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andré picard's second opinion

When reports are published and news stories written about hot-button topics like childhood obesity and physical inactivity, the responses are as impassioned as they are varied.

The release this week of the annual report card of Active Healthy Kids Canada - which concluded, among other things, that only 12 per cent of children are physically active enough and that one-quarter of preschool kids are already overweight - is a case in point.

There are the doubters. "Nonsense," they say, "the kids in my neighbourhood are all thin as rakes and they play morning, noon and night."

The statistics, they say, are all lies, trumped up to generate attention (and grants) for self-interested organizations.

There are the parents who cite their own children's hectic schedules - hockey, soccer, gymnastics, swimming, karate and so on - as anecdotal proof that the data are nonsense.

Others are more scientific in their disbelief, arguing that setting the bar of adequate activity at a minimum of 90 minutes a day is unrealistically high and thus exaggerates the extent of the problem.

There are reminders too from social justice proponents that health challenges are not evenly distributed across society: The twin crises (so-called) of obesity and inactivity are more acute in lower-income groups, for a host of socio-economic reasons.

Then there are the nostalgics, who recall the days of yore, when children walked five miles through five-foot snowdrifts to get to school and played outside until the streetlights came on every night. (The days before the metric system and satellite TV, apparently, were free of homework and the fear of sexual predators.)

Then there are those who read the reports of fat, sedentary, pop-swilling kids and see in the numbers explanations for all of society's woes: A school system that has utterly failed our children by neglecting their physical health; an economy adrift due to laziness; and a health system verging on bankruptcy because of soaring rates of heart disease and diabetes.

There is an element of truth in the points made by each of these camps, from the doubters to the despondent.

So what are policy-makers (and parents) to do with all this contradictory information?

The key is to not get bogged down in trivialities and side issues and to keep our sights set firmly on the goal: healthy children.

Everyone one can agree - one hopes - that kids should be physically active and physically fit. That doesn't mean other factors - diet, family income, physical environment, education - are not important.

Body weight/shape and activity levels are just a couple of components in a bigger puzzle that makes up good health.

Quibbling about numbers is easy.

Is 90 minutes a day of physical activity really needed? Is it realistic?

There is a sound scientific basis for the recommendation but, when you boil it down to a one-line exhortation, the subtleties are lost. For example, the activity doesn't have to be continuous, intensity matters, and so does what a child eats.

One problem is that people often confuse "exercise" and "physical activity." They are not the same thing. But, reading the headlines, one can be forgiven for thinking that every child who does not run a marathon daily is deemed a couch potato.

Saying that "only 12 per cent of children are active" overstates reality, but such dire warnings are made to get the public's attention.

This type of spin, however well-intentioned, can also leave the public feeling skeptical, discouraged and disenfranchised.

Therein lies one of the major challenges of public health - how do you promote physical activity in a society that is built for inactivity?

How do you deliver a subtle message to a skeptical, time-pressed public?

There is no simple answer. But there needs to be an attempt to appeal to the different segments of society in ways other than using the traditional scary statistics.

For the doubters, some pointed questions like: Is expecting kids to actually move for 90 minutes a day really so outrageous?

Put another way, does being sedentary for 22.5 hours a day actually sound healthy? By any measure, that's a lot of on-your-butt time.

The scientifically-inclined could use some explanation of how recommendations for adequate physical activity are arrived at, and how obesity is actually measured in children. (It is based on percentiles on growth charts, not body mass index as in adults.)

For the nostalgics, an acknowledgment that, yes, kids were a lot more active in decades past, coupled with some practical suggestions on how to reintroduce movement into daily living - walking instead of driving to school; tossing a ball in the yard instead of on the Wii; taking the family to a park instead of to the movies.

And for the despondent, some hope. Children are hard-wired to move. We've engineered activity out of our lives in a short time period; we can engineer it back in just as quickly, if there is a will.

The numbers - regardless of how accurate you may think they are - tell us something important: Current methods of promoting physical activity hasn't been particularly effective.

It has created a tiny minority of super-active kids and a huge mass of increasingly inactive ones.

We need a different approach, one that says being sedentary is the problem.

Get up out of the chair; get out of the car; get out of the stands; get off the golf cart. Do something.

Don't call it exercise. Don't call it physical activity. Don't count the minutes.

Just move - even if it's a couple of steps in the right direction.