The kids got up long before sunrise and went to school early because some grown-ups had offered them a chance to play. The grown-ups rose in darkness because they had an opportunity to use sports and games to fight, in a small way, the obesity that is rampant among young Americans. The kids and the grown-ups arrived at Parker Memorial, a public school for third- and fourth-graders in Tolland, Conn., just as the early autumn fog was lifting off the nearby green hills. The students tossed their backpacks and jackets onto a table and stormed into the small gymnasium. The adults tightened the laces on their sneakers and cued up a boom box. ¬∂ This sweet convergence of problem and solution was born last winter when Jaci VanHeest, an associate professor of kinesiology at the University of Connecticut's Neag School of Education, was referred to Parker Memorial by representatives of a state health district that had received a small federal grant. "[Parker officials] felt that a lot of children were at risk for overweight and obesity," says VanHeest, 42, who has studied physiology and body-weight regulation for nearly two decades. "I asked them what they wanted. They said, 'We're not sure. What can you provide?' So we created a program that I had been thinking about for 15 years: Paw Pals." ¬∂ The name is derived from UConn's Husky mascot, and the concept is as simple as a game of tag. VanHeest and five of her master's and doctoral students "gave the kids exactly what does not exist today: free play," she says. "We did whatever they wanted to do, and we played with them."
The most delicate task was inviting students who were overweight or at risk of becoming so. "That was some letter to write," says VanHeest. "A lot of people were convinced we were ostracizing chubby kids." The program was made cool by its exclusivity--56 students were invited, but only the first 20 to sign up were accepted--and by the addition of a half-dozen popular kids of normal weight, some of them good athletes and all generous and mature.
On the first day of Paw Pals, last March 9, skeptical parents stood outside peering through the open gym doors. Children lined up against the wall, appearing terrified of the unfamiliar adults in their school. (Their gym teacher was not directly involved in the program because VanHeest didn't want the kids to think they were being forced into remedial phys ed at age nine.) VanHeest asked them what they wanted to play.
"Superman tag," said one pupil, breaking the silence. So they played Superman tag. They played an approximation of Harry Potter's sport, Quidditch, minus the flying brooms. For one hour every morning before school, through the end of May, the children played games that they themselves suggested. And something extraordinary happened: They discovered that they loved exercising. "My daughter couldn't wait to get up every morning and go to school," says Wendy Dunham, whose child, Mackenzie, was then in third grade. No statistics were kept, but parents reported to VanHeest that their children were losing weight. Teachers said the kids were more alert in the classroom.
The children finished every session by huddling in the middle of the floor, joining hands--like a team before a game--and shouting, "One, two, three ... Paw Pals!" On the last day UConn's mascot, Jonathan the Husky, participated in the play activities. In the hallway outside the gym other Parker students awaited their chance to shake hands with the Big Dog.
The program was resumed in late September, and this time it runs throughout the school year and weight statistics are being kept. (The program will remain limited to roughly 25 students, including the half-dozen normal-weight kids.) VanHeest acted as announcer for relay races on four-wheeled plastic scooters, and the children yelped deliriously. Instead of Superman tag, this time they played octopus tag. When the session was finished at 8:30 a.m., as sunlight streamed through the high windows on the gym walls, Jacqueline David, a nine-year-old fourth-grader returning to Paw Pals for a second year, stood in the middle of the floor, smiling as if it were Christmas and sweating like Mia Hamm after a breakaway run. "It's morning," she said. "Normally you wouldn't invite all your friends over to play a game of tag right now, but we come here every morning. It's fun."
Sure, it's fun to play. Back in the day, my friends and I in Whitehall, N.Y., never stopped playing. Tackle football on the sloping lawn of the coat factory off Kirtland Street. Two-hand touch under the lights in the new Grand Union parking lot after closing time. Basketball on the three half courts outside the old high school or the full court at the playground over on the other side of the barge canal. Exercise? I had to ride my bike a couple of miles just to get to either of those places. It was that or stay home and play in my driveway, channeling Walt Frazier or Pete Maravich. On summer nights there was kickball in the middle of the well-lit street, or hide-and-seek in the darkness. Home was just a place to eat and sleep. In the house for dinner and back out again. Never stopped sweating. Nobody told me I was working out. It just happened. It happened to all of us.
So it was that sports and games inoculated kids against sloth for most of the 20th century. Play was organized not by university scholars--or by overzealous parents living vicariously through their offspring--but by the children themselves, simply because it was fun and because (let's be frank) there was little else to do with idle time. "Nobody worked at being active; you had to be active," says James O. Hill, professor of pediatrics and medicine at the University of Colorado at Denver's Health Sciences Center. Kids were healthy and fit almost by habit.
