• The prevalence of obesity has not changed or has increased in many jurisdictions around the world. A recent report from the Johnson Foundation says that if the United States doesn't start getting its obesity problem in check, 13 states could have adult-obesity rates higher than 60 percent by 2030, according to a reportreleased Tuesday by the Trust for America's Health (TFAH) and Robert Wood Johnson Foundation (RWJF). Similar national and provincial reports in Canada (PEI, Nova Scotia) also report little or no progress.
• The research basis for seeking to prevent childhood obesity through schools seems faulty, with major assessments done by the relevant evidence assessment bodies in the United States and the United Kingdom expressing caution and with several Cochrane and similar reviews suggesting that there has been too much focus on physical activity as a weight loss strategy and too little focus on diet, mental health and work life factors that structure our families/daily lives as well as higher risk situations caused by poverty, discrimination and genetics.
• Much of the recently funded research on obesity has focused on prevalence and on the risk and protective factors, most of which already known in earlier research studies. These studies have replicated studies demonstrating the impact of various social influences such as parents, peers and the media and have even “discovered” the fact that poor people usually have poorer diets.
• Similarly, the policy documents being approved by governments look much the same as previous ones written decades earlier. As is often the case, they don’t specify how progress will be measured in terms of food consumption and physical activity patterns. In Canada, there have been some specifics done in 2011 after over two decades of various national and provincial initiatives. In terms of the school-related progress, there have been some national and provincial reports on these behaviours but they are often part of research projects rather than government-funded, monitoring programs that provide regular reports to the public. As well, there is little reporting on the capacity of health, education and other systems to deliver the necessary multi-intervention programs or on the actual learning achieved by students in Canadian schools about nutrition and health in classrooms,
• Most of the focus in Canada’s obesity initiative has been on the link between physical activity and weight, seeking to achieve a caloric energy balance. Research reviews noted in this article show that this is a somewhat tenuous connection. It is now increasingly understood that unless we all have personal trainers and very accommodating schedules, we cannot burn off enough calories to make a difference. As well, only recently has some of the research on the “social construction of eating” led to greater regard to mental health (loneliness, boredom, body image), and work-life factors (unsafe neighbourhoods, two working parents, walkable neighbourhoods) and the use of food as a reward or compensation. Key concepts such as mental health, work-lifestyle, parental influence, parent concerns about safety, working parents, pressure on schools to perform academically have been largely ignored in school policy-making/advocacy in favour of the physical activity-energy balance approach. This has led to an unbalanced research basis for many of the long term policy initiatives.
• The approach has also been disease or deficit oriented, seeing the prevention and management of obesity as being caused by the “inactivity epidemic” and “over-eating”. Many other issue-focused strategies have moved past this deficit approach to look for strengths, assets and resilience and it is time for the obesity movement to do so as well.
• Much of the discussion has focused on single interventions (e.g. regulating or restricting school food sales, providing fresh fruit & vegetables, increased time for physical education) and only more recently on multi-intervention programs and approaches. In many ways, Canadian and many other country efforts have re-invented multi-intervention approaches that, two decades ago, used to be called “active schools” and “nutrition-friendly schools”. And, now, just as the funding is drying up, the research is now turning to implementation and capacity issues associated with these multi-intervention approaches.
• As well, as is often the case with multi-intervention approaches on specific health issues, the researchers and program developers are calling their new, shiny models “healthy schools” or “healthy school communities” that ignore most of the 25+ other health and social issues that are part of human health in favour of a selected few issues related to obesity. Further, despite now using the language of “ecological approaches” much of the discourse is on the school and educators and ignores the roles of local health authorities, school boards, municipalities as well as health, family/social service, agriculture, consumer and education ministries.
• Our monitoring over the past 18 months identified several media reports that indicate changing public opinion on the issues. Much of this has been negative in nature, citing student dissatisfaction with the food, over-zealous use of BMI in student report cards, controversies with celebrity chefs and more.

• A wide variety of planning guides, educational resources and tools have been published. The reference documents with the lists of items noted above have identified over 25 specific tools that can easily be adapted for high income countries such as Canada.
• Food producers and processers have created educational materials and programs for kids and parents that are quite appropriate despite their potential for commercial abuse.
• Researchers are now focusing on specific results and will be better able to estimate cost effectiveness and cost benefits. We have identified some articles that have specifically noted the number of activity minutes gained in different types of interventions and others have reviewed articles examining the cost-benefits of school physical activity and nutrition programs.
• There are some recent attempts to work across ministries and systems, with exploration of interventions such as municipal by-laws restricting the location of fast food outlets near schools and a convergence of interest from safety officials, educators and public health on safe/active routes to school. However, in our conclusions, we will add some cautions about these innovations, especially in communities where the streets and neighbourhoods are already well-established and not likely to change substantially in re-zoning.

A. Understanding the Problem: (Prevalence, nature, aspects, importance of the problem, behaviour theories that explain it)
B. Impact, Role of the School on the Problem (Influence of the physical and social environment, school organization & practices)
C. Effects of Multi-Intervention Approaches, Programs, Strategies including Comprehensive Approaches (Multi-issue, multi-level, multi-system programs) Coordinated Programs and Services (School-Agency
Programs and Whole School (Educator-only Strategies)
D. Effects of Individual Evidence-based and Experience-tested Interventions (Including Policy, Instruction, Services, Social Support, Physical Environment Interventions)
E. Implementation, Capacity, Sustainability and Systems Change (Including Evidenced-based, Practical and Strategic Implementation Strategies, diffusion or education change theories, Capacity-building/Continuous
Improvement and Strategic Consideration of System/Agency/School Characteristics
F. Consideration of Local Community Contexts (Including rural, cultural, disadvantaged, faith communities etc)
G. Consideration of and Integration within the Constraints and Educational Mandate of the School
H. Questions related to Future and Current Research (Methods, link to educational outcomes, cost-effectiveness etc.)

