Students in Camille Rimmer's first-grade class at Summitview Elementary start their day covering common ground.

After taking roll, deciding their choice for lunch and saying the Pledge of Allegiance, the students line up at the door. Some prance and rev their feet, waiting for the door to swing open.

When Rimmer opens the door, the students are off -- darting out, one after another, on a half-mile run around the school, up a small hill, around a berm and back to the classroom.

Rimmer runs, too.

"At first I go really fast and then I start slowing down," said 7-year-old Hunter Hansen, a student in Rimmer's class. "It feels like half my breath is taken away. My legs feel like I'm on fire."

Being active is something Rimmer, 58, takes seriously. She recently qualified and competed in the 112th running of the Boston Marathon. Running a 9:51-minute-mile pace, Rimmer finished the 26-mile course in 4 hours, 18 minutes, 5 seconds.

She tries to pass on her passion for physical fitness and living a healthy lifestyle to her students. For the past eight years, Rimmer has started her day in a pair of running shoes to make the run with her students.

"I feel really good because it gives you lots of energy," said Sydney Rikard, 7, after completing the run Thursday morning.

In recent years, as concerns about childhood obesity have increased nationwide, the focus on fitness has spread. Rimmer's efforts are part of a larger initiative to increase children's awareness of the importance of physical fitness and dietary nutrition.

With the allure of video games, computers and other forms of indoor entertainment that foster a sedentary lifestyle, coupled with the business of daily family routines, obesity -- particularly among children -- has become an area of focus.

In March 2007, the state Legislature passed a law establishing goals for youth nutrition and access to physical fitness. That law also launched the start of efforts toward comprehensive school health reform. Earlier, in 2004, the state Legislature passed a bill that directed the Washington State School Directors Association to develop a model school nutrition and physical fitness policy. The bill also required each school board to establish its own policy.

"It's important for our schools to be healthy environments," said Jessica Brown, who coordinates a local program, called Rev It Up, through the Yakima Health District that connects members of the health community with area schools.

"We give information to schools so they can be advocates for children."

Studies have found that overweight children and adolescents are more likely to become obese adults. Additionally, overweight children are at risk for certain health problems during their youth and as adults. Problems include risk factors associated with cardiovascular diseases such as high blood pressure, hypertension, high cholesterol and type 2 diabetes.

"I'm an adult cardiologist. I don't want these kids to be my patients when they grow up," said Dr. David Krueger, a cardiologist with the Yakima Heart Center and president of the Yakima County Medical Society.

In an effort to keep the youth of today from becoming future patients, Krueger highlights some of the "best practices" by teachers for instilling healthy lifestyles among youth. Summitview's Rimmer is one of them.

"In medicine we have best practices, so let's have best practices for teachers," Krueger said.

Krueger believes that promoting a healthy lifestyle should begin at home. It also takes a community effort to address the problem and establish healthy habits.

In Yakima County, 64.4 percent of residents of all ages are classified as overweight or obese, according to 2006 data from the Behavioral Risk Factor Surveillance System. That's an increase from 60.2 percent in 2003.

Additionally, Yakima County has a significantly higher percentage of eighth-graders who are overweight or at risk of being overweight than the state -- 32 percent for the county versus 25 percent for the state. That's according to the Healthy Youth Survey.

That same survey indicates that time allowed for physical education activities continues to decline. In 2002, 41 percent of high school sophomores participated in daily physical education classes. By 2006, that number had dropped to 32 percent.

"Kids just aren't as active," said Barry James, a second-grade teacher at West Valley's Apple Valley Elementary School. "They are watching TV, eating foods that are not healthy and not getting outside to exercise. It's pretty sad."

In an effort to be part of the solution, James, who is president of the Yakima Hard Core Runner's Club, has planned an inaugural Kids Marathon, which culminates today.

More than 250 children from West Valley schools will be completing the final 1.2 miles of a marathon, which is 26.2 miles. During the past three months, the students have kept record of their first 25 miles of running and walking under adult supervision.

"It's just one of the things to help foster healthy habits," said James.

Next year, James hopes to expand the event to schools throughout the Valley, not just West Valley.

"We're also trying to get the parents involved," he said.

