Definition

Body mass index (BMI) is widely used to determine obesity and overweight because it is inexpensive, reproducible, and convenient. BMI is calculated using the individual's height, weight, age, and sex.(1) For individuals aged 2 to 20, overweight and obesity is determined by calculating the individual's BMI and comparing it to age and sex standardized growth charts distributed by the Centers for Disease Control and Prevention. Children and adolescents are considered obese if their BMI is greater than or equal to the 95th percentile for BMI by age and sex based on the 2000 CDC Growth Charts.(2)

Numerator

Number of individuals surveyed or measured who are obese (BMI greater than or equal to the 95th percentile for BMI by age and sex based on CDC Growth Charts).(2)

Denominator

Total number of people surveyed or measured.

Why Is This Important?

The number of overweight or obese children and adolescents is increasing and diseases previously thought to affect mainly adults, such as type 2 diabetes, high blood pressure, and high cholesterol, are now being diagnosed in children and adolescents. The social and psychological impacts of childhood obesity include social isolation, increased rate of suicidal thoughts, low self-esteem, increased rate of anxiety disorders and depression, and increased likelihood of being bullied.

Healthy People Objective NWS-10:

Reduce the proportion of children and adolescents who are considered obese
U.S. Target: Not applicable, see subobjectives in this category

Other Objectives

NWS-10 Reduce the proportion of children and adolescents who are considered obese. NWS-10.2: Children aged 6 to 11 years. Utah Target: 10.0% NWS-10.3: Adolescents aged 12 to 19 years. Utah Target: 10.0%

How Are We Doing?

The percentage of obese children in Utah increased dramatically in the first decade of the century. From 1994 to 2010 the number of obese third grade boys increased by 97 percent, from 6.0 percent in 1994 to 11.8 percent in 2010. The percentage of obese third grade girls increased by 40 percent over the same time period. In 2010, 8.4 percent of third grade girls were obese compared to 6.0 percent in 1994. Childhood obesity in Utah seems to have leveled off since 2010. In 2014 10.4% of boys and 8.2%of girls were obese. Among adolescents, in 2013 6.4 percent of Utah public high school students were obese; boys were almost twice as likely as girls to be obese (8.3% compared to 4.4%). The adolescent obesity rate nationally is double Utah's rate, where 13.7% of U.S. adolescents were obese. The obesity rate in 2013 among adolescents in grades 8, 10 and 12 was lower in Summit County Local Health District (4.1%), Davis County (5.7%), and Utah County (7.3%) than the state rate (8.9%). It is likely that these data, based on self-reported height and weight, under represent the prevalence of overweight or obesity among high school students.

How Do We Compare With the U.S.?

In the U.S. there has been more than a 300 percent increase during the past 40 years in the number of obese children aged 6 to 11 years (4.2% in 1963-65 and 18.0% in 2009-10).(3) An increase has also been observed in Utah between 1994 and 2010 with the number of overweight third grade boys and girls increasing by 97 percent and 40 percent, respectively. In 2013 a total of 13.7 percent of American public high school students were obese compared to 6.4 percent of Utah public high school students.

What Is Being Done?

Through funding from the Centers for Disease Control and Prevention (CDC) the Healthy Living through Environment, Policy, and Improved Clinical Care Program (EPICC) was established from the consolidation of three programs (Diabetes Prevention and Control Program, Heart Disease and Stroke Prevention Program, and the Physical Activity, Nutrition and Obesity Program) and the addition of one (School Health). This consolidation was designed to assist in the coordination of activities to ensure a productive, collaborative, and efficient program focused on health outcomes. The program aims to reduce the incidence of diabetes, heart disease, and stroke by targeting risk factors including reducing obesity, increasing physical activity and nutritious food consumption, and improving diabetes and hypertension control. Housed within the EPICC Program, the Utah Physical Activity and Nutrition Plan (U-PAN) 2010-2020 plan was released April 2010 and addresses the six areas of focus including 1) increase physical activity; 2) increase consumption of fruits and vegetables; 3) decrease the consumption of sugar sweetened beverages; 4) increase breastfeeding initiation, duration, and exclusivity; 5) reduce the consumption of high energy dense foods; and 6) decrease television viewing. Implementation of the plan is accomplished through five workgroups: Schools, Childcare, Healthcare, Worksite, and Community. One of EPICC's partners, Utah Partnership for Healthy Weight, a non-profit organization, is focused on bringing informational and financial resources not readily available to state health departments to obesity prevention efforts in Utah. The Partnership works to coordinate the many ongoing and future initiatives within Utah's communities. UDOH staff attend regular meetings of the Partnership and also serve as Partnership board members. Currently, activities are occurring in five main areas: In Schools: (1) The USDA's HealthierUS Challenge helps elementary schools set up policy and environmental supports that make it easier for students and staff to be physically active and eat healthy food. (2) Height and weight trends are being tracked in a sample of elementary students to monitor Utah students. (3) Action for Healthy Kids brings partners together to improve nutrition and physical activity environments in Utah's schools by implementing the school-based state plan strategies, working with local school boards to improve or develop policies for nutritious foods in schools. This includes recommendations for healthy vending options. In Worksites: (1) The Utah Council for Worksite Health Promotion recognizes businesses that offer employee fitness and health promotion programs. (2) The U-PAN worksite workgroup provides toolkits and other resources for employers interested in implementing wellness programs through the choosehealth.utah.gov website: http://choosehealth.utah.gov/business/worksite-wellness.php In the Community: (1) Local health departments (LHDs) receive federal funding to partner with schools, worksites, and other community based organizations to increase access to fresh fruits and vegetables through farmers markets and retail stores. LHDs also work with cities within their jurisdictions to create a built environment that encourages physical activity. (2) The EPICC program leads a statewide coalition to implement strategies within the U-PAN state plan. In Healthcare: (1) The Utah Medical Association's Healthy Lifestyles workgroup also serves as the U-PAN Healthcare workgroup. They work to address objectives of the U-PAN State Plan. (2) Several of the U-PAN Healthcare Workgroup objectives involve regularly assessing and counseling for physical activity during patient visits. (3) The EPICC program works with health care systems to establish community clinical linkages to support individuals at risk for or diagnosed with diabetes to engage in lifestyle change programs such as chronic disease self-management. In Childcare: (1) LHDs statewide are implementing the TOP Star program, which aims to improve the nutrition and physical activity environments and achieve best practice in child care centers and homes. (2) EPICC works with state and local partners through the Childcare Obesity Prevention workgroup to implement policy and systems changes in early care and education across agencies statewide.

