Andrea Cantarero, BSEH Tom Scharmen, MPH Elizabeth Yakes Jimenez, PhD, RD Peter Kinyua, PhD Tom Genne, MA Healthy Weight Assessment Project (HWAP) New Mexico Public Health Association Annual Conference 4/2/14
Objectives Review current national and local trends in childhood obesity Describe unique features of HWAP data Discuss future steps and uses for HWAP
Quick Review: How is healthy weight defined in pediatric populations?
Body Mass Index (BMI) BMI = weight(kg)/height(m) 2 CDC Growth charts Use: BMI, age, sex Get: BMI percentiles (BMI%)
Healthy weight distribution in a normal, reference population 80% 5% 10% 5% Underweight Normal Weight Overweight Obese
The latest trends in childhood obesity
NATIONAL DATA (N=3355) Source: Ogden et al. 2014
NEW MEXICO DATA (N=7731) 5.0 Source: New Mexico Childhood Obesity 2013 Update
NEW MEXICO DATA (N=20973) 80% PERCENT LOW INCOME TODDLERS IN BMI PERCENTILE CATEGORIES, BY AGE, 2013 DOH-WIC STATEWIDE, 2013 DATASET 70% 60% 50% HEALTHY WEIGHT (5th - 85th) 40% OVERWEIGHT OR OBESE (>85th) 30% 20% 10% 0% 2 YRS 3 YRS 4 YRS OBESE (>95th) OVERWEIGHT (85th - 95th) EXTREMELY OBESE (>97th) UNDERWEIGHT (<5th)
ALBUQUERQUE DATA (N=141773) 80% PERCENT STUDENTS IN BMI PERCENTILE CATEGORIES, BY AGE, 2008-2013 DOH-APS 2008-2013 TREND DATASET 70% 60% 50% HEALTHY WEIGHT (5th - 85th) 40% 30% 20% 10% 0% 5 YRS 6 YRS 7 YRS 8 YRS 9 YRS 10 YRS 11 YRS 12 YRS 13 YRS 14 YRS OVERWEIGHT OR OBESE (>85th) OBESE (>95th) OVERWEIGHT (85th - 95th) EXTREMELY OBESE (>97th) UNDERWEIGHT (<5th)
What is HWAP? A project to consolidate effort and information about the healthy weight status of children in Albuquerque Public Schools (APS) and the impact of the school and community environment on healthy weight and hunger. UNM Human Research Review Committee approved 11/5/13 HRPO ID:13-472 APS Research Review Committee approved 11/19/13
How was HWAP created? School nurses measured Kindergarten (K), 3rd, 5th and 8th grade students annually (since 2007). Student height, weight, age, and sex used to determine BMI% and weight status. Individual students linked to other APS datasets (e.g. demographics, test scores, attendance). Schools and student residences geocoded Thanks to the McCune Charitable Foundation.
Why this surveillance project is valuable: Local Very large sample Multi-factorial and multi-level Truly longitudinal cohorts Not just a series of cross-sectionals
HWAP data has multiple socio-ecological levels Community SES, food access, crime, safety, walkability School physical activity and nutrition policies, curriculum, menus, food vendors Family household makeup, location, SES, language use Child age, race/ethnicity, allergies, asthma, enrollment, academic achievement, attendance, disability/gifted status, birth country
HWAP sample is powerful because it is large and HWAP Samples Other Samples School Year Sample Size 2007-2008 22278 2008-2009 24851 2009-2010 25982 2010-2011 26137 2011-2012 24595 NHANES 2011-2012 N=3355 (ages 2-19) Healthy Kids NM N=7731 (K & 3 rd ) 2012-2013 18818
because it is longitudinal Students Measured More than Once by Grade and School Year 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 K 3RD 5TH K 3RD K 3RD 3RD 5TH 8TH 3RD 5TH 3RD 5TH 5TH 8TH 5TH 8TH 102,229 individual students 37385 repeat measures 10 longitudinal cohorts 2978 measured 3 times 2 longitudinal cohorts
Enrollment Cohorts
Percent of Students in Weight Categories Over Time NM 3 rd Grade 2013 cross-sectional NM K Grade 2010 cross-sectional Different students from different samples across the state APS 3 rd Grade Third Grade 2010-2013 3.8 62.9 15.4 17.9 Same students measured 3 years later APS K Grade 2007-2010 Kindergarten 3.6 69.0 14.4 12.9 Standard Reference (Healthy Goal) 5.0 80.0 10.0 5.0
A closer look at APS weight progression from K to 3rd Obese 3 rd graders = 2400 2000 1600 1200 Number of Students 800 400 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 K Grade BMI% 3 rd Grade BMI%
Healthy Weight and Equity in Albuquerque How is student weight status related to? Income Race/ethnicity Disability Academic achievement School attendance And more
DISABILITY 70% PERCENT STUDENTS IN BMI PERCENTILE CATEGORIES, BY DISABILITY STATUS, 2008-2013 DOH-APS 2008-2013 TREND DATASET; N= 142,661 63.5% 60% 50% 58.7% NO DISABILITY DISABILITY 40% 37.4% 33.0% 30% 20% 15.8% 16.0% 17.2% 21.4% 15.7% 12.1% 10% 3.5% 3.9% 0% UNDERWEIGHT (<5th) HEALTHY WEIGHT (5th - 85th) OVERWEIGHT (85th - 95th) OVERWEIGHT OR OBESE (>85th) OBESE (>95th) EXTREMELY OBESE (>97th)
How is this data being used? 6 major grant proposals (that we know of so far) many small ones Community Transformation Grant ($3M received) Built-in tool for evaluation of obesity prevention programs Annual district and school-level reports for APS: school nurses, leadership and School Health Advisory Councils (SHAC). New Mexico Community Data Collaborative (NMCDC) interactive HWAP maps for community engagement. Outreach Specialist assists schools and community groups to use the data for proposals, program evaluation and policy change. Thanks to the McCune Charitable Foundation.
New Mexico Community Data Collaborative (NMCDC): HEALTHY WEIGHT ASSESSMENT, ALBUQUERQUE, 2008-2013 Mapping Social and Health Conditions in New Mexico Neighborhoods http://nmcdc.maps.arcgis.com/home/
How else could HWAP be used? Community/school engagement More grant applications and evaluation Trending compared to state and national Comprehensive modeling of multi-level influences on healthy weight in children Link to other datasets? CEPR, RWJF, other UNM co-investigators
Other Questions/Ideas?? FOR MORE INFO CONTACT: Tom Scharmen, DOH Epidemiologist, 897-5700 ext126, (thomas.scharmen@state.nm.us) Andrea Cantarero, Project Analyst, 720-877-6616, (arcantarero@salud.unm.edu) Beth Yakes Jimenez, UNM Primary Investigator, (eyjimenez@unm.edu) Sarah Haynes, Project Outreach, (mcglothster@gmail.com)
References Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014 Feb 26;311(8):806-14. New Mexico Department of Health. New Mexico Childhood Obesity 2013 Update. 2014.
EXTRA SLIDES
ALBUQUERQUE, 2013 NEW MEXICO, 2013