CHILDHOOD OBESITY Rubelyn Mays, M.S., R.D., LDN Revised 01-25-07

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

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

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.

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% 10%–14%

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

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

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

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

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

Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

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

Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

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% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

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% 10%–14% 15%–19% 20%–24% ≥25%

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

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

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 12-19 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

Trends in Child and Adolescent Overweight Percent Percent Males 12-19 Males 6-11 Females 12-19 Females 6-11 1963-67 1971-74 1976-80 1988-94 1999-2000 1966-70

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

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

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

Some Overweight Preventive Initiatives in Tennessee

Vending Machines in Tennessee Schools * Elementary Schools: 75% * Middle Schools: 78% * High Schools: 85% Source: CDC, School Health Policies and Programs Study 2000

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

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.

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

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

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”

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

BMI Screening Results School Year (SY) 2005-2006

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

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

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

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

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

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)

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

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

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 2007-2008 all public schools in Tennessee will have CSH

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.

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!

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