• In the May-June 2012 Issue of the Canadian Journal of Public Health, the editorial asks: Have we lost the war on obesity?
• In that same CJPH issue, a small study reports on the implementation of the Ontario Daily Physic al Activity policy in 16 schools (stipulating a minimum of moderate or vigorous activity 20 minutes per day) and notes that not a single child in all of those had met or exceeded that minimum and that half of the students were not getting daily activity opportunities.
• Another article in that same CJPH issue reported that over half of BC schools were located within a ten minute walk of a fast food outlet, with larger schools in urban areas and less advantaged areas more likely to be closer.
• A regular PEI study done in schools reports that the survey found 30 per cent of students are considered overweight or obese for their age, a number that has remained steady since 2008. Only about 45 per cent of students meet national physical activity guidelines of 60 minutes per day, the survey found, results which are also relatively unchanged since 2008. However, the survey did note a drop of seven per cent in students who reported eating and drinking unhealthy foods and beverages excessively, down to 23 per cent from 30 per cent.
• The preliminary results of a similar Nova Scotia, Canada study done in 2003 and 2011 found that Childhood obesity rates have continued to rise over the last eight years, with approximately one third of Grade 5 students were either overweight or obese, about one third of Grade 5 students meeting Canada’s Food Guide recommendations for vegetables and fruit intake, the average daily consumption of sugar sweetened beverages (including pop and fruit drinks) decreased from 2003 to 2011. Most Grade 5 students exceeded recommendations for screen time (less than 2 hours per day). In 2011, students reported watching less TV but more computer and video game usage. The full report from the Nova Scotia project puts a positive spin on the results between 2005 and 2010, saying that the increases in obesity rates are slowing. It also should be noted that the agreement between the sponsoring school board and local health authority on this Healthy Schools program has been modified in the light of budget cutbacks throughout the province.

• Headlines such as these were noted in our 18 month time period; Mixed grades for new, healthy school lunch rules (Sep 17-12, Boston, USA), School apologises after making children eat their greens (Jun 11-12, London, UK), Turns out school food initiatives can be difficult to swallow (Jan 22-11, Washington State, USA), The crusade against cupcakes – and common sense (Jan 15-11, Canada-wide), Junk food in schools not making kids fat: Study (Jan 17-12, London-ON), Falling Short in the Obesity Fight (Jun 19-11, Toronto, ON), Student Complaints Prompt LA Officials to Revise Healthier Lunch Menu (Dec 22-11, Los Angeles, USA), School board may ease ban on junk food (Seattle, USA, Dec 11-11), ) Despite Obesity Concerns, Gym Classes Are Cut across USA (Jul 10-12)
• A 2011 CDC report, 2011 Children's Food Environment State Indicator Report, noted that “as ofDecember 2008, only one state –Georgia– had enacted all of the following state licensure regulations for child care facilities: to restrict sugar drinks, to require access to drinking water throughout the day, and to limit TV and computer screen time”, and that “forty-nine percent of middle and high schools allowed less healthy foods like candy, soft drinks, and fast food restaurants to be advertised to students on school grounds. In Ohio nearly 70 percent of middle and high schools allowed such advertising, while in New York only 24 percent of schools allowed it”.
• A 2011 report on physical activity by young people in France (Recours et al, 2011) reported that “data from a representative sample of 2474 French youth show that, despite a 7-year French Ministry of Health strategy for nutrition and physical activities, adolescents' motivation to practise sports and physical activities decreased significantly between 2001 and 2008.
• The use of celebrity local chefs like Jamie Oliver from England has also come under fire in Chicago, Los Angeles, Seattle and of course, England.
• Two reports from the CDC published in June 2011 say that “U.S. teens skimp on exercise, but not sodas” according to a news story in a BC newspaper. They found only about one out of 10 US high school students met the targets for both aerobic and muscle strengthening activities set for the federal government’s Healthy People initiative. In a separate study, CDC researchers surveyed U.S. high school students and found that teens drink water, milk and fruit juice most often, but a quarter also drink at least one sugar-sweetened soda a day.
• A 2011 report from Norway states that “In 2010 there was an increase of three percentage points for third-graders who were overweight or obese compared to 2008.
• A Time Magazine article (Dec 7-2011) reports that “Most U.S. Schools Don’t Require P.E. Class or Recess” The article is based on a study done by researchers at the University of Illinois at Chicago who analyzed results of a survey sent to every state except Hawaii, Alaska and Wyoming.

• Some systematic reviews clumped together a variety of interventions with little regard for the delivery mechanisms required. As is often the case with systematic reviews of research, we found reviews that combine various types of school-based and school-linked interventions in summary type reviews and then fail to distinguish their respective effectiveness. For example Waters et al (2011) provide a “synthesis” of potential or promising interventions (curriculum that includes activity, nutrition and body image, increased activity during the school week, improved food quality and more) but then add that the results of the review should be viewed cautiously because of the heterogeneity of the data and small size of the studies. Other reviews wander off on other outcomes, such as Story et al (2009) reporting on schools and obesity prevention. They note that fast foods are sold in schools and are largely responsible for high intake of calories (ie the point of the review) and then cite the “emotional and social” benefits of physical activity.

• An article in Issue #4, 2012 of Critical Public Health opens the door to a discussion of how public health systems need to divest themselves of terms, practices, structures and underlying assumptions imported from the health care system. The authors note that "Public Health specialists have increasingly deployed the concept of ‘dose–response’ in areas such as diet (‘five-a-day’), alcohol (‘21 weekly units’) and physical activity (‘150 minutes of weekly activity’). Using these examples and a case study that sought to establish an optimal dose of physical activity for mental health gain, this article offers a critical assessment of the nature, robustness and function of ‘dose’ in public health. Drawing from a ‘sociology of knowledge’, the article argues that dose–response can best be considered an analogy that does not necessarily translate favourably from its original expression in toxicology to some public health domains. Rather than having technical robustness, its attractiveness and utility is seen to lie in it possessing ‘cultural capital’ (ie sounding medical). Here, the ability to link behavioural concerns to clinical practice, to simplify complex ideas and to act as a regulatory form of behavioural governance. The article is skeptical of further empirical pursuits in identifying optimal doses and offers an alternative course for public health framing.The discussions of obesity have been inundated with this dose-response, intensity, duration type thinking derived from medicine rather than behavioural science. We used to have calls for “150 minutes of physical education per week”, now it is for “60 minutes of MVPA” per day. We remind everyone to eat at least “five servings” of fruit & vegetables per day. We tell our young people that more than “two hours of screen time per day” is unhealthy (as we return from jobs with seven or eight hours of screen time per day).

• A couple of articles were identified in our monitoring that clarified the concept of “behavioral intention” A Canadian study provides a picture of the frequency and some of the characteristics of children who use active routes to go to school. Pabayo et al (2011) report that “longitudinal analyses (from the cohort study National Longitudinal Survey of Children and Youth) indicated that as children aged, the likelihood of using active transportation to school increased, peaked at the age of 10 years, and then decreased. Urban settings, households with inadequate income, living with one parent and having an older sibling living at home were significant predictors of active transportation to school at baseline and carried through across time.