Now they are not playing, and many of them are not healthy. "Obesity is soon going to overwhelm all other health issues in this country," says pediatrician Tom Robinson, director of the Center for Healthy Weight at Lucile Packard Children's Hospital at Stanford University.
According to a survey by the Centers for Disease Control and Prevention (box, page 88), an estimated 15% of children ages six to 19 were overweight in 2000, when the report was completed. (The CDC does not apply the term obese to children. It defines overweight as at or above the 95th percentile in the Body Mass Index [a height, weight and, in children, age correlation], which corresponds to the definition of obese in adults.) The percentage of children who were overweight more than tripled from 1974 to 2000 in the six-to-11 age group and more than doubled among 12- to-19-year-olds. As a result, type 2 diabetes, once a disease of the middle-aged and elderly, is increasingly found in kids.
In this changing culture children who once were viewed as fat--and teased about it--are now considered ordinary, their self-esteem boosted by what have come to be called "fat role models" such as Queen Latifah, Rosie O'Donnell and John Goodman (not to mention any NFL offensive lineman). Acceptance only fuels the epidemic. Overweight children are more likely than their healthy peers to become obese adults, begetting further generations of overweight citizens. "Where do we wind up at the end of this road?" asks William Dietz, the CDC's director of nutrition and physical activity. "With a population that is medically handicapped and with a bankrupt health-care system. The cost is enormous."
The reasons for this crisis are numerous (box, below), but solutions are as handy as the nearest organization devoted to weight loss, healthy eating or exercise. What seemingly cannot be overcome is Americans' denial of their corpulence. (The CDC estimated in 2000 that 64.5% of U.S. adults were overweight and 30.9% were obese.) Two years ago the nonprofit Institute of Medicine, based in Washington, D.C., impaneled 19 specialists in a wide range of disciplines and asked them to come up with a plan to win the fight against obesity. On Sept. 30 the panel issued a report asking for what Robinson, a panelist, described as "nothing less than a revolution" in society, with sweeping changes in diet and exercise, and an emphasis on prevention, not treatment.
The cause of obesity is simple: "An imbalance of energy intake over energy expenditure," says Steven L. Gortmaker, professor of society, human development and health at the Harvard School of Public Health. "Eating versus activity." The last 30 years have seen explosive changes in both areas.
•EATING The fast-food industry, which was born in the 1950s, took off in the '70s and was supersized and invited into schools in the '80s and '90s. As a result Kristie Andres, a physical-education instructor in Fairhope, Ala., sees students arriving at her elementary school with paper sacks containing fast-food breakfasts. "They've already been to Hardee's, and they've got their sausage biscuit and a Coke," says Andres. "And by the afternoon they're talking about going to KFC after school." Four years ago Andres had a student who weighed 185 pounds at the start of third grade, and one day the boy was so short of breath during moderate exercise that she thought he was having a heart attack.
While VanHeest was organizing her program for Parker Memorial, she came across two 10-year-olds whose parents had already placed them on the Atkins Diet.
•ACTIVITY Over the last half century, technology--first television, then video games and finally the Internet--has lured children indoors. In two-income and single-parent homes, these electronic devices are virtual babysitters, and their overuse is, according to study after study, an accurate predictor of obesity in children. The CDC has recommended 60 minutes a day of exercise for school-age children. Many of them spend far more time in front of the TV or the computer.
Residents of suburbs rely on cars for nearly all their transportation, and parents stymie what little wanderlust their children might feel out of fear of abduction by unseen pedophiles. "There is a much greater chance that your child is going to be dangerously overweight from staying inside than that he is going to be abducted," says James Sallis, a professor of psychology at San Diego State and cocreator of a phys-ed program used in hundreds of schools across the nation. "Yet the fear of abduction looms large in people's imaginations."
"One of the worst things that happened was the milk-carton campaign," says Dietz, of the effort to locate missing children by posting their photos on the sides of cartons. "It made people feel that if their children were outside, they would be abducted--when, in fact, most abductions are family-related. It contributed to the notion that it's dangerous for children to be outside." That's one of the reasons, says Robert Putnam, professor of public policy at Harvard and author of Bowling Alone, a 2000 best seller that examined the increasing disconnectedness of Americans, that "our kids are growing up isolated in front of glowing screens."
These changes have driven children away from exercise, and we're left with a bunch of overweight kids. Specialists on obesity suspect that the epidemic will worsen before it improves. If it improves. "What do I think is going to happen?" asks Colorado's Hill. "I am afraid that [society] probably is not going to deal with this properly. Our kids will be obese and, by the age of 12, on five drugs to manage their diabetes and high blood pressure and high cholesterol. The most likely scenario is that anyone who is not genetically protected will become obese, and we will just accept that we're an obese society. It depresses me to think about it in those terms."
