1. Overweight and Obesity in the Kenai Peninsula Borough School District, 2011-2012 Alaska Department of Health and Social Services Section of Chronic Disease Prevention and Health Promotion Andrea M. Fenaughty, Ph.D. KPBSD School Board Meeting November 12, 2012

2.  Why care about childhood obesity?  Results from 2011-2012 school year study  Results of cohort  Students at most risk Overview

3. Why Care about Childhood Obesity?

4. Obesity is…  Associated with poor health outcomes in adults  Associated with poor health outcomes in childhood  Associated with poor academic performance  Economically costly to Alaskans  On the rise

5.  Hypertension  Dyslipidemia  Coronary Heart Disease  Stroke  Type II Diabetes  Endometrial, Breast, Prostate, and Colon Cancers  Osteoarthritis  Sleep Apnea  Complications of Pregnancy  Menstrual Irregularities  Depression  Intimate Partner Violence  And… Overweight and Obese Individuals Are at Greater Risk of:

6.  “[Due to obesity]…today's younger generation will have shorter and less healthy lives than their parents for the first time in modern history unless we intervene” - Jay Olshansky, life expectancy researcher Obesity and Premature Death

7.  70% of obese 5-17 year olds have 1+ CVD risk factor; 39% have 2+  Obesity and overweight increase the following risks in youth:  Type II diabetes  Asthma  Obstructive sleep apnea  Orthopedic problems  Fatty liver disease  Depression, low self-esteem  And obese youth become obese adults Childhood Health Consequences of Obesity

8. What % of overweight or obese 10-15 years olds will be obese at age 25?

9. Academic Performance Costs of Obesity  Obesity associated with: ×Lower academic performance ×Lower teacher ratings of social-emotional well-being ×Increased absenteeism  Good nutrition and physical activity linked with: + Increased academic test scores + Improved attendance + Better class participation

10. Source: AK YRBS Prevalence of Getting Mostly A’s or B’s, by Select Risk Factor Groups, Alaska High School Youth, 2009

11.  $459 million annually in direct medical expenditures  $380 million on tobacco-related medical costs  $33.7 million on Alaska Medicaid recipients with an obesity diagnosis in SFY09  Lost productivity?  Absenteeism?  Presenteeism? Economic Costs of Obesity in Alaska

12. 12

13. Childhood Obesity Nationally Alaska

14. Obesity Rates  US: 17% of 2 -19 year olds are obese  AK high school students: 12% are obese  AK children < HS: ???  Statewide representative data on obesity prevalence for children younger than high school are not available in Alaska.  Self-report bias

15. Objectively Measured Weight Status  Anchorage School District  2010-2011  pre-K--12 th graders  18% obese  Matanuska-Susitna Borough School District  2009-2010  K, 1 st, 3 rd, 5 th, 7 th graders  12% obese

16. KPBSD BMI Study

17. Purpose 1.Establish baseline prevalence of overweight and obesity in 2011-2012 2.Determine groups at highest risk 3.Examine change in weight status from 2010-2011 to 2011-2012 school years in a cohort

18. 2010-20112011-2012 Sample Size1,1025,902 Schools1840 Methods  School nurses/ designees collect height and weight during routine screenings  Pre-K through 9 th, 11 th

20.  Body mass index (BMI) calculated as an non-invasive, indirect measure of  percent body fat  risk of obesity-related health events Measures

21. How We Measure Weight Status in Adults BMI Classification for Adults BMIClassification <18.5Underweight 18.5 to less than 25Healthy weight 25 to less than 30Overweight ≥ 30Obese Body Mass Index = weight (kg) / [height (m)] 2 21

22. Determine weight status differently for kids…  Same BMI formula  But weight category determined based on BMI by age and sex

23.  95 th Percentile  85 th Percentile  50 th Percentile  5 th Percentile

24.  95 th Percentile  85 th Percentile  50 th Percentile  5 th Percentile

25.  95 th Percentile  85 th Percentile  50 th Percentile  5 th Percentile

26. Weight Status in Children: BMI Percentiles BMI Classification for Children 2-18 Years Old BMI for Age PercentilesClassification <5 th Underweight 5 th to less than 85 th Healthy weight 85 th to less than 95thOverweight ≥95thObese Barlow SE, et al. Pediatrics 2007; 120:S164-92

27.  For 2011-2012 prevalence and risk estimates  Weighted data to 2011-2012 enrollment  Analyzed by Age Sex Grade Race/ethnicity Geographic region (east, south, central) Socioeconomic status (SES) of the schools Analysis

28.  East region  Cooper Landing  Hope  Moose Pass  Seward schools  South region  Ninilchik and all schools south of Ninilchik  Central region  all other schools Region

29.  SES: proportion of students enrolled in the free- and reduced-price lunch program (FRPL)  School level measure  Proxy for SES Socioeconomic Status % students in FRLPSES Category < 45%High SES ≥ 45%Low SES

30.  Change in weight status of same set of students from 2010-2011 to 2011-2012 school years  Data not weighted because the cohort was not representative of the enrolled student population  2010-2011 was start-up year for data collection Cohort Analysis

31. Results

32. Weight Status of Students in KPBSD Pre-K through 11 th grades, 2011-2012 School Year (n=5,902)* *10 th and 12 th grade students not included in the sample; weighted percentages shown.

