Physical education in the eyes of overweight or obese adolescents' parents.

Li, Weidong ; Rukavina, Paul B. ; Sutherland, Sue 等

The national public health documents including Healthy People 2010: Understanding and Improving Health (U.S. Department of Health and Human Services (USDHSS), 2000) and Physical Activity and Health: A Report of the Surgeon General (USDHSS, 1996) have indicated a need for school physical education (PE) to shift from an emphasis on competitive team sports to a focus on providing quality daily PE programs to promote a healthy, physically active lifestyle among children. The role of school PE in public health has also been debated by researchers in the fields of PE, exercise and public health. Many researchers have argued for a health-based curriculum in school PE (e.g., Pate & Holm, 1994; Sallis & McKenzie, 1991). On the other hand, others have questioned the "uncritical acceptance of particular narrow health imperatives, especially the 'obesity epidemic' and the effects this has on the research conducted in the name of PE" (Gard & Wright, 2001, p. 545), and placing 'healthism' at the core of PE curriculum (e.g., Gard & Wright, 2001; Tinning & Kirk, 1991) based on uncertain scientific knowledge about the link among activity (inactivity)-obesity-ill health. Despite the ongoing discourses of obesity and the role of PE in public health from researchers, an important piece that is missing among these discourses is the voices of parents, especially those with overweight children.

According to the expectancy-value model of achievement motivation, parents are one of the important socializers whose beliefs and behaviors can significantly influence their children's beliefs, expectancies, values, and behaviors (e.g., Wigfield & Eccles, 2000). Previous research has shown that parents as an important socializer, play a critical role in their children's motivation (Gonzalez-DeHass,Willems, & Doan Holbein, 2005), academic performance (e.g., Senechal & LeFevre, 2002), and eating and exercise behaviors (e.g., Lindsay, Sussner, Kim, & Gomnaker, 2006). Parental knowledge, attitudes, and behaviors are all influential in the development of a healthy, physically active lifestyle among their children (e.g., Kaplan, Liverman, & Kraak, 2005). Many researchers have argued that parents should become a central part of national campaigns to combat the epidemic of childhood obesity (Epstein, 1996; Lindsay et al., 2006).

Perceptions of school PE among parents with overweight or obese children is an important area for investigation because they need to cope with many obesity-related issues that their children encounter in their daily lives. Children who are overweight or obese often experience weight-related stigma or teasing during school PE classes, and are commonly excluded from participating in PE due to limited physical ability and skills (Li & Rukavina, in press; Bauer, Yang, & Austin, 2004; Fox & Edmunds, 2000; Trout & Graber, 2009). Weight-related teasing can adversely affect overweight children's psychological well-being and emotional development (Morgan, Tanofsky-Kraft, Wilfley, & Yanovski, 2002; Puhl & Brownell, 2003). As a result of teasing in physical activity settings, vulnerable overweight children can withdraw from socializing with peer groups, avoid physical activity, and use unhealthy means to cope with teasing (e.g., drug use, binge eating or television) (Hayden-Wade, Stein, Ghaderi, Saelens, Zabinski, & Wilfley, 2005).

Positive parental perceptions and involvement are widely perceived as critical factors to the viability of school PE (e.g., Sheehy, 2006). However, limited research has been conducted to examine parental perceptions about PE and their involvement in PE. The results from the previous studies indicated that parents valued PE and believed that PE should be part of school curriculum. They had different views of the major purposes of PE (e.g., Sheehy, 2006; Stewart & Green, 1987; Tannehill, Romar, O'Sullivan, England, & Rosenberg, 1994; Zakrajsek & Tannehill, 1992). For example, Stewart and Green reported that parents of elementary and secondary school children perceived physical fitness and motor skill development as the primary objectives of PE, rather than cognitive and social development. In the Tannehill et al. and Zakrajsek and Tannehill studies, a large number of parents believed that promotion of health and fitness (fitness/well being) should be the major purpose of PE.

The previous studies, however, have mainly focused on a general population of parents. Little is known about the perceptions of school PE from parents with overweight or obese children. For example, what is their understanding of the purposes of school PE? Do parents with overweight or obese children perceive PE as being important in their children's education? Why is PE important or unimportant to their children? What do they expect their children to learn in school PE? There is an urgent need to examine these unanswered questions to better inform researchers, practitioners, and legislators of societal needs from school PE. Therefore, the purpose of the present study was to qualitatively describe the perceptions of overweight or obese adolescents' parents toward PE.

