Designer Schools: The Role of School Space and Architecture in Obesity Prevention

Perspective
Designer Schools: The Role of School Space
and Architecture in Obesity Prevention
Nicholas Gorman,* Jeffery A. Lackney,† Kimberly Rollings,‡ and Terry T.-K. Huang§
Abstract
GORMAN, NICHOLAS, JEFFERY A. LACKNEY,
KIMBERLY ROLLINGS, AND TERRY T.-K. HUANG.
Designer schools: the role of school space and architecture
in obesity prevention. Obesity. 2007;15:2521–2530.
Spatial features of obesogenic environments studied on a
broad community level have been associated with childhood
overweight and obesity, but little research has focused on
the effects of the design of micro spaces, such as schools, on
individual health behaviors. This article aims to generate
thinking and research on the link between school space and
architecture and obesity prevention by reviewing and syn-
thesizing available literature in architecture, environmental
psychology, and obesity research, in an effort to propose
promising ideas for school space design and redesign. The
school environment is defined through 5 dimensions: phys-
ical, legal, policy, social, and cultural domains. Theories
underlying environmental interventions and documented as-
sociations between the environment and health behaviors
and outcomes are reviewed to illustrate how existing envi-
ronmental research could translate to obesity prevention.
Design strategies aimed at promoting physical activity and
healthful eating are proposed, with particular emphasis on
the design of cafeterias, activity spaces, connectivity with
the larger community, and student health centers.
Key words: childhood obesity, environmental factors,
prevention, public health, energy balance
Introduction
Efforts to identify factors contributing to rising obesity
rates in the United States and beyond have implicated the
burgeoning obesogenic environment as a key determinant of
obesity-related health behaviors (1). Given the potential for
long-term individual benefit and large population-level im-
pact, prevention among school-age children has become
critical (2). In today’s society, schools are no exceptions:
exposure to laborsaving technologies and access to un-
healthful foods abound. Walks or bike rides to schools are
increasingly displaced by car rides, as convenience and
safety concerns prevail (3–5). Once at school, students have
ready access to fast food and vending machines due to
partnerships meant to offset school budget shortcomings
(4,6,7). The lack of time, funding, access, and planning and
increased competition with various academic demands have
also reduced in-school opportunities for physical activity
and healthful eating (2,6). The combination of these and
other factors have resulted in an environment that steers
health behaviors away from physical activity and healthful
diets (2,8).
The role of school space design and redesign in obesity
prevention is an area that merits consideration, as school
sites have served as promising venues for both research and
intervention efforts (9). School-based obesity interventions
have demonstrated encouraging but often modest short-term
results (10 –13), an observation that underscores the need
for new directions in school-based prevention efforts. Al-
though the research community has begun studying the role
of the larger environment on children’s diets and physical
activity, little research has focused on the intersection of
school architecture and design and individual health behav-
iors within schools. Previous work on school designs, in-
tended to influence outcomes such as attention or scholastic
performance, documents the profound impact physical
space can have on student behavior and development, pro-
viding much insight into how school space might be de-
signed or redesigned to prevent obesity (14).
Received for review November 14, 2006.
Accepted in final form March 12, 2007.
The costs of publication of this article were defrayed, in part, by the payment of page
charges. This article must, therefore, be hereby marked “advertisement” in accordance with
18 U.S.C. Section 1734 solely to indicate this fact.
*Institute of Health Promotion and Disease Prevention Research, Department of Preventive
Medicine, Keck School of Medicine, University of Southern California, Los Angeles,
California; †Department of Engineering Professional Development, College of Engineering,
and Department of Interior Design, School of Human Ecology, University of Wisconsin,
Madison, Wisconsin; ‡School of Architecture and Urban Planning, University of Wisconsin,
Milwaukee, Wisconsin; and §Endocrinology, Nutrition, and Growth Branch, Center for
Research for Mothers and Children, National Institute of Child Health and Human Devel-
opment, National Institutes of Health, Bethesda, Maryland.
Address correspondence to Terry T.-K. Huang, Pediatric Obesity and Metabolic Syndrome,
National Institute of Child Health and Human Development, 6100 Executive Boulevard,
4B11, Rockville, MD 20852.
Contents of this publication do not necessarily reflect the views or policies of the National
Institutes of Health.
E-mail: [e-mail]
Copyright © 2007 NAASO
OBESITY Vol. 15 No. 11 November 2007 2521

Directing built environmental efforts into the school set-
ting has the benefit of ensuring both sustained contact with
target populations and access to large segments of youth (6).
