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From "Fat Nation" to Healthy Active Cultures



I Introduction



Warnings of the growing "obesity epidemic" are regularly spouted by public health officials, researchers, and media. Some examples of alarmist headlines published over the past month include "Fat Nation" (National Post, July 7, 2005, p. A1), "Canada's obesity problem continues to worsen" (CTV.ca, July 7, 2005), "Obesity now on Ontario hit list" (Toronto Star, July 14, 2005, p. A3), "New Minister's first battle cry: 'Fat is the new tobacco'" (National Post, July 14, 2005, p. A15). These panic headlines have been a common occurrence since the World Health Organization declared obesity to be a "chronic disease" and to be one of the "most significant contributors to ill health" (2000: 1-2). But, is there an epidemic of obesity? Is our focus on the body mass index (BMI) as a measure of health misguided? Are children and teenagers "bodies at risk"? This article will (i) interrogate how obesity research, and the headlines they provoke, pathologize young bodies, (ii) question the deployment of crisis narratives as a strategy of health communication, and (iii) suggest a more comprehensive approach to fostering cultures of health and activity-for-all by examining the Living School Initiative.

II Bodies at Risk, Fat Stats and Fostering Fear



The deployment of the "obesity epidemic," "obesity crisis," and "obesity tsunami" phrases are political choices that exaggerate statistical probability and foster fear. The alarm instills a moral panic about all children being bodies of risk -- some at risk now and all at risk in the future. The strategy of communicating moral panic normalizes slenderness as a particular vision of fitness and wellness without solid empirical evidence to link slimness to health and fatness to disease (Evans, 2004; Gard & Wright, 2005). The questioning of the overestimation of obesity-related burden and death rates is just beginning within epidemiology (see Flegal, Graubard, Williamson, and Gail, 2005; Mark 2005).



Furthermore, obesity is a condition. Unlike SARS it is not an infectious, potentially epidemic, disease. Nor, unlike a tsunami, is it a disaster. The current measurement tool of choice -- the BMI -- is arbitrary and highly unreliable Bruce Ross (2005:106) summarizes numerous reasons to be skeptical of "obesity epidemic" claims, including that

* the BMI is an inaccurate measure of human adiposity as it does not, for example, take into account the diversity of male and female physiques;

* corpulence and fatness are conflated;

* it is simplistic to assume obesity can be explained as malfunction of food intake and energy output of individuals; and

* it is illogical to classify large body size as a disease simply because it has a weak association with various non-communicable diseases (Bray, 2003, Seidell, 2000).



The vast majority of overweight kids, as measured by the BMI, are not currently suffering from disease, thus extrapolating trends from a flawed instrument does not provide sound rationale for pathologizing youth (for examples of BMI benchmarking studies, see Janssen, Katzmarzyk, Boyce, Vereechken, Mulvihill, Roberts, Currie, & Pickett (2005); Shields 2005; Tjepkema 2005; Tremblay & Willms 2003; Willms, Thremblay, Katzmarzyk 2003).



Of course, for extremely obese people, and for some overweight, disease-related concerns are real. Yet, as John Luik has recently declared, "we now live in a post-BMI age." To pathologize children who are currently healthy within the BMI "overweight" zones may lead to disordered eating, lowered self esteem, taking the joy out of play when physical activity becomes medicalized, and heightening institutionalized body-based harassment by teachers and public health workers. "The simplification and misreading of evidence about human body size reinforces our cultural prejudices about the sinfulness of being fat rather than alerting us to the mysterious, dynamic contingent processes of biological and cultural evolution that continue to shape individuals and societies" (Ross 2005, 106). Instead of panic communication about speculated epidemics, we need more interdisciplinary research into the causal relationships of obesity-associated diseases.



Promoting healthy eating and activity for all sizes and states of health is a more promising direction to enhance the health of populations at present (Jonas, 2002). The following section overviews the Ontario Physical and Health Education Association's (Ophea) Living Schools Initiative, which attempts to foster cultures of health rather than pathologizing individuals of various girths.



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III A Culture of Activity Case Study: Ophea's Living School Initiative



"A Living School is a school that is open: to children, to families, to the community, and to new opportunities. A living school is alive, not only with academics, but also with play, sport and activity. It's an environment that encourages emotional well-being, healthy lifestyles, and optimum nutrition. It is a place where people can nurture their bodies as well as their minds. A living school is the center of an active, healthy school community." (Ophea, 2004).



