1. A STUDY OF RURAL CHILDHOOD OBESITY Dr. Marilyn Duran PhD, RN Department of Nursing Tarleton State University

2. Childhood Overweight and Obesity Children and teens (2–19 years)16.9% obese: ~12.5 million ( http://www.cdc.gov/obesity/childhood/index.html )

3. Childhood Obesity Trends

4. The Impact of Obesity In some communities, almost half of pediatric diabetes cases are type 2 diabetes, which was once believed to affect only adults. Obese children have a 70% chance of being overweight or obese as adults—facing higher risks for many diseases, such as heart disease, diabetes, stroke, and several types of cancers. Source-http://www.cdc.gov/HealthyYouth/keystrategies/pdf/make-a-difference.pdf

5. The Burden of Childhood Obesity in Texas ∙ Sixteen percent of Texas youth (9th–12th grades) are overweight, and another 16% are obese, according to 2007 Youth Risk Behavior Survey data. ∙Only 45% of the youth in these grade levels are meeting current physical activity recommendation levels. ∙Only 17% eat fruits and vegetables five or more times a day. Thirty-eight percent drink at least one non-diet soda each day. Almost 40% watch three or more hours of television each day. Source-http://www.cdc.gov/obesity/stateprograms/fundedstates/texas.html

6. Background of Study Current research data is lacking in the comparison of rural verses urban childhood obesity incidence and prevalence. Most of childhood obesity rates are reported on children living in urban areas. Purpose of this study is to identify prevalence of childhood obesity in rural school age children.

7. Study Description The study began in spring of 2010 and is currently ongoing and will continue in the spring of 2011. Internal Review Board for the protection of human subjects (IRB) approval received from Tarleton State University (TSU). Rural schools in Erath county and adjacent Hood county participated in the study. School age children ages grades K-9 th grade included. Consent of parent required.

12. Study Funding TSU department of sponsored projects provided funds to purchase a digital scale that measures height, weight and body mass index(BMI), 2 skin calipers and several hundred tee shirts. Students were given a tee shirt as an incentive to participate in the study. Only students with a signed parental consent form were allowed to participate in the study.

13. Study Methods/Materials Senior level nursing students trained as data collectors. Students trained in the use of the scale and skin calipers. Older children completed a questionnaire about their amount of physical activity. Weight and height measurements were obtained. BMI calculated based on gender specific age percentiles.

14. Defining Childhood Overweight and Obesity ∙Body mass index (BMI) is a practical measure used to determine overweight and obesity. ∙BMI is a measure of weight in relation to height that is used to determine weight status. ∙BMI is the most widely accepted method used to screen for overweight and obesity in children and adolescents because it is relatively easy to obtain the height and weight measurements needed to calculate ∙BMI, measurements are non-invasive and BMI correlates with body fatness. ∙While BMI is an accepted screening tool for the initial assessment of body fatness in children and adolescents, it is not a diagnostic measure because BMI is not a direct measure of body fatness. Source: Center for Disease Control and Prevention-http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html 

15. What is a BMI percentile? After BMI is calculated for children and teens, the BMI number is plotted on the CDC BMI-for-age growth charts (for either girls or boys) to obtain a percentile ranking. Percentiles are the most commonly used indicator to assess the size and growth patterns of individual children in the United States. The percentile indicates the relative position of the child's BMI number among children of the same sex and age. The growth charts show the weight status categories used with children and teens (underweight, healthy weight, overweight, and obese). Source: Center for Disease Control and Prevention- http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

16. BMI-for-age weight status categories and the corresponding percentiles. Weight Status Category Percentile Range ∙Underweight Less than the 5th percentile. ∙Healthy weight 5th percentile to less than the 85th percentile. ∙Overweight 85th to less than the 95th percentile. ∙ Obese Equal to or greater than the 95th percentile. Source: Center for Disease Control and Prevention- http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

18. Preliminary Findings K-2 nd grade ● 112 children ages 5-7yrs ● Obese-25 (22.3%) ● Overweight – 19 (16.9%) ● Obese & Overweight-44 (39.2%) ● Hispanic- 13.3% ● White- 86.7%

19. Preliminary Findings Middle School ● 6-8 th grades ● 191 children and adolescents ages 11-15yrs ● Obese-50 (26.1%) ● Overweight-28 (14.6%) ● Obese & Overweight- 78 (40.7%) ● Hispanic- 29.4% ● White- 70.6%

20. Preliminary Finding ● 9 th grade only ● 219 Adolescents 14-16 yrs ● Obese-57 (26%) ● Overweight- 41(18.7%) ● Obese & Overweight- 98 (44.7%) ● Hispanic- 16.3% ● White- 83.7%

21. Discussion of Preliminary Findings These findings suggest that rural school age children may experience obesity prevalence at higher rates than current CDC estimates. These are only preliminary findings and do not prove a relationship or causation. When study is completed final sample should exceed over 1000 rural school age children.

22. Conclusion After study is completed the data will be used to identify rural childhood obesity prevalence and gain understanding of the significance of the problem in rural communities. Plan is to work with schools, parents, healthcare providers and community members to identify and develop collaborative programs at the community level to reduce rural childhood obesity prevalence thereby improving the health of rural children.