Child Health and
Wellness Initiative Results
Karen Holly, MBA
Executive Project Administrator
Marion County Health Department
3838 North Rural Street, Rm. 721
Indianapolis, Indiana 46205-2930
Phone: 317-221-2299
kholly@hhcorp.org
P. Joseph Gibson, MPH, Ph.D.
Director of Epidemiology
Health & Hospital Corporation of Marion County
3838 North Rural Street, Rm. 721
Indianapolis, Indiana 46205-2930
Phone: 317-221-3142
jgibson@hhcorp.org
Contents
Table 1: BMI percentile statistics
for public school students in Marion County, 2005
Table 1: BMI percentile statistics
for public school students in Marion County, 2005 (continued)
Figure 3: BMI percentile statistics
by age for public school students in Marion County, 2005
Comparison with other populations
Table 3: Percent of school
population by BMI category
Table 4: Percent of high school
population by BMI category
Coverage of the population, missed
students, and refusals
Overweight among students in grades
K-12, Arkansas, 2003-04 and 2004-05 school years
Youth Risk Behavior Surveillance –
United States, 2005
Created 16Oct2006. Marion County Health Department,
Epidemiology DR0228, DR0442, DR0444.
Introduction
In 2005, the Marion County Health Department (MCHD) worked with ten of the eleven public school districts in Marion County to measure the height and weight of the students. The measurements were converted to measures of body mass index (BMI), and compared to BMI percentiles from the CDC’s standard, age and gender-appropriate distributions for children’s BMIs. The CDC’s standard distributions are based on United States (US) children’s BMI distributions from the 1970s.
Results
A body mass index distribution similar to US children's BMIs in the 1970s would have had 5 percent overweight, 10 percent at risk for overweight, 5 percent underweight, and 80 percent in the normal BMI range. Overall:
- 22 percent of the measured Marion County children were overweight
- 18 percent were at risk of overweight
- 1 percent were underweight
- The remaining 58 percent were in the normal BMI range for their age and gender
This pattern was fairly consistent across gender, race, and age.
Of the demographic groups with over 100 members, the heaviest was Hispanic males, with 31 percent overweight, 20 percent at risk, and 1 percent underweight. The lightest group was Asian and Pacific Islander females, but even this group had 13 percent overweight and 16 percent at risk, with 3 percent underweight. By age, the heaviest groups were in the 9 to 15 year old range. Most demographic sub-groups were within two or three percent of the overall percentages.
Table 1: BMI percentile statistics for public school students in Marion County, 2005
Percent of group by BMI category* Number of
Demographic Group Underweight Normal At risk Overweight Students
Overall 1 58 18 22 90147
Gender
Male 2 58 18 23 45412
Female 1 59 18 21 44735
Race
White (Not Hisp.) 2 61 17 20 43360
Black (Not Hisp.) 1 57 19 24 34119
Hispanic 1 50 20 28 7217
Multiracial 2 57 17 23 3786
Asian/Pac. Is. 4 65 16 14 1130
American Indian 1 51 21 27 186
Unknown 1 67 13 20 349
Table 1: BMI percentile statistics for public school students in Marion County, 2005 (continued)
Percent of group by BMI category* Number of
Demographic Group Underweight Normal At risk Overweight Students
Race &
Gender
White Male 2 59 17 22 21793
White Female 1 63 18 18 21567
Black Male 1 58 18 22 17187
Black Female 1 55 19 25 16932
Hispanic Male 1 47 20 31 3731
Hispanic Female 1 54 21 24 3486
