1. CHILDHOOD
OBESITY
Rubelyn Mays,
M.S., R.D., LDN
Revised

2. Overview Problems Associated with excessive weight
Trends and Incidence of overweight in children and youth
Overweight Prevention Initiatives in Tennessee
and
Results of voluntarily BMI Screening in Public Schools in Tennessee

3. Societal Problems with Obesity
Airlines charge double
Ambulances capable of loading 1,600 pounds
Hospitals replacing everything with bigger models
Goliath Casket Company produces extra large caskets
Higher Healthcare Costs
Sport facilities have wider turnstiles and seats
Absence from school/work
Lost Productivity
Soldier Field, the home of the Chicago Bears

4. Health Problems with Obesity
Type 2 Diabetes
Hypertension
Cardiovascular Disease
Dyslipidemia
Coronary Heart Disease
Psychological problems
Cancers (endometrial, breast, colon)
Orthopedic problems
Stroke
Gallbladder Disease
For children – Poor self-esteem and depression – unhappiness, social struggles, academic troubles
Although universal screening is not recommended, The American Academy of Pediatrics and The ADA recommend that all youngsters who are overweight and have at least two other risk factors should be tested for Type 2 diabetes beginning at age 10 or at the onset of puberty and every 2 years thereafter.
….Dyslipidemia: Disordered fats in the blood (A disorder of lipoprotein- lipo means fat- metabolism including overproduction and deficiency.

5. Obesity Trends* Among U.S. Adults BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
BRFSS means Behavioral Risk Factor Surveillance Survey. Telephone health survey conducted in all states through CDC each year it’s self reported.
No Data <10% %–14%

6. Obesity Trends* Among U.S. Adults BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14%

7. Obesity Trends* Among U.S. Adults BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14%

8. Obesity Trends* Among U.S. Adults BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14%

9. Obesity Trends* Among U.S. Adults BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14%

10. Obesity Trends* Among U.S. Adults BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14%

11. Obesity Trends* Among U.S. Adults BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19%

12. Obesity Trends* Among U.S. Adults BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19%

13. Obesity Trends* Among U.S. Adults BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19%

14. Obesity Trends* Among U.S. Adults BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19%

15. Obesity Trends* Among U.S. Adults BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19%

16. Obesity Trends* Among U.S. Adults BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19%

17. Obesity Trends* Among U.S. Adults BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19% ≥20

18. Obesity Trends* Among U.S. Adults BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19% ≥20

19. Obesity Trends* Among U.S. Adults BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19% ≥20

20. Obesity Trends* Among U.S. Adults BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19% ≥20

21. Obesity Trends* Among U.S. Adults BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19% %–24% ≥25%

22. Obesity Trends* Among U.S. Adults BRFSS, 2002
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19% %–24% ≥25%

23. Obesity Trends* Among U.S. Adults BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19% %–24% ≥25%

24. Obesity Trends* Among U.S. Adults BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.
About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
No Data <10% %–14% %–19% %–24% ≥25%

25. Obesity (Overweight for Children and Youth)
A Public Health Problem of Epidemic proportion among the Nation’s and Tennessee’s Children and Youth

26. Childhood Overweight: Defining the Problem
Obese
Term should not be used for children, only for research purposes
Overweight
Preferred term for children at or above the
95th percentile of the BMI-for-age
At Risk for Overweight
Between 85th-95th percentile of the BMI-for-age
Percentiles come from CDC growth charts

28. An Epidemic of Overweight Children
* Since the 1970s, obesity (or overweight prevalence has
Doubled for preschool children aged 2-5 years
Doubled for adolescents aged years
Tripled for children aged 6-11 years
* More than 9 million children and youth over 6 years are obese
* Similar trends in U.S. adults and adults internationally

29. Trends in Child and Adolescent Overweight
Percent
Percent
Males 12-19
Males 6-11
Females 12-19
Females 6-11

31. Leading Causes of Overweight in Children: Inappropriate Eating Habits
* Skipping breakfast and overeating later
* High fat, sugar, sodium snacks and meals
* Eating out and meals on the go
* Decrease in “family meal time”
* Lack of consistent meal times
* Inappropriate serving sizes (super sizing)
Department of Health – Nutrition Services

33. Leading Causes of Overweight in Youth: Inactivity
* 75% of waking hours spent inactive
* 5 1/2 hours or more each day with electronic
media
* Prohibitive costs, transportation difficulties and time constraints are leading reasons why parents say their children are less involved in organized activities
* Inadequate physical activity at schools
Inadequate physical activity at school:
– Elementary School: Daily PE at only 8% of schools
– Middle School: Daily PE at only 6% of schools
– High School: Daily PE at only 6% of schools and a decline in percentage of high school students involved in daily PE from 42% in 1991 to 31% in 2001

34. Combine Inactivity with Poor Eating Habits…
* One in five schools offers fast foods like McDonald’s
* More schools have “pouring rights” contracts to sell soft drinks in vending machines and at school events
* Americans eat out 1/3 of meals
* Increases in “super sized” portion
* An extra 200 calories per day from sugary drinks results in a 2 pound weight gain per month

36. Some Overweight Preventive Initiatives in Tennessee

37. Vending Machines in Tennessee Schools
* Elementary Schools: %
* Middle Schools: 78%
* High Schools: 85%
Source: CDC, School Health Policies and Programs Study 2000