Americans love sports, but mostly from their seats. "We're not a nation that plays sports," says Hill. "We're a nation that watches." Sports have too long been neglected as a means of promoting our children's health, but they can reestablish a beachhead in kids' lives on three levels--if inherent problems in each area can be overcome.
•FREE PLAY Another CDC survey, published in 2003, found that 22.6% of children ages nine to 13 do not engage in any "free-time physical activity." Even when children report that they have been active, Gortmaker wonders how active. "We had kids fill out diaries and also wear accelerometers [to measure movement]," he says. "What happens is that a kid reports that he was playing basketball, yet the accelerometer shows very little activity. Well, he was probably standing around on a basketball court, talking with his friends."
Given kids' ready access to technology (and the harried lives of their parents), it's highly unlikely that they will, of their own accord, return to afternoons filled with free play. "Face it," says Dietz, "video games are more exciting and more stimulating than running around the neighborhood."
Solution: Parents must push their children out the door, and communities must encourage--and fund--the creation of before- and after-school programs similar to Paw Pals. We can't expect overburdened schools to solve all of the nation's child health problems. It's encouraging news that the health-club industry has begun courting young members.
•PHYSICAL-EDUCATION CLASSES Once a staple of school life, daily gym class is becoming obsolete. A CDC survey released in mid-September verified widely held suspicions that daily gym class participation among high school students has not increased significantly since it fell dramatically from 41.6% in 1991 to 25.4% in '95. By 2003 the figure had risen only to 28.4%. Just one state, Illinois, has mandatory daily phys ed for all students in grades K-12.
What has robbed children of their gym time? The culprit most often identified by teachers and school administrators is an emphasis on improving standardized-test scores--even more so since the enactment of the federal No Child Left Behind program in January 2002. The program challenged schools to "achieve academic proficiency" largely by raising scores in the math and reading tests. "P.E. was always a very low priority for schools throughout my teaching career," says Peter Saccone, who taught fifth grade in El Cajon, Calif., for 23 years before retiring in June '03. "At the elementary level I found it was basically discouraged. They wanted test scores. Period." Time that might have been given to physical education, teachers say, has in many cases been shifted to test preparation.
What's more, too few phys-ed programs have made the transition from old school forms of exercise to new-age. Traditional team sports such as football and basketball don't appeal to all students and, more significantly, don't teach fitness-building skills that students can readily carry into adulthood. "Face it," says VanHeest, "to play football you need 10 friends."
Solution: Legislation mandating minimum phys-ed requirements for public schools, and curriculums created by innovative professionals who make the best of the time they are given (box, page 82). Sallis says, "There is no excuse for P.E. malpractice." Other studies, and vast anecdotal evidence, suggest that children who exercise regularly do better in the classroom.
There is no government-mandated national minimum for phys-ed activity or performance--except the old President's Physical Fitness Program, which tests students in, for example, the mile run, push-ups, sit-ups and sit-and-reach. Says Russell Pate, professor of exercise science at South Carolina, "We have to think in terms of policies at the community and full-population level."
•YOUTH SPORTS PROGRAMS For at least the last two decades, a child's first exposure to sports participation has been through organized leagues for baseball, basketball, football, hockey and, in recent years, soccer, rather than neighborhood games that once dominated the landscape. However, these leagues seldom provide adequate exercise for players. Driving around northern Connecticut and watching youth soccer practices, UConn's VanHeest has seen children standing in line, waiting to kick a ball, only to return to the end of the line, where they wait several minutes for another kick. "At the end of an hour," says VanHeest, "the kid has been active for 15 or 20 minutes at most."
Kids who stay involved in sports for several years find themselves climbing a steep pyramid. While some communities, primarily in affluent suburbs, operate extensive recreational or "house" programs for all children willing to pay an entry fee, far more programs are geared toward building competitive travel teams through tryouts that cut less talented players. It is the American way, and it often leaves those youths most in need of exercise with few or no organized options, especially in low-income communities. "Nobody is worried about the quarterback, the shortstop, the soccer star," says Jim Pivarnik, professor of kinesiology at Michigan State. "It's the ones who don't have the skill to play those games as they get older who will be a health burden later in life."
Solution: Communities, rec departments and independent youth sports leagues need to create or retain broad-based, participatory teams even as they form high-powered squads for gifted athletes. Children consistently tell adults that they don't want to hang up their cleats, skates or sneakers simply because they aren't good enough for elite teams. "Kids as young as eight or nine are telling us that they don't want to compete at a higher level," says pediatrician Robinson, "but they get very excited about having a soccer program that wouldn't be as high-powered."