Multiracial Male 2 57 17 24 1899
Multiracial Female 2 58 18 23 1887
Asian/Pac. Is. Male 5 63 16 16 562
Asian/Pac. Is. Female 3 68 16 13 568
Amer. Indian Male 1 52 27 20 92
Amer. Indian Female 0 50 15 35 94
Unknown Male 0 66 11 24 148
Unknown Female 1 68 14 17 201
Years of age
5 2 64 17 17 2612
6 2 63 17 18 7196
7 2 62 17 19 8081
8 1 61 17 21 8311
9 1 58 18 23 8211
10 2 56 18 25 7795
11 2 54 19 25 7860
12 1 55 20 24 7671
13 1 54 20 24 7535
14 1 57 18 24 7303
15 1 58 19 23 6073
16 1 59 18 21 5264
17 2 62 17 20 4215
18 2 62 17 19 2020
* Underweight: under 5th percentile; Normal: 5th less than 85th percentile; At risk: 85th less than 95th percentile; Overweight: 95th percentile and greater
Figure 1: BMI percentile statistics by gender and by race for public school students in Marion County, 2005
Figure 3: BMI percentile statistics by age for public school students in Marion County, 2005
Does not include students in the Metropolitan School District of Wayne Township
Overweight
or at risk of becoming overweight
Male Female Total
Number
of
Age in years / Race Students
Measured No. (%) No. (%) No. (%)
5-9
(Elementary School)
White 16,027 2,836 36% 2,688 33% 5,524 34%
Black 12,214 2,274 37% 2,385 39% 4,659 38%
Hispanic 3,504 925 51% 743 44% 1,668 48%
Other 2,415 437 36% 451 38% 888 37%
Total 34,160 6,472 38% 6,267 37% 12,739 37%
10-13 (Middle School)
White 14,454 3,033 42% 2,841 39% 5,874 41%
Black 12,272 2,791 44% 2,879 48% 5,670 46%
Hispanic 2,358 667 55% 549 48% 1,216 52%
Other 1,714 389 46% 369 43% 758 44%
Total 30,798 6,880 44% 6,638 44% 13,518 44%
14-17 (High School)
White 11,717 2,367 40% 2,062 36% 4,429 38%
Black 8,937 1,822 41% 2,053 45% 3,875 43%
Hispanic 1,251 307 47% 275 46% 582 47%
Other 918 160 36% 160 34% 320 35%
Total 22,823 4,656 41% 4,550 40% 9,206 40%
5-17 (Total)
White 42,198 8,236 39% 7,591 36% 15,827 38%
Black 33,423 6,887 41% 7,317 44% 14,204 42%
Hispanic 7,113 1,899 52% 1,567 46% 3,466 49%
Other 5,047 986 39% 980 39% 1,966 39%
Total 87,781 18,008 41% 17,455 40% 35,463 40%
Comparison with other populations
Below
are comparators for the Marion County results.
Our numbers are similar (though a little worse) than Arkansas'. Our results are much worse that the Youth
Risk Behavior Surveillance System (YRBS) survey from 2003, but that may be due
to the YRBS using self-reported height and weight.
Table 3: Percent of school
population by BMI category
|
|
Marion County public schools (K-12),
2005 |
Arkansas schools (K-12),
2003 |
Reference
(US children in the 1970s) |
|
Underweight |
1% |
2% |
5% |
|
Normal |
58% |
60% |
80% |
|
At
Risk for Overweight |
18% |
17% |
10% |
|
Overweight |
22% |
21% |
5% |
|
N |
90,147 |
~350,000 |
|
Table 4: Percent of high
school population by BMI category
(+/- 95% confidence interval in parentheses)
|
|
Marion County public schoolchildren age 15-19 years,
2005 |
IN High Schools sample (self-report), 2005 |
US High Schools sample (self-report), 2005 |
Reference (US children in
the 1970s) |
|
Underweight |
1.4% (0.0) |
combined with Normal |
combined with Normal |
5% |
|
Normal |
60.8% (0.4) |
74.3% |
71.2% |
80% |
|
At
Risk for Overweight |
17.5% (0.3) |
14.3% (1.3) |
15.7% (0.9) |
10% |
|
Overweight |
20.3% (0.3) |
15.0% (2.5) |
13.1% (0.9) |
5% |
Marion County n=11,499
Marion County statistic 95% confidence interval calculated
as +/-1.98*p(1-p)/sqrt(n)
Sources:
·
2005
Children's Health and Well Being Initiative, Marion County Health Department,
Epidemiology DR0228 & DR0340.
