Using School Wellness Plans to Fight Childhood Obesity

Testimony

Statement by
Howell Wechsler, Ed.D, MPH,
Director
Division of Adolescent and School Health
Centers for Disease Control and Prevention
U.S. Department of Health and Human Services

on
Using School Wellness Plans to Fight Childhood Obesity

before
Education and Labor Committee
Subcommittee on Healthy Families and Communities
United States House of Representatives

Thursday, May 10, 2007

Mr. Chairman, Members of the Committee, thank you for the opportunity to provide this Statement for the Record for today’s hearing on using school wellness plans to fight childhood obesity. I am Dr. Howell Wechsler, Director of the Division of Adolescent and School Health at the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services (HHS). My statement discusses what we know about the implementation of local school wellness policies mandated by the Child Nutrition and Women, Infants, and Children (WIC) Reauthorization Act of 2004, along with complementary school-based efforts to address obesity among children and adolescents.

Analyzing the Early Stages of Local Wellness Policies
The mandate required local educational agencies, usually school districts that participate in federally-funded school meal programs, to have wellness policies in place by the beginning of the 2006-2007 school year. It is still much too early to draw conclusions about the effectiveness of the law in spurring the adoption of scientifically sound and effective policies or, more importantly, in leading to the actual establishment of health promoting school environments. A number of data collection efforts and research studies are under way, but it will be some time before they are completed and published. In the meantime, I will share with you the limited information we do have about the adoption of school wellness policies.

Two national non-profit organizations -- Action for Healthy Kids (AFHK) and the School Nutrition Association (SNA) -- are dedicated to protecting and promoting the health of the nation’s youth. These organizations have conducted analyses of wellness policy adoption during this school year. AFHK analyzed wellness policy adoption and content in 112 urban, suburban, and rural school districts, and SNA looked at the 100 largest school districts in the Nation. From these two analyses, it appears that the overwhelming majority of school districts have indeed adopted wellness policies as the law requires and that the policies they have adopted do include most but not all of the components required by the law. That is they address: 1) goals for nutrition education, physical activity, and other wellness activities; 2) nutrition guidelines for all foods and beverages outside of school meals; 3) guidelines for school meals that are no less restrictive than federal requirements; 4) a plan for measuring implementation of local wellness policy, including designation of a coordinator; and, 5) involvement from parents, students, community members, and others. The law does not specify what the policies need to say, only that they need to address these issues.

These two early analyses did show that some district policies are lacking some of the components required by the law. For example, AFHK found that many of the policies they analyzed lacked timeframes and measurable objectives to evaluate; 40 percent of the policies did not specify who was responsible for implementation. In addition, some policies do not address some of the more recognized components of a comprehensive school-based approach to wellness promotion and obesity prevention. For example, the SNA found that about half of the policies they analyzed did not include a requirement for recess in elementary schools, which can provide children with opportunities for physical activity.

The analyses found a range of approaches to policy content. In the SNA analysis, 37 percent of the districts had a broad policy with no procedures for implementation included, while 35 percent included some specific procedures, and 26 percent included a great deal of specificity about procedures for implementation. This range of specificity is not surprising, because school boards tend to vary substantially in the degree of specificity of their policies on other educational issues as well. The wellness policies ranged in length from less than one page to 20 pages, with the average length of a policy being five pages.

All in all, it seems that the wellness policy adoption process is off to a good start, though many school districts could certainly benefit from further technical assistance on policy development. Wellness policy adoption is clearly feasible for school districts. It is also clear that a great many school districts have engaged in thoughtful and diligent processes to craft policies that are consistent with the science-based recommendations that CDC, the US Department of Agriculture (USDA), other federal agencies, and trusted scientific organizations such as the Institute of Medicine have established. AFHK has a local wellness policy database on its website that highlights policies from school districts across the nation, and a number of states have developed similar online databases of thoughtful policies from school districts in their states.

Research in the Field
The most rigorous and comprehensive analysis of wellness policies to date is currently being conducted by university researchers with funding support from the Robert Wood Johnson Foundation (RWJF). This study will analyze the content of wellness policies in a nationally representative sample of 585 school districts. Findings should be available sometime in 2008. RWJF is also supporting several other studies that will yield additional information on the impact of wellness policies and effective strategies for promoting policy implementation.

USDA is currently supporting the Wellness Policy Demonstration Project, which is analyzing wellness policy adoption and implementation in California, Iowa, and Pennsylvania to: 1) assess local wellness policy activities in selected school districts; 2) document the process used by these school districts to develop, implement, and measure policy implementation; 3) document changes resulting from policy adoption in the school physical activity and nutrition environment; and, 4) assess the types of technical assistance necessary to help school districts implement and evaluate a local wellness policy. Findings from this three year study won’t be available until 2009.

