Center for Health and Social Policy, Lyndon B. Johnson School of Public Affairs, University of Texas, Austin, USA.
University of Iowa, Iowa City, USA.
Milbank Q. 2023 Mar;101(1):204-248. doi: 10.1111/1468-0009.12604. Epub 2023 Mar 13.
Policy Points Between 1998 and 2016, 24 states and the District of Columbia passed laws meant to increase the time that children spent in physical education (PE) or other school-based physical activity (PA). Schools largely disregarded changes to PE/PA laws, which did not increase the time that children spent in PE or recess and did not reduce body mass index, overweight, or obesity. Closer oversight of schools would be needed to improve compliance with state PE and PA laws. Yet, even with better compliance, we estimate that PE and PA policies would be inadequate to reverse the obesity epidemic. Policies should also address consumption, both inside and outside of school.
To control childhood obesity, leading medical organizations have recommended increasing the time that children spend in physical education (PE) and other school-based physical activity (PA). Yet, it is unknown how many states have passed laws that codify these recommendations, and it is unknown what effect changing state laws has had on obesity or the time that children actually spent in PE and PA.
We joined state laws to national samples of 13,920 children from two different cohorts of elementary students. One cohort attended kindergarten in 1998; the other attended kindergarten in 2010; both cohorts were followed from kindergarten through fifth grade. We estimated the effects of changes to state laws in a regression with state and year fixed effects.
Twenty-four states and the District of Columbia increased the time that children were recommended or required to spend in PE or PA. These changes in state policies did not increase actual time spent in PE or recess, did not affect average body mass index (BMI) or BMI Z score, and did not affect the prevalence of overweight or obesity.
Increasing the PE or PA time required or recommended by state laws has not slowed the obesity epidemic. Many schools have failed to comply with state laws. A back-of-the-envelope calculation suggests that, even with better compliance, the legislated changes in PE laws might not have changed energy balance enough to reduce obesity prevalence.
在 1998 年至 2016 年期间，24 个州和哥伦比亚特区通过了旨在增加儿童参加体育课（PE）或其他学校体育活动（PA）时间的法律。学校基本上忽略了对体育课/PA 法律的修改，这些修改并没有增加儿童上体育课或休息时间，也没有降低体重指数、超重或肥胖的比例。需要更密切地监督学校，以提高对州体育课和 PA 法律的遵守程度。然而，即使有更好的遵守，我们估计体育课和 PA 政策也不足以扭转肥胖症流行。政策还应解决在校内外的消费问题。
为了控制儿童肥胖，主要医学组织建议增加儿童上体育课和其他学校体育活动的时间。然而，目前尚不清楚有多少州通过了将这些建议编纂成法律的法律，也不清楚修改州法律对肥胖或儿童实际上体育课和 PA 的时间有何影响。
我们将州法律与两个不同的小学生队列的 13920 名儿童的全国样本相结合。一个队列在 1998 年上幼儿园；另一个队列在 2010 年上幼儿园；两个队列都从幼儿园一直跟踪到五年级。我们使用州和年份固定效应回归来估计州法律变化的影响。
24 个州和哥伦比亚特区增加了儿童参加体育课或 PA 的推荐或规定时间。这些州政策的变化并没有增加体育课或休息时间，也没有影响平均体重指数（BMI）或 BMI Z 分数，也没有影响超重或肥胖的流行率。
增加州法律规定或推荐的体育课或 PA 时间并没有减缓肥胖症的流行。许多学校没有遵守州法律。一个简单的计算表明，即使遵守情况更好，体育课法律的立法变化可能也不足以改变能量平衡，从而降低肥胖症的流行率。
