Enter a typical classroom in an American primary school, and you may see a familiar scene: blackboards, books, teachers, and students seated at desks. This iconic image has changed little over the decades. But the health risks facing the students have changed and not for the better. In the more than 25 years that Steven Gortmaker has been a member of the HSPH faculty, he has seen the obesity rates and associated risks for diseases such as type 2 diabetes among American children have skyrocketed. Approximately 17 percent of children between the ages of six and 19 years are overweight or obese. And they will eventually enter the ranks of U.S. adults, two-thirds of whom are estimated currently to be overweight or obese.
"There are very few programs aimed at promoting improved nutrition and exercise for school children that are evidence-based and that have been evaluated for their effectiveness," said Gortmaker, professor of the practice of health sociology in the HSPH Department of Society, Human Development, and Health and co-author of both books. "Both Eat Well and Keep Moving and Planet Health strive to provide information that is adaptable to different classrooms and that engage children in a fun way, while ensuring the programs' efficacy."
Eat Well and Keep Moving is targeted towards upper-elementary students, and Planet Health is aimed at middle-school students. The new editions are published by Human Kinetics and are based on research conducted at HSPH.
In addition to Gortmaker, the authors of the new edition of Eat Well and Keep Moving are Lilian Cheung, lecturer, HSPH Department of Nutrition; Hank Dart, health communications consultant; and Sari Kalin, program coordinator, HSPH Department of Nutrition.
Both curricula strive toward the same goals - to help children develop healthy eating and physical activity habits and to encourage them to watch less television. The books' authors realized that adding more material to already jammed primary school curricula would be unappealing to school systems. So, they purposefully designed the books to work with existing classes in math, science, language arts, social studies, and physical education. See sidebar below for an example of how a lesson in calculating the consumption of beverages reinforces skills in math and critical thinking.
"We understand that America's classrooms are already packed with required lesson plans, so we worked hard to incorporate these health and exercise messages into existing curricula," said Wiecha.
The curricula offer lesson plans, microunits, worksheets, student self-assessment tools, and PowerPoint training presentations. They incorporate the latest nutrition recommendations and offer new and updated lesson plans, including novel lessons on sugar-sweetened beverages, a major determinant of child obesity.
The first edition of Eat Well and Keep Moving was published in 2001 after a joint project by HSPH and Baltimore Public Schools showed that students enrolled in the program consumed more fruits and vegetables, ate less fatty foods, watched fewer hours of television, and improved their understanding of nutrition and physical activity. Now the program has reached all 50 states and more than 20 countries. The curriculum has won the Dannon Institute Award for Excellence in Community Nutrition.
"We are facing a health nightmare when it comes to childhood obesity and type 2 diabetes," said Cheung. "We want to empower children, parents, teachers, and school staff to learn how to make better food and physical activity choices, and this new edition of Eat Well and Keep Moving helps inform them of those choices, based on the latest scientific evidence."
Both Planet Health and Eat Well and Keep Moving curricula have been scientifically tested. See sidebar below for a summary.
Multifaceted Lessons Learned and Applied
Both second editions of Eat Well and Keep Moving and Planet Health offer lesson plans that incorporate many of the skills that children are taught in other classes. Read an example below based on a new lesson plan from Eat Well and Keep Moving that reinforces math and critical thinking skills.
An elementary-school student leans over a worksheet and scribbles down the number of cups or units of soft drinks, sports drinks, and fruit punch she consumed over the past two days. She is asked to calculate the amount of sugar she has consumed just from those drinks. If she had one of each kind on both days, she calculates that she has consumed 48 teaspoons, or one full cup, of sugar. She learns that there is little nutritional value her beverage choices. She calculates how much calcium she would have consumed if she had replaced the soft drinks, sports drinks, and fruit punch with milk. The answer? 912 milligrams of calcium, putting her a long way towards the 1,300 milligrams recommended for children each day. She is asked to write a short essay that describes at least one health effect of the beverage choices she has made.
What the Literature Says
A cornerstone of both the Eat Well and Keep Moving and Planet Health curricula is their ability to be scientifically tested to see if they work. A sampling of the published research:
- A randomized, controlled field trial involving five intervention schools and five control schools found that girls participating in Planet Health were less obese, ate more fruits and vegetables, and consumed fewer calories each day. Both girls and boys participating in Planet Health watched less TV than those who did not participate. Archives of Pediatrics and Adolescent Medicine, 1999;153:409-418.
- A study asked classroom teachers to use the Eat Well and Keep Moving curriculum in math, science, language arts, and social studies classes for more than two years. Results showed that students in participating schools ate less saturated and total fat and more fruits, vegetables, vitamin C, and fiber. Television viewing was also reduced. Archives of Pediatrics and Adolescent Medicine, 1999;153: 975-983.
- A randomized controlled trial involving 480 girls in early adolescence found that girls in intervention schools were less than half as likely to report purging or using diet pills than those in control schools. Planet Health was implemented for two school years at the intervention schools. Archives of Pediatrics and Adolescent Medicine, 2005;159:225-230.
- A study of an obesity prevention program called 5-2-1-Go! - which includes Planet Health - showed that almost four percent of middle-school girls receiving only their regular health education began abusing laxatives or diet pills or vomiting to control weight, but just one percent of the girls in the 5-2-1-Go! program did so. Archives of Pediatrics and Adolescent Medicine, 2007;161: 865-869.
Copyright, 2007, President and Fellows of Harvard College
