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At their June 3 meeting, members of the District 65 School Board received an analysis of middle-school students’ physical-fitness data collected over the past year. They debated what their next steps should be to promote students’ health and well-being. Some Board members expressed dissatisfaction with the pace at which a steering committee was proceeding to connect certain families with resources.
The data was generated by Fitnessgram, a software program used in some District 65 schools and other school districts across the nation to measure students’ physical abilities and attributes in five areas: cardiovascular fitness, muscular strength, muscular endurance, flexibility and body composition (though body mass index, or BMI). The results show whether a student is in what the program calls the “Healthy Fitness Zone.”
After some parents and Board members objected nearly a year ago about the way students’ BMI was communicated, the Board decided not to expand BMI testing but to continue it at the schools already using the software.
Data presented at the June 3 meeting was collected during the fall and spring from students in some of the District’s middle schools.
Board member Suni Kartha introduced cardiologist Timothy Sanborn, M.D., of NorthShore University HealthSystem, who is also a professor at The University of Chicago Medical School. “He has been in discussions with the District and has generously offered his services to take the data and synthesize it,” she said.
A steering committee is working to refine the testing process, Ms. Kartha said. “One of the questions we had is ‘What exactly are we learning from what we’re gathering?’ … This is a starting point for us to see what we gathered this year … and see what other kinds of health and fitness initiatives we can bring to our school.”
Dr. Sanborn said he identified two questions arising from conversations with the Board: “What is Fitnessgram doing?” and “Is it making an impact on our students?”
Abdominal Strength: “As students went through sixth, seventh and eighth grades they improved their abdominal strength,” he said. To be in the Healthy Fitness Zone for abdominal strength, 11-year-olds must be able to perform more than 15 curl-ups, and 12-year-olds must do more than 18.
Upper-Body Strength: “There is perhaps some improvement in the upper-body strength,” Dr. Sanborn said. Girls aged 11 and up must be able to perform more than seven push-ups; 11-year-old boys must do more than 8. The required numbers increase with the children’s age.
BMI: Fitnessgram 10 uses the BMI definitions of the Centers for Disease Control for what is considered “overweight” and what is considered “obese.”
Using CDC’s standard, in Evanston last fall 10.6% of sixth-graders, 12.5% of seventh-graders and 11.1 percent of eighth-graders were considered “overweight.” At the same time, 25% of sixth-graders, 24% of seventh-graders and 22 percent of eighth-graders were considered “obese.”
By gender, 10.2% of females and 12.5% of males were “overweight”; and 25.2% of females and 22% of males were “obese.”
Thus, on a combined basis, about 35% of the students measured by the Fitnessgram last fall were either “overweight” or “obese” and not in the Healthy Fitness Zone. This is about the national average.
Disaggregated by race, the figures showed the following numbers of students were not in the Healthy Fitness Zone because they were “overweight” or “obese”: white, 21.2%; Asian, 31%’ mixed-race, 33%; Latino, 48%; and African American, 49%.
“There is little difference by gender. By races, as has been seen nationally, [minorities] and the underprivileged have a greater rate of overweight and obesity,” Dr. Sanborn said.
Between last fall and this spring, the numbers shifted somewhat, with the percentage of students in the Healthy Fitness Zone increasing from 61% to 66%. In the fall 23% of students were in the “obese” category, and that number shrank to 14% in the spring; 13% were “overweight” in the fall, and 17% were “overweight” in the spring, possibly having moved down from “obese.”
“Looking at the prevalence of overweight [middle-schoolers] in the fall of 2013, [we see] they are pretty close to the national average. Perhaps there’s a decline in obesity as kids get older, so this is encouraging. … You can see an actual encouraging increase in the Healthy Fitness Zone. Perhaps we’re having an impact between fall and spring,” said Dr. Sanborn. “Hopefully, the kids will stay active over the summer.”
Some ‘Encouraging’ Shifts
Board member Richard Rykhus said the shifts may not represent “improvement … because they are different sets of kids. So it’s not that they’ve actually improved yet. What I’ll be curious about next year is if the sixth-graders continue the progress as seventh-graders.”
“As children age, they improve their strength, and I think what you’re seeing is Evanston children are doing the same thing,” said Dr. Sanborn.
“Something that stood out to me,” Mr. Rykhus continued, “is that 11 percent of [these middle-school students] are overweight, and twice that number – 22 percent – are obese. … So, looking at the change here, 9% of the overall population fell out of the ‘obese’ category. Some went to ‘overweight’ and some continued down to the Healthy Fitness Zone.”
Dr. Sanborn appeared to agree, saying, “It looks like some of the obese children are becoming overweight and some going to the Healthy Fitness Zone.”