The Living School Initiative began in 2004 spearheaded by Ophea and funded by the Ministry of Health and Long-Term Care. The program seeks to "foster school community action to benefit health, scholastic achievement and community development" (Bodkin and Valleau, Spring 2005). Seventeen school sites from nine diverse communities have been involved in the first year. Each school site has engaged in four phases of the initiative: (1) community consultation, (2) declaration and commitment, (3) action planning and implementation, and (4) evaluation and celebration. All sites have designed and provided activities in the school and community settings in four comprehensive action areas: health policies and guidelines, physical and health education curriculum, healthy and supportive school community environments, and school community programs and services. This community-driven program is like a crystal that continues to grow in new directions and sparkle with thoughtful ideas as more members of each community join the collaborative effort. It is bringing together kids, parents, teachers, boards of education, parks and recreation, sporting organizations, local governments, businesses, community coalitions, and public health groups to tackle diverse needs in each unique community.



"Public health has been there from the start providing resources, support and expertise to address the diverse issues," according to Ophea consultant Margaret Good. Before each community applied to Ophea, they were expected to set up "pillar partners" between education, recreation and public health sectors. Public health professionals have provided health displays, resource materials, parent workshops, and collaborated in delivering classroom content on such topics as lifestyles, body image, tobacco use prevention, and dealing with stress at many of the Living School sites. While obesity was one of the initial concerns put on the table alongside poor nutrition and inactivity issues in initial community consultations, Good observed that as Living School sites focused on solutions to redress inactivity and nutrition issues for everyone, concern for obesity fizzled out.



Each community has developed its own strategies to increase healthy action and nutritious food consumption. For example, at Greensboro Public School site in Markham, the "Living School Action Plan" involved offering nutrition and active living workshops to parents, teachers and kids (Good, 2005). The School Nutrition Advisory Committee (SNAC) formed with students, parents, teachers, and public health workers serving as members. Their efforts led to a universal milk program, snack breaks, nutrition advice in school newsletters, a catered lunch program reviewed by a dietitian, and partnerships with local grocers (Bodkin and Valleau, 2005). York Region Health Services created the "Fitness Ambassadors" program in which grade 7 and 8 volunteers trained to lead daily energy breaks for primary students. This enhanced the daily activity of all students in school and has provided leadership activities for senior students within the school. In the broader school community, Markham Parks and Recreation has also provided after school sport clubs and PLAY ("peer leadership for active youth").



In Thunder Bay, Bishop Gallagher Senior Elementary School's tuck shop now carries a wide range of nutritious options. To build community interest and commitment to their Living School pledge, they hosted the Live It Up Challenge last January. This kick start event involved a winter walk and a vegetarian chili dinner prepared by parents. A website facilitated getting pledges from other community members and schools to be active. The principal and teachers believe that numeracy and literacy can be taught using "exercise in disguise." Students write poems or compositions about how the Living School experience has affected their lives. Junior students can experience motion in math class or by rhythmically moving during spelling test.



The overweight/obesity issue drops off the agenda when the wider climate of a community is one that values the wellness of children. At a recent Living School Forum, obesity was not specifically raised by any of the participating schools. Instead, all sites reporting improved health knowledge, activity levels and energy, and in addition many reported some unexpected benefits such as decreased discipline problems, less junk food garbage in the school yard, and improved school spirit by students and teachers alike. Martin Shain, the evaluation consultant for the Initiative, found 71% of students in Living Schools believe they can be overweight and still be fit: an attitude Shain suggests "supports a holistic view of health" (April 7, 2005). The Living School Action Teams continue to swap school guidelines and policies, research and tools, success stories and advocacy advice at forums and through a team website.



What makes a Living School successful? According to Andrea Bodkin, project director of the Living School Initiative,



"A Living School targets the culture whereas other health promotion programs target behaviour alone. Living Schools try to get into the community to help effect healthy eating, promote physical activity, and drug and alcohol prevention. All the people involved stop and think about the choices they make, and how those choices affect others. Students also develop a sense of social capital and citizenship in the process (July 21, 2005). "



The Living School Initiative has successfully redefined school children from being bodies at risk to members of a community in motion.