Method

A descriptive qualitative research design was employed for the present study as we were interested in the perceptions of school PE among parents with overweight or obese adolescents in an urban city school district in the Southwestern USA. This district serves more than 119,000 students in grades K-12. Approximately 87% of students are African American and 71% of students receive free or reduced price lunch. PE classes at nine participating middle or high schools were all taught by certified teachers. There were two to four PE teachers at each of the school sites and their teaching experience ranged from 5 to 15 years. The 2007 Youth Risk Behavior Survey showed that 16.2% of high school students were obese and 19.7% were overweight as compared to 13% being obese and 15.8% being overweight nationwide (Eaton et al., 2008).

Participants

As a part of a larger study to investigate weight-related teasing and coping in physical education (Li & Rukavina, in press), 44 parents (42 mothers, 2 fathers) from 42 families (28 African Americans and 16 European Americans) provided written consent to participate. All parents had children, who attended a city school, were overweight or obese adolescents with a Body Mass Index (BMI) greater than the 85th percentile, and were enrolled in PE either at the time of the interview or in the previous year. Students were first visually identified as being overweight or obese by their PE teachers or the first two investigators and then their height and weight were measured after we obtained parental consent and child assent forms to calculate BMI adjusted for age and gender. The adolescent participants' BMI ranged from 25 to 62.2. A total of number of 47 adolescents participated in the larger study (28 females and 19 males; 33 African Americans and 14 European Americans). The adolescent participants' age ranged 11 to 19 year olds (M = 14.86, SD = 1.97). Not all of the parents of the adolescents were interviewed due to busy work schedules or lack of availability.

Recruitment was a rigorous and lengthy process. Initially, we worked with the city schools to identify a pool of adolescents and their parents. Consent forms were handed to these adolescents by their PE teacher and if they and their parents were interested, they returned the forms. Much care was taken in communication with participants and their families due the sensitivity of the topic. Previous literature had identified the sensitivity of the topic of overweight (O'Keefe & Coat, 2009). To ensure a heterogeneous sample and to recruit enough participants, several methods were used. Consent forms were handed out at multiple schools, flyers were distributed at weight loss clinics and summer camps organized through a local community center, and we asked participants to tell their friends about the study (i.e., word of mouth). Participant families were provided $50 for participation in the study.

The flyers included information similar to that of the consent forms, but were more general. When interested parties contacted the researchers, more specific details were provided and consent was achieved if they were interested. At the clinics, the flyers were handed out to the families by the supervising physician. If the family was interested or had questioned about the study, one of the researchers answered the families question and explained the details of the study. Approvals from the Institutional Review Board (IRB) were obtained. For participants recruited through schools, approvals from the school district and school principal were also obtained. Approvals from the weight loss clinics and summer camps were also obtained.

Data Collection

Interviews were considered to be the most appropriate method for exploring the perceptions of parents with overweight or obese adolescents. The interview allowed us to gain insight into the sensitive topic related to obesity while providing flexibility in conversations to address other issues raised by the parents (Edmunds, 2005). A conversational style interview was guided by three initial questions, including what are the purposes of PE? Do you think that PE is important or unimportant to your child? Why PE is important or unimportant for your child? And what are the barriers that their children encounter in PE? The initial questions were followed by prompts from the interviewers based on the responses from the parents and knowledge of issues related to obesity in PE. Each parent participated in one in-depth interview to address these issues and those related to helping their child cope with weight-related teasing which lasted between 30-90 minutes. The interviews were face-to-face for 42 parents and 2 parents selected a phone interview due to scheduling constraints. All interviews were conducted by the first two investigators privately at the participants' home, school offices, weight loss clinics, or the first author's university office. The location of the interview was selected by the participants to accommodate their schedule, family commitments, and to allow them to feel most at ease during the interview. The full interview guide is available upon request.

Prior to beginning the interview, the first two investigators framed the interview (Kvale, 1996) through engaging in conversation to put the parents at ease, discussing the study, and highlighting the importance of hearing the voices of parents of overweight or obese adolescents, and assured parents that any time they felt uncomfortable with the interview they could stop without any repercussions. Once all of the interviews were completed, a focus group interview with six parents was conducted to provide an opportunity for member checks and further explore parents' view on the inclusion of overweight or obese students in PE. All interviews were audio-taped with the parents' permissions.