Evidence-based Practices

The EPICC program promotes evidence based practices collected by the Center TRT. The Center for Training and Research Translation (Center TRT) bridges the gap between research and practice and supports the efforts of public health practitioners working in nutrition, physical activity, and obesity prevention by: *Reviewing evidence of public health impact and disseminating population-level interventions; *Designing and providing practice-relevant training both in-person and web-based; *Addressing social determinants of health and health equity through training and translation efforts; and, *Providing guidance on evaluating policies and programs aimed at impacting healthy eating and physical activity. Appropriate evidence based interventions can be found at: http://www.centertrt.org/?p=interventions_interventions_overview

Available Services

Gold Medal School Initiative - for more information, call (801) 538-9454 Action for Healthy Kids Program - for more information, visit www.actionforhealthkids.org A Healthy Worksite Award Program - for more information, visit www.health.utah.gov/worksitewellness The Utah Department of Health's obesity website located at www.choosehealth.utah.gov

Data Notes

Childhood obesity is determined by calculating BMI using the height, weight, age, and sex of the child. The child is considered to be obese if the resulting BMI is greater than or equal to the 95th percentile for age and sex based on the Centers for Disease Control and Prevention Growth Charts (2 to 20 years: Boys Body Mass index-for-age percentiles and 2 to 20 years: Girls Body Mass index-for-age percentiles).   [[br]] [[br]] In 2014 height and weight measurements were collected from 4,303 1st, 3rd, and 5th grade students in 69 randomly selected public elementary schools in Utah.

Data Source

Utah Department of Health, Bureau of Health Promotion, Physical Activity, Nutrition and Obesity Program Height/Weight Measurement

Data Notes

Childhood obesity is determined by calculating BMI using the height, weight, age, and sex of the child. The child is considered to be obese if the resulting BMI is greater than or equal to the 95th percentile for age and sex based on the Centers for Disease Control and Prevention Growth Charts (2 to 20 years: Boys Body Mass index-for-age percentiles and 2 to 20 years: Girls Body Mass index-for-age percentiles).   [[br]] The Youth Risk Behavior Surveillance survey is performed only in odd-numbered years. YRBS BMI data should be used with caution since individual height and weight are self-reported.

Data Notes

Childhood obesity is determined by calculating BMI using the height, weight, age, and sex of the child. The child is considered to be obese if the resulting BMI is greater than or equal to the 95th percentile for age and sex based on the Centers for Disease Control and Prevention Growth Charts (2 to 20 years: Boys Body Mass index-for-age percentiles and 2 to 20 years: Girls Body Mass index-for-age percentiles).   [[br]] [[br]] The Youth Risk Behavior Surveillance survey is performed in odd-numbered years. [[br]] [[br]] * Data do not meet UDOH standards for precision and should be interpreted with caution. [[br]] [[br]] ** Data are suppressed due to insufficient sample size. [[br]] [[br]] YRBS BMI data should be used with caution since individual height and weight are self-reported.

Data Source

Utah Youth Risk Behavior Surveillance System, Utah Department of Health

Data Notes

Childhood obesity is determined by calculating BMI using the height, weight, age, and sex of the child. The child is considered to be obese if the resulting BMI is greater than or equal to the 95th percentile for age and sex based on the Centers for Disease Control and Prevention Growth Charts (2 to 20 years: Boys Body Mass index-for-age percentiles and 2 to 20 years: Girls Body Mass index-for-age percentiles).   [[br]] [[br]] Based on the Prevention Needs Assessment Survey, Form B.

Data Source

Prevention Needs Assessment Survey

References and Community Resources

1. U.S. Department of Health and Human Services. The Surgeon General's call to action to prevent and decrease overweight and obesity. [Rockville, MD]: U.S. Department of Health and Human Services, Public Health Services, Office of the Surgeon General; [2001]. Available from: U.S. GPO, Washington. 2. Tools for calculating body mass index (BMI). Nutrition & physical activity. Center for Disease Control and Prevention. Retrieved June 28, 2005, from http://www.cdc.gov/nccdphp/dbpa/growthcharts/bmi_tools.htm 3. National Center for Health Statistics, Centers for Disease Control and Prevention. Prevalence of overweight among children and adolescents: United States, Trends 1963-1965 Through 2009-2010. Retrieved on September 28, 2012, http://www.cdc.gov/nchs/data/hestat/obesity_child_09_10/obesity_child_09_10.html Bureau of Health Promotion. Tipping the Scales: Toward a Healthier Population In Utah. Salt Lake City, UT: Utah Department of Health 2005; available at http://health.utah.gov/obesity