Fighting Childhood Obesity

What:  As the number of overweight adolescents grows, the need for intervention becomes more and more vital.  I work at a school that has been approved to create an afterschool program for overweight middle school students in order to reduce the risk of cardiovascular disease and diabetes.  I am to come up with an action plan and present it to school officials and parent-teacher groups, while highlighting my approach, strategies and activities. It is important for these children to understand the importance of including exercise in their daily lives and changes in behavior need to happen quickly and effectively while they are still young.

So What:  The benefits of physical exercise on a regular basis are something we have all heard about.  According to Gill and Williams (2008) “physical inactivity has been linked to nearly all major health problems, including heart disease, diabetes, osteoporosis, and negative psychological conditions such as depress and anxiety” and at least 25% of the world does not exercise at all. (p. 148). Knowing this, it’s hard to imagine that people don’t exercise more.  I am just as guilty as the other 60% of the world’s population in that I don’t get the recommended 30 minutes per day on a consistent basis.  Some days I don’t have the time, while other days I simply don’t have the motivation.  Whatever the case may be, it’s important that the children of today don’t fall into the same habits the rest of society has.  Granted, children don’t have ideal behaviors modeled for them.  That just makes it that much more important to intervene quickly so they don’t fall into the same life-style so many people before them have. 

Now What:  There are countless approaches that could be used to try to get overweight children to start exercising.  In this program, I wouldn’t want to single out only the overweight children.  I would start by showing all children in the middle school some sort of visual (either a video or an actual live presentation) on the importance of exercise and how it can avoid the most preventable and deadly diseases.  Education is vital to cognitive-behavioral approaches as it enables the person to really look at themselves and understand why change is necessary.  During the presentation, it may useful to explain to them that their loved ones that have had heart attacks or suffer from diabetes may have been able to prevent those things from regular exercise.  Hopefully this will hit home, give them something to relate to, and help them realize the importance of taking care of their bodies.  Similar to “community-wide campaigns” mentioned in The Task Force On Community Preventive Services (2002) article, advertising the exercise program throughout the school can also increase cognitive understanding and importance of the program.  From there, getting the children to make out contracts might be a good way to hold them accountable, and should be focused on attendance more than anything else.  As Gill and Williams (2008) mention, peak performance is not the goal of exercise, but instead maintenance of physical activity is.  Getting the children to take that first step is important, and hopefully the fun and engaging exercise will keep them coming back.  Some suggestions for activities could include: jump roping, roller-blading, swimming aerobics, swimming teams, running club, walking club, football, basketball, soccer, etc.  Things that are both fun to do as well as keep the children moving at all times.

The next step will come once the children show up to the first day of the program.  Based on the Transtheoretical Model presented by the Cancer Prevention Research Center (2010) as well as in Gill and Williams (2008) the children are probably in the contemplation stage as they are just now starting to think about changing their behaviors.  This is a very important stage as they can be easily turned off and regress back to the Precontemplation stage.  On the other hand if they enjoy the exercise they may move on to the Action stage, so it is very important to engage them in an activity that is both fun and challenging.  The Task Force on Community Preventive Services (2002) strongly recommends both social support interventions as well as individually-adapted health behaviors.  The children could be grouped into two or even four people.  I think it would be beneficial for there to be diversity in strengths and weaknesses between each person in the group so everyone is being pushed in a different aspect of exercise.  If you put four children who are all good at the same thing they may only focus on what they are good at.  Also each child should have individualized goals to focus on what needs the most work.  Some children may not enjoy competition, so they could focus more on individualized activities.  Others may benefit more from team games and competition so that could be part of their plan.  Whatever the children find enjoyable that still gets them engaged in physical activity is the main goal.  Moreover, the goals should not be focused on weight loss.  Focusing on weight loss implies that they are overweight.  Whether they are or not, this could create a variety of negative emotions.  The goal is not necessarily to lose weight, it is to become a more healthy and active person.  Finally, I feel it would be important to provide the children with constant feedback as well as positive reinforcement and praise.  If children are just expected to go and play, they might become bored.  If they can track their increased performance in some way, this may keep them coming back.  If the children have a dress code at school, one way to provided positive reinforcement could be to allow them to dress in jeans and a tee-shirt if their attendance and performance is adequate.  Giving them days off from exercise is not a form of positive reinforcement.

Conclusion:  Preventing childhood obesity through exercise has countless advantages and is something to be addressed immediately.  Physical inactivity is addressed above by creating an after-school program aimed at preventing cardiovascular disease and diabetes.  This plan takes important aspects from cognitive-behavioral approaches as well as the Transtheoritical model discussed both by the Cancer Prevention Research Center (2010) as well as in Gill and Williams (2008).  The plan discussed involves education on exercise, using contracts, social support groups, individualized behavior plans, as well as interactive and interesting activities to keep the children active and engaged.  The main goal of the program not to lose weight, but instead to get the children to take part in physical activity regularly.