Data Analysis

An ID number and a pseudonym were assigned to each participant for the purpose of identification in the analysis and reporting of the data. All audio tapes were transcribed verbatim. Inductive content analysis and constant comparison were used to analyze the data (Denzin & Lincoln, 1994). In the initial phase of analysis, the first two investigators carefully read the interview transcripts multiple times to ensure familiarity with the data. In the second phase, the unit of analysis was first determined. Major concepts that arose frequently were identified and formed into themes. Then, the researchers developed main themes and a coding template that emerged from the data. To ensure the clarity and consistency of definitions of themes, eight interviews were initially double-coded and disagreements were discussed until both coders reached an agreement. Each investigator then independently analyzed the data using the coding template. Finally, the interpretations of the themes identified were made and the relationships between the themes were identified. The narratives were written by incorporating the data from the focus group interview.

Data Trustworthiness

Trustworthiness of the data was established through several strategies. First, we recruited 44 parents for our interview to ensure a good representation of perspectives from the population of interest. Second, throughout the data analysis, peer debriefing was conducted with a colleague who has extensive experience in qualitative research. Feedback and insights with regard to data collection procedures, coding development, formation of conceptual linkages, alternate interpretations, overall representation of the data, and conducting a focus group interview were obtained from the peer debriefer. Third, transcripts were member checked. Transcripts were mailed to all participants based on the address provided at the time of interview. These parents were asked to check the transcripts for accuracy and mail them back to the researchers using the stamped addressed envelope. However, we only received ten of them and the rest were returned back to us due to incomplete address information. An examination of the returned transcripts indicated that only typographical and grammar errors were identified for changes by participants. Fourth, our interpretations of the data were member-checked through a focus group interview. Six parents were recruited through random phone calls and voluntarily participated in the focus group. During the focus group interview, the first researcher presented the themes to participants to check the accuracy of interpretations and further explored the issues in PE that emerged from the data. Finally, a search for any cases to refute themes or provide an alternative viewpoint was conducted throughout the data analysis.

Findings and Discussions

Themes are illustrated through parent voices taken from the individual and focus group interviews. No new themes emerged from the focus group interview. However, more in-depth information was provided by parents for these themes. A hierarchical tree was developed resulting in two higher order themes and six lower level themes, as reflected in figure 1.

[FIGURE 1 OMITTED]

Importance of health-related PE

In the late twentieth century, several researchers (Pate & Hohn, 1994; Sallis & McKenzie, 1991) have begun to promote a health-related PE curriculum to address current public health issues. In this study all 44 parents believed that school PE was important. Forty parents said that school PE should be health-oriented; however, the reason why it was important differed in many ways. Some parents argued that the curriculum should include "basic knowledge about health and fitness and how to be healthy and doing exercises should be the main foci of PE." These parents' conceptions are consistent with PE programs that integrate fitness concepts throughout the curriculum and/or have several units on fitness. As a part of the basic knowledge of health, other parents wanted their children to learn how to eat healthy. One parent said, "knowing what to eat and what not to eat is a lot ... It's good to have a piece of candy, but not all the time." Many school programs include a nutrition component as a part of their health and PE curriculum. Implementation of a nutrition program in middle schools has the potential to create positive changes in students' eating knowledge and behavior (e.g., Fahlman, Dake, McCaughtry, & Martin, 2008).

Consistent with health-related content knowledge, other parents placed an emphasis on learning how to take care of the body and being healthy. One parent said, "we should put a lot more emphasis on being healthy instead of ... looking a certain way, a big emphasis on nurturing our bodies and taking care of ourselves and accepting of different types of body shapes and weights." Physical educators can create a culture of size acceptance where students value a variety of body shapes and sizes. This type of culture can be transformative, allowing students to feel safe to be themselves and exercise and learn about their body without ridicule (e.g., Azzarito & Solmon, 2006).

Other contents that parents wanted their children to know was the development of their bodies and shapes, especially gender differences. One parent commented, "Taught more about the fact of life.... where girl and boy bodies are different ... how girls and boys are different." This parent's belief is consistent with the National Association of Sport and Physical Education (NASPE; 2004) conceptualization of a physically educated person. In this position statement, six standards to achieve in physical education are expected of a student. NASPE standard two states that students should acquire movement related concepts, for example, content-specific disciplines like motor development. Students need to know about gender differences so they understand the reality of motor performance (Williams & Payne, 2003). For example, girls go through puberty earlier than boys or boys gain testosterone which enables them to acquire greater muscle mass. Having better knowledge allows students to understand their motor performance and set relevant goals.