• Another Canadian study (O’Loghlen et al, 2011) was one of several recent studies that have recognized that active and safe routes to school offer a good opportunity for increased physical activity. This study reported on a survey of the practices of 400 Canadian accompanied by a GIS analysis. The authors report that “Greater than 70% of schools had passive policies (e.g., skateboards permitted on school grounds) and facilities (e.g., bicycle racks in secure area to avoid theft) to encourage bicycle and small-wheeled vehicle use. Less than 40% of schools had active programs designed to encourage active transportation, such as organized ‘walk to school’ days. Garbage in the streets, crime and substance abuse were barriers in most school neighbourhoods. Approximately 42% of schools were located on high-speed roads not amenable to active transportation and 14% did not have a sidewalk leading to the school. Secondary schools had less favourable active transportation policies/programs and neighbourhood safety/aesthetics compared to primary schools. Rural schools had less favourable built environments than urban schools”.

• The interaction between the home food environment, school programs and individual characteristics on eating habits is explained in another recent article identified in this review. Lippevelde et al (2011) Changes in home-related determinants were significantly related to changes in fat intake from snacks; therefore, school-based obesity programmes on adolescents should try to address these determinants. In the Lippevelde et al study, one of the three investigated home-related factors, namely parental support, was affected by the parental component intervention.
• Use of Complexity Framework to Assess PA Programs An article in the latest issue of Health Promotion Practice identifies the barriers and facilitators in adopting, implementing, and maintaining a school-based physical activity intervention using RE-AIM as a theoretical evaluation framework. It was concluded that interventions that consider complexity and compatibility with the school setting are more likely to be adopted, implemented, and maintained.
• An article in Issue #4, 2011 of Critical Public Health demonstrates how a socio-ecological perspective was deployed during an exploratory study into the role of primary school dining halls in improving children's nutrition-related behaviour. This study revealed how policies at local and school levels reflected national objectives with respect to nutritional guidelines, but were also influenced by multiple, competing interests at other socio-ecological levels. These included pupils’ food preferences; organisational objectives such as protecting school meal uptake; and the practices of school meal staff. It is argued that higher level policy interventions may have limited effectiveness if undermined by lack of attention to lower level factors. The use of socio-ecological frameworks as theoretical, methodological and evaluative tools to support a consistent, holistic approach during the design, implementation and evaluation of health improvement policies is recommended.

• The social consequences and correlates between obesity and risky behaviours such as substance abuse and sexual activity as well as mental health problems are described in a special issue in the January 2012 Issue of Journal of Youth & Adolescence
• A Canadian study found that obese teens not only make easy targets for bullies, in the case of girls, they're more likely to turn into bullies themselves, according to the findings of a Canadian study on the social fallout of being overweight. Researchers who followed more than 1,700 Ontario high school students for one year found that overweight and obese boys were twice as likely than their healthy-weight peers to be hit, kicked, pushed or shoved around. They also were two-times more likely to suffer "relational" bullying -- being shunned or excluded from groups and activities. Obese girls, meanwhile, were three times more likely than healthy-weight girls to become the perpetrators of relational bullying -- a kind of psychological torment that can cut as deeply as any physical wound
• A Canadian news story, reporting on a BC parents meeting, quoted a study saying that obese kids were far more likely to be bullied than LGBT youth.

• Childhood Obesity Prevention Focus on the School
  Reflecting the reality of many national and state childhood obesity prevention initiatives, Issue $4, 2012 of Childhood Obesity focuses almost entirely on the school setting as the way to prevent obesity. Three editorials are presented, there are articles examining the impact (or lack thereof) of state and school district policies on food sales, a thorough look at farm-to-school programs and more.
  
• A news story identified in this review noted that cutting short lunch time in school may lead to obesity (USA Today, Aug 17-2011). Citing a national survey done by the US-based School Nutrition Association, which shows elementary kids have about 25 minutes for lunch; middle school and high school students about 30 minutes. That includes the time students need to go to the restroom, wash their hands, walk to the cafeteria and stand in line for their meals. Many students may have only about 10 to 15 minutes left to eat their meals, school nutrition directors say. But students should have at least 20 minutes to eat their lunch, the government recommends.
• In some countries such as the UK and in some states in the US, there are or were policies to add body weight or BMI to student report cards so that parents and students would know that their children are overweight. Our monitoring of the news media over the past 18 months found several articles that were very critical of adding BMI to student report cards, with really negative reports coming out of the UK from Kingshurst, Birmingham and Selly Oak, Birmingham. This practice never found favour in Canada but we do know that many school jurisdictions no longer benefit from the confidential basic health screening that local health authorities used to do for children beginning school (which examined weight, height, vision, hearing, vaccinations etc.) This type of screening is now often done by teachers in some school boards in a circuitous way through their participation in a widespread university-led early childhood assessment test.

• How do we implement these multi-intervention approaches and programs in complex, ever-changing environments?
• How can we tailor the various interventions and combinations to suit different local circumstances, conditions and most importantly, different resource levels within communities and countries?
• Who will be assigned to coordinate the various interventions?
• How can we ensure that the participating agencies and systems will continue to be there supporting school systems after the research and demonstration projects are complete?
• How do we encourage researchers to spend less time publishing copyrighted programs and worrying about fidelity (in order to maintain a funding source and research credibility) and spend more time in examining issues of evolution, adaptability and sustainability of their programs in real world conditions.
• What happens when the normal cycles of teacher and principal turnover occur? Who inducts new teachers into the principles and practices of the multi-intervention approach? How do we enable systems to respond to new demands and issues without abandoning what has been established already?

• Implement a whole school planning strategy (eg Active Schools, Nutrition Friendly Schools) that includes action on physical activity and nutrition and has components such as parent involvement, PE and health instruction, changes to the school environment such as recess, lunchroom facilities and reverse order lunch hours, extra-curricular activities and other factors.
• Implement an instructional program (eg Healthy Buddies) that addresses mental health, nutrition and physical activity.
• Encourage teachers to use updated lists of lesson plans and resources (eg BC Curriculum Supplement)
• Follow the guidelines or requirements of the provincial policies on food sales in cafeterias and canteens (eg BC Guidelines).
• Discourage school, external groups and parental practices or activities that use food or activity as rewards or punishment, or that use unhealthy food or overly competitive sports in fund-raising or athletic activities.
• Provide 5or more servings of fruit and vegetables per day to students.
• Work with local food producers to organize Farm to School programs or activities.
• Seek support and community involvement in delivering fruit and vegetables to schools in disadvantaged communities
• Ensure school cafeterias offer attractive salads and vegetable sides
• Limit screen time per day to less than two hours. Educate and encourage parents and students to restrict their screen time, discourage any TV before two years of age and do not provide TV’s in children’s bedrooms. (Eg ScreenSmart program).
• Ensure one or more hours of moderate or vigorous physical activity per day.
• Make use of the Active, Safe Routes to School resource for planning and suggested activities. Work with safety, crime prevention and environmental groups to make this happen.
• Use “reverse lunches” that have children play outside for the first part of the lunch hour and then eat afterwards.
  
