Jean DuRussel-Weston

Understanding childhood obesity in America: Linkages between household income, community resources, and children's behaviors

BACKGROUND Understanding childhood obesitys root causes is critical to the creation of strategies to improve our childrens health. We sought to define the association between childhood obesity and household income and how household income and childhood behaviors promote childhood obesity. METHODS We assessed body mass index in 109,634 Massachusetts children, identifying the percentage of children who were overweight/obese versus the percentage of children in each community residing in low-income homes. We compared activity patterns and diet in 999 sixth graders residing in 4 Michigan communities with varying annual household income. RESULTS In Massachusetts, percentage of overweight/obese by community varied from 9.6% to 42.8%. As household income dropped, percentage of overweight/obese children rose. In Michigan sixth graders, as household income goes down, frequency of fried food consumption per day doubles from 0.23 to 0.54 (P < .002), and daily TV/video time triples from 0.55 to 2.00 hours (P < .001), whereas vegetable consumption and moderate/vigorous exercise go down. CONCLUSIONS The prevalence of overweight/obese children rises in communities with lower household income. Children residing in lower income communities exhibit poorer dietary and physical activity behaviors, which affect obesity.

Health status and behavior among middle-school children in a midwest community: What are the underpinnings of childhood obesity?

BACKGROUND Childhood obesity is one of the nations foremost health challenges. How much of this is due to lifestyle choices? The objective of the study was to determine health behaviors that contribute to obesity in sixth-grade children. METHODS To assess which health habits contribute to childhood obesity, we studied body mass index, blood pressure, lipid profile, glucose, and heart rate recovery after a 3-minute step test among sixth-grade children enrolled in a school-based intervention study from 2004 to 2009, comparing health behaviors and physiologic markers in obese versus nonobese children. Univariate associations with obesity (P values≤.10) were entered into a stepwise logistic regression to identify independent predictors. RESULTS Among 1,003 sixth graders (55% white, 15% African American; average age 11.5 years), 150 (15%) were obese. Obese students had higher levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, and recovery heart rates. They consumed more regular soda and school lunches but were less likely to engage in physical activities. Obese students were more likely to watch TV≥2 hours per day. Independent predictors were watching TV or video games (odds ratio [OR] 1.19, 95% CI 1.06-1.33) and school lunch consumption (OR 1.29, 95% CI 1.02-1.64); moderate exercise was protective (OR 0.89, 95% CI 0.82-0.98). CONCLUSIONS Obesity is present in 15% of our sixth graders and is associated with major differences in cardiovascular risk factors. Opportunities to improve childhood health should emphasize programs that increase physical activity, reduce recreational screen time, and improve nutritional value of school lunches. Whether genetic or not, childhood obesity can be attacked.

Gender Differences in Physiologic Markers and Health Behaviors Associated With Childhood Obesity

BACKGROUND: Previous studies have demonstrated gender-related differences in body composition, physical activity, and diet. This observational study assesses gender variance in independent predictors for obesity to determine targeted areas for intervention. METHODS: Data from 1714 sixth-grade students enrolled in Project Healthy Schools were compared by using health behaviors and physiologic markers (lipids, random glucose, blood pressure, and resting and recovery heart rates). Students were stratified by gender and obesity (BMI ≥95th percentile by age and gender). Physiologic markers and behaviors were compared by using χ2 analysis. Univariate associations with P < .10 were included in a stepwise logistic regression model to determine independent predictors for obesity by gender. RESULTS: Nonobese students (both boys and girls) showed significantly healthier physiologic parameters compared with their obese counterparts. Two behaviors independently correlated with obesity in both boys and girls: regularly eating school lunches (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01–1.64; OR 1.27, 95% CI 1.00–1.62, respectively) and watching ≥2 hours of television per day (OR 1.19, 95% CI 1.07–1.32; OR 1.19, 95% CI 1.06–1.34, respectively). Vigorous physical activity and involvement in school sports teams appeared to be protective against obesity in boys (OR 0.90, 95% CI 0.82–0.98; OR 0.77, 95% CI 0.64–0.94, respectively), whereas milk consumption appeared protective in girls (OR 0.81, 95% CI 0.67–0.98). CONCLUSIONS: Among middle-school children, we observed gender-related differences in factors associated with obesity. Additional research is warranted to determine the beneficial impact of improving school lunches and decreasing screen time, while improving our understanding of gender-related differences in milk consumption and physical activities in relation to BMI.

Sustained benefit over four-year follow-up of Michigan's Project Healthy Schools

OBJECTIVES We determined the sustainability of effects of a school-based intervention to improve health behaviors and cardiovascular risk factors among middle school children. METHODS We administered a questionnaire and health screenings to 5 schools in Ann Arbor and 2 schools in Ypsilanti, Michigan. We assessed demographics, physiological factors, diet, physical activity, and sedentary behaviors from 1126 students who received a health curriculum (Project Healthy Schools) in the fall of sixth grade in 2005, 2006, and 2007. We administered the questionnaire and screening again in the spring and each subsequent spring through ninth grade to all available, consenting students. RESULTS In the 4 years following the school-based intervention, total cholesterol, low-density lipoprotein cholesterol, and triglycerides improved, and for most years systolic and diastolic blood pressure improved. Serum glucose and body mass index did not change. Physical activity increased and sedentary behaviors diminished. CONCLUSIONS Project Healthy Schools is associated with sustainable improvements in both cardiovascular parameters and healthy behaviors.

