Rubelyn Mays, Rubelyn Mays,

M.S., R.D., LDNM.S., R.D., LDN

Revised 01-25-07Revised 01-25-07

Overview

Problems Associated with excessive weight

Trends and Incidence of overweight in children and youth

Overweight Prevention Initiatives in Tennessee

andResults of voluntarily BMI Screening in Public

Schools in Tennessee

Societal Problems with ObesityAirlines charge double

Ambulances capable of loading 1,600 poundsHospitals replacing everything with bigger

modelsGoliath Casket Company produces extra

large casketsHigher Healthcare Costs

Sport facilities have wider turnstiles and seats

Absence from school/workLost Productivity

Health Problems with Obesity

Type 2 DiabetesHypertension

Cardiovascular DiseaseDyslipidemia

Coronary Heart DiseasePsychological problems

Cancers (endometrial, breast, colon)Orthopedic problems

StrokeGallbladder Disease

Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1986

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1987

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1988

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1989

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1990

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1991

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1992

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1993

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1994

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1995

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1996

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1997

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1998

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 1999

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2000

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2001

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*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%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

Obesity Trends* Among U.S. AdultsBRFSS, 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. AdultsBRFSS, 2004

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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

ObeseTerm should not be used for children, only for research purposes

OverweightPreferred term for children at or above the 95th percentile of the BMI-for-age

At Risk for OverweightBetween 85th-95th percentile of the BMI-for-age

JUNE 2005 5

Total

Female

Male

White

BlackMexican

American

0 10 20 30

Percent

Child and Adolescent Overweight by Race: 1988-94 to 1999-2000

2010 Target

1988-94

An Epidemic ofOverweight 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

0

5

10

15

20

0

5

10

15

20

Percent

1963-67 1971-74 1976-80 1988-94

Percent

Males 12-19

Females 12-19

Trends in Child and Adolescent Overweight

1999-20001966-70

Females 6-11

Males 6-11

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

* 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

Leading Causes of Overweight in Youth: Inactivity

* 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

Combine Inactivity with Poor Eating Habits…

20 oz/ day = 20 pounds

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 2000Source: 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

Tennessee Healthy Weight Network (THWN)

Message:

Eat Smart.....Move More…..Tune In

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.

Blue Cross/Blue ShieldWalking 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

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

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

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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The End