·
CDC
Youth Risk Behavior Surveillance System, http://apps.nccd.cdc.gov/yrbss/CategoryQuestions.asp?Cat=5&desc=Dietary%20Behaviors
(IN & US)
Methods
Population
We computed BMI percentiles for 90,147 students from ten of the eleven public school corporations in Marion County. After eliminating incomplete records, records with data errors or measures beyond the World Health Organization's (WHO) valid ranges, and multiple measures for a single student, BMIs for 90,147 students were calculated. The school districts that were included were Beech Grove, Decatur, Franklin, IPS, Lawrence, Perry, Pike, Speedway, Warren, and Washington. Measurements were not obtained from the Wayne Township school district. All measurement was performed by MCHD staff, with the exception of all of the approximately 650 measured students from Beech Grove, and the approximately 230 Speedway high school students for whom measurements were available. The measures by MCHD were taken between February, 2005 and December, 2005. Some of the other Speedway and Beech Grove measures were from as early as August 2004, and as late as January 2006.
To assure good protection of confidentiality, and to avoid unproductive comparisons, we agreed with the school corporations to combine data from all the school corporations before analyzing the BMI distributions. We will only do corporation-specific analyses at the request of and in coordination with the associated school corporations.
Computation
To determine the BMI percentile for each student, the student’s BMI was computed and compared to the CDC reference BMI distribution for that student's gender and months of age. Children were classified into four categories: Underweight (BMI below the 5th percentile), Normal (BMI from the 5th to less than the 85th percentile), At risk of overweight (85th to less than 95th percentile), and Overweight (95th percentile or greater). The standard BMI distributions reflect US children's BMI distributions from the 1970's. They are based on two national surveys (NHANES I and II), which were conducted from 1971 to 1974, and from 1976 to 1980.
For more details about the CDC reference populations, see page 14 of "2000 CDC Growth Charts for the United States, Methods and Development". Series Report 11, Number 246. 201 pp. (PHS) 2001-1696. http://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf . The BMI and BMI percentile computations were computed using the SAS programs available at “A SAS Program for the CDC Growth Charts” http://www.cdc.gov/nccdphp/dnpa/growthcharts/sas.htm.
Coverage of the population, missed students, and refusals
Based
on Indiana Department of Education data about enrollment
(http://mustang.doe.state.in.us/SAS/sas2.cfm?type=s&tab=schls&already=
), there were about 126,500 students in the ten participating districts when
MCHD took the measurements. We have
measures for 71.3 percent of those students (90,147/126,500=0.713). Most of the students not measured were
missed because they were absent on the measurement day, or their schedules did
not include a class period during which measurements were being taken. We have measures for approximately half of
kindergartners, 80 percent of first through fifth graders, 73 percent of sixth
through eighth graders, and 60 percent of high school students.
Our
refusal rate was 0.5 percent (one half of one percent, or one in 200
students). We did not measure 484
students because of refusals to participate, or, much less commonly, because
the student had some condition that prevented accurate height or weight
measurement with our equipment (for example, the student could not stand
without support). About one third (35
percent) of those were refusals by the student, and almost two thirds (61
percent) were refusals by a parent.
Before the measurement, parents were informed it would occur, and could
send in a notice asking that their child not be measured.
Measurement Accuracy
We
double-checked the height measurement of a sample of students at each school,
to assure that our measures were consistent to within 1/4 inch, as is the
standard for BMI measurement. Two
height measurements were taken for 810 students, by different assessment
staff. All but eight of the
measurements were within 1/4 inch, so our consistency in height measurement was
just over 99 percent.
However,
we also had 1874 measurements (about 2 percent) that were "biologically
implausible" by the WHO criteria.
Inaccurate age information, and some by children having extreme height
or weight for their age may have caused some of this 2 percent. However, some is also likely to have been
caused by data entry errors or measurement errors.
Benchmarks and References
Overweight among students in grades K-12, Arkansas, 2003-04 and 2004-05 school years
The following is a direct extract from MMWR 55(01);5-8 [January 13, 2006]
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5501a2.htm
On the basis of
assessments resulting in valid BMIs for 347,250 students in Year 1 and 367,879
in Year 2, nearly 21 percent of students were classified as overweight, 17
percent as at risk for overweight, 60 percent as normal weight, and 2 percent as
underweight in both years.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5501a2.htm#tab
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5501a2.htm#fig
Youth Risk Behavior Surveillance – United States, 2005
The following is a direct extract from MMWR 55(SS05);1-108 [June 9, 2006] http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5505a1.htm
NOTE: This is a survey of High School students
NOTE: These are self-reported measures. Height and weight was not measured directly.
