Schools & Early Care

Early Care

Not even our youngest children are spared from the obesity epidemic. Currently, more than 20% of 2-5-year-olds are either overweight or obese176. Only 25% of US preschool children get the recommended daily servings of vegetables177. Preschool children now spend more than 4 hours/day watching TV and videos178.

As a result, more emphasis is being placed on obesity prevention during early childhood. Because 60% of children spend time in early child care179, these programs are a target of opportunity in preventing obesity at a young age through increased physical activity, limited screen time, and improved access to healthy foods.

The Institute of Medicine176 recommends that:

  • Children be active for at least 15 minutes of every hour
  • Children should not sit or stand in place for more than 30 minutes at a time
  • Caregivers limit use of strollers, seats, or other equipment that restricts movement
  • Caregivers limit screen time to no more than 30 minutes for children in half-day programs, and 60 minutes for children in full day programs
  • Caregivers provide a quiet environment for children to nap on a regular schedule
  • Caregivers provide healthy meals, consistent with the Child and Adult Care Food Program


The nation's schools can play a large part in preventing obesity by creating healthy environments for the 55 million students they serve180.

Healthy Eating

Children participating in both school lunch and school breakfast may consume up to 50% of their daily calories at school, making it an ideal place to promote a healthier diet90. Currently, over 31 million kids participate in the National School Lunch Program (NSLP),91 and more than 12 million participate in the School Breakfast Program (SBP).181 Families whose income is at or below 130% of the poverty line are eligible to receive free school meals and families whose income falls between 130% and 185%, are eligible to receive reduced-cost meals91. All students can buy school lunch.

The importance of providing nutritious school meals for the health of our nation's children is reflected in the USDA's new nutrition standards for school meals. These standards require that schools serve more whole fruits and vegetables, a greater variety of vegetables, and an increased proportion of whole grains; and that they eliminate higher-fat, flavored milk182. Schools must comply with these federal regulations in order to qualify for reimbursement of school meals. Schools are challenged to meet these standards under a strict budget, while serving foods that students like.

The good news: schools can meet, or even surpass these standards, and many are doing so with great success. Some schools have instituted farm-to-school programs, partnering with small farmers who provide low-cost, high quality produce that can be integrated into school meals183. First Lady Michelle Obama helped launch the Chefs Move to Schools and Let's Move Salad Bars to Schools initiatives. The Chefs Move to Schools initiative matches schools with a local chef who can help integrate healthy dishes into school meals and teach kids the power of cooking for better nutrition. Let's Move Salad Bars to Schools helps schools raise money to receive a salad bar unit, and provides resources for schools to understand how to use a salad bar in the National School Lunch Program184, 185. Innovative school food service teams survey students on which new items they'd like to see on the menu, pilot test healthy new dishes with students, use their salad bar creatively, and freeze seasonal produce for service throughout the year.

Competitive Foods

With improved school meal guidelines in place, many public health leaders are focusing on competitive foods – foods that are not part of the school meal. Competitive foods are often sold in vending machines, a la carte lines, school stores, and/or snack bars; and until now, they have not been subject to the same nutrition standards as school meals186.

Staying Active

Physical activity is important for all children – and especially for those who are overweight. In addition to helping maintain a healthy weight, physical activity helps children build strong bones and muscles, lowers their risk of chronic disease, and promotes a positive self-image187. Few children get the recommended 60 minutes of activity each day, and as young people age, physical activity tends to decline188.

Increasing physical activity at school during recess, physical education, and in short breaks can have a meaningful impact on children's weight status189. Additionally, high-quality physical education programs help children develop positive attitudes toward physical activity, and set the stage for regular physical activity throughout life190.

Physical Education

Due to funding cuts, an increased focus on core academic subjects, and added pressures of standardized testing, daily physical education is rare in schools. Nationwide, only 4% of elementary schools, 8% of middle schools, and 2% of high schools provide daily physical education191. Evidence shows that increasing physical education can improve grades and test scores192.


Like physical education, recess is an opportunity for kids to be active. Recess has been shown to improve classroom behavior;193 yet, recess is sometimes withheld as a form of punishment, or to make up for a shortage of time in the classroom.

Extracurricular Activities

Most schools offer a range of extracurricular activities to keep children active and help them learn teamwork. Enrolling children in extracurricular sports can boost their physical activity and promote goal setting, conflict resolution, social skills, and improved self-esteem194.

Schools can be a valuable resource for families looking to get active together. School events such as fun runs, field days, jump-rope-a-thons, and dances can be a great opportunity to enjoy physical activity as a family. Schools may allow families to use their facilities for open gyms, kickball, indoor walking, swimming, or strength training sessions. Taking a walk to the school playground on a Saturday is another way to get active with your kids.

Improving Health Education

Like physical education, health education can take a backseat due to budget cuts and competing priorities. However, effective programs can help students develop the skills to adopt and maintain a healthy lifestyle.

The most effective health education programs focus less on teaching scientific facts and more on helping students relate to the material, set goals, and develop skills that bring about sustainable behavior change195.

Schools are using innovative ways to engage students in healthy living. Some keep a school garden to help students understand where food comes from and increase fruit and vegetable consumption196.

Others are revitalizing home economics and teaching students how to cook healthy meals. Physical education programs are integrating a greater variety of activities, such as yoga and dance.

Monitoring Weight Status

To help parents understand whether or not their child is at risk for weight-related health problems, some states have established school-based BMI reporting programs. Height and weight measurements are taken at school or during required school physicals, and BMI is reported to parents. BMI reports usually include an explanation of the results, follow-up actions as appropriate, and information about healthy eating, physical activity, and weight management197. While research shows that most parents are supportive of BMI screening and reporting at school, others worry that it may cause poor self-image, bullying, or disordered eating198. In response, schools can ensure that screenings are conducted by well-trained staff, that measurements are taken in a private setting, and that high-quality resources are provided to caregivers187. More research is needed to assess the impact of these programs.

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