Jennifer Linchey

Ethnic Disparities in Trends in High BMI Among California Adolescents, 2003–2012

INTRODUCTION Because California is home to one in eight U.S. children and accounts for the highest Medicaid and Childrens Health Insurance Program spending, childhood obesity trends in California have important implications for the entire nation. Californias racial/ethnic diversity and large school-based data set provide a unique opportunity to examine trends by race/ethnicity, including understudied Asian and American Indian youth, which has not been possible using national data sets. This study examined racial/ethnic disparities in prevalence of high BMI from 2003 to 2012. METHODS This observational study included 11,624,865 BMI records from repeated cross-sections of fifth-, seventh-, and ninth-graders who underwent Californias school-based fitness testing. Analyses conducted in 2015 used logistic regression to identify trends in prevalence of high BMI (BMI ≥85th, 95th, and 97th percentiles) and differences in trends by race/ethnicity from 2003 to 2012. RESULTS African American and Hispanic girls and American Indian boys increased in prevalence of high BMI, whereas non-Hispanic white and Asian youth and Hispanic boys decreased in prevalence of high BMI (p-values<0.05) from 2003 to 2012. Over this period, African American, Hispanic, and American Indian youth had higher slopes for trends in high BMI than non-Hispanic white youth (p-values<0.05). CONCLUSIONS Based on Californias statewide data, there is evidence that racial/ethnic disparities in prevalence of high BMI have widened over time. Minority youth have either decreased more slowly or increased in prevalence compared with non-Hispanic white youth. There continues to be an urgent need for policies and interventions that effectively reduce racial/ethnic obesity prevalence disparities.

Energy Balance for Kids with Play: Design and Implementation of a Multi-Component School-Based Obesity Prevention Program

BACKGROUND Improving nutrition and physical activity behaviors associated with childhood obesity are significant national public health goals. Energy Balance for Kids with Play (EB4K with Play), developed through a partnership between the Academy of Nutrition and Dietetics Foundation and Playworks, is a multi-component school-based intervention designed to address youths nutrition and physical activity behaviors. This article describes the EB4K with Play intervention and evaluation study and presents the baseline data. METHODS The evaluation is a 2-year cluster-randomized design targeting third- to fifth-grade students enrolled in a low-income, urban school district in northern California. Six schools were recruited to participate. Four were randomized to the intervention group and two into a control group. Baseline student-level data pertaining to nutrition, physical activity, fitness, and BMI were collected in the fall of 2011. The EB4K with Play program, which includes direct-to-student nutrition and physical activity interventions, a school wellness component, and parent/community partner outreach components, began immediately after baseline data collection. RESULTS An ethnically diverse sample of students (n=844) was recruited to participate in the study. Baseline data showed a higher percent of eligibility for free and reduced-price school lunch and higher rates of obesity/overweight than the California state averages. Fitness levels and levels of moderate-to-vigorous physical activity were comparable to state averages. CONCLUSIONS End-point data will be collected after 2 years of the intervention. The findings from this study should help guide future efforts to design effective intervention programs to support the prevention of pediatric obesity.

Critical Elements of a School Report to Parents on Body Mass Index

School-based body mass index (BMI) screening and reporting could have a positive impact on student health, but best practices for writing a report are unknown. Building on previous qualitative work, 8 focus groups were conducted with a diverse group of California parents (n = 79) to elicit feedback on report content and design. Results indicate that parents want a visually appealing, picture-heavy report that clearly defines BMI, avoids stigmatizing language, and includes recommendations for appropriate actions whole families can take. Next steps involve using the final report in a statewide, randomized trial to determine the effectiveness of school-based BMI screening and reporting in reducing childhood obesity.

Reach Out and Eat Food and Beverages Depicted in Books for Preschoolers

Objective. To examine food and beverage depictions in books for preschoolers. Methods. Books for preschoolers from Reach Out and Read (ROR; n = 42), public library (n = 27), and Publisher’s Weekly booklists (n = 31) were examined for nutritive and empty-calorie food and beverage depictions. Results. It was found that 66% of books depicted at least 1 food or beverage. More books depicted nutritive items than empty-calorie items (87.5% vs 54.7%, P < .001). There was a trend toward fewer empty-calorie depictions in ROR books than in other booklists. Yet nearly half of ROR books depicted at least 1 empty-calorie item. ROR books also accounted for 5 of 10 books with the most empty-calorie item depictions and 3 of 4 books with branding. With regard to messaging, approximately a third of books with the most empty-calorie depictions promoted unhealthy foods. Conclusions. When selecting books for ROR, it may be important to consider food and beverage depictions and messages.

The Feasibility of a Physical Activity Referral Network for Pediatric Obesity

BACKGROUND Pediatricians cite a lack of physical activity referral (PAR) opportunities as a major barrier to treating obesity. However, no literature exists on PARs for youth in the clinical setting. This study explores the feasibility of implementing PARs in a pediatric obesity clinic. METHODS Patients ages 6-18 years in an obesity clinic from July 2010 to October 2011 were referred to PARs in their community. Researchers confirmed enrollment and participation in activities by follow-up phone calls. RESULTS Of 130 eligible youth, 102 (78%) agreed to be referred to a physical activity program; 45 (35%) enrolled and 35 (27%) reported actually participating in an activity, for an average of 1.4 hours per week. Youth participated in 9 of 69 available activity programs included in the PAR network. Patient characteristics at baseline did not predict participation in an activity. Youth referred to organizations that contacted interested families were 5 times as likely to enroll in activities as youth referred to organizations that did not contact families (p < 0.001). CONCLUSION Although only 27% of eligible youth participated in an activity through the PAR network, exposing 1 in 4 obese youth to 1.4 hours of physical activity weekly could have a significant public health impact. These results suggest that PAR networks for overweight and obese youth should focus on organizations that have the infrastructure to contact youth and their families, and that a small number of physical activity programs could form the basis for launching PAR networks.