Indeed, both the number of hours spent in school each year
and total enrollment are on the rise, while drop-out rates
have declined since 1972 (15). In addition, a significant
portion of students stay on campus after classes; recent
surveys suggest that almost 1 in 5 students in grades K-8
engage in campus-based after-school activities (16). Simi-
larly, studies suggest that anywhere from 19% to 50% of
students’ daily food intake occurs at school (6). The case for
environmental interventions within schools is further sup-
ported by precedent; plans for novel school design and the
redesign of existing spaces have been proposed and imple-
mented to influence everything from academic performance
to toxic environmental exposures (14). The goal of this
paper is to generate thinking and research on similar obesity
prevention interventions by reviewing and synthesizing
available literature in architecture, environmental psychol-
ogy, and obesity research in an effort to propose promising
ideas for school space design and redesign.
The scope of the current paper focuses on feasible micro-
level school design and redesign to promote healthful phys-
ical activity and diets. In our discussions on school design,
one distinction should be drawn to distinguish between
micro- and macro-level environments. The behaviors that
take place in any school system are likely to be moderated
by the broader macro-environment. Examples of macro-
level changes include efforts to promote walking and bicy-
cling to and from school through healthful urban planning.
Geographic information system mapping technologies have
allowed for the construction of detailed environmental maps
that may prove useful in investigating the impact of macro-
level factors, such as the location and density of fast food
restaurants in a given community. Details on these macro-
environmental investigations can be found elsewhere (5). In
the current article, we discuss the larger built environment
only in terms of optimizing the connectivity of schools with
their exterior community context.
Defining School Spaces
It has been previously suggested that, for public health
practices, the built environment may be conceptualized as
containing 3 sub-domains, the physical, legal, and policy
environments, each of which may operate on multiple levels
to discourage or facilitate any given health behavior (5). For
example, students’ meal choices at school could be viewed
as the result of these forces. In this case, the legal environ-
ment would include regulations regarding the nutritional
content of foods sold on campus. Meals provided as part of
the National School Lunch Program, for instance, are held
to federal nutrition standards, while competing foods are not
(6). In addition, the decision of which foods to eat could be
affected by physical environment factors such as ease of
access to competing foods. Are these foods available
through vending machines, cafeterias, or student stores?
Furthermore, school policies, such as the amount of time
allocated for lunch, may also influence children’s decisions.
In many cases, the influences of these domains interact,
further strengthening their impact on health behaviors. For
instance, in situations where cafeteria designs are inefficient
or insufficient to handle growing enrollment rates, shorter
lunch periods could be especially likely to steer children
away from more nutritious cafeteria meals.
While these 3 domains provide the beginnings of a frame-
work for public health researchers to describe environ-
ments, expanding on previous conceptualization to also
include social and cultural domains, both critical compo-
nents of the school environment, may be important. One
field of study within environmental psychology that ad-
dresses the impact of space on social domains is proxemics,
the study of how physical space passively influences and is
actively used in social interactions. Proposed by Edward T.
Hall in the 1960s (17), the study of proxemics grew from the
concept of territoriality and revolves around measuring the
distance maintained between individuals. Hall maintained
that the distance between 2 or more people could be defined
as intimate, personal, social, or public, and that each dis-
tance would have implications that could influence social
behaviors. Such behaviors, in turn, may have ramifications
for health outcomes worth considering during school design
and redesign efforts.
The environmental psychology literature has long recog-
nized the transactional relationship between social life and
the built environment (18). Within the school environment
literature, this transactional nature between social and phys-
ical environments became clear during the 1970s when new
school designs featured open-space planning that diverged
from traditional teaching methods (19 –21). The spatial def-
inition of learning spaces, especially reading nooks, has
been shown, for example, to improve children’s reading
behavior (22).
The impact of class layouts on both children’s and teach-
ers’ behaviors is attributable to more than simply wall
placement (23). Spatiality and proxemics acknowledge that
occupants of space take an active role in constructing the
meanings of that space, which, in turn, may influence be-
haviors (19). The influence of a given school space on
behavior may be markedly different throughout a typical
school day. In a classroom, for instance, although physical
characteristics of the classroom remain constant, its influ-
ence on behaviors may vary throughout the day based on
factors such as the subject being taught, the teacher, student
age, or group dynamics, among other factors (21).
It is important to note that these concepts extend beyond
the classroom as well. The entire school grounds deserve
consideration in the design or redesign of school space, as
they also pose constantly reinterpreted barriers and facilita-
School Design and Obesity Prevention, Gorman et al.