Overweight And Weight Control
At Risk for Overweight
Nationwide,
15.7 percent of students were at risk for becoming overweight (Table 6). The prevalence of being at risk for becoming
overweight was higher among black female (22.6 percent) than black male (16.7
percent) students. Overall, the prevalence of being at risk for becoming
overweight was higher among black (19.8 percent) than white (14.5 percent) and
Hispanic (16.7 percent) students and higher among black female (22.6 percent)
than white female (13.8 percent) and Hispanic female (16.8 percent) students.
Overall, the prevalence of being at risk for becoming overweight was higher
among 9th grade (17.1 percent) than 12th grade (14.8 percent) students and
higher among 9th grade male (18.3 percent) than 10th grade male (14.5 percent)
and 12th grade male (14.1 percent) students. Prevalence of being at risk for
becoming overweight ranged from 10.3 percent to 17.8 percent across state
surveys (median: 14.6 percent) and from 13.3 percent to 20.7 % across local
surveys (median: 17.3 percent) (Table 7).
Overweight
Nationwide,
13.1 percent of students were overweight (Table 6). Overall, the prevalence of being overweight was
higher among male (16.0 percent) than female (10.0 percent) students; higher
among white male (15.2 percent) and Hispanic male (21.3 percent) than white
female (8.2 percent) and Hispanic female (12.1 percent) students, respectively;
and higher among 9th grade male (15.0 percent), 10th grade male (16.5 percent),
11th grade male (17.2 percent), and 12th grade male (15.5 percent) than 9th
grade female (10.4 percent), 10th grade female (10.6 percent), 11th grade
female (9.4 percent), and 12th grade female (9.7 percent) students,
respectively. Overall, the prevalence of being overweight was higher among
black (16.0 percent) and Hispanic (16.8 percent) than white (11.8 percent)
students; higher among black female (16.1 percent) than white female (8.2
percent) and Hispanic female (12.1 percent) students; higher among Hispanic female
(12.1 percent) than white female (8.2 percent) students; and higher among
Hispanic male (21.3 percent) than white male (15.2 percent) and black male
(15.9 percent) students. Prevalence of being overweight ranged from 5.6 percent
to 15.6 percent across state surveys (median: 12.0 percent) and from 10.4
percent to 21.5 percent across local surveys (median: 12.7 percent) (Table 7, Figure 6).
Figure 6:
Percentage of high school students who were overweight, in selected states –
Youth Risk Behavior Survey, 2005
* Overweight is defined as ≥ 95th percentile for body mass index, by age and sex, on the basis of reference data
http://www.cdc.gov/HealthyYouth/overweight/overweight-youth.htm
Table 6: Overweight and at risk of overweight, for high school students in the United States, by sex, race/ethnicity, and grade – Youth Risk Behavior Survey, 2005
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5505a1.htm#tab60
Table 7: Overweight and At Risk of Overweight, for
high school students in several States and Cities – Youth Risk Behavior Survey,
2005
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5505a1.htm#tab61
Population: low-income
children
Data Source: 2003 PedNSS, http://www.cdc.gov/pednss/pdfs/PedNSS_2003_Summary.pdf
Figure 8: Percentage of United States and Indiana high school students who were overweight or at risk for becoming overweight,* 1999 – 2005
^ Confidence intervals were not available for the “Combined” statistics, but would be similar to those from the overweight or at risk categories for the region in the same year.
Marion County Health Department, Epidemiology DR0443.
Source: National Youth Risk Behavior Surveys, 1999 - 2005, http://apps.nccd.cdc.gov/yrbss/
Web Links
·
US CDC Overweight and Obesity
main web page http://www.cdc.gov/nccdphp/dnpa/obesity/
·
US CDC NCHS Obesity fact
sheet http://www.cdc.gov/nchs/pressroom/04facts/obesity.htm
·
Indiana State Dept. of Health
Community Nutrition/Obesity Prevention Program http://www.in.gov/isdh/programs/cnop/index.htm
· Indiana State Dept. of Health Childhood Obesity/Overweight Fact Sheet http://www.in.gov/isdh/programs/cnop/program areas/childhood_facts.htm