Incidence of Obesity among Hartford School Children

1
Incidence of Obesity among Hartford School
Children

• 1Georgine Burke, PhD 2Rose Maljanian, RN, MBA
  2Mark Sabo 3Pamela J. Clark, RN, MPH
• 4Elizabeth Estrada, MD
• 1Child Health Data Center and 4Department of
  Endocrinology, Connecticut Childrens Medical
  Center
• 2Center for Outcomes Research and Evaluation,
  Hartford Hospital
• 3Hartford Public Schools

2
Objectives

• To document prevalence of obesity among
  school-based urban population and compare to
  national reference group
• To identify trends in body mass index in a
  longitudinal sample
• To provide information for Hartford Health
  Partnership and the Diabetes Call to Action

3
Background

• Increasing incidence of type 2 diabetes in
  pediatric population
• Need for city-wide data on obesity
• Hartford Health Partnership
• 3 hospitals, Hartford Health Department, Child
  Health Data Center, Center for Outcomes Research
  and Evaluation, school-based health clinics

4
Method

• Eligibles students using school-based health
  centers
• e.g.., headache and other pain, respiratory
  symptoms, pregnancy-related, minor injury
• Cross sectional - 61 schools, 35 district
• Longitudinal samples - 35 schools, 12 district

5
Data Sources

• School Health Assessment Record
• K, 6, 10th grades
• height, weight, age recorded at pediatric visit
• CDC Growth Charts, 2000
• Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et
  al. CDC growth charts United States. Advance
  data from vital and health statistics no. 314.
  Hyattsville, MD National Center for Health
  Statistics, 2000 (revised 6/8/2000)

6
Definitions

• Overweight
• BMI 95th percentile for age and sex
• At risk of overweight -
• BMI 85th and
• Body Mass Index (BMI)
• (weight (kg)/stature (m)2)
• CDC Growth Charts, 2000

7
Study Samples
8
BMI Group by Grade
9
BMI Distribution by Age and SexCompared to US
Reference Group5th to 95th tile
10
At Risk for Overweight Grade at Evaluation by
Sex
BMI 85th and 11
Overweight Grade at Evaluation by Sex
BMI 95th tile for age and sex
12
At Risk of Overweight by Grade and Ethnicity
13
Overweight by Grade and Ethnicity
14
Prevalence of Overweight at Kindergarten
Comparison of Hartford Students to US Reference
Group (NHANES III)
Girls
Boys
Ogden CL, Troiano RP, Briefel RR, Kuczmarski RJ,
Flegal KM, Johnson, CL. Prevalence of overweight
among preschool children in the United States,
q971 through 1994. Pediatrics99, 1997.
15
Hartford Public School Students (n866)BMI
Status at 6th grade by BMI Status at
Kindergarten Entry
CDC/NCHS, 2000
OR - at risk K to obese 6th 3.0 (1.9-4.8)
16
Hartford Public School Students (n 118)BMI at
10th grade by BMI at 6th grade
CDC/NCHS, 2000
OR - at risk 6th to obese 10th 8.2 (2.2-31.6)
17
Change in BMI tile Category with Grade
18
Conclusions

• Hartford children are more obese than national
  reference populations
• But ethnic-specific references show no difference
• The greatest increase in obesity occurs between
  Kindergarten and 6th grade

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Conclusions

• The NCHS/CDC at risk category does not
  predicted only half of subsequent overweight in
  this sample of low income, minority children and
  youth
• 49 of at risk in kindergarten became
  overweight by 6th grade
• 10 if 6th graders became overweight by 10th
  grade
• Among Hartford students, overweight does not vary
  significantly (clinically or statistically) by
  sex and ethnicity
• Interventions to reduce overweight should focus
  on elementary school population