33. Prevalence of Overweight and Obesity (≥ 85 th Percentile), by Sex, KPBSD Students, 2011-2012 Statistically significant difference at α = 0.05

34. Prevalence of Overweight and Obesity (≥ 85 th Percentile), by Race/Ethnicity, KPBSD Students, 2011-2012 *Statistically significant difference at α = 0.05 *

35. Prevalence of Overweight and Obesity (≥ 85 th Percentile), by Age Group, KPBSD Students, 2011-2012 *Statistically significant difference at α = 0.05 *

36. Prevalence of Overweight and Obesity (≥ 85 th Percentile), by Grade, KPBSD Students, 2011-2012

37. Prevalence of Overweight and Obesity (≥ 85 th Percentile), by SES, KPBSD Students, 2011-2012

38. Prevalence of Overweight and Obesity (≥ 85 th Percentile), by Region, KPBSD Students, 2011-2012

39.  Students from 18 schools with height and weight measures in both school years (n=1,102)  Students in cohort:  54% Male  82% White - 82%, 10% AI/AN, 8% Other Races Cohort Analysis Results (2010-2011 to 2011-2012)

40. Prevalence of Overweight and Obesity (≥ 85 th Percentile), Cohort Study, KPBSD Students, 2010-2011 through 2011-2012 Statistically significant using McNemar test at α = 0.05 Among 332 students who were overweight or obese in 2010-2011, 88% were still overweight or obese in 2011-2012.

41. Summary & Conclusions

42.  Prevalence of childhood obesity in KPBSD is higher than the Healthy People 2020 goal of 14.6%  Overweight and obesity prevalence is higher among minority children  Overweight and obesity are issues that arrive on your doorstep  Overweight and obese students are unlikely to “grow out of it” Key Points

43.  KPBSD now has a baseline and can start monitoring trends to evaluate progress  School environment just one of many settings that will need to change if Alaska is to address obesity  District has taken many positive steps  Increase participation in Healthy Futures  Changes to the school environment should give consideration to the unique needs of minority populations Conclusions

44. Dr. Steve Atwater Superintendent Naomi L. Walsworth Health Services Coordinator Sharon Whytal & Judy Dean Homer Public Health Nursing All the KPBSD school nurses! KPBSD Acknowledgements

45. Myde Boles, PhD Program Design and Evaluation Services Karol J Fink, MS, RD DHSS Obesity Prevention Manager Charles J Utermohle, PhD DHSS Epidemiologist Andrea M Fenaughty, PhD DHSS Deputy Section Chief Chronic Disease Authors

46. Thank You! Questions? Contact Information: Andrea Fenaughty, PhD - Andrea.Fenaughty@Alaska.gov Karol Fink MS, RD – Karol.Fink@Alaska.gov 46

47. Aurora Borealis Charter School 167 Chapman School 127 Cooper Landing School 5 Fireweed Academy 122 Homer Flex School 15 Homer High School 125 Homer Middle School 193 Hope School 10 Kachemak Selo School 62 Kaleidoscope School 246 Kalifornsky Beach Elementary 285 Kenai Alternative High School 1 Kenai Central High School 116 Kenai Middle School 355 McNeil Canyon Elementary 120 Moose Pass School 11 Mt. View Elementary 317 Nanwalek School 62 Nikiski Middle/Sr High School 205 Nikiski North Star Elementary 375 Participating Schools (n=40) in 2011-2012 Nikolaevsk School 62 Ninilchik School 104 Paul Banks Elementary 128 Port Graham School 15 Razdolna School 60 Redoubt Elementary 306 River City Academy 35 Seward Elementary 287 Seward High School 59 Seward Middle School 80 Skyview High School 169 Soldotna Elementary 288 Soldotna High School 204 Soldotna Middle School 396 Soldotna Montessori Charter 152 Sterling Elementary 143 Susan B English School 32 Tustumena Elementary 175 Voznesenka Elementary 84 West Homer Elementary 204