• Use “active recess” strategies to encourage children to be active during the break.
• Encourage regular classroom teachers to incorporate physical activity into their classes wherever possible.
  
• Encourage zero consumption of sugar sweetened beverages per day. Encourage parents to pack water or milk in their child’s lunch. Consider using the SipSmart or Drop the Pop programs in your school.

• Active support and funding for parent education programs
• Ongoing community awareness activities and funding for community-based groups
• Regional planning mechanisms to ensure that sports, recreation and nutrition services are available to all schools
• Regional planning and funding for farm to school programs
• Coordinated municipal policies regulating sales of junk food at sports centres and hockey rinks
• Inter-agency agreements making it easier for schools and community groups to share sports and recreation facilities

• Regular funding of joint in-service activities for nurses, teachers and others

• Policy requiring school boards, health authorities and other agencies to establish inter-agency protocols and committees
• Establishing inter-ministry committees to develop, oversee implementation and conduct regular evaluations of progress
• Requiring health ministries to report on activity and diet of young people in regular reports to the public
• Requiring education ministries to report on the health, nutrition and physical education knowledge, skills, beliefs, intentions and attitudes of students as they leave primary and secondary schools
• Ensuring that all children in their jurisdiction have access to a healthy breakfast, lunbch and snacks through equitable provision of school meal programs

• Departments responsible for industry and consumer protection (eg Industry Canada) need to take stronger action on protecting consumers from processed foods through regulations, consumer awareness advertising and more
• Departments responsible for agriculture (eg Agriculture Canada) should invest in farm-to-school programs, fruit & vegetable programs in disadvantaged areas
• Departments responsible for families and citizen welfare (Human Resources and Skills Development Canada) should be investing in school meal programs and, adding nutrition supplements to head start programs and investing more for food stamps and similar programs
• Departments responsible for citizen health (eg Health Canada, Public Health Agency of Canada and the Food Inspection Agency of Canada) need to invest in food supplement programs for isolated communities that include schools as distribution mechanisms
• Research and knowledge development agencies (eg Canadian Institutes for Health Research, Canadian Best Practices Portal, Health Evidence Canada and others) need to coordinate their efforts around an explicit and shared research and knowledge development agenda. This should include the formation of as well as ongoing support for links and knowledge exchange activities between university-based research centres, professions such as the Dieticians of Canada, advocacy and service groups such as the Centre for Science in the Public Interest and Breakfast for Learning, intergovernmental mechanisms such as the federal-provincial Nutrition Working Group and the Joint Consortium for School health and in national conferences, communities of practice and web-based knowledge exchange activities.

• An article in the July-August 2012 issue of Canadian Journal of Public Health would suggest that the school food sales policy in Quebec appears to have changed meal offerings since 2002. (71% of primary schools, 71% of public secondary schools, and 54% of private secondary schools did not offer cold-cut dishes, stuffed pastry, or a fried food on their daily menus. But sugared beverages and whole grain breads were still problems).
• Two studies report on the effect of policies regulating school meal offerings in England in the February 2011 Issue of Public Health Nutrition. The studies report that schools complied with the policies and that students who purchased meals at school made healthier choices. Both studies noted that food provided by parents for consumption at school was not affected. In the same issue, a New Zeal study noted that family-provided food was the mainstay for school children.
• Having a good policy does not ensure change in school nutrition An article in Issue #4, 2012 of Childhood Obesity examines the impact of well-written state and school district "local wellness policies” (LWP) (actually addressing only nutrition and healthy eating in schools) as measured by perceived actual implementation of healthier reimbursable meals and sales of competitive (ie fast foods) in schools. "Data was collected from school districts in California, Iowa, and Pennsylvania included district LWPs and online surveys at the district (n = 23) and school levels (n = 76). Overall LWP and component strength scores did not consistently predict perceived implementation of LWP reimbursable school meals or nutrition guidelines for competitive foods offered or sold in school settings. These findings are similar to a recent report by Kubik and colleagues, where school district nutrition policies were not associated with less “junk” food in vending machines and school stores. That study suggests neither state policy nor district policy influence the availability of junk food in high schools; however, state policies did influence junk food availability in elementary and middle schools. Conversely, these results contrast those of Schwartz and colleagues,24 who reported higher LWP strength scores were predictive of implementation among schools in Connecticut. Collectively, results of this study and those reported previously suggest LWP scores, which indicate comprehensiveness or strength of a LWP, may not result in greater perceived or actual implementation.
• State Laws on PE affect Elementary, Middle but not High School PE time A study reported in Issue #8, 2012 of the American Journal of Public Health examined the actual time for PE classes in elementary, middle and secondary schools. The US states with stringent laws requiring PE time had 27 & 60 more minutes per week in elementary and middle schools than states with general laws and 40 & 60 more minutes than states with no laws for those schools. High school results were non-significant.
  