Besides health-related content, parents wanted physical educators to help their children value physical activity. One parent argued that technological advances have presented many opportunities for their child to be sedentary, "Well, I think it's important because we (are) living in an electronic age and more and more kids are spending time on computers, Nintendo, and TVs and they are just not exercising like back when I was a kid." As a result, school PE has a crucial role in promoting the importance of physical activity and a healthy lifestyle. One parent said, "I want my kids to be exercise-minded. I mean she's not real sports-orientated. But she can, you know, like run and walk."

Ultimately students should leave PE valuing physical activity and a healthy lifestyle. One parent commented that physical educators should provide activities that their children love to do instead of making exercise seem arduous, "It should be something fun because sometimes when you think of exercise you think of something stressful, painful, and then you don't want to do it." This parent advocated giving students some activities that they like and then ... "let them do the activity and just monitor them with the activity thirty minutes, however long the program should be." While the researchers recognize the importance of giving students' choice and providing activities that are fun and motivating, students should also be equipped with essential skills and knowledge to develop and maintain a healthy, physically active lifestyle. School PE is more than just being "busy, happy, good" (Placek, 1983).

Self-regulation and decision-making are important skills and abilities that students need to learn in PE to develop and maintain a healthy, physically active lifestyle. Parents in the present study felt that PE is important to educate their children to self-regulate their eating and exercise behaviors and make good decisions about nutrition, physical activity, and health. The following parent commented that making bad or unhealthy choices has consequences. Children should learn about self-regulation and responsibility, "try and make her be a little more responsible.... make her understand what we choose to do everyday effects the rest of our lives.... The negative effects, the negative choices we make have a devastating outcome later." Other reasons that parents expressed for why PE is important included teaching how to play different sports, teaching social skills, feeling better, developing cooperation and team work, losing body weight, having good mood, and reducing stress.

The comments from these overweight or obese adolescents' parents mainly echoed the call by several researchers (Pate & Hohn, 1994; Sallis & McKenzie, 1991) for shifting the focus of PE curriculum from traditional competitive sports to health-related physical activity. However, some parents also recognized the social and emotional benefits of school PE as researchers (e.g., Gard & Wright, 2001; Tinning & Kirk, 1991) have argued that PE should focus on educational objectives such as critical thinking, social skills, and personal and social responsibility. Given the strong voices on adopting health-related curriculum from these overweight or obese adolescents' parents, researchers and physical educators should identify effective ways to recruit and maintain their support for PE curricular reform, public policy and legislation.

Frustrations with PE

Parents expressed some frustrations with PE when they were asked to report the barriers that their children encountered in PE. Eighteen parents indicated that they were frustrated with school PE for many different reasons: Limited time or no PE at all, lack of accountability for teachers, developmentally inappropriate instruction, no fun or no choices, and unsafe, non-supportive or overly competitive learning environments.

Limited time or no PE at all. Over the past two decades, the number of PE classes that students receive have dramatically decreased (e.g., Lee, Burgeson, Fulton, & Spain, 2007; NASPE, 2008). Only a few states mandate daily PE and this mandate differs by state and school districts (NASPE, 2008). Parents in the present study recognized that their children had less opportunity to participate in school PE as compared to the times when they went to school. They argued that school PE should be offered daily on a yearly basis. They perceived that their child does not have enough opportunities to engage in physical activity at home or outside of schools due to their dangerous neighborhood and busy work schedule. They also believed that PE programs can be part of the solutions to address the issues of childhood obesity. One parent commented that PE should be mandatory and taken every year, "I see our kids only get PE as far as with a PE teacher once a week." The parents also recognized the impact of TV and video games on their child's lifestyle. To combat this impact, one parent stated "PE should start early for the little ones to learn ... parents and kids need to be more aware of being active and how it's going to help them health wise and everything." Another parent was also frustrated with the number of semesters that the school offered PE per year. She stated, "I'm disappointed in city schools because they only offer them PE one semester instead of two [per year]. I think that's absurd to only have PE half the year and not the other half."