References:

Cancer Prevention Research (n.d.). Detailed overview of the transtheoretical model. Retrieved August 17, 2010 from http://www.uri.edu/research/cprc/TTM/detailedoverview.htm.

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Task Force on Community Preventative Services. (2002). Recommendations to increase physical activity in communities. American Journal of Preventative Medicine, 22 (4S). 67-72.

Personal Improvement to Fulfill Ego

What:  As we can probably all recall from middle-school and high-school, having all the students fully participate in physical activity is quite rare.  This appears to be a growing problem for physical educators as childhood obesity is dominating the news.  Growing up we may have viewed these children as, un-athletic, nerds, weird, or just plain lazy.  In order to truly understand why some children are fully involved in sports and exercise and why others are not it’s important to look at the motives behind effort and participation. 

So What:  Creating an achievement motivation profile for both Kate and Robin will help us quickly recognize the apparent differences between the two girls.  According to the case study, Kate is always eager to participate and chooses personally challenging tasks.  Kate tries hard, even when losing, and seems to enjoy physical activity even though she may not be as skilled as her peers.  Robin on the other hand does not seem to enjoy physical activity and tends to choose the easiest task possible.  Robin expects to fail and although she could “win” more (objective success) she does not apply herself. 

Right away it’s clear that Kate is task-oriented as she demonstrates an ability to learn and improve her individual skills, regardless of how well her peers are doing. Kate finds success not in if she is winning, but instead from her ability to learn, improve, and put forth effort. Because of Kate’s focus on individual progress and not objective success, she appears to have a relatively low level of ego-orientation.  Robin’s behavior is almost a polar opposite of Kate’s.  Robin’s task-orientation is undoubtedly low as she makes little to no effort to improve her individual skills.  On the other hand it appears that Robin may be ego-oriented and does not fully involve herself in competition for fear of losing.  Gill and Williams (2008) mention that people who are ego involved only perceive themselves as able when they perform better than others.  Robin appears to not enjoy any physical activities anymore which may be a result of a variety of things.  One possibility is that Robin may have been skilled and enjoyed objective success in the past, but over time she did not keep up with her peers increasing skill level because she had low task-orientation and never worked on improving individual skills.  Although not necessarily the case, this could explain why Robin no longer finds pleasure in competition or physical activity in general.  When constantly subjected to a negative stimuli, humans ten to adopt avoidance behaviors (Elliot, 2006).  This explains why children bullied skip school, or possibly why ego-oriented people who consistently lose in competition quit putting forth effort.  Over time Robin may have become more and more incompetent in her skills which affected the teams she was on negatively, possibly resulting in Robin developing performance avoidance behaviors to the point that she no longer applies herself in PE class.

Now What:  If the above scenario was accurate, I would attempt to increase Robin’s task orientation so her skills can develop to the point where she can fulfill her ego-interest.  I think in order for Robin to become involved in physical activity it would be vital for the PE teacher to remove objective evaluation (winning or losing) from the classroom altogether (at least for some time).  This is something that seems almost impossible because physical activity for most of us is centered around getting better in order to win in the future.  The belief behind this follows Veroff’s (1969) stages of achievement motivation (autonomous competence, social comparison, integrated achievement motivation.  In team games Robin does not apply herself like other students do.  The first thing to do would be to remove winning and losing from team games and create something for the students to do that will create autonomous competence.  Instead of just “playing basketball,” each student can create their own individual goal for the basketball game.  Robin’s goal could be something along the lines of making three shots from between 5 and 15 feet on offense, and forcing at least one turnover while on defense. If done for a reasonable amount of time, this goal, if nothing else, may motivate Robin to do more than half court shots and lay-ups, and hopefully improve her skill level enough so that she is competent enough to compete.  The next stage of the model is the social comparison stage, and it is here where Robin will be able to put her ego-oriented personality on display and compete with a peer.  This example may be a little too general and idealistic, but the point is that if Robin is indeed ego-oriented and not participating in physical activity, there is a good chance it is because she is afraid to lose.  One way to make her more competent in having her team win would be to increase her own individual competence.

Conclusion:  From the behaviors mentioned in the case study Kate is task-oriented while Robin may be ego-oriented. The reason Robin no longer finds physical activity fun is because she finds losing un-pleasurable and does not have the individual skill competence to change anything.  In order to increase Robin’s skill competence and decrease participation avoidance behaviors I suggested that Robin creates individual goals for each competition that focus on building individual skill and not objective success (winning).  Hopefully over time Robin will be more competent in her ability to play well resulting in more participation and enjoyment in physical activity.

References:

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.).Champaign,   IL: Human Kinetics.

Elliot, A. (2006). The hierarchical model of approach-avoidance motivation. Motivation and Emotion,30(2), 111.