PASSIVE SCREEN TIME ASSOCIATED WITH UNHEALTHY DIETARY CONSUMPTION AND PHYSIOLOGICAL CHARACTERISTICS: A CLOSER LOOK AT CHILDHOOD BEHAVIORS

TV, computers, and video games are sedentary activities associated with childhood obesity. While studies show that screen time promotes unhealthy behaviors, there is evidence that these activities have varying effects due to food advertisements and activity levels. 1003 sixth graders were divided

School intervention incorporates farm to school programs to highlight healthy eating: a report from Project Healthy Schools.

Approximately one third of American children and adolescents are overweight or obese and childhood obesity rates have tripled since 1980.1 Obesity sets the stage for a host of potential emotional and long-term health problems, including low self-esteem, cardiovascular disease, diabetes, and some types of cancer.2–4 Lifestyle changes which improve nutrition and activity can reduce overall health risk.4,5 Project Healthy schools (PHs), a University–community collaborative, strives to improve the present and future health of middle school students, the full methods of which have been previously published.6 Prior studies have demonstrated improvements in both physiological and behavioral measurements immediately after intervention and 3 years postintervention.6,7 since its inception in 2004, PHs has encouraged healthy habits in over 13,000 Michigan youth in 21 schools through education and environmental changes. PHs meets its educational aims through 10 standardized, half-hour, in-class lessons, delivered weekly, focusing on the project’s five behavioral goals:

HEALTH BEHAVIORS PREDICTS CARDIOVASCULAR RISK PROFILE IN MIDDLE-SCHOOL CHILDREN

Lifestyle behaviors related to diet, physical activity (PA) and sedentary behavior (SB) are associated with increased cardiovascular (CV) risk in adults; however, less is known about adolescents. We examined PA, SB and diet in association with CV risk factors among middle school students. Data from

GENDER DIFFERENCES IN PHYSIOLOGIC MARKERS AND HEALTH BEHAVIORS ASSOCIATED WITH CHILDHOOD OBESITY

Previous studies have demonstrated differences between boys and girls in body composition, physical activity and diet. This study assesses gender variance in independent predictors for obesity in order to determine targeted areas for intervention. Data from 2048 6th grade students enrolled in

Top 10 Lessons Learned from Project Healthy Schools

Childhood obesity is increasing in the United States; obese children are more likely to become obese adults with obesity-associated health issues. Effective programs designed to reduce the prevalence of childhood overweight and obesity are needed. We sought to review one such program, Project Healthy Schools (PHS), for key findings. Project Healthy Schools is a health curriculum that includes educational lessons, school environment changes, and health measurement. Data have shown improvement in numerous metrics after the program, including positive changes in physiologic measures and healthier lifestyle behaviors. The schools socioeconomic status has been shown to correlate with baseline and follow-up measures, and gender differences exist. Additionally, school environmental changes support improved health behaviors. The collaborative effort and support of various stakeholders have led to the success of this health education program, resulting in numerous physiologic and behavioral benefits in middle school students throughout Michigan, and providing a replicable, real-world approach to combating childhood obesity.

Differences in Cardiovascular Disease Risk Factors and Health Behaviors between Black and Non-Black Students Participating in a School-Based Health Promotion Program

Purpose: To compare cardiovascular disease (CVD) risk factors of black and non-black children participating in Project Healthy Schools (PHS), a school-based wellness program. Design: Participants were surveyed and participated in physiological screenings pre- and post-PHS intervention. Setting: Middle schools in 4 Michigan communities of varying socioeconomic status. Participants: A total of 3813 sixth-grade students comprised the survey sample, and 2297 sixth-grade students comprised the screening sample. Intervention: Project Healthy Schools is a school-based intervention designed to reduce the risk of obesity and CVD in children through the promotion of healthy eating and physical activity. Measures: Physical examination, blood test, and self-reported survey data on dietary habits, physical activity, and sedentary behaviors were collected pre- and post-PHS. Analysis: Paired and independent t tests were used for physiologic variables. Wilcoxon sign-rank and rank-sum tests were used for survey variables. Results: At baseline, blacks had a higher percentage of overweight/obese students (43% vs 34%; P < .0001) and demonstrated poorer health habits than non-blacks; however, non-blacks had poorer lipid profiles. At follow-up (post-PHS intervention), both groups demonstrated significant improvements in physiological measures and health behaviors. Conclusion: Despite disparities between the groups at both baseline and follow-up, changes seen post-PHS intervention were beneficial in both groups. These results suggest that early intervention for risk factor modification is possible and may be of great importance in the prevention of CVD, particularly in high-risk groups.