Nutrition and Physical Activity

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Nutrition and Physical Activity | Overview

Nutrition and physical activity

This is Chapter 3, Outcome Area 3 of California's adolescent health strategic plan. To view the full plan, click here.

Within the United States, poor diet and physical inactivity are second only to tobacco as preventable causes of death among adults.⁹² Childhood and adolescence are critical times for the development of these lifestyle habits. Moreover, adolescent nutrition and physical activity are important for the development of bone density and the prevention of obesity. The incidence of obesity has increased affecting approximately one out of five adolescents, a two-fold increase over the past two decades.^93,94,95 Obese adolescents are at higher risk for being obese adults and developing cardiovascular disease, diabetes, and hypertension.⁹⁶

The Dietary Guidelines for Americans recommend that to stay healthy, one should eat a variety of foods and choose a diet that is plentiful in grain products, vegetables, and fruits; moderate in salt, sodium, and sugars; and low in fat, saturated fat, and cholesterol.⁹⁷ In addition, regular physical activity throughout life is important for maintaining a healthy body, enhancing psychological well-being, and preventing premature death. The California Department of Health Services recommends that adolescents engage in a minimum of 30 minutes of moderate to vigorous physical activity per day on most days of the week as part of play, games, sports, work, transportation, recreation, physical education, or planned exercise, in the context of family, school, and community activities.⁹⁸

Data snapshot

Nutrition

Table 3.2

CalTEENS, the first representative survey of the dietary practices of California adolescents indicates that, like adults, adolescents are far from meeting many of the dietary recommendations (Table 3.2). Most notably, well under half ate the recommended amount of fruits, vegetables, and whole grains. In general, as adolescents age, they are less likely to meet the recommendations. Although adults and adolescents have similar diets in terms of healthy foods, adolescents are twice as likely as adults to report eating high calorie, low nutrient foods. Sixty-eight percent of teens reported that on the previous day they had eaten at least two of the following: pastries, deep-fried foods, bakery desserts, chips, or candy/soda.⁹⁹

Many adolescents have dietary deficiencies. Females, in particular, often have calcium, iron and folate intakes below recommended values. Low income adolescents have lower than average intakes of vitamin A, vitamin C, vitamin B10, folate, calcium, iron, and zinc than do adolescents from higher-income groups.¹⁰⁰

The 1988-1994 National Health and Nutrition Examination Survey (NHANES) III found that approximately 10 to 20% of teens ages 12 to 19 were overweight depending on the definition used.

View Indicator

Data from previous NHANES indicate that this percentage has been increasing. In California, 7% of teens are classified as overweight, with this percentage varying from 4% among whites and Asians, to 10% among Latinos and 19% among African Americans.⁹⁹

Access to nutritious foods at low-cost is limited whereas access to fast and junk foods through snack bars, restaurants, liquor stores, convenience stores, and vending machines is easy. Moreover, low-income neighborhoods often lack access to grocery stores which provide healthy food choices. Schools are required to provide lunches that meet USDA guidelines, but can also serve other foods as a la carte items. These items tend to be higher in fat, sodium, and sugar. A la carte sales account for more than 40% of total food sales in nearly 60% of high schools.¹⁰¹ Food sold outside of the school lunch program through vending machines and fundraising sales further increase the availability of appealing foods with little nutritional value. Additional resources available to California's schools under the National School Lunch Act are underutilized. Only one fourth of the school districts in the state have taken advantage of automatic enrollment of youth receiving foodstamps and CalWorks.

Physical Activity

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The CalTEENS survey asked adolescents about their participation in different activities on the day preceding the survey. On average, adolescents reported spending 47 minutes involved in vigorous physical activity and 130 minutes watching television or playing video games. Fifty-eight percent of teens reported being involved in physical activity at least five times a week, and 29% reported getting the one or more hours of vigorous physical activity per day recommended in the California Daily Food Guide.

This survey found that 10% of adolescents reported no physical activity, slightly less than the 14% reported in the 1999 California Youth Risk Behavior Survey (YRBS).^73,99 One of the factors that limits physical activity in many communities is lack of access to safe outdoor spaces.¹⁰²

The 1999 YRBS shows significant overall grade level differences with amounts of physical activity dropping off sharply as students age. Only 56% of students in 12th grade as compared to 80% of students in 9th grade engaged in physical activity at least three times per week.⁷³

There are also significant gender differences in physical activity. The CalTEENS survey found that 94% of males as compared to 86% of females were involved in physical activity five times per week. In addition, adolescent girls became less physically active as they get older.⁹⁹

Figure 3.8

Physical education in school is a key component of a coordinated school health program and is required by the California Education Code. Although the Education Code contains specific requirements for the number of minutes of physical education, additional efforts and resources are needed to ensure that these requirements are met.⁶⁶ Participation in school physical education drops sharply among both males and females as students age (Figure 3.8).

