1

Dianne Montano
HLTH 309
Dr. Dixon
December 9, 2020
Childhood Obesity With School-Based Physical Activity

Introduction

As a child, recess was always what I looked forward to the most because it was free time

to run around and play with friends. Teachers would also allow the students the last 30 minutes

of school-time for physical activity as a class such as dodgeball and kick-ball. However, as I

grew up recess became less frequent and only a select few teachers had time for physical

activity. Many children have similar experiences with less time in school focusing on physical

activity. In the past years, a significant increasing trend in youth obesity rates has been reported.

There have been many interventions and programs that have been implemented based on family

or school. ​I will be exploring the impact of implementing mandatory physical activity as a

school-based prevention policy to combat childhood obesity rates. The independent variable is

the enforcement of physical activity in schools, while the dependent variable is the body

composition and fitness of the children.

Methods:

Two main databases were used to find the studies: PubMed and SpringDirect. I modified

the search to focus on studies conducted within the last ten years and peer-reviewed. All of the

studies were found using keywords such as “childhood obesity”, “school-based”, and “physical

activity.” It was important to not focus on systematic reviews, but studies that cover the methods

they used to collect data, analysis of data, and peer-reviewed. Two of the studies were discovered
 2

in the PubMed database (Bagherniya et al., 2018 and Wright et al., 2016), while the other three

were discovered in the SpringDirect database (Ip et al., 2017, Li et al., 2010, and Thompson et

al., 2020).

Sampling Methods:

There are different kinds of sampling, and two of the studies used simple random

sampling to collect data for the target population, where schools were randomly selected in each

district (Li et al. 2010 and Wright et al. 2016). Each school had an equal opportunity to be picked

and the data collected were used to generalize the population. One study used cluster sampling to

collect data for their target population (Bagherniya et al., 2018) which started from randomly

selected schools that had similar socioeconomic status, then each school was randomly selected

to be either in an intervention or control group. Within each group, students were randomly

selected and observed. This type of sampling is useful because it takes into account that

children’s weights can vary due to their different socioeconomic statuses. It also takes into

account that children of different genders may also account for different childhood obesity rates.

One study used convenience sampling (Ip et al., 2017) to gather data from their target population

by sending questionnaires via postal mail to all the teachers in the district to gather information

about school environment factors and only used the data from those who participated. Thomas et

al.’s (2018) study obtained data from stratified random sampling. It focused primarily on schools

that participated in the FitnessGram program. It then randomly selected students that had

complete state fitness testing and sociodemographic data. This is ideal because it can be used to

represent the schools that implement a physical fitness program.

Methodology:
 3

There was more preference toward quantitative data in all five articles (Bagherniya et al.,

2018, Ip et al., 2017, Li et al., 2010, Thompson et al., 2020, and Wright et al., 2016) with one

study utilizing qualitative data as well (Ip et al., 2017). All five studies used the children’s BMI

score as the initial basis of their studies. The initial BMI score was quantitative because it is

measurable data, assumes a measurable and fixed reality (BMI being the fixed variable).

Measuring the BMI score as the fixed variable allows researchers to analyze the data through

numbers and statistics. The data can be represented visually which makes it easier to compare the

BMI scores of children that attended schools with physical activity programs and schools

without. One study (Ip et al., 2017) used mixed methods to collect qualitative data as well. It

used teacher questionnaires about students’ growth and other environmental factors that may

have contributed. This results in qualitative data because it is interested in the world from the

teachers’ perspectives and how they may see the children’s weight changing. The questionnaire

also involved questions about environmental factors such as school campus size and the quality

of each physical activity program. These are beneficial because broader connections can be made

such as the better the quality of the physical activity programs, the lower the rates of childhood

obesity. Although there was qualitative data, the majority is quantitative.

The studies were either longitudinal or cross-sectional. Three studies that were conducted

focused on the same group of participants over the different courses of time (Bagherniya et al.

2018, Li et al.,2018, and Wright et al., 2016). Using longitudinal research in these studies was

used to see the effects of times that physical activity programs may have on children. The data

collected from the beginning of the study is later compared to the data from the end. The studies

were able to see that physical activity programs have positive effects on children, especially

children with obesity. However, certain drawbacks that were seen throughout the studies were
 4

participants dropping out of the program. All the studies required participants to have consent

from either a parent or guardian. However, since the studies were conducted over time, consent

can be withdrawn at any point. The other two studies used cross-sectional research (Ip et al.,

2017 and Thompson et al., 2020). The use of cross-sectional research is beneficial because it

allowed researchers to compare many variables from the same point in time. It was used to

compare schools that implemented physical activity programs with schools that did not have

these programs. As seen in the studies, those who had physical activity as an intervention

implemented in their school saw significantly lower BMIs and higher physical ability compared

to schools that did not use physical activity as the control. One drawback of this method is that

the researchers were not able to see the long-term effects of physical activity programs.

Data Collection:

All five of the studies collected data by measuring the BMI score of students (Bagherniya

et al., 2018, Ip et al., 2017, Li et al., 2010, Thompson et al., 2020, and Wright et al., 2016). This

method was costly as it was done by trained professionals and each student had to measure. This

method not only is expensive, but it is a slow process. However, it provides accurate data for

researchers leaving little error. One study also utilized questionnaires (Ip et al. 2017) in their

study, which is beneficial because it was quick and not as expensive as other methods. It also

allows researchers to focus on questions relevant to their study and account for other variables.