We have received many positive reports that strong policies have been effectively implemented in some school districts, but it will be some time before we know the magnitude of change in school policies and practices. For example, CDC’s School Health Profiles survey collects data on physical activity and nutrition policies and practices in schools across participating states and cities. CDC conducts this survey every other year, and it will be conducted again in 2008 with final data available in 2009.

State Actions
The wellness policy law makes no mention of a role for state agencies in promoting school wellness policies; however, the law has had a profound effect in stimulating action by states to help school districts adopt and implement scientifically sound wellness policies. For example, at least 40 states have produced policy guidance documents and resources to aid local education agencies in creating wellness policies, and state agencies in at least 18 states disseminate their own model wellness policies. At least nine states have passed laws or adopted regulations that reference the wellness policies required by the Child Nutrition and WIC Reauthorization of 2004 and establish content requirements that go beyond those required by the federal government.

Many states have gone beyond issues of policy content to address the critical challenge of how to ensure that scientifically sound policies that are adopted by school boards actually get implemented in schools. At least 15 state legislatures or state boards of education have adopted requirements intended to strengthen policy evaluation and accountability, including mandating that school districts report to the state on policy implementation and requiring ongoing local level accountability for implementation of wellness policies.

Strong actions have been taken in the 23 states that CDC supports to implement coordinated school health programs that promote physical activity and healthy eating. For example, Arkansas, Rhode Island, and South Carolina have integrated local wellness policies into their general accountability system. Arkansas’ Consolidated School Improvement Plan requires each district to incorporate a Wellness Priority into each of their School Improvement Plans. Rhode Island mandates that each school district establish a district-wide coordinated school health and wellness subcommittee that is responsible for the development of policies, strategies, and implementation plans that meet the requirements of the Child Nutrition and WIC Reauthorization Act of 2004. South Carolina requires each school district to establish and maintain a Coordinated School Health Advisory Council (CSHAC), charged with implementing and monitoring health policies and programs, including the district wellness policy. Districts must collaborate with the CSHAC to develop a school health improvement plan that addresses strategies for improving student nutrition, health, and physical activity and is integrated into the district’s five-year strategic improvement plan.

Many of these state-level efforts were stimulated by the January 2006 School Wellness Policy Institute in Atlanta, sponsored by CDC in collaboration with the USDA and the National Governor’s Association. This meeting brought together teams of education and health agency officials and representatives of governors’ offices from 44 states to develop collaborative efforts to meet the technical assistance needs of school districts in their states related to wellness policy adoption and implementation.

State agency professionals who lead school physical activity and nutrition programs tell me that the local wellness policy requirements have been a very positive development. I have also heard from many school health professionals, as well as from principals, superintendents, and school board members, who tell me the local wellness policy requirement was the tipping point for their district, the decisive factor that prompted educational policy makers to help schools strongly and consistently promote healthy eating and physical activity.

Evidence Base for Effective Strategies and Tools for Implementation

The local school wellness policy law builds upon strong progress achieved in recent years in developing an evidence base that describes the policies and practices schools can implement to effectively promote physical activity and healthy eating. CDC has reviewed the research literature and consulted with leading researchers and practitioners to identify 10 critical strategies: http://www.cdc.gov/healthyyouth/keystrategies/index.htm.

Address physical activity and nutrition through a Coordinated School Health Program (CSHP).
Designate a school health coordinator and maintain an active school health council.
Assess the school's health policies and programs and develop a plan for improvements.
Strengthen the school's nutrition and physical activity policies.
Implement a high-quality health promotion program for school staff.
Implement a high-quality course of study in health education.
Implement a high-quality course of study in physical education
Increase opportunities for students to engage in physical activity.
Implement a quality school meals program.
Ensure that students have appealing, healthy choices in foods and beverages offered outside of the school meals program.

In addition, CDC and other federal agencies have, in recent years, developed a strong product line of technical assistance tools that support wellness policy implementation by empowering schools and school districts with guidance on how to effectively implement these recommended policies and practices. These tools include:

CDC’s School Health Index (SHI), a self-assessment and planning tool that enables schools to identify the strengths and weaknesses of their health promotion policies and programs, and use those findings to develop an action plan for improving student health;
Fit Healthy and Ready to Learn, a school health policy guide developed with CDC support by the National Association of State Boards of Education, that provides education policymakers and administrators with sample physical activity and nutrition policies and information to support the policies;
CDC’s Physical Education Curriculum Analysis Tool (PECAT), which enables educators to evaluate and improve physical education curricula based on the extent to which the curricula align with the National Standards for Physical Education developed by the National Association of Sport and Physical Education (NASPE) guidelines and best practices for quality physical education programs;
CDC’s Building a Healthier Future Through School Health Programs, which describes promising practices that states should consider when planning school-based policies and programs to help young people avoid behaviors that increase their risk for obesity; and
Making It Happen: School Nutrition Success Stories, developed by CDC and USDA in partnership the U.S. Department of Education, describes six key strategies used to improve the nutritional quality of foods and beverages offered on school campuses and highlights 32 schools or school districts that have implemented important improvements in the quality of their nutritional environment.

