Letters from Maine

It takes a family


Usually, once an idea enters my head these columns write themselves ... albeit with occasional and substantial help from the editor and the fact checkers. For the last month, however, I have been struggling with the notion that we need to include more physical activity in the school day. It’s not an original idea by any means. Michelle Obama has included making schools more active as one of the cornerstones of her program to stop the surge in obesity.

If we suspect that inactivity is a major contributor to the obesity epidemic, and if children spend a large part of their day in school, it just makes sense that we should inject more activity into the school day. The problem is that many schools have eliminated recesses for middle-school children and many high schools have just the skeleton of a physical education program. And, at least in the school systems that I am familiar with, gym class is as lame an exercise (maybe a poor word choice) as when I was in school 50-plus years ago.

The column I was going to write included a plea to increase recess and free playtime. I also was going to urge that, for the early grades, physical activity be woven into the academic curriculum. In fact, I had already found examples on the Internet of just such innovative curricula that could be downloaded free by any teacher who wanted to enhance his or her academic program.

I also was going to advocate for a whole new approach to physical education at the high school level by replacing traditional gym class with a smorgasbord of active opportunities. These could include small-group walks, jogs, or bike rides with a teacher. Or dance. Or tai chi, etc. It would take some creative thinking, and it would mean turning a deaf ear to the naysayers who can’t envision beyond their noses.

That is what I was going to write until I stumbled across a New York Times story that sent me to an article in the British Medical Journal entitled "Effectiveness of intervention on physical activity of children: systematic review and meta analysis of controlled trials with objectively measured outcomes" (BMJ 2012;345:e5888).

The authors looked at 30 studies involving over 14,000 subjects in which programs focused on increasing the physical activity of the children. Presumably most of these were school based. What they found was that, when one looked at the children’s total activity for the day, there was little or no increase. This observation could mean that the children had some exercise set point, so when it was exceeded at school they would compensate by being less active when they arrived home.

These results fit with other observations of weight loss programs in which success seems to require the total package. Just diet change or just exercise usually won’t work. If one wants to be a leaner, healthier person, then one must live like a leaner, healthier person ... all day long.

The data also could be interpreted to mean that we shouldn’t be wasting school time and energy on trying to keep children more active, but they also suggest that efforts at school are fruitless if there is no follow through at home. Families must play a significant role in the solution to obesity. It already seems pretty clear that they have played a big part in its creation.

There are days when I think that the solution to many of the problems facing our children would be to send them all to military school from 6th grade on. But those days are few. I remain hopeful that we can find better and more human solutions. Despite the discouraging findings by these researchers, I still believe that making the school day more active is a good idea. It can’t do the job alone, and it may take a while to see measurable results, but I think it won’t hurt.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at pdnews@elsevier.com.

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