He, too, has been identified by Dr. Krueger for his best practices in promoting healthy living among kids.

A parallel, but more formal local effort comes by way of a grant awarded to the Yakima Health District in January for Rev It Up. The local program connects the health community with schools as they implement aspects of their state-mandated wellness policies. It's funded with a three-year, $150,000 grant and essentially teaches kids to eat better and exercise more.

"We want to work with (schools) around policy so it's something that can be sustained past the three years," said Brown, the Rev It Up coordinator.

Other efforts to increase awareness of healthy living among students include things as simple as keeping school gyms open into the evening so families can use them, and having recess before lunch so students take their time to eat their meals.

Some schools do things like mileage clubs, where students keep track of the number of miles they run or walk in a competition similar to reading challenges. Many of these efforts also include an opportunity for parents to participate.

"We want them to be exercisers their whole lives. We want outreach to the average kid who doesn't have a team talent, but you want to excite them with exercise," Krueger said.

But not all of the efforts are about physical fitness. There's also a focus on nutrition, such as the efforts at Granger High School, where fresh fruits and vegetables are promoted in school. For at least the past two years, the high school has kept a cart of fresh fruits and vegetables for students to snack on throughout the day.

Efforts through the health district and Kreuger, who calls childhood obesity his "favorite topic to talk about," try to create a way for teachers throughout the Valley to share ideas about ways to encourage healthy living and habits in their classrooms.

For Rimmer, simply talking to her students about her own fitness regimen is also part of the deal. She runs about 50 miles a week, rides a bike and spends about three hours a week in the gym lifting weights.

"It enables them to see adults as active people. And then they will want to be active people," Rimmer said. "I just open the door and say here we go. ... I do it with them. I don't just send them out the door."

* James Joyce III can be reached at 577-7675 or jjoyce@yakimaherald.com.

How obesity harms a child's body

* HEART -- Studies on children have shown that obesity can directly affect the structure and function of the heart. In some cases, the size of the heart muscle and left atrium appears to increase in obese children. Irregularities in the left atrium would affect the heart's ability to fill properly. Other studies found the pumping action of the hearts of obese children increased, as did the amount of blood pumped out with each beat.

* LIVER -- Fatty liver disease, typically found in adults who indulge in high-fat foods or large amounts of alcohol, now occurs in a third of obese boys and girls, particularly Hispanics. In the short term, it can cause recurrent abdominal pain, infection and fatigue. In the long term, it is linked to scarring and cirrhosis of the liver, liver failure (potentially requiring a transplant) and liver cancer

* GALLSTONES -- Gallstones -- solid clusters of cholesterol that form in the gallbladder -- used to be considered rare in children. But in the obese, excessive levels of cholesterol are produced. Obese people might also have gallbladders that do not empty normally or completely, paving the way for the excess cholesterol to collect and harden.

* PANCREAS -- Some case reports estimate a tenfold increase in Type 2 diabetes among children and teens, with African-American girls particularly vulnerable. 

* HORMONAL CHANGES -- Obese girls can undergo early onset of menstruation. Because a girl usually stops growing about two years after the onset of her menstrual period, overweight girls might not achieve their full growth potential. Research indicates that obese adolescent girls have two to three times the risk of dying by middle age compared with girls of normal weight.

* BRAIN -- Obese children are prone to pseudotumor cerebri, a little-understood buildup of pressure in fluid around the brain. It can cause severe headaches and impaired vision.

* LUNGS -- Fat deposits in the chest wall can push against the lungs and diaphragm, making it harder for the lungs to expand and bring in oxygen. An obese child can feel out of breath while standing still.

* SLEEP APNEA -- Obese children are two to five times as likely to develop sleep apnea, in which breathing is temporarily interrupted during sleep when the thicker tissues in the throat and neck sag. As a result, less oxygen is sent to the brain, which can hamper a child's ability to concentrate and learn. Sleep apnea can also heighten the risk of heart attack and stroke.

* ASTHMA -- Obesity increases the risk of asthma, a disease in which the airways become constricted. Having asthma can trigger a cycle in which a child is unable to be physically active and therefore gains weight. Obese children have a twofold risk of asthma.