One article used secondary data (Wright et al., 2016) which involved using data collected from

the California Department of Education. This is useful because it allows researchers to data that

is already available without wasting time collecting data themselves. However, it can also be a

downfall as not all data is trustworthy nor is it the exact information that is needed. I believe the

best approach is measuring the BMI score, even though it is a slower process and costly. It does
 5

yield the best results and leaves little room for error. It can be easily compared with the results of

different schools and programs. A common trend was a control group and intervention group in

the studies. This allows for a better comparison of the effects that physical activity programs

have on children. All the articles are valid because it measures what is intended, and reliable

because it has the evidence to back up the findings. The different studies showed external

validity as the evidence shows that physical activity programs positively affect schools and

children.

Analytical Techniques:

The majority of the studies analyzed the data through regression analysis, specifically

multiple regression analysis (Ip et al., 2017, Li et al., 2010, Thompson et al., 2020, and Wright et

al., 2016). Regression analyses are used to explore and model the relationship between multiple

variables. The independent variables among all of the studies were the BMI scores of the

children and the dependent variables are whether the physical activity programs have any effect.

It allows finding trends in databases, such as physical activity programs affect lowering BMI

scores. Multiple regression analysis is used to see if there is a statistically significant relationship

between sets of variables. It is important to consider the levels of measurement to see which

statistical test is appropriate to use. For example, using multiple regression analysis when

factoring in more than two variables. This is especially beneficial when taking into account

outside variables such as school campus size and the number of physical activity programs (Ip et

al., 2017). One study used a T-test (Baghernita et al., 2018) which showed the difference

between two groups at the baseline and the end of the study. This is beneficial because it can

determine that physical activity programs affected the children by comparing the weights of
 6

children before and after the intervention. Researchers should focus on using chi-square and

crosstabs tests as well to have different perspectives on the results.

Conclusion

Childhood obesity is an epidemic that is occurring globally, and the rate is continuously

rising. One school-based prevention is allowing for mandatory physical activity as many children

spend a large proportion of their time at school. The longitudinal studies showed a decrease in

weight in children who participated in physical activity when compared to children who did not

participate. The cross-sectional studies compared the differences in schools that had physical

activity programs already implemented, with schools that did not. As seen in the studies, those

who had physical activity as an intervention implemented in their school saw significantly lower

BMIs and higher physical ability compared to schools that did not use physical activity as the

control. However, since the studies were conducted on adolescents there were limitations that

each study faced such as consent from parents, patient privacy, among other limitations and

barriers. In longitudinal studies, there were many cases of students dropping out of the study.

Despite this, all studies were able to conclude that physical activity as health prevention is one of

the many ways that can combat the rising number of childhood obesity cases.
 7

Bibliography

Bagherniya, M., Mostafavi Darani, F., Sharma, M., Maracy, M. R., Allipour Birgani, R.,

Ranjbar, G., Taghipour, A., Safraian, M., & Keshavarz, S. A. (2018). Assessment of the Efficacy

of Physical Activity Level and Lifestyle Behavior Interventions Applying Social Cognitive

Theory for Overweight and Obese Girl Adolescents. ​Journal of research in health sciences​,

18​(2), e00409.

Ip, P., Ho, F. K., Louie, L. H., Chung, T. W., Cheung, Y., Lee, S., . . . Jiang, F. (2017).

Childhood Obesity and Physical Activity-Friendly School Environments. ​The Journal of

Pediatrics,​ ​191​, 110-116. doi:10.1016/j.jpeds.2017.08.017

Li, Y. P., Hu, X. Q., Schouten, E. G., Liu, A. L., Du, S. M., Li, L. Z., Cui, Z. H., Wang,

D., Kok, F. J., Hu, F. B., & Ma, G. S. (2010). Report on childhood obesity in China (8): effects

and sustainability of physical activity intervention on body composition of Chinese youth.

Biomedical and environmental sciences: BES,​ ​23(​ 3), 180–187.

https://doi.org/10.1016/S0895-3988(10)60050-5

Thompson, H. R., Hewawitharana, S. C., Kao, J., Rider, C., Talmage, E., Gosliner, W.,

Woodward-Lopez, G. (2020). SNAP-Ed physical activity interventions in low-income schools

are associated with greater cardiovascular fitness among 5th and 7th-grade students in California.

Preventive Medicine Reports,​ ​20​, 101222. doi:10.1016/j.pmedr.2020.101222

Wright, C. M., Duquesnay, P. J., Anzman-Frasca, S., Chomitz, V. R., Chui, K.,

Economos, C. D., Langevin, E. G., Nelson, M. E., & Sacheck, J. M. (2016). Study protocol: the

Fueling Learning through Exercise (FLEX) study - a randomized controlled trial of the impact of
 8

school-based physical activity programs on children's physical activity, cognitive function, and

academic achievement. ​BMC public health​, ​16​(1), 1078.

https://doi.org/10.1186/s12889-016-3719-0