From Paper to Practice

T he prevalence of overweight children in the United States is at an alltime high and increasing at such a dramatic rate that the problem has been described in terms of pandemic proportion. Furthermore, the number of overweight children has nearly quadrupled in the past three to four decades (Hedley et al., 2004). Approximately one in every three of America’s youth is at risk for overweight and one in every six is overweight (Ogden, Flegal, Carroll, & Johnson, 2002). In addition, the chance of overweight and obesity in children persisting into adulthood is 20% at four years of age and 70% to 80% if the child is still overweight into adolescence (Center for Health and Health Care in Schools, 2003). Alarmingly, findings indicate that the incidence of overweight children continues to be on the rise, placing youth at a much higher risk of developing chronic health problems such as asthma; type 2 diabetes; obstructive sleep apnea; renal disease; metabolic syndrome; and cardiovascular disease, including hypercholesterolemia, hypertension, and hyperlipidemia (Freedman, Dietz, Srinivasan, & Berenson, 1999). According to the American Academy of Pediatrics, Committee on Nutrition (2003), additional complications of childhood and adolescent overweight include orthopedic problems, especially in weight-bearing joints and psychosocial problems, which are often a result of poor self-esteem. Long-term implications related to the effects of such chronic health problems greatly impact individual wellness, but also extend beyond the individual person to the family, the greater community, and society at large in a time when resources are limited and health care costs continue to soar. Considering the increasing prevalence and negative consequences associated with childhood overweight, today’s schools play a key role in the primary prevention of this health disparity. Children spend an average of six to eight hours per day at school. In school, children may have the following opportunities not available in other settings, including one or two meals per day, physical activity instruction in a safe environment, psychosocial counseling, access to health care, and educators who can be trained in a healthy behavior curriculum. Therefore, schools have both the opportunity and responsibility to affect health outcomes by implementing policy and practices in the school environment that reflect the overarching goals of our national and state health promotion and disease prevention plans, Healthy People 2010 and Healthiest Wisconsin 2010, respectively. Healthiest Wisconsin 2010 is a companion to the nation’s health plan in that it shares a vision of health promotion and health protection for all individuals and communities by transforming the public health system into a coordinated, effective, and sustainable system (Wisconsin Department of Health and Family Services, 2005a). Healthiest Wisconsin 2010 (available at http://dhs.wisconsin. gov/statehealthplan/index.htm) identifies 11 evidence-based public health priorities that have the greatest potential leverage for improving the health of people in Wisconsin. Risk factors determined to be linked with each of the 11 health priorities have been conceptualized into four domains: nonmodifiable risk factors, environmental risk factors, societal risk factors, and individual risk factors. Public health partners, including schools, must work collectively to employ multiple intervention approaches