At a glance
- Obesity affects nearly 1 in 5 young people aged 6–19 years in the United States.
- Schools reach a majority of children and adolescents and can affect this trend.
- Schools can involve people and places to help youth achieve and maintain a healthy weight.
- A comprehensive school approach supports the health and well-being of all students by focusing on nutrition and physical activity.
Why it's important
In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s.
In 2017–2018, about 1 in 5 school-aged children were affected by obesity:
- 20.3% of 6–11 year-olds.
- 21.2% of 12–19 year-olds.
Obesity among 2–19 year-olds:
- 25.6% for Hispanic children.
- 24.2% for Black children.
- 16.1% for White children.
- 8.7% for Asian children.
Many factors contribute to childhood obesity, including:
- Metabolism—how your body changes food and oxygen into energy it can use.
- Eating and physical activity behaviors.
- Community and neighborhood design and safety.
- Short sleep duration.
- Negative childhood events.
Genetic factors cannot be changed. However, people and places can play a role in helping children achieve and maintain a healthy weight. Changes where young people spend their time—homes, schools, and community settings—can enable youth to access nutritious foods and be physically active.
Addressing obesity in schools
Schools are a priority setting for obesity prevention efforts because they reach the vast majority of school-aged youth. They provide regularly scheduled options for physical activity and offer nutritious foods in school meal programs.
Schools can adopt in-school and after-school programs, policies, and practices that are cost-effective and cost-saving, helping students:
- Eat more fruits and vegetables.
- Consume fewer foods and beverages high in added sugars or solid fats.
- Increase daily minutes of physical activity.
In-person learning offers children consistent access to: physical activity opportunities; healthy meals; and services from school nurses and counselors.
Comprehensive approach to childhood obesity
A comprehensive approach can address childhood obesity in schools, especially for elementary and middle school students. Scientists know less about what school-based obesity prevention approaches are effective for teenagers.
A comprehensive approach means routinely directing attention to nutrition and physical activity in schools. It can involve school nurses, parents, caregivers, and other community members, such as pediatricians and after-school program providers.
- A comprehensive approach supports the health and well-being of all students.
- It does not single out students according to their weight status or body size.
- Overweight and obesity are sensitive issues for students, and families and must be addressed with compassion, understanding, and care.
School-based programs to promote physical activity and improve diet quality have not contributed to increases in depression, anxiety, or body-dissatisfaction. However, it should be noted that many studies do not collect information about these unintended effects.
REMINDER: Schools should not emphasize physical appearances or reinforce negative stereotypes about obesity.
Recommendations
How school nurses can help
School nurses play a key role to prevent and reduce student overweight and obesity. School nurses can address the complex physical, social, and health education needs of children and adolescents who have overweight or obesity. School nurses have the knowledge and skills to:
- Create a culture of health and wellness in school.
- Promote and implement school-based policies and strategies for healthy eating and physical activity.
- Coordinate care with families and health care professionals.
- Lead the school community to influence policy changes that reinforce healthy eating, physical education, and physical activity—before, during, and after school.
Resources
- CDC MMWR: Longitudinal Trends in Body Mass Index Before and During the COVID-19 Pandemic Among Persons Aged 2–19 Years — United States, 2018–2020s
- School Health Guidelines
- School Nutrition
- Physical Education and Physical Activity
- Parents for Healthy Schools
- Local School Wellness Policy
- Tips for Parents
- Lange SJ, Kompaniyets L, Freedman DS, et al. Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2–19 years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep. 2021;70(37):1278–1283.
- Schroeder K, Travers J, Smaldone A. Are school nurses an overlooked resource in reducing childhood obesity? A systematic review and meta-analysis. J Sch Health. 2016;86(5):309–321.
- Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2–19 years: United States, 1963–1965 through 2017–2018. NCHS Health E-Stats. 2020. Accessed September 5, 2024. https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf
- Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804–814.
- Committee on Accelerating Progress in Obesity Prevention; Food and Nutrition Board; Institute of Medicine, Glickman D, Parker L, Sim LJ, et al., eds. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. National Academies Press; 2012.
- Eisenburg LK, van Wijk KJE, Liefbroer AC, Smidt N. Accumulation of adverse childhood events and overweight in children: a systematic review and meta-analysis. Obesity. 2017;25(5):820–832.
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- U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. 2010. Accessed September 5, 2024. https://www.ncbi.nlm.nih.gov/books/NBK44660/
- Micha R, Karageorgou D, Bakogianni I, et al. Effectiveness of school food environment policies on children’s dietary behaviors: a systematic review and meta-analysis. PLoS One. 2018;13(3):e0194555.
- The Community Guide. Interventions to increase healthy eating and physical activity in schools. 2022. Accessed September 5, 2024. https://www.thecommunityguide.org/content/interventions-increase-healthy-eating-and-physical-activity-schools
- Gortmarker SL, Wang CY, Long MW, et al. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Aff (Millwood). 2015;34(11):1932–1939.
- Cradock AL, Barrett JL, Kenney EL. Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Prev Med. 2017;95(Suppl):S17–S27.
- Brown T, Moore THM, Hooper L, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2019;7:(7):CD001871.
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