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IV Conclusion



An alternative to individualistic approaches to targeting health behaviour is to improve the health of a community using a more ethically engaged and socio-cultural perspective. To respond to diverse populations, Nick Fox suggests this broader response to health should entail,



"an emphasis which would act very locally, as opposed to more indiscriminate or totalizing interventions; programs which enable people to make active decisions about the lives they lead; a celebration of diversity in a target population, rather than a perspective which sees individuals as deviates from some norm of behaviour; involvements which take advantage of spaces in routines and lives to explore new possibilities for activity and identity; and programs which do not detract from the humanity of those who are clients." (Fox, 1998: 20, cited in Gard and Wright, 2005, 186).



To redress poor health, public health officials need to go beyond promoting individual behavioural change and beyond the removal of environmental barriers to safe play and nutritional food choices to proactively build cultures of active health. This entails helping sound knowledge about healthy bodies to percolate among kids in their local communities, questioning what values inform, and result from, educational and public health policy and strategies, fostering respectful relationships that avoid stigmatization, and engaging young people and community members at all stages of public health/educational policy developments and interventions.

V References



Bray, G.A. (2003). Evaluation of obesity, Who are the obese?, Postgraduate Medicine, 114 (6), 19-27, 38.



Bodkin, A. (July 21, 2005). Ophea Project Leader, Active School Initiative: telephone interview.



Bodkin, A., & Valleau, L. (Spring 2005). Living School: Let's build one in our community, NRC Digest, 5(1), pp. 4-5.



Evans, J. (2003). Physical education and health: A polemic or 'let them eat cake!', European Physical Education Review. 9(1), 87-101.



Flegal, K.M. Graubard, B.I., Williamson, D.F., & Gail, M.H. (2005). Excess deaths associated with underweight, overweight, and obesity, Journal of American Medical Association, 293, 15, 1861-1867.



Fox, N. Postmodernism and "Health", in A. Petersen and C. Waddell (Eds.), Health Matters: A Sociology of Illness, Prevention, and Care. Sydney: Allen & Unwin.



Gard, M. & Wright, J. (2005). The Obesity Epidemic: Science, Morality and Ideology. New York: Routledge.



Good, M. (July 21, 2005). Active living consultant to Ophea: telephone interview.



Luik, J. (July 12, 2005). Fat Nation: Out of proportion, National Post, p. FP19.



Janssen, I., Katzmarzyk, P.T., Boyce, W.F., Vereechken, C. Mulvihill, C., Roberts, C., Currie, C., & Pickett, W. (2005). Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns, Obesity Reviews, 6, 123-132.



Jonas, S. (2002). A healthy approach to the "Health at Any Size" movement, Healthy Weight Journal, 16(3): 45-8.



Ophea. (2004). Living School - Building Healthier Communities Website: www.livingschool.ca/



Mark, D. (2005). Deaths attributable to obesity, Journal of the American Medical Association, 293 (15), 1918-1919.



Nestle, M. and Jacobson, M.F. (Jan./Feb. 2000). Halting the obesity epidemic: A public health policy approach, Public Health Reports, Vol. 115., 12-25.



Ross, B. (2005). Fat or fiction: Weighing the 'obesity epidemic', in M. Gard and J. Wright, pp. 86-106 The Obesity Epidemic: Science, Morality and Ideology. New York: Routledge.



Seidell, J.C. (2000). The current epidemic of obesity, in C. Bouchard (Ed.). Physical Activity and Obesity. Champaign, Ill.: Human Kinetics.



Shain, M. (April 7, 2005). The Living School evaluation, research presentation given to the Living School Forum, Toronto.



Shields, M. (July 2005). Overweight Canadian Children and Youth, Nutrition: Findings from the Canadian Community Health Survey. Retrieved July 22, 2005: http://www.statcan.ca:8096/bsolc/english/bsolc?catno=82-620-MWE2005001



Tjepkema, M. (July 2005). Adult Obesity in Canada: Measured Height and Weight and Overweight Canadian Children and Youth, Nutrition: Findings from the Canadian Community Health Survey. Retrieved July 22, 2005: http://www.statcan.ca:8096/bsolc/english/bsolc?catno=82-620-MWE2005001



Thremblay, M.S., & Willms, J.D. (2003). Is the Canadian childhood obesity epidemic related to physical inactivity?, International Journal of Obesity, 27, 1100-1105.



Willms, J.D., Thremblay, M.S., Katzmarzyk, P.T. (2003). Geographic and demographic variation in the obesity of Canadian children, Obesity Research. 11, 668-673.



World Health Organization. (2000). Obesity: Preventing and Managing the Global Epidemic, Technical Report Series 894. Geneva: World Health Organization.