This is an excerpt from Positive Behavior Management in Physical Activity Setting 3E w/WR by Barry Lavay,Ron French & Hester Henderson.
Childhood obesity is a serious medical condition in which a child or adolescent is significantly above the normal weight based on his or her age and height (Mayo Clinic, n.d.). The prevalence of childhood obesity has reached epidemic proportions in the United States and in many other industrialized countries in the world since the 1980s (Ogden, Caroll, Curtin, Lamb, & Flegal, 2010). It is quickly becoming the leading cause of death in the United States.
The concern is that childhood obesity is associated with numerous physiological and psychological comorbidities. Childhood obesity has been reported in some instances as a disease (Wallace & Ray, 2009) and in other sources as what might be an educational disability (French, Sanborn, Stephens, & DiMarco, in press). Childhood obesity is often misunderstood and stigmatized; currently, it is not recognized as a disability, and so services are not always provided. Some possible common behaviorsassociated with being overweight and obese along with a list of a few illustrative teaching strategies are provided in table 9.5.
There are numerous program modifications and strategies that a physical activity specialist may consider to more effectively engage children and youth who are underweight, overweight, or obese in physical activity programs. The following are a few proactive modifications and strategies that may be considered. The first two are safety considerations.
- Ensure the physical activities are within a participant's medical margin of safety. For example, appropriate weight-bearing activities may need to be included. In addition, students who are classified as morbidly obese need a physician's written consent to participate in physical activity (French, Sanborn, Stephens, & DiMarco, in press).
- Consider the use of heart rate monitors. Children and youth who are obese carry a lot more weight than those within a usually recommended weight range. Even if obese students are among the slowest in class, they may have the highest heart rates because of the extra weight they are carrying.
- Consider peer tutors for instructional (e.g., achieving healthy diet and physical activity goals) and emotional - social support.
- Use differentiated instruction to accommodate multiple levels of performance and learning. Using stations may be a useful strategy. In the station activities consider the use of health video games as well as exercise games that are fun and motivating (e.g., Dance Dance Revolution, Wii, Play Station) as motivational techniques. This strategy can also be used for homework assignments. Commercially available health video games have been used as a motivational intervention strategy for students who are overweight or obese (Lu, Kharrazi, Gharghabi, & Thompson, 2013).
- Use staff training, collaborate with families and students and community leaders, and adopt school-wide programs to reduce stigmatization of those who are overweight or obese.
- Model trusting and caring behavior for children or youth who are overweight or obese and for others who are participating in physical activity. All children and youth deserve to be respected and be learners. Sometimes, even with the best intentions, a physical activity professional could actually be increasing guilt, stigmatizing a child or youth who is obese, and negatively affecting a student's body image and self-esteem. For example, a physical activity professional may be overprotective and not ask an overweight or obese child or youth to be accountable for performing and learning at his or her appropriate level (Rovegno & Bandhauer, 2013).
- Evaluate the program to determine whether inactivity can be reduced (e.g., transitions between activities, standing in lines).
- Be a resource to parents, guardians, children, and youth regarding your physical activity program. Consider using e-mail or Twitter to provide initial support for programs in which a child with weight issues and his or her parents may be involved. Consider a community-based program the first time one of your students with weight issues attends.
- Observe the recess program and provide ways to motivate students to take part in activities and encourage those with weight issues to do the same.
- Focus on helping students meet manageable and achievable goals in an enjoyable environment (e.g., increase number of steps a day, monitor results, and provide intrinsic and extrinsic reinforcers [see chapter 3] ).
- Encourage participation with others through small groups or teams to provide peer instructions and motivation to all members of the small group or team.
- The physical activity environment is the most logical place for programs that address obesity prevention and intervention in children and youth (Richards, Shimabukuro, Combs, & Kreuter, 2004). Some of the advantages in using the physical activity environment are that both preventive and intervention programs can be provided; large numbers of students can be provided continuous and concentrated intervention; and the costs to parents and guardians are minimal (Brownell & Kay, 1982). To date there have been mixed results on the effectiveness of school-based weight-gain programs and the retention of losses over time (Shaya, Flores, Gbarayer, & Wang, 2008). One of the major components of the most effective programs is the use of appropriate behavior management strategies with a focus on a participant within a class or team (Brownell & Kaye, 1982).