Mr. Rykhus asked what factors might have influenced that change, saying he was looking for a “context for this. … I wonder, as kids grow, do they naturally through the school year become less obese and less overweight?” Dr. Sanborn said he thought education and outreach to families might have helped but deferred to Mary Larson, School Health Coordinator, and Denise Rossa, physical education chair for the District.
“As we go through, we’ll be able to see if this is a trend – whether kids would naturally become stronger or if anything District 65 did helped,” said Board member Katie Bailey.
“We know that, nationally – as you said, [kids’ being] overweight is a problem,” Ms. Bailey said. She asked whether health and proper weight were aspects of the incipient Evanston Cradle to Career Initiative (EC2C).
Assistant Superintendent Susan Schultz said that there is a health component to EC2C.
“I think this could be one component of trying to change an epidemic,” said Ms. Bailey. “One thing I would ask is what we are going to do with the data over time, because it does point to a national trend that is alarming.”
“That’s why I asked about change,” said Mr. Rykhus.
Board member Candance Chow said the McGaw Y has begun a Pioneering Healthier Communities initiative in Evanston. Dr. Sanborn said that initiative looks at ways to stem obesity in kids up to age 5.
Board President Tracy Quattrocki, who has opposed BMI testing of middle-school children because of the sensitive nature of the information and the vulnerability of students of that age, said she had recently read an article that indicated that research showed that most children who would become obese were already headed in that direction by kindergarten.
“So I wonder why we’re testing middle-schoolers, when we already have that information for kindergartners,” Ms. Quattrocki said.
“Things can change at later points in time [after kindergarten]” said Ms. Chow. “I’m just saying that there’s another group of kids who … become obese later.”
Referring to the word gap that exists at kindergarten between children of more educated and affluent parents and children of less educated and poorer parents, Ms. Bailey said, “That doesn’t mean we should ignore [the obesity problem]. That means we should address these things as early as possible. I think your [Ms. Quattrocki’s] point is well taken that we should address these things as early as possible.”
Board member Suni Kartha said, “I can see starting early, but I don’t think you should end [the testing] at middle school.” She said the Board should not make it an “either/or” question.
Communication With Families Not in the HFZ
The way in which families are informed that their children are not in the Healthy Fitness Zone and at possible risk for serious disease apparently continues to baffle the steering committee and concern at least some Board members.
Ms. Quattrocki said she was concerned about the contents of any letters sent to families. Referring to a letter that had been submitted for approval but rejected at a previous Board meeting, she said, “You know my concerns about sending a letter to parents [saying] ‘Your kid is overweight or obese and at risk of cancer or diabetes’ without really offering them solutions or changes in lifestyle.”
There appeared to be a discrepancy between what some Board members thought was supposed to be done and what in fact the District is doing in communicating to certain families that their children could develop serious health problems because of their weight or body mass.
Ms. Larson said the District had sent a letter in the fall to all families, informing them how to access information about the Fitnessgram results of their own children.
Ms. Quattrocki said that, at a Board meeting in March when communication with families was discussed, Ms. Larson and Ms. Rossa said they would send another letter to the families whose students were deemed at risk of serious health problems. “You said a social worker would be calling them. But the letter went out saying a gym teacher would be calling, so I am confused.”
Ms. Rossa said, “A letter was sent home. … The only conversation [with a family] was if I was called by any of the parents. And I was. I don’t think anybody else made any phone calls.”
“No phone calls,” said Ms. Quattrocki. “[Making phone calls] was part of the plan.”
Ms. Larson said it was only in March that the Board had asked that they actively communicate with families.
“I was under the impression that there would really be some effort made, to really have direct communication with [families of] those kids at risk. I was under the impression there was an agreement [to do so],” said Mr. Rykhus.
“The steering committee has not figured out how to get in touch with the families,” said Ms. Larson. “It could take 200 phone calls. … The physical education teachers don’t want to do it, and the health clerks have broad experience but are not certified professionals.”
“I believe it is important that we get [the communication] right,” said Ms. Bailey. “It’s important that the steering committee come up with a thoughtful recommendation,” she added.
Ms. Larson said the steering committee “will get together to figure out what is a reasonable and respectful way” to communicate with the families whose children are at some weight and mass outside the healthy fitness zone. The committee would not target all overweight students, she said.
Composition of the Steering Committee
Ms. Quattrocki asked about the composition of the steering committee. She said she thought it was important to have a “balance of voices” on the committee and that the membership include some gym teachers who opposed or expressed concerns about BMI testing. She asked whether Ms. Larson had reached out to any of those teachers.
Ms. Larson said she was “confused about that.”
“I thought you were going to actively recruit those teachers,” said Board member Claudia Garrison.
The members of the steering committee will not solicit teachers who oppose BMI testing, but Board members who know such teachers who wish to be on the steering committee will refer those teachers to Ms. Kartha.