• Questions and Pushback on Effect of Regulating School Food Sales. There are several items in this week reporting on questions and push back on the effectiveness of regulations affecting food sales in schools. A longitudinal study points out that the sale of fast foods in schools has much less effect on weight than other factors, primarily the home environment and parent lifestyle. Canada's national newspaper questions the value of regulations when children can go to food outlets nearby. A blog post reviews the recent changes made in Los Angeles, Seattle and other cities when students rebelled against tasteless healthy meals.
• A research study reported in a news story (Aug 13-12) found that “ School snack laws may help prevent weight gain” Students gained less weight over three years if they lived in states that restricted the sale of unhealthy snacks at school than kids in states without those laws, a study has found. The study did not examine the impact of food sales in cafeterias. Students in states with strong laws all three years gained an average of 0.44 fewer BMI units and were less likely to remain overweight or obese than their peers in other states. That’s about 2.25 fewer pounds for a child who is 5 feet tall and weighed 100 pounds.
• Bans on sugared beverages reduce in-school access but not consumption An article in the March 2012 issue of the Archive of Pediatric and Adolescent Medicine reports on an analysis of students across 40 states The proportions of eighth-grade students who reported in-school SSB access and purchasing were similar in states that banned only soda (66.6% and 28.9%, respectively) compared with states with no beverage policy (66.6% and 26.0%, respectively). In states that banned all SSBs, fewer students reported in-school SSB access (prevalence difference, −14.9; 95% CI, −23.6 to −6.1) or purchasing (−7.3; −11.0 to −3.5), adjusted for race/ethnicity, poverty status, locale, state obesity prevalence, and state clustering. Results were similar among students who reported access or purchasing SSBs in fifth grade compared with those who did not. Overall SSB consumption was not associated with state policy; in each policy category, approximately 85% of students reported consuming SSBs at least once in the past 7 days. Supplementary analyses indicated that overall consumption had only a modest association with in-school SSB access.
• School sales of sweetened beverages has no effect on weight We find almost no evidence that availability of sweetened beverages for sale at school leads to heavier weight or greater risk of overweight or obesity among children. We also find limited evidence that availability of sweetened beverages for sale at school leads to higher total consumption of these beverages. This startling conclusion is based on a large US longitudinal study of young children. Go to this article in the Nov/2011 issue of Social Science & Medicine.

• Time spent being active in Australian PE Classes An article in Issue #3, 2012 of Journal of Science & Medicine in Sport reports on another small study of time spent in moderate or vigorous activity in PE classes; this time from Australia. Systematic direct observation of Year 7 PE classes over a six-month period. Eighty one (81) PE lessons across six schools were observed. The mean (SD) percentage of class time spent in moderate to vigorous physical activity (MVPA) was 56.9% (18.7). However, only 60% of the 81 met the recommended 50% of class time spent in moderate to vigorous physical activity (MVPA). Just over 6% of class time was spent in skill instruction. Game play made up nearly half of the lesson context (44%) and teachers spent just under one-third (31%) of class time promoting PA
  

• Less than Half of Time in PE Classes is Active An article in the May 2012 Issue of Physical Activity & Health reports on a detailed Texas study of time spent in PE classes in actually being moderately to vigorously active. Students engaged in less than half their PE class time in MVPA (38%), while approximately 25% of class time was spent in classroom management. Percent time in MVPA was significantly higher in outdoor classes.

• In a similar vein, the use of renewed popularity of dance on television has coincided with a “Dance, Dance Revolution” in PE programs. An increased focus on dance in PE may be one way to encourage adolescent females and males to be more active. However, an article identified in our August monitoring (Gao, 2012) suggests that although junior high students are definitely motivated to dance, they lack the movement skills necessary to participate and therefore, the PE classes teaching dance end up with students not achieving moderate or vigorous activity levels. A Canadian analysis of girls’ experiences and involvement with physical activity (Clark et al, 2012) concluded that “unstructured play that occurred in girls’ free time and dance appeared as important forums, which allowed girls to engage in activities they enjoyed and explore their physicality”.

• The American food guide MyPlate discussed Several articles and summaries of poster presentations at a recent nutrition conference in Issue #4 (Supplement), 2012 of Journal of Nutrition Education and Behavior report on and evaluate the US food guide program called MyPlate. Canada has changed its icon when it released its new set of nutrition guidelines and produced educator materials as well. The American articles discuss the impact of the new icon but the issue to be raised here is this: do these guidelines encourage teachers to teach the facts (food groups, nutrients, portion size, balance etc. about nutrition rather than emphasize the skills (reading labels, making healthy snacks, etc) and the practical knowledge (advertising tricks, weight loss gimmicks etc.) One of the conclusions often reached when reviewing the impact of health education classes in schools is that curricula and instruction should be as specific and practical as possible in encouraging students to follow specific behaviours. Our monitoring of the research and news located some items that suggested this kind of specificity.

• Programs to Encourage Eating Breakfast Articles from the February issues of the European and American Journals of Clinical Nutrition can be combined to show the value of nutrition education on eating breakfast. The article in the American journal notes that eating breakfast can have a positive impact on food choices and eating later in the day. The European article reports that a school educational program affected the number of children eating breakfast each day.

• Cooking Skills, not nutrition facts are best: Study. A new study published in the Journal of Nutrition Education and Behavior shows that having cooking classes alongside subjects such as math and science may promote healthier eating habits as well as curb the childhood obesity epidemic. Researchers at Colorado State University Department of Food Science and Human Nutrition wanted to find out whether nutrition education had any positive effect on students. Using the Cooking with Kids program as a model, they interviewed 178 fourth graders to evaluate children’s attitudes towards cooking and experiences at school and home following a series of cooking plus tasting or just tasting classes alone.

• Knowledge alone does not change behaviour A study reported in Issue #4, 2012 of the Journal of Nutrition Education & Behavior reports that a classroom nutrition education program combined with parent involvement and teacher training improved knowledge but did not change consumption. This is hardly a surprise, since we have similar studies on many health issues over the past two decades. The real questions before us are whether such knowledge is a prerequisite for behaviour change, how to teach practical skills related to food selection and preparation, understand social influences and modify normative beliefs about food and eating.

• A review of the research (Branscum & Sharma, 2012) on the impact of after school programs on obesity/overweight reports that such programs have little impact on weight or the antecedents of overweight/obesity. A total of 20 interventions were found from 25 studies. Children in the interventions ranged from kindergarten to middle schoolers, however a majority was in the 4th and 5th grades. Most of the interventions targeted both physical activity and dietary behaviors. Among those that focused on only one dimension, physical activity was targeted more than diet. The duration of the interventions greatly varied, but many were short-term or brief. Many interventions were also based on some behavioral theory, with social cognitive theory as the most widely used. Most of the interventions focused on short-term changes, and rarely did any perform a follow-up evaluation. A major limitation among after school interventions was an inadequate use of process evaluations. Overall, interventions resulted in modest changes in behaviors and behavioral antecedents, and results were mixed and generally unfavorable with regards to indicators of obesity.
• News Story (Jul 20-11) No point in telling parents about children's weight: Study. School policies that let parents know when their children are overweight or obese appear to have little impact on the problem, according to a U.S. study (Madsen & Linchey, 2012). In the last decade, almost all public schools in California collected information about the height and weight of fifth, seventh and ninth graders, but only some schools opted to send the results to parents -- giving Kristine Madsen, at the University of California, San Francisco, a chance to evaluate the impact of that notification. She found that, years later, children whose parents were told they were overweight were no more likely to have lost weight at that point than children whose parents were not notified, according to a report published in the Archives of Pediatric Adolescent Medicine.