As researchers and physical educators have scrambled to justify keeping PE programs in schools, recruiting parental support and involvement should be the first thing on our agenda. When recruiting parental support and involvement, however, we need to keep in mind that parents do rank PE low in priority as compared to other academic subjects, such as math and science. Parental involvement in school PE can come in many different forms, including providing physically active home environments, supporting and encouraging their children to be engaged in PE, and engaging in school events, parent-teacher conferences and policymaking, etc. It is suggested that a better communication channel between PE professionals and parents should be established at a national level to recruit and maintain parental support and involvement in school PE. Through this channel, hopefully, legislators and policy-makers can be better informed about the importance of school PE from the perspectives of parents.

Lack of accountability for PE teachers. The literature on teaching effectiveness has demonstrated that the quality of PE teachers positively impacts how students spend their time and what they learn in PE (for a review, see Van Der Mars, 2006). However, parents in the present study indicated some serious issues about the quality of PE teachers, which should elicit substantive discussions about accountability for PE teachers. They reported that some teachers did nothing in PE and that students dressed out for PE activities, but did not play. For example, one parent said, "She [my daughter] tells me a lot of times they just sit there and talk. They just sit there on the bleachers on the gym and just talk and cuddle up. They don't do anything sometimes." This is indicative of the roll out the ball philosophy, where teachers loosely organize physical activities and let students sit on the sidelines talking to their friends if they do not feel like participating (Graham, 2008). Spencer (1998) discusses that teachers might use a roll out the ball approach when they experience high pressures to produce results in after-school athletics or when veteran teachers are burned out, or if the teacher is unqualified. Future research should examine what are the reasons that lead teachers to use a roll out the ball approach and how this can be changed so that meaningful learning can occur in PE. Another parent commented that PE teachers did not push students to be as physically active as when they were in school and took PE, "I honestly expect the teacher to go a little bit farther than they do because like I said, when I used to go to school teachers used to make you get up.... They don't push them as much as they used to push...." Possible explanations were that teachers are not held accountable for their teaching, lack teaching commitment or are ill-equipped with skills and strategies to engage overweight students in PE (Fox, Cooper, & McKenna, 2004).

Despite these frustrations of teachers' quality, some anecdotal evidence indicates that there are effective physical educators in the schools that these overweight or obese students attended. They are committed to teaching and devoted to making a positive impact on children and youth through school PE. As one parent in the focus group interview commented, "according to my kids, they workout, they do different activities, basketball or just different kinds of exercises. It depends on the teacher."

Data from some parents in the present study suggest that teaching was not happening in some school PE programs. Actions must be taken to hold in-service PE teachers accountable for their teaching practices. As suggested by Bulger and Housner (2009), a feasible nationwide accountability system should be developed and implemented to change the status of PE programs. Future research should test the feasibility and effectiveness of implementing these accountability measures into school PE.

Lack of differentiated instruction and positive inclusive learning environments. Childhood obesity has presented a historical challenge to PE teachers on how to include overweight or obese students in PE classes. According to the Standards for Initial Programs in Physical Education Teacher Education published by NASPE (2001), PE teachers should be able to design differentiated instruction and create positive learning environments to maximize individual student learning. However, research has shown that PE teachers and student teachers possessed negative biases toward obese individuals (e.g, O'Brien, Hunter, & Banks, 2007). PE teachers might lack the skills to work with overweight or obese students (Fox et al., 2004). In the present study, five parents expressed that their children were not effectively included in school PE from multiple perspectives involving curricular contents, instructional strategies, and learning environments. They argued that activity contents should be developmentally appropriate for overweight or obese students given that they have health problems and limited physical skills and ability. PE teachers should create a safe, supportive, and mastery-oriented learning environment for overweight or obese students, and allocate more positive attentions to them. Activity choices should be provided for overweight or obese students based on their physical ability and interests.