Examples of current efforts

The SHAPE program (Shaping Health as Partners in Education), through the Nutrition Education and Training Section (NETS), California Department of Education, assists school districts in providing nutrition education, offering healthy meals, and establishing policies that promote good nutrition.
Through NETS, the California Endowment is offering Model Nutrition Education Grants to schools and school districts for implementing innovative programs that promote healthy eating and nutrition education.
The California Department of Health Services’ Project LEAN Food on the Run campaign, promotes healthy eating and physical activity to multi-ethnic high school students and their families through education and peer advocacy. Project LEAN focuses on environmental change and education to support healthy eating and physical activity.
State School Superintendent Delaine Easton has made it a priority to create a garden in every school through the School Garden Project Grant Program. Garden projects offer the opportunity to learn about healthy eating while learning the skills to grow healthy foods. The program has primarily attracted elementary schools, but also some middle and high schools.
California Food Policy Advocates (CFPA) works to increase access to free and low-cost meals for low-income students by educating schools and communities about provisions under the National School Lunch Act which can increase access to school lunches and reduce stigma. Schools with over 30% eligibility for free meals can break even by establishing universal free lunches. Schools receive increased subsidies for increased participation and avoid the administrative costs associated with establishing eligibility.
California Adolescent Nutrition and Fitness (CanFit) is a statewide program that strives to improve physical fitness and nutrition among young adolescents (ages 10 to 14) by developing culturally appropriate and innovative community-based programs, training youth service providers, and providing scholarships to youth interested in careers in nutrition and fitness.
Active Community Environments (ACE) works to make communities more amenable to walking and biking by linking public health to land use and transportation planning. ACE is a component of the California Physical Activity and Health Initiative, a joint project of the California Department of Health Services and the Institute for Health and Aging at the University of California, San Francisco.

Strategies to improve nutrition and physical activity

1. Increase opportunities and support for healthy eating within families, schools, and communities.

Make fast, low-cost, and appealing healthy food options available as part of school lunches, fundraising activities, rewards, snacks served and/or sold at after school activities and other public spaces such as movie theaters.
Reduce the number of corner markets, which tend to be outlets of alcohol, tobacco, and junk foods, while ensuring that community residents have access to affordable fresh produce at a local grocery store.
Enhance participation in school food programs, particularly in the under-utilized school breakfast and summer food programs. Pilot strategies to eliminate the stigma associated with participation in subsidized food programs.
Encourage food companies and the media to limit commercials featuring unhealthy food during programming for youth.
Assess the prevalence of eating disorders and unhealthy weight reduction regimes common with adolescents, and create school-based programs that address them.

2. Increase opportunities and support for physical activity within families, schools, and communities.

Provide the physical education in schools taught by credentialed physical education specialists for the number of minutes per week required by the Education Code.
Administer the mandated Fitnessgram physical fitness assessment instrument in grades 5, 7 and 9 and make results available within the community.
Create a range of free or low-cost community sports and recreation/fitness programs that are attractive to all young people by expanding safe park and recreational facilities and encouraging schools and other organizations (such as faith organizations and community groups) to make their facilities available after hours.
Encourage families to support adolescents’ participation in physical activity, to be physically active role models, and to include physical activity in family events.
Create bike lanes to promote biking and enhance bike safety.

3. Promote social norms that support healthy eating and physical activity.

Use advertising and the media to change the way eating is portrayed so that youth will want to eat healthier foods.
Reduce the presence of advertising on school campuses that encourages youth to drink sodas and eat fast food.
Promote appealing physical activities—such as dancing, skating, climbing, and rollerblading—that involve social interaction and are perceived as fun and easy to do.
Encourage health care providers to talk routinely to adolescents about the importance of physical activity to their health.

Additional resources

Physical Activity for Children: A Statement of Guidelines. Corbin C.B. and Pangrazi R.P. Council for Physical Education for Children. National Association for Sport and Physical Education. Reston, VA, 1998.

Creating an Adolescent Nutrition and Physical Activity Policy Agenda: A Report on a Public Policy Needs Assessment. Craypo, L., Samuels, S. Prepared for California Project LEAN Food on the Run Campaign. August, 1998.

Playing the Policy Game: Preparing Teen Leaders to Take Action on Healthy Eating and Physical Activity. Craypo, L., Samuels, S. Prepared for California Project LEAN. February, 1999.

2000 California High School Fast Food Survey: Findings and Recommendations. Public Health Institute and California Project LEAN. February, 2000.

Guidelines for school and community programs to promote lifelong physical activity among young people. U.S. Department of Health and Human Services. Morbidity and Mortality Weekly Report. 46(RR-6). Washington, D.C. March 7, 1997.

Guidelines for school health programs to promote lifelong healthy eating. U.S. Department of Health and Human Services. Morbidity and Mortality Weekly Report. 45(RR-9). Washington, D.C. June 14, 1996.

The President’s Council on Physical Fitness and Sports Report: Physical Activity and Sport in the Lives of Girls, Physical and Mental Health Dimensions from an Interdisciplinary Approach. U.S. Department of Health and Human Services. Spring, 1997.

A Report of the Surgeon General. Physical Activity and Health. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Disease Control and Prevention and Health Promotion, Atlanta, GA, 1996.

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