improvement in the district's cardiovascular scores while BMI figures have remained steady, placing 30 percent of students in the overweight or obese zone. "AISD uses FitnessGram as an awareness tool so parents can understand the importance of health and fitness and also how it relates to them being fit healthy and ready to learn," she said. "It's not another grade from the school, but an individual report for the student."

The FitnessGram assessment data is also valuable for school nurses because it allows them to identify students needing case management for a body mass greater than 99 percent. According Sally Freeman, RN, BSN, NCSN, senior school nurse manager with Dell Children's/AISD Student Health Services, "Many times these students have other health problems such as asthma, sleep apnea, high blood pressure and type 2 diabetes. The school nurse will work with the students and their families to provide education and resources so that the children will be successful at school. In addition, the school nurse will work with the school to modify the child's activities as needed."

Results from the whole district can be reviewed after assessment. Physical education programs from one school can be compared to another school or to the whole district - or even on a state or national level. Just as administrators can look at TAKS math scores and pinpoint low scores and identify where additional resources should be allocated, FitnessGram scores can be compared between schools. With just the click of a mouse, a school can see if another school has enough cardiovascular activity for the students.

In addition to the FitnessGram program, AISD uses the "The Coordinated Approach to Child Health" - or CATCH – Program, a classroom health education curriculum that teaches children to identify, practice and adopt healthy eating and physical activity habits. By learning the meaning of "Go, Slow and Whoa," students can identify foods they should eat, ones they shouldn't eat so often and foods they should question and probably avoid.

Combating Childhood Obesity

While many people are quick to blame video games for the increase in childhood obesity, a combination of factors contribute to the epidemic. Increased food intake, eating non-healthy foods and larger portions as well as physical inactivity all contribute to weight gain.

"Personal factors, family factors, friend factors, community factors, along with government regulations and environmental factors all contribute to a fairly complicated problem," said Stephen J. Pont, MD, MPH, medical director of Dell Children's/AISD Student Health Services and the Texas Center for Prevention and Treatment of Childhood Obesity. "This is an important screening test. If there are any concerns or questions about what it means or if the child is at risk, then those should be discussed with the school nurse, PE teacher who conducted the screening or with the child's doctor."

National programs to get kids to exercise are nothing new. The President's Council on Physical Fitness and Sports has been around since Dwight D. Eisenhower in the 1950s. Whether it's the President's Fitness Council, The Mayor's Fitness Council or first lady Michelle Obama's recently announced Let's Move program, a lot of people are working hard on the obesity problem.

As with the FitnessGram program, the first lady is encouraging doctors and health care providers to include BMI assessments in routine checkups with guidance in lowering the numbers, if found to be too high. One of the benefits of the FitnessGram program, compared to other programs, is the ability to accurately screen students based on age and gender differences. The NFL Charities, the charitable foundation behind the National Football League, recently partnered with FitnessGram to create the Play60 program to tackle childhood obesity. Children should strive for 60 minutes of activity each day, whether it comes from in-school, after-school or team-based programs.

Obese children face more challenges than just teasing from their peers. Cardiovascular disease, diabetes, high blood pressure, high cholesterol and other health problems await these children down the road. If lifestyle habits are not corrected while they're young, this group of kids could be at risk of leading shorter lives than their parents. The earlier intervention begins to encourage good exercise and eating habits the better. From the 2008 Texas data, it was found that fitness scores decreased as students aged so that seniors in high school were the least cardiovascularly fit in the bunch. Fewer than 9 percent of 12th-grade boys and girls met healthy standards on all six tests.

While it's easy to recognize weight gain over time in photos, most of the diseases associated with obesity are silent killers. Nobody can feel their cholesterol getting higher. "Obesity is such a slow process," Dr. Pont explained. "It's not a big change - like you're healthy today and tomorrow you have fever and chills. You see yourself in the mirror every day and you get used to what that looks like. And then you see an old photograph and recognize that you've put on some pounds."

That's why assessment and testing is so important. Knowing what the numbers are and keeping them in check is the key to good health.

Dell Children's/AISD Student Health Services
The unique collaboration with the Austin Independent School District and the Seton Family of Hospitals allows over 130 registered nurses and School Health Assistants to care for more than 82,000 students in 112 schools. This model program, the first of its kind in the United States, has been nationally recognized by the Robert Wood Johnson Foundation.

Stephen J. Pont, MD, MPH, FAAP
Medical Director, Dell Children's Pediatric Obesity Programs
Medical Director, Dell Children's/AISD Student Health Services
Assistant Professor of Pediatrics
The University of Texas Southwestern Medical School - Austin
The University of Texas at Austin, Department of Advertising
Dell Children's Medical Center of Central Texas

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Good Health for Kids is produced by Dell Children's Medical Center of Central Texas.