2522 OBESITY Vol. 15 No. 11 November 2007

tors to health-related behaviors. In the example of physical
education (PE)1 classes, static spaces are sometimes trans-
formed daily to accomplish various goals with different
student populations. Should a single large space be used to
conduct group sports emphasizing teamwork, or should a
variety of smaller spaces be used to offer a greater diversity
of activities? The answer to this and other questions requires
consideration of the intersection between the PE environ-
ment and the changing needs of the different student groups
using it.
Theories of Environmental Intervention
Many current theories may be adapted to describe the
relationship between environmental factors and health be-
haviors. As noted by Gordon-Larsen and Reynolds (5), such
adaptations have included elements drawn from the pre-
cede-proceed model, system theory, social ecology, and
social cognitive theory. Similarly, other fields of study,
including motivation theory, environmental psychology,
and efforts to influence health norms may bear implications
for environment-based health behavior interventions. The
common theme underlying these theories is their ability to
be applied across diverse facets composing the school en-
vironment. For example, examining social ecological the-
ory, the most frequently adopted underlying framework for
environmental interventions, reveals how its flexibility suits
a number of environmental studies (5). First, social ecolog-
ical models of health typically approach several contributors
to health behavior decisions, including factors unique to the
individual, factors external to the individual, and an inter-
action between the two (24). Gordon-Larsen and Reynolds
(5) note that the proposed external environmental factors
vary across studies, but this flexibility has allowed research-
ers to test hypotheses on a wide range of environmental
facets encompassing the interpersonal, social, cultural, and
physical domains (25–27).
One example of such a theory in application may be seen
in a recent school-based fitness intervention targeting eighth
grade girls in an effort to increase PE participation (28).
Social cognitive theory was used to derive a social ecolog-
ical model for intervention. Not only were students offered
a variety of gender-specific PE options, but their choices
were further broadened to include competitive and non-
competitive activities. In addition, the intervention ad-
dressed several environmental facets by promoting im-
proved faculty role-modeling, involving school nurses, and
extending activities off campus to promote community and
parental involvement.
That a single, integrative theory for interventions
grounded in environmental design and redesign has yet to
emerge underscores the importance of continuing collabo-
ration. Successful school-based environmental interventions
for obesity are likely to require the participation of archi-
tects, psychologists, health behavior researchers, students,
and other stakeholders, each of whom will bring a unique
perspective and explicit or implicit theoretical model to the
table.
Environment, Health, and Obesity
A growing body of literature documents the effects of the
environment on health behaviors and outcomes (14). As
obesity is frequently marked by comorbidity with other
physical and mental health problems, consideration of sev-
eral environmental factors will be vital in school design and
redesign efforts. In this section, we discuss the wide range
of pertinent environmental factors. We then illustrate how
previous environmental research can impact or be translated
to obesity prevention by exploring the case of air pollution
in further depth.
Range of Environmental Factors. An increasing number
of environmental factors, such as air quality, acoustics,
climate control, crowding, ergonomics, and lighting, may be
implicated in activity patterns, stress, and/or appetite and
food choices, all relevant facets of overweight and obesity.
The relationship between exposure to these factors and the
subsequent development of unhealthful behaviors is, in
many cases, multifactorial and complex. For instance, ex-
posure to high levels of noise not only affects scholastic
measures, such as attention, but has also been linked to
heightened blood pressure and stress, which may, in turn,
influence health behaviors and outcomes (14).
These facets of the environment, while not appearing
directly relevant to obesity prevention at first thought,
could, indeed, interfere with school-based obesity interven-
tions. For example, the effect of an intervention focused on
improving PE spaces may be moderated by factors such as
air quality. If school or PE attendance were to decrease due
to respiratory complications, then the success of any phys-
ical activity program could be limited.
Case of Air Quality. School air quality may indirectly
influence health behaviors relevant to overweight and obe-
sity. Respiratory infection, allergy, and absenteeism rates
have been shown to rise with increasing exposure to air-
borne allergens, such as those introduced through heating
and ventilation systems, cleaning chemicals, caulks and
sealants used to insulate buildings, and other building ma-
terials at school sites (14,29). Outdoor air pollution levels
have also been linked to absenteeism, exacerbation of pre-
existing asthmatic conditions, and a rising incidence of new
asthma cases (30,31).
The exacerbation of asthma is of special concern because
in the absence of carefully tailored asthma management
programs, asthmatic students may be less likely to partici-
pate in physical activity (32). In addition to their impact on
asthma rates, indoor and outdoor air quality levels can also1 Nonstandard abbreviation: PE, physical education.
School Design and Obesity Prevention, Gorman et al.
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