• Renovating School Yards for Physical Activity Two studies in the April 2011 Issue of International Journal of Behavioral Nutrition & Physical Activity report that renovating playgrounds on school grounds can increase their use and physical activity. Shade, cleanliness & safety seem to be important.
• Evaluation of USDA Fresh Fruit & Vegetable Program: The 10-year-old Fresh Fruit and Vegetable Program, which began with four states and the Zuni tribe in New Mexico, now operates in all 50 states and several U.S. territories. More than 4,000 elementary schools participate, and the program has an annual budget of $150 million—or nearly $1 billion each time the federal Farm Bill is renewed. An evaluation of the programlast year found that students at schools participating in the Fresh Fruit and Vegetables Program ate an average of a quarter cup more fresh produce per day than students at schools without the program, and consumed almost no additional calories in the process.
• School snack programs work in isolated indigenous communities: The impact of a school snack program on the dietary intake of grade six to ten First Nation students living in a remote community in northern Ontario, Canada was reported in Issue #3, 2012 of Rural and Remote Health. The authors report that "Students participating in the snack program during the 2004 data collection (37%; n=23) compared with those who did not (63%; n=40) had significantly (p<0.05) higher mean intakes from the ‘Vegetables and Fruit’ food group (7.5 vs 3.4 servings), folate (420 vs 270 µg), dietary fiber (18 vs 8 g), vitamin C (223 vs 94 mg), calcium (1055 vs 719 mg) and iron (16.5 vs 11.7 mg). For the 2007 data collection, snack program participants (52%; n=26) had higher intakes from the ‘Milk and Alternatives’ food group (3.3 vs 2.2 servings), vitamin A (697 vs 551 RE [retinol equivalents]), calcium (1186 vs 837 mg), and vitamin D (6.9 vs 4.4 µg) and significantly lower intakes of 'Other' foods (6.0 vs 7.2 servings) compared with non-participants (48%; n=24). Given the positive impact of the program on the food and nutrient intake of school snack program participants, qualitative feedback will be used to enhance the program and participation. Clearly, school snack programs can be an important venue to address the nutritional vulnerability of First Nation youth living in remote communities."

• Seliske et al (2012) examined Canadian data in the Health behaviours in School-Age Children Survey and suggested that a buffer zone of 1000 metres was the preferred distance to deter students from leaving the school. Students who had at two or more food retailers within 750 m of their schools had a 2.74 times greater relative odds of purchasing food at those locations.
• Black & Day (2012) did a similar analysis in British Columbia and found that “in 2010, over half of the public schools in BC (54%) were located within a 10-12 minute walk from at least one limited service food outlet. The median closest distance to a food outlet was just over 1 km (1016 m). Schools comprised of students living in densely populated urban neighbourhoods and neighbourhoods characterized by lower socio-economic status were more likely to have access to limited service food outlets within walking distance. After adjusting for school-level median family income and population density, larger schools had higher odds of exposure to food vendors compared to schools with fewer students.
• A Canadian webinar recently addressed the topic of school zoning by-laws.
• The Association pour la santé publique in Quebec has published a planning guide for municipalities. .

• Roman Pabayo,Lise Gauvin, Tracie A. Barnett (2011) Longitudinal Changes in Active Transportation to School in Canadian Youth Aged 6 Through 16 Years Pediatrics 2011; 128:2 e404-e413

• Roman Pabayo, Katerina Maximova b, John C. Spencea, Kerry Vander Ploegc, Biao Wuc, Paul J. Veugelersc, (2012) The importance of Active Transportation to and from school for daily physical activity among children, Preventive Medicine, Volume 55, Issue 3, September 2012, Pages 196–200

• Sean O’Loghlen, William Pickett, Ian Janssen (2011) Active Transportation Environments Surrounding Canadian Schools, Canadian Journal of Public Health, Vol 102, 5, 364-8

• Research funding agencies, research programs and individual researchers creating or developing knowledge based on studies while administrators create other forms of knowledge base on administrative data sources and practitioners experiences
• A number of organizations gathering and synthesizing knowledge from research reviews, studies, reports, and other sources
• Other practitioner organizations, government funded organizations and university centres translating knowledge into different print, media and web formats for a wide variety of audiences
• Other national and state/provincial organizations and publications disseminating knowledge through journals, newsletters, conferences, webinars and other formats
• Other national, state and local organizations, professional associations, program developers and others exchanging knowledge in two way or multiple directions through conferences, communities of practices and other means
• Local managers, individual professionals, parents, officials and others taking up knowledge based on their particular needs, biases, experiences
• Local managers, senior managers, researchers and others reflecting on knowledge acquired through implementing specific programs or approaches as well as their on-going professional assignments

• The Canadian Fitness & Lifestyle Research Institute and other centres such as the Alberta Centre for Active Living being more capable of doing analyses
• The creation of a peer reviewed Canadian journal on Physical & Health Education
• A rebirth of the Active Living Coalition through another vision statement
• Regular reports on youth physical activity levels from a Foundation
• A database of planning, educational and other resources on recreation, sports and active leisure
• A Research database on Parks, Recreation and Sports Benefits Hub
• There are collections of evaluated programs on Canadian Best Practices Portal (26 on school physical activity and 41 overall) as well as a set of over 25 background and policy papers
• The physical education teachers association (formerly CAHPERD) has developed a role in knowledge exchange to complement its role in promoting or delivering PA programs and publishes a teachers magazine

• The National Institute on Nutrition had closed earlier and was not revived
• he Centre for Science in the Public Interest (Canada) provides advocacy but is not funded by government. It has a newsletter reaching 100,000 Canadians.
• The Canadian Best Practices Portal has collected numerous interventions on healthy eating, including 106 interventions overall, 48 school-based or school-linked interventions and over 20 background/policy documents.
• The Canadian Association for School Health has a national Community of Practice on School Nutrition that organized over 15 webinars and symposia but it has gone dormant when its funding expired in 2010.
• The International School Health Network (based at Simon Fraser University) is starting up an International Discussion Group on School Nutrition and has done a series of webinars, Wikipedia style summaries and maintains a bibliography/toolbox and twitter-based news/research feed.