Developmentally inappropriate instruction. Overweight or obese students generally have limited physical fitness/skills and ability (e.g., Fogelholm, Stigman, & Huisman, 2008; Williams, Wake, Hesketh, Maher, & Waters, 2005) and experience health problems (e.g., Dietz, 1998), which can impede their participation in PE. The literature has also indicated that overweight or obese students were commonly excluded from participating in PE settings due to their body weight (e.g., Pierce & Wardle, 1997). Therefore, it is very important for PE teachers to design developmentally appropriate instruction to include overweight or obese students, thus maximizing their activity levels and learning in PE. Data reported by overweight or obese students' parents in the present study, however, showed that instructions provided by PE teachers were generally developmentally inappropriate for overweight or obese students. One parent commented if students have health problems, they should do something different. "My daughter had asthma and diabetes. For a lot of the things that the kids do, she can't do." Another parent also stated, "a lot of big, heavy kids are having health problems. [PE Teacher] has them running ... I have seen PE teachers ... get [the big] child running, running because other kids are doing it. "

In contrast to the sentiments of the majority of parents, one parent believed that body weight should not be an issue for participating in PE. She strongly believed that overweight or obese students can do all the exercises and even better than their peers, and they should be held accountable in the same way as others. This parent commented, "I wouldn't care if they were 300 lbs. They can do it ... I was a big child too. But I did all those exercises better than the thin ones. You can never tell a child what they can't do because they can do it."

Another parent during the focus group argued strongly that PE teachers should not single out overweight or obese students by incorporating exercise only for those students, "let them show their exercise and let them get to know each other ... get the obese teens and the smaller kids to interact ... you don't zone out one certain child. It's for everybody."

The data from the present study demonstrated an urgent need for designing developmentally appropriate instruction for overweight or obese students (Rukavina & Li, 2008). However, caution needs to be taken to ensure that instructions are designed to include every child in PE and that overweight or obese students are not singled out. Appropriate pedagogies on how to successfully include overweight or obese students in PE is a big challenge to teachers. Although a lot of research has been conducted on differentiated instruction in PE with regards to ability levels and including students with disabilities, research on including overweight students in PE is still in its infancy. A qualitative exploration of specific instructions and practices to include overweight or obese students in PE is needed.

No fun and no choices. Some parents reported that school PE was not fun and that no activity choices were provided for their child. They believed that fun and choices can enhance their child's participation in PE. Fun and choices also emerged in the focus group interview. Parents perceived that PE should be fun and provide "opportunities to show what they want to do," and "give them a variety of sports and activities." One parent stated that to increase their participation, rather than sitting on bleachers, PE teachers should provide activity options, "If some kids don't like basketball, then pull out some jump ropes or hula hoops."

Motivational research literature has identified fun and choices as effective strategies to intrinsically motivate students to participate in physical activity/education (e.g., Chen & Ennis, 2004; Hellison & Walsh, 2002), including selecting novel tasks, providing leadership opportunities, listening to students' voices, providing autonomy support, instilling personal and social responsibilities, focusing on task-mastery and effort, and setting goals. Based on the findings of this study, professional development opportunities should be provided for the PE teachers serving those children in order to be better informed of research-based effective teaching practices, thus enhancing overweight or obese students' motivation and improving their levels of physical activity in PE.

Learning environments: Not safe, non-supportive, and too much on competition. In the past two decades, traditional competitive sports have been placed at the center of school PE curriculum. Under this curriculum, overweight or obese students may have been at a risk of being excluded from school PE due to their health problems and limited physical skills and abilities. There is also evidence showing that overweight or obese students were often teased or criticized due to their body weight during physical activity (Faith, Leone, Ayers, Moonsseong, & Angelo, 2002). This weight-related teasing was linked to the feeling of being embarrassed during physical activity (Pierce & Wardle, 1997), less enjoyment in sports, and reduced levels of physical activity (Faith et al., 2002).

Parents in the present study complained that school PE put too much emphasis on competition and failed to provide a safe and supportive environment to include overweight or obese students. One parent commented, "PE without the competitive focus would be much more effective ... everything offered is related to a competitive sport, and even [for] doing sit-ups or jumping jacks it's a competition ... 'let's compete.' I wish that there was a more noncompetitive PE offered ... so that my kid can participate." Another parent was concerned about unsafe locker rooms, "some boys can sneak into the girl locker room ... My daughter (told me) boys sneaked in there when (girls) are changing clothes into their shorts."