38. School Vending Law
Schools must improve the nutritional quality of all foods sold in K-8thgrade schools
Provide high-quality foods
School-based nutrition services
Nutritional guidelines for Foods-
-Maximum calories form fat: 35% (except nuts, seeds and nut butters)
-Maximum calories from saturated fat: 10%
-Maximum sugar by weight: 35% (except fresh, dried, or frozen fruits)
-Maximum sodium 230 mg/serving (except pasta, meat, soup)
Standards were based on the 2005 US Dietary Guidelines for Americans

39. Tennessee Healthy Weight Network (THWN)
Message:
Eat Smart.....Move More…..Tune In
Started by a group of interested individuals and agencies in 2002.
Developed plan for communities to take and adapt for their populations that addresses Schools, Families, Communities, Faith Based Organizations, Industry, and Medical Groups.
Tune In means to address the mental health aspect of obesity…….eating because of hunger not emotions, etc.

40. Action For Healthy Kids (AFHK)
* Part of the National AFHK
* Very active School Committee of the THWN
* Sponsor and Planning this meeting
* Received grant to provide technical assistance to schools developing wellness policies
* Distributed Action Plan for Tennessee AFHK

41. Wellness Policy Mandate
Tennessee public schools, by national mandate, formed wellness committees that established wellness policies to address student wellness and the growing problem of childhood obesity. Wellness policies were established by the beginning of the school year 2006.
Wellness policy minimum requirements:
1. Goals for nutrition education and physical activity
2. Nutrition guidelines for foods available in school
Guidelines for reimbursable school meals and
4. A plan for measuring implementation

42. Blue Cross/Blue Shield Walking Works for Schools
* Voluntary in-school walking program for students, teachers, staff and administrators in Tennessee
* Teaches children grades k-4, benefits of proper exercise as part of a healthy lifestyle
* Participants walk at least 5 minutes each school day for 12 weeks
Show packet of materials
In the fall of 2006 any elementary school in Tennessee can join Walking Works for schools engaging an estimated 191,850 students. Schools with 90% participation of grades K-4 will be designated as “Extra Mile School”

43. Body Mass Index (BMI) Law
* Signed into law by Governor Phil Bredesen in May, 2005
* Authorizes Local Education Agencies (LEA)
on a voluntary basis to identify public school children who are at risk for obesity by measuring BMI
* Intervene with Healthy Lifestyle Education to those at risk
Weight/(Height)2

44. BMI Screening Results School Year (SY) 2005-2006

45. About the Sample
*The sample was convenience comprised of those units voluntarily providing data
*None of the Metro Regions were represented nor was the Southwest Region

46. Total Students *16,513 students (104 units - 22 counties)
*Ranged in age from 7 to 16 years
*Represents 7 0f 14 Health Department Regions
-2 Northeast -7 East
-3 Southeast -3 South Central
-4 Upper Cumberland -2 Mid Cumberland
-1 Northwest

47. More About the Students
* More boys (26%) were overweight than girls (22%)
* A greater proportion of black students (29%) were overweight than white (24%)
* Black girls had the highest proportion of overweight or at risk for overweight (50%)
* White girls had the lowest proportion of overweight or at risk for overweight (40%)
* Only age group with combined proportion of overweight and at risk for overweight less than 40%: Students under age 7

48. Limitations
* Not representative of the entire state school-age population
* Only 5% of the sample was black or African American (current population estimate 21%)
* Under-represents state’s urban and black population

49. Results
*Despite limitations, the 16,513 students are a sizable sample that likely represents the population from which they came
*Results provides insight into the BMI status of school children in the Tennessee as a whole

50. Results (continued) *24% overweight (above 95th percentile)
*18% at risk for overweight (85th – 95th percentile)
*42% total overweight and at risk
*56% normal weight (above the 5th and below the 85th percentile)
*2% underweight (below the 5th percentile)

51. Observation
*The proportions of overweight and at risk for overweight are considerably higher than those reported for Tennessee high school students in the 2005 Youth risk Behavior surveillance System (YRBSS)
* 32.1% YRBSS verses 42% BMI Project

52. Recommendations
*Overall summary should be widely distributed since the 16,513 student base likely represents the population from which they came
* BMI project provides insight into the BMI status of school children in Tennessee
* School and class BMI reports should only be distributed to individuals with approved access to confidential information due limited small samples within the data set
* Continue BMI measurement based on population-based sampling of Tennessee’s school-age children

53. Coordinated School Health (CSH) Statewide Funding by SY 2007
* The l04th General Assembly passed and appropriated statewide expansion of the CSH program
* CSH in Tennessee was funded at 15 million dollars recurring annually
* The original 10 pilot sites will continue to be funded
* Beginning SY all public schools in Tennessee will have CSH

54. Governor Bredesen Speech March 27th –
We will adjust the premiums for whether a person is a smoker, and for whether a person is substantially overweight. People who take care of themselves should not have to pay extra for those who don’t! It’s time to move past political correctness and instead to reward personal responsibility.

55. Professional Efforts to Conquer Obesity
* Starts with the willingness of those who are overweight to get moving
* Teach young children the importance of health
* Offer healthy choices for meals at home and at schools
* Special facilities for people who need to Get Moving!

56. Follow This
The End