• Many of the indicators selected are focused on physical activity despite the research review evidence cited above that presents a consensus that increasing physical activity does not lead to weight loss among children. We may want to track activity levels for other reasons but obesity prevention does not really offer a strong scientific rationale.
• Other behavioural indicators relating to nutrition should be added, including the frequency of family meals, composition of school lunches packed by parents, amount of time spent by children in unsupervised time at home after school, availability of televisions and computers in bedrooms and others.
• Other environmental indicators should include the number of students who purchase or who are provided lunches at school, the composition and frequency of snacks purchased at school, the number of schools following school food sales regulations, the amount and nature of food advertising permitted by schools, the reported parent views on the safety of their neighbourhoods and routes to school, the number of family meals consumed outside of the home and the nature of those restaurants, the estimated number of students who leave school at lunch hour etc
• The data sources for these 2011 indicators appear to vary in regards to their continuity and nature. The Physical Activity Monitor is actually a report prepared by a research institute using various surveys. The HBSC survey data is actually controlled by a university and is not easily and automatically available to other researchers or inquiries. The only data source that has guaranteed life from one survey to the next is the CCHS.
• How do these data sources relate to others noted in this article? Is this data coordinated with the Canadian Health Measures Survey? Is there duplication with the provincial data collection done in several provinces?

• For early childhood, about half of provinces/territories are “involved” in baby-friendly initiatives, publishing infant feeding guidelines for professionals, early prevention/intervention, food guidelines for day care centres, developing a screening tool for pre-school children at risk from nutrition problems, and adapting WHO growth charts
• For schools, almost all provinces/territories are “involved” in active, safe routes to schools, comprehensive school health initiatives, publishing school food sales guidelines and promoting physical activity after school
• In urban and rural planning, a few provinces/territories are “involved” with community design initiatives, professional development for planners, age-friendly initiatives, healthy community initiatives
• In other areas and sectors, a few provinces/territories are “involved” with activities such as comprehensive overweight strategies, engaging stakeholders in vulnerable communities, and efforts to decrease marketing of food to children and youth.

• The status, content and objectives and actual time spent teaching of nutrition education objectives in the K-12 health curricula
• The status, content and objectives and actual time spent in active play in physical education curricula
• The involvement of parents in school-sponsored and school-linked parent education programs that include nutrition
• The provisions and supports provided by other agencies in coordination with schools for obese students
• The degree to which school food sales restrictions are being observed in schools
• The proportion of students who eat lunches from home at school
• The proportion of students leaving schools at lunch time
• Etc.

• The school menus for former CATCH schools contained less total fat content than former control schools but no difference with the new unexposed group of schools. Training of school food service personnel had no lasting effect.
• There were no differences among all of these groups of schools on the proportion of PE time spent on vigorous physical activity.
• PE teachers in former CATCH schools reported that they used CATCH activities 33% of the time. Former control schools used CATCH activities 30% of the time. Unexposed schools used CATCH activities 10% of the time.
• Classroom instruction using CATCH materials were low in all schools. Former CATCH schools reported using 2 out of the 15 lessons. Teaching time was also low in all schools.
• The CATCH family component was used infrequently in all three groups of schools.
• Time spent teaching about tobacco did not vary and was low in former CATCH and former control groups.
• CATCH training was associated with continued use of CATCH materials.
• The maintenance of the school menus was deemed to be likely due to a state decision to mandate such menus.

• Understanding the Characteristics of School Food Services: A recent article noted in our August 2012 monitoring of research articles identified an analysis of “competitive food sales” in the US by Guthrie et al (2012). The researchers delved into the US situation in order to examine the fears of reduced revenues from food sales that are often expressed by school administrators. They found that the schools who profited most from such sales were secondary schools from affluent districts which had fewer school meals subsidized by the federal government or the state. They also found that revenues from vending machines most often went directly to the school rather than to the food service. They suggest that increasing student participation in USDA school meals may be one of the strategies used to offset potential losses from such sales. However, the larger point is that by better understanding the segments of the audience (ie types of schools and characteristics of the food services within those schools) more effective strategies to promote, adopt and sustain healthier school meals might be more likely.
• Social networks within and between bureaucracies & system/policy change: Several articles in Issue #3, 2012 of Policy Studies Journal examine how informal social networks within and across government ministries as well as among organizations and sectors can affect policy development. Five of the articles discuss how to track the influence of these networks within systems using various statistical analysis tools. One article examines how such networks can be used in rebuilding communities after disasters and another examines inter-organizational cooperation via networks or competition during economic development programs. These informal social networks are one of the characteristics that need to be considered when pursuing systems change and sustainability.
• Adopter Concerns as a focus for Implementation: Five articles in Issue #3, 2012 of Evaluation & Program Planning use adopter concerns or perceptions as a lens in delving more deeply into implementation and program sustainability issues. The articles examine the concerns and perceptions of NGO educators in program evaluation, researchers at university centers in organizing site visits from external evaluators, junior high school teachers in using web-based in-service programs, public health staff in implementing environmental/systems change strategies and educators in implementing an after school program physical activity program for under-served students. The unifying message from these articles is that practical concerns of adopters will ultimately determine the fate of any intended change in their practices.
• Obesity and School Counselors: An American study (Laurier et al, 2012) of the perceived barriers and facilitators to involving school counsellors more on student obesity issues reported that “About two-thirds of the professional school counselors in this study reported that working with students who present with obesity-related issues was part of their role and function. Another 81.3% stated that among three major barriers, lack of time was the most significant factor that prevented PSCs from working with students with obesity related issues. On the other hand, 90% of the PSCs in this study stated that they would be more involved in prevention/treatment of obesity related issues if they received more requests from parents, teachers and students with obesity related issues.

• Pressure on Recess: One of the unintended consequences of pressuring schools to do better on standardized tests may be the loss of recess as a valuable play time, an essential part of the learning process at school. A blog post (DeWitt, 2012) that was identified in our 18 month scanning process noted that ``Recess has traditionally served as the one outlet during the school day when kids get to recharge their bodies and minds. But those minutes have been steadily eroding. Up to 40 percent of U.S. school districts have reduced or eliminated recess in order to free up more time for core academics, and one in four elementary schools no longer provides recess to all grades"(Zygmunt-Fillwalk and Bidello, 2005; McKenzie and Kahan, 2008. Robert Woods Johnson Foundation, 2010). That blog post also quoted a report from the Johnson Foundation that states: “When most people talk about how to improve education, they tend to focus only on what happens in the classroom. But the most unexpected opportunity to boost learning lies outside the classroom: on the playground at recess"(The State of Play. Robert Wood Johnson Foundation).In Canada, the Council of Ministers of Education, Canada has developed a formal statement supporting play-based learning which is apparently more concerned with the content of early childhood education programs (ensuring that they do not become too focused on academic skills). Perhaps we can persuade the same education ministers that other parts of the school experience are equally important for older students.