Other parents mentioned about their child's embarrassing experiences in PE. These comments included, "my daughter didn't want to play or do the exercise because kids would be looking at her ... I hate gym. I would ask why and she would say my gym teacher is going to make me do some sit-ups and all the kids are going to look at me to see if I can do it"

Learning environments, where students feel safe, are supported and cared for, and learning and task-mastery are emphasized, can foster intrinsic motivation in PE (e.g., Standage, Duda, & Ntoumanis, 2005). Based on the findings of the present study, research on what motivational strategies have been used and how these strategies are implemented by in-service teachers is needed to identify effective ways to solve the issues. Weight-related teasing is a serious issue in PE. There is no research on effective institutionalized preventive policies and strategies and how PE teachers can effectively handle teasing to provide a safe and supportive learning environment for overweight or obese students. Future research in this area is recommended. There is evidence showing that PE teacher education (PETE) curriculum socializes PETE undergraduate students to be more negatively biased toward overweight or obese individuals (O'Brien et al., 2007). Additionally, pre-service teachers lack education on this topic and are unprepared to successfully teach this population (Greenleaf, Martin, & Rhea, 2008). The data from the present study also suggest that in-service teachers are lacking knowledge and skills in this area. Governmental survey reports that PE teachers want in-service on how create inclusivity. In the recent 2006 SHHPS study, 52% of teachers interested in staff development wanted information on teaching strategies to promote inclusion and active participation, specifically for overweight or obese students during PE (Lee et al., 2007). Therefore, a teaching module on how to successfully include overweight students through differentiated instructions and the creation of inclusive, bias-free, and motivating learning environments is needed for both in-service and pre-service teachers.

Four specific inclusive strategies were recommended by parents during the focus group, including providing leadership opportunities for overweight or obese students, boosting their confidence by providing opportunities for overweight or obese students to show their competence, using peer instruction, and providing activity choices (indoor versus outdoor, noncompetitive activities or sports versus traditional competitive sports). Parents commented, "let them lead the exercise ... show what they are capable of doing ... And that was motivation for them", "I think that PE teacher ought to step back ... let them instruct ... gave the opportunity to show what they want to do", and "give them a variety of sports and activities." These strategies have been widely recommended by researchers in the motivational research areas to motivate students to be fully engaged in PE (e.g., Hellison & Walsh, 2002). Multiple channels of disseminating these evidence-based practices should be established to help in-service teachers improve their teaching. These best practices should also be more integrated into PETE undergraduate preparation programs.

The present study indicated that parents of overweight or obese adolescents value school PE and expect their children to learn and be successful in PE. PE is an important subject that provides their children with activity time and learning opportunities for the improvement of their child's health in a variety of ways. Especially, most parents emphasized that school PE should be a health-oriented program to help overweight or obese students develop the knowledge, attitudes, and behavior skills needed to develop and maintain a physically active lifestyle. However, at the same time, some parents experienced frustrations about their children's experience in PE for many different reasons. Parents are one of the important socializers whose beliefs and behaviors can significantly influence their children's beliefs, expectancies, values, and behaviors (e.g., Wigfield & Eccles, 2000). Building upon the present study, future research should examine the degree of parental involvement in PE and how parental perceptions and involvement influence their children's perceptions toward and behaviors in school PE.

Another strong voice that emerged from the interviews was how to include overweight or obese students in PE by providing differentiated instruction and creating positive, inclusive learning environments. Given that childhood obesity is still increasing and no research has been conducted in this area, how to successfully include overweight or obese students in PE/ activity is an important area worthy of future research endeavors. The findings of the present study suggest that there is a need for improved communication between physical educators and parents about PE. Strategies to recruit and maintain parental supports, and a nationwide accountability system for PE should be developed and implemented. Teachers should also be equipped with knowledge and strategies to successfully include overweight or obese students in school PE. A teaching module for successful inclusion of overweight or obese students in PE should be implemented into undergraduate preparation programs and professional development workshops for in-service teachers to maximize overweight student learning and educate them to develop and maintain a healthy, physically active lifestyle.

Author's Note

This project is part of a larger one, funded by American Association of Health, Physical Education, Recreation, and Dance---Research Consortium Grant Programs

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Weidong Li

The Ohio State University

Paul B. Rukavina

Adelphi University

Sue Sutherland

The Ohio State University

Bo Shen

Wayne State University

Kim Insook

The Ohio State University

Address correspondence to: Weidong Li, Ph.D., The Ohio State University, College of Education & Human Ecology, PAES Building A270, 305 West 17th Avenue, Columbus, OH 43210-1224. Phone 614-247-6506, Fax 614-688-4885, Email: li.832@osu.edu