Health affects students’ ability to learn. Leaders at MUSC’s Boeing Center for Child Welfare (MUSC BCCW) believe that healthy living lessons can be part of every student’s school experience.
“Healthier students are better learners, and the best learners actually live healthier adult lives,” said Kathleen Head, MD, Associate Medical Director of MUSC BCCW.
In a recent study published in the Journal of School Health, a research team led by the chief and director of BCCW Janice Key, MD, compared the average body mass index (BMI) of students in schools participating and not participating in the MUSC BCCW school-based wellness initiative. The team used BMI data from the SC FitnessGram Projecta statewide program to collect and track student health and fitness data in public schools.
Schools participating in the initiative saw the average BMI of their students drop significantly over time, regardless of school type. The average BMI of students in schools that used more wellness tools and programs was up to 15% lower than in schools that used fewer.
Implementation of the School Wellness Initiative
Between 2014 and 2018, 103 South Carolina schools in five counties participated in School Wellness Initiative. The program targets policies, systems and environmental changes, such as school-wide gardening projects or classroom-wide stress reduction strategies, rather than just individual changes.
To achieve this, the initiative uses the School Wellbeing Checklist (SWC). The SWC offers seven categories of evidence-based strategies that schools can use to promote a culture of well-being that includes start-up, nutrition, physical activity, social-emotional well-being, culture of well-being well-being, staff well-being and sustainability. Schools can choose which SWC items work best for them, and points are awarded based on how many they use. One of the objectives of the study is to determine which of these seven categories is most associated with the decrease in the average BMI of students.
Designing a wellness plan for a school using the SWC is a community effort. Head said each school’s wellness committee designs a wellness plan specific to that school’s needs, explaining that the committee includes teachers, staff, administrators and parents, as well as members of the community, some of whom may have children in school or simply live in the area and are invested in advocacy.
Head stressed that the school-based nature of the initiative is particularly important. “The environment around us as humans is critically important to our overall well-being,” she explained. “Children spend the majority of their day, five days a week, in school, eating, learning and playing.”
Bringing the initiative to schools also ensures program equity, as school programs reach all children, regardless of medical access. “We want to reach every child and provide more than we can in one doctor’s visit,” Key said. “The BCCW needs to go where the kids are, which is to school.”
Defining child well-being
Over the past 40 years, childhood obesity rates have increased by 240%. Obesity is the state of having a BMI over 30, and the term overweight applies to people with a BMI between 25 and 30. This category changed in 1998 from a BMI between 27 and 30, moving 25 million Americans from normal weight to overweight. category.
“We want to reach every child and provide more than we can in a visit to the doctor. The Boeing Center for Children’s Wellness needs to go where the kids are, which is to school.
–Dr. Janice Key
About a third of the students in the study had a BMI in the obese or overweight category. Since children are still growing, their weight cannot be measured against preset ranges. Instead, pediatric BMIs are grouped by age and sex. Children in the 85th to 95th percentile of their group are considered overweight, and those above the 95th percentile are considered obese.
While having an overweight or obese BMI is not an individual guarantee of a negative health outcome, Head said children classified as obese are four times more likely to be diagnosed with diabetes by age 18. 25 years.
Key said there are instances where BMI does not paint an accurate picture of a child’s body composition, such as in an athletic student who may have above average muscle mass.
“For something that’s simple and easy for a whole class of kids to check out, the size and weight is the best we’ve got,” she said. “But when you look at an individual patient, you would go beyond that.”
Building equitable and effective welfare systems
Average BMI decreased in schools that participated in the initiative and increased in schools that did not. Additionally, in schools that participated for two or more years, a higher SWC score was associated with a greater decrease in BMI. Students in schools that scored 250 SWC points were 15% less likely to have an overweight or obese BMI than students in schools that scored only 50 SWC points.
“Our results were the same whether the school was elementary, middle, or high school, whether it was rural or urban, or whether it was a Title I school or a non-Title I school.”
–Dr. Kathleen Head.
However, just as important, the results were evenly distributed among the schools, Head explained.
“Our results were the same whether the school was elementary, middle, or high school, whether it was rural or urban, or whether it was a Title I school or a non-Title I school,” said she declared.
Older school wellness programs failed to deliver health benefits in different types of schools.
Although physical activity was most associated with lower BMI, followed by socio-emotional well-being and staff well-being, nutrition education did not. “The disappointment for us was that the decrease in BMI was not associated with the nutritional intervention score,” Key said.
She explained that this may be because students can actively engage in physical activity and social-emotional well-being at school. However, the choice of food is not made in the same way. Most food choices and options for students, such as evening dinners, take place outside of school and the wellness initiative.
Despite these challenges, Key said they wouldn’t give up on nutrition.
Team members also want to diversify the data they track to monitor the effectiveness of their program. “In the future,” Head explained, “we would like to measure the knowledge, attitudes, and behaviors associated with some of our interventions rather than going straight to BMI.”
Chief KC, Morella K, Lugo MP, Key JD. Participated in a school-based wellness initiative associated with improving K-12 student body mass index trends. J Sch Health. 2022 Dec 27. doi:10.1111/josh.13292. Epub ahead of print. PMID: 36575648.