CDC also provided support to the Institute of Medicine of the National Academies to carry out a Congressionally-mandated study to develop scientifically sound guidance on what foods and beverages should be offered and sold at schools. The study focused on identifying nutritional standards for “competitive” foods; these are foods and beverages sold at school in competition with the nutritious meals offered through the federal school lunch and breakfast program. The IOM report, Nutrition Standards for Foods in Schools: Leading the Way toward Healthier Youth, was released in April 2007 and emphasizes the importance of offering healthful snack foods and drinks, such as fruits, vegetables, whole grains, and nonfat or low-fat dairy products, that are consistent with the 2005 Dietary Guidelines for Americans (DGA).

In addition, the USDA supports efforts to improve school nutrition through its Team Nutrition program and dissemination of a tremendous variety of high quality technical assistance resources. Many federal agencies, such as the National Institutes of Health (NIH), Food and Drug Administration (FDA), and the President’s Council on Physical Fitness and Sports, have developed and disseminate high quality health curricula, instructional materials, and after school programs for elementary and secondary schools.

Challenges Remain
In recent years CDC has helped to develop a much stronger knowledge base on what constitutes effective policies and practices schools can implement to help students develop and maintain physically active and nutritionally sound lifestyles. We have translated that knowledge into effective tools that make it easier for schools to implement these policies and practices. At the federal and state levels, our greatest challenge continues to be the dissemination of this knowledge and these tools into the more than 14,000 public school districts, and over 120,000 schools across our Nation. At CDC our primary vehicle for dissemination is the support we provide to state education and health agencies to deliver the scientifically sound training, technical assistance, and supportive state policies that local school districts and schools urgently need.

Another vehicle for dissemination is Secretary Leavitt’s Adolescent Health Promotion Initiative which aims to create a national culture of wellness that helps young people take responsibility for personal health through actions such as regular physical activity, healthy eating, and injury prevention. The School Health Index is central to this initiative and will enable schools to assess their policies and programs and develop action plans for improvement. After developing action plans that include specific research-tested strategies schools will be able to apply to their State Education Agency for a School Culture of Wellness Grant. These grants will support the implementation of HHS-developed tools relevant to the school wellness improvements featured in their action plans.

At a time when schools are relentlessly focused on student achievement so they can ensure no child is left behind, it is important to remember that wellness policies can help students be healthy and ready to learn. In fact, a growing number of educators have come to realize that strong school wellness policies can enhance academic performance, as well as critical health outcomes. The Association for Supervision and Curriculum Development (ASCD) asserts that decisions about education policy and practice should begin with strategies that are comprehensive in nature. ASCD is working to recast the definition of a successful learner from one whose achievement is measured solely by academic tests, to one who is knowledgeable, emotionally and physically healthy, civically inspired, engaged in the arts, prepared for work and economic self-sufficiency, and ready for the world beyond formal schooling. The Council of Chief State School Officers and the Association of State and Territorial Health Officials affirm that policies and programs built through a coordinated approach to school health will make a significant contribution not only to individual students, but also to entire communities, and that these initiatives will clearly demonstrate that healthy kids make better students and better students make healthy communities. The National Association of State Boards of Education maintains that coordinated school health programs can help young people achieve higher standards of health and learning through improving health knowledge, attitudes, skills, and behaviors, and improving health education and social outcomes.

With the requirement for wellness policies and the work of the CDC-funded state programs in coordinated school health, CDC has seen a growing number of educators who appreciate the important role of health and wellness in the mission of our schools. As a nation, we have a long way to go and many critical barriers to overcome, but some important progress is being made. I recently had the privilege of visiting a school in Wisconsin that had just been named the winner of the Governor’s School Health Award, which recognizes and celebrates schools with policies, programs, and the infrastructure to support and promote healthy eating; physical activity; alcohol-, tobacco-, and drug-free lifestyles; and parental and community involvement. In the previous two years, they had adopted a strong wellness program that included more time for students to engage in physical activity, enhanced nutrition education efforts for students and their families, and distribution of fruits and vegetables as snacks during the school day. I asked the principal of this school how he could justify spending so much time and resources on wellness when he, along with all principals, was under great pressure to improve the academic performance so critical to students’ future success. “I have no doubt,” he replied, “that these measures we’ve taken to promote physical activity and nutrition will help our students’ academic performance. And, besides, it’s good for the kids.”

Last revised: August 29,2008