• Don't Mess with My Lesson Plans: Teachers Strike Over Professional Autonomy: An article in Issue #4, 2012 of Educational Policy (Jacoby & Nitta, 2011) helps us to understand how much teachers value their professional autonomy in selecting lesson plans and learning activities. Striking for nine days in 2008, teachers in Bellevue, Washington State, USA carved a distinctive path through the contradictory movements for professional reform unionism and national accountability. In addition to compensation, Bellevue’s teachers struck over the top-down prescriptive management epitomized by the Gates Foundation supported “Curriculum Web.” Where district administrators envisioned the web as a community resource, teachers complained that its detailed daily lesson plans hamstrung their ability to teach effectively. Teachers returned to work only when a memorandum of understanding was signed recognizing their authority to deviate from the district’s web-based curriculum.

• PE in Irish Education: A National Case Study: All of the articles in Issue #3, 2012 of Irish Educational Studies address the theme of a special issue on physical education. The articles include a research review and two other articles on the role of the generalist primary school teacher and the teaching of PE as well as critical look at school self-evaluation as a means to review progress in whole school PA programs.

• Professional Norms and Ideologies: One of the things that we have learned about teachers is that they often identify with the discipline which they are teaching. Math teachers consider themselves mathematicians, science teachers and scientists, etc.) Our recent monitoring of the journals has identified one such article that examines the expectations or normative beliefs about overweight people that are currently health by PE teachers who may consider themselves to be athletes. Peterson et al (2012) note that “Findings indicate that physical educators' expectations, attributions, and attitudes regarding students may be negatively influenced by youth body weight, and differ by student gender. They then discuss the potential effect of the physical educators' weight bias on adolescent participation in physical activity and its implications for students' physical health, academic achievement, and social development. The issue of normative beliefs among teachers is well-examined in the research on teacher education and development but is not really examined in health except in relation to substance abuse, so this article may be a start of this discussion in relation to activity.

• Parent/family privacy and role of the school. Some of the news stories noted earlier in this paper have reported on parents and the media responses to teachers becoming very active about child weight by monitoring what actions parents are taking. After this kind of coverage noted here, do we really expect teachers to check student lunches? (School apologises after making children eat their greens (Jun 11-12, London, UK), Turns out school food initiatives can be difficult to swallow (Jan 22-11, Washington State, USA), The crusade against cupcakes – and common sense (Jan 15-11, Canada-wide), Junk food in schools not making kids fat: Study (Jan 17-12, London-ON), Falling Short in the Obesity Fight (Jun 19-11, Toronto, ON), Student Complaints Prompt LA Officials to Revise Healthier Lunch Menu (Dec 22-11, Los Angeles, USA), School board may ease ban on junk food

• Prevailing social norms that see food as a reward. Teachers are selected for their jobs because they reflect the dominant values and social norms of their communities. This is so that parents will be comfortable in send ing their children to these teachers every day. I am finishing this paper the day after Halloween is celebrated in North America, a custom that now equals Christmas in its spending and that glorifies candy. Last week, I watched out local television news that reported that cake was served at a celebration of an expansion of a school famous for its healthy lunches. Yes, both of these were special occasions and food should be part of the celebration. But don’t we all have many of those special occasions almost every week? And exactly how and with what funds should teachers replace food as the reward at student birthday parties in class, class outings and more?

1. We need to understand that eating and physical activity are socially constructed behaviours, like all other human behaviours and not simply a matter of caloric intake and expenditures. Our behaviours can be better understood by ecological analysis, a concept that has been around for several years. But we need to restructure our interventions to be based on ecological action, and therefore use a systems-based, multi-level, cross sectorial, economic, political, social and institutional approach.
2. We need to shift attention to health authorities, social service agencies, school boards and employers rather than the front lines comprised of teachers, nurses and nutritionists. We have lots of checklists for schools. We need to develop similar checklists for provincial/territorial ministries and governments and hold them accountable. We need to ensure that federal departments (Health Canada, Industry Canada, Agriculture Canada) do their part as well as federally CIHR research institutes. We need to ensure that the Council of Ministers of Education, Canada (CMEC) reports regularly on the nutrition knowledge and skills being acquired as part of the mandatory health education curricula in all provinces, as they do foer science and math and reading. We need to have the inter-governmental committees on nutrition and school health continue their work, with the Nutrition Working Group developing national, inter-governmental policy options on school meal/snack programs in schools and the Joint Consortium for |School health completings its work to harmonized the many child health surveys. We need the Canadian Institute for Health Information to resume their child health monitoring and regular reports.
3. We need to refocus, with less emphasis on physical activity, more emphasis on diet, sleep, mental health, poverty.
4. We need more focus on the work-lives, safety concerns, daycare and transportation needs that create huge constraints on parents. But we need to be realistic about what can be achieved in terms of rezoning and moving fast food restaurants away from schools, or creating walkability in older established neighbourhoods. We also need to alter parent perceptions about the weight of their children and their health beliefs about their ability to influence the weight of their children.
5. We need to establish a national school snack and meal program for schools serving disadvantaged schools and join the rest of the western world in using schools to provide healthy food that helps to ensure that no child in Canada is hungry. We need cost benefit studies of offering a universal school lunch program to parents at all other schools.
6. We don’t need to try to maximize physical education time in schools. We have learned that better, more active use of the current time available in PE classes is needed. Instead, we need to worry about the time available for nutrition education in health curricula that have been combined with PE, resulting in less than 17 hours of secondary health instructional time in two jurisdictions to cover over 25 health issues and less than two hours of time available in one jurisdiction. We need to consider bringing back mandatory Home Economics/Family Studies curricula where students used to be taught basic skills like cooking healthy meals and managing home budgets. Indeed, this renewed curricula could be combined with recent calls for better financial literacy education through a return to consumer education and other content, including parenting skills.
7. We need to extend the school day to allow for more time at recess and lunch. Many jurisdictions and school boards are experimenting or expanding with pre-school education, so the extension of the school day to include after school child care should be considered for older children.
8. We need to decide who will do the coordination at all levels across the education, health and other systems. School nurses can be the backbone for obesity preventon and management at the school level and should be considered as several jurisdictions review their role. Increased nurse capacity would also be critical for many other issues coming at schools, including renewed outbreaks of measles, whooping cough and other infections as well as increased trauma from bullying.
9. We know that advertising works, so we need to ban it when it comes to marketing food to children.
10. We need to restrict and regulate food sales in hospitals, municipal sporting facilities and other publicly funded venues where children gather