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