It would also be helpful if programs leaned toward individual sports such as running and swimming, in which kids can compete against their own best times rather than for spots on elite teams.
The challenge seems nearly insurmountable, yet every day people swim against the surging wave of obesity. In the fall of 1980 Saccone, then 37, walked into his first fifth-grade classroom at Meridian Elementary in El Cajon, which is near San Diego. In a strange and vaguely intimidating turn near the middle of his life, Saccone had moved west from Connecticut and undertaken a new career. He was responsible not only for teaching a room of more than 30 10-year-olds but also for giving them a daily dose of unspecified physical education. "By state law I had to teach P.E.," Saccone says. "They told me the minimum was 20 minutes a day. I was naive. I believed I was supposed to do what I was told. Little did I know that virtually no P.E. was being given by other teachers."
Like many other Americans caught up in the waffle-soled frenzy of the early '80s, Saccone was a runner. So he thought, Maybe I'll run with the kids a bit, to get me through a few weeks, and then I'll think of something else. He started on that sunny fall day and never stopped. Every morning, before doing anything else in school, Saccone and his students ran the one-third-mile perimeter of the school grounds for 50 minutes. His first class named the activity It's Funner to Be a Runner, and the title stuck.
"Kids in my class who had never had any success with sports--kids who were uncoordinated, kids who were heavy, kids who were little--found that they could put one foot in front of the other," says Saccone. "And boy, you talk about health. You could tell which kids were in my class." After the hour outside every morning, the children went inside and wrote in a journal. It was usually about running, but it was still writing. They kept lap charts and incorporated them into their math lessons.
"You'd be amazed at how far the kids came along every year," says Saccone. "Sure, I was a runner myself, but anybody could get the kids running, or even just walking."
For Crystal Gorwitz, 47, a middle school physical-education teacher in Hortonville, Wis., the goal was to expose students to a broad range of new exercise options. In 2001 she joined with her district's high school P.E. teacher, Marcia Schmidt, and their elementary school counterpart, Cheryl Richardson, to request a $250,000 federal grant to revamp the district's P.E. program. (They would receive $233,000.) "We're dedicated teachers," says Gorwitz. "We wanted to change what we do, and we didn't have any money [from the district]. So we typed out a 25-page single-spaced application on our laptops and won the grant."
Gorwitz wrote an innovative curriculum that included not only traditional units in football, soccer and softball but also units in mountain biking, backpacking, in-line skating, cross-country skiing and snowshoeing. Students wear pedometers every day and heart-rate monitors once a week. "Kids won't go out and play without a push," says Gorwitz. "We tried to give them more options."
Last winter one of her fifth-graders asked his parents to give him snowshoes for Christmas. It was the type of small victory that warms an educator's heart. In the high school Schmidt has had success with an aerobics program for girls that has been copied elsewhere, sometimes including dance. ("I've yet to find any physical activity that is as motivating for girls as dance is," says Robinson.)
Phys-ed classes at Hortonville Middle School meet for 45 minutes every other day. Gorwitz wishes it were more often, but she and her colleagues are pushing on with alternative plans. They wrote another grant request, this one for $900,000, which was denied. "If we had gotten that," Gorwitz says, "we would have built a fitness center in the school, with treadmills and weights."
Creativity and drive in this area are not limited to teachers. Ron Green grew up in a housing project in Tupelo, Miss., and played minor league baseball until he left the game in 1999, at age 28. He went back home to help kids and found that his old neighborhood, Haven Acres, was overrun by gangs and drugs. "Every day was a crime wave," Green says. He went to work for the Boys and Girls Clubs of North Mississippi, and when he became director of operations he made sports and physical activity the top priority.
"I could not believe the number of kids who didn't play anything at all," says Green. "We've tried to change that. We start our summer programs every day with exercise. We put little kids in games of red light--green light. We have the older kids play gateway mix-up, which is like musical chairs, but it also teaches you the names of gateway drugs [drugs that lead to more dangerous ones] and makes you move. We try to be creative. If a kid doesn't want to compete in the usual way, we encourage him to compete against himself, against his own times or skills."
Green, who is now chief professional officer for the Boys and Girls Clubs of Northwest Tennessee, helped start a club in the middle of Haven Acres. On the day in May 2003 that its doors opened, 280 kids rushed inside--to play.
In the same spirit, on a September morning in northern Connecticut, children blasted out of their gymnasium, energized by an hour of Paw Pals. They snatched their gear and barreled down the hallway toward their classrooms, one day fitter than before. In their slipstream they left a simple message: It can be done.
Child Obesity By Gender, Race And Ethnicity In 2000
Here is the breakdown, by percentage, for children in the U.S. classified as overweight (at or above 95th percentile in Body Mass Index).