The potential epidemiologic, clinical, and economic impact of requiring schools to offer Physical Education (PE) classes in Mexico City

Abstract

Background Many schools have been cutting physical education (PE) classes due to budget constraints, which raises the question of whether policymakers should require schools to offer PE classes. Evidence suggests that PE classes can help address rising physical inactivity and obesity prevalence. However, it would be helpful to determine if requiring PE is cost-effective. Methods We developed an agent-based model of youth in Mexico City and the impact of all schools offering PE classes on changes in weight, weight-associated health conditions and the corresponding direct and indirect costs over their lifetime. Results If schools offer PE without meeting guidelines and instead followed currently observed class length and time active during class, overweight and obesity prevalence decreased by 1.3% (95% CI: 1.0%-1.6%) and was cost-effective from the third-party payer and societal perspectives ($5,058 per disability-adjusted life year [DALY] averted and $5,786/DALY averted, respectively, assuming PE cost $50.3 million). When all schools offered PE classes meeting international guidelines for PE classes, overweight and obesity prevalence decreased by 3.9% (95% CI: 3.7%-4.3%) in the cohort at the end of five years compared to no PE. Long-term, this averted 3,183 and 1,081 obesity-related health conditions and deaths, respectively and averted ≥$31.5 million in direct medical costs and ≥$39.7 million in societal costs, assuming PE classes cost ≤$50.3 million over the five-year period. PE classes could cost up to $185.5 million and $89.9 million over the course of five years and still remain cost-effective and cost saving respectively, from the societal perspective. Conclusion Requiring PE in all schools could be cost-effective when PE class costs, on average, up to $10,340 per school annually. Further, the amount of time students are active during class is a driver of PE classes’ value (e.g., it is cost saving when PE classes meet international guidelines) suggesting the need for specific recommendations.

Health and Economic Value of Eliminating Socioeconomic Disparities in US Youth Physical Activity

“…Using the previously described Virtual Population for Obesity Prevention ABM, 14 , 15 , 16 , 17 , 18 we represented all 50 million US children and adolescents 6 to 17 years old (starting in 2023), their growth over time, daily levels of PA, and physical health outcomes. The model represents each child as a computational agent and simulates each day of their childhood/adolescent years until age 18 years, then each year for the rest of their lives.…”

“…Starting at age 18 years, agents enter a Markov model ( Figure 1 ), described in previous publications, 15 , 16 , 17 which consists of 15 mutually exclusive health states accounting for both anthropometric measures (eg, BMI) and the presence and severity of risk factors associated with weight. Agents start at a metabolically healthy state and assume 1 of 3 states based on their BMI category (normal weight, overweight, or with obesity) at the end of childhood.…”

Factores que influyen en la Educación Física en México (Factors that influence in Physical Education in Mexico)

“…Según George y González-Moreno (2020), la duración de las clases de EF no facilita que el profesorado pueda aplicar sesiones que incluyan recursos materiales e instrumentos en donde el docente pueda estimular su creatividad, contribuyendo a sesiones más atractivas para los estudiantes. En este mismo sentido, según Ferguson et al (2022) es urgente el establecimiento de políticas educativas con sustento en organizaciones internacionales y especializadas, que establezcan el número de sesiones y la duración de clases de EF, así mismo, es pertinente la generación de estrategias para vigilar su cumplimiento.…”