Education and Deep Breathing to Control Emotional Irregularity

What:  Matt, a talented junior tennis player in my tennis camp, is displaying many emotional ups and downs during his matches, and they are inhibiting his overall potential.  The behaviors include getting upset at calls, his own personal errors, and even when he’s doing well he appears to be “on edge,” especially in big matches.  As many of us have seen portrayed in the media, and in real life, young athletes may be especially hard on themselves when they are expected to be exceptional.  It is crucial for Matt to overcome these emotional ups and downs in order for him to become a more competent and skilled tennis player and to avoid burnout and injury.

So What:  Gill and Williams (2008) discuss the importance of emotional control and managing ones stress in their textbook.  If Matt’s emotional ups and downs are not soon addressed his potential for a successful career could come to an abrupt end very soon. According to Gill and Williams (2008) physiological arousal and cognitive worry go hand in hand, and along with increased cognitive worry comes lower self-confidence.  Things associated with physiological arousal include: a focus on rapid breathing instead of a focus on performance, high anxiety in which unnecessary muscles and energy are used, and perceived stress which leads to poor coping behaviors. In Matt’s situation it is unclear whether his high physiological arousal causes his cognitive worry to increase, or if the cognitive worry causes his physiological arousal to increase.  What is important is that if one is decreased (physiological arousal), there is a good chance the other will decrease as well (cognitive worry).  If Matt is able to control his physiological arousal and his cognitive worry, this may lead to higher self-confidence, he will be less distracted on his arousal and more focused on his performance, and hopefully Matt will be able to play to his potential.  If Matt continues to display the behaviors previously mentioned, he will continue to have stress and the risk for injury will be increased, or burnout may occur; both of which may end his career prematurely. 

Now What:  Goodger, Gorely, Lavallee, and Harwood (2007) state that “it is typical for athletes experiencing burnout to be characterized by motivational loss shown as reduced intrinsic motivation or amotivation, a lack of enjoyment, possession of poor or ineffective coping skills, high perceived stress and anxiety…” (Goodger et al. p. 143).  Many of these characterizations of burnout appear to be displayed by Matt so as one of his coaches I need to do what I can to address these behaviors and emotions before they get the best of him. 

I would first start by educating Matt on his current situation and what his behaviors could result in.  It would be important not to be too hard on Matt and further frustrate or upset him, but to simply sit him down and explain to him the detrimental effects that stress and increased arousal has on athletes.  I would first teach Matt the importance of “emotional intelligence,” defined as “the ability to process emotion-laiden information competently and use it to guide cognitive activities such as problem solving and to focus energy on required behaviors” (Gill and Williams, p. 191).  If Matt understands the consequences of his increased arousal, according to step 2 of Smith’s Cognitive-Affective Stress Management Model, Matt will understand the rationale of controlling his emotions, thus making him more susceptible to accept and fully participate in training. 

Once Matt understands the benefits of being under control while on the court I would teach him the most basic form of stress management; breathing exercises.  If I believe that Matt begins his matches by getting to “psyched up” I may encourage him to take part in meditation prior to taking the court.  This would be a proactive way to settle Matt down physiologically.  A major part of meditation is breathing technique.  Breathing technique, according to Gill and Williams (2008), emphasizes slow, deep breathing and might be an effective way to initiate relaxation.  When Matt becomes angered about a call or error, it would be important for him to utilize breathing exercises to initiate relaxation and avoid increased physiological arousal.  If this is unsuccessful, I may teach Matt a progressive relaxation technique specific to tennis to help avoid tension in his muscles, reducing the risk of injury as well. 

If these simple techniques are ineffective in improving Matt’s emotions on the court, it may be time to implement a cognitive-behavioral stress management technique.  In order to do this, a clinical psychologist, who is both well trained and competent in his or her ability, should work with Matt.  The three main cognitive-behavioral stress management approaches, according to Gill and Williams (2008) are: Suinn’s Visuomotor Behavioral Rehearsal Technique, Smiths’ Cognitive-Affective Stress Management Model, and Emotinal Control for Anger and Aggression.  All three of these techniques have shown to be successful at some level to calm one’s physiological arousal and control aggressive emotions as well as stress.

Conclusion:  Both Gill and Williams (2008) and Goodger et al. (2007) discuss the danger that high physiological arousal, perceived anxiety and stress, poor coping skills, and cognitive worry can have on an athlete, especially in regards to burnout and injury.  If I were Matt’s coach at a tennis camp I would first educate him on the threat his behaviors and emotions are posing on his career.  Once he comes to realize the importance of maintaining his emotions I would teach him how to do simple meditation prior to matches, including deep breathing exercises to use before and during the match.  Whether these are effective or not, progressive relaxation techniques could be beneficial to help keep Matt’s muscles from experiencing excess tension.  If none of these techniques are successful, it may be time for a trained clinical psychologist to work with Matt in developing a cognitive-behavioral stress management technique to address his emotional irregularity.

References:

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign,   IL: Human Kinetics.

Goodger, K., Gorely, T., Lavalle, D., & Harwood, C. (2007). Burnout in sport: A systematic review. The Sport Psychologist, 21, 127-151.