Summary

In 2002, the California Center for Public Health Advocacy (CCPHA) released a study reporting that 26.5 out of every 100 children enrolled in grades 5, 7, and 9 in California in 2001 were overweight. In August 2005, CCPHA released new study reporting that in 2004 childhood overweight rates had increased by 6%, to 28.1 out of every 100 children.

CCPHA analyzed data collected in the 2004 California Department of Education Physical Fitness Test from almost 1.4 million children to determine the number of children enrolled in grades 5, 7, and 9 who were overweight.(1) CCCPHA compared the 2004 findings to findings from its analysis of the 2001 Physical Fitness Test and found that between 2001 and 2004, the percentage of overweight children increased among all demographic groups: boys and girls, students in all grades studied, and children of all racial/ethnic backgrounds.

CCPHA reported its analysis of the 2004 data by state Assembly and Senate districts as well as by county and city.

Background

The growing levels of childhood overweight point to two of the most serious public health crises facing California today: unhealthy diets and low levels of physical activity among our children. Poor eating and inadequate physical activity put California children at risk for diabetes and other chronic diseases in their youth, can lead to expensive and preventable adult illnesses, and may reduce their life expectancy.
These crises reflect not only factors under the control of children and their parents, but also conditions in schools and communities that encourage children to eat and drink unhealthy foods and beverages and that limit their physical activity.

During the past three decades, the prevalence of overweight among young people in the United States more than tripled among children 6 to 11 years and more than doubled among adolescents aged 12 to 19 years.(2) These figures are particularly alarming because of the health problems associated with children being overweight. Children and adolescents who are overweight are at increased risk for type 2 diabetes mellitus, asthma, and orthopedic problems; they are more likely to have risk factors for cardiovascular disease (such as increased blood pressure and cholesterol); and they are more likely to have behavioral problems and depression.(3,4) In addition, children and adolescents who are overweight are more likely to remain so as adults,(5,6) with an estimated 75% of overweight adolescents being obese as young adults.(6)

The increasing prevalence of overweight is a reflection of critical and fundamental health problems that plague our children: poor diet and a lack of regular physical activity. These problems are the result of a variety of individual, social, and environmental factors. These factors include increased availability and consumption of soft drinks and high-fat, high-calorie foods; increasing amounts of time spent in sedentary activities, including television viewing; and limited access in many neighborhoods to healthy foods and safe places to be physically active.

The Study

The California Physical Fitness Test evaluates children using the FITNESSGRAM assessment tool, which consists of six measures of physical fitness.(7) The Healthy Fitness Zone is the FITNESSGRAM term used to describe the minimum level of fitness (that is, the level thought to provide some protection from health risks imposed by a lack of fitness) in each component of the test. Each Healthy Fitness Zone is based on criterion-referenced standards that have been tested and shown to be valid and reliable.

CCPHA analyzed one of these measures, body composition, as an indicator of whether or not children were overweight. Each student’s body composition was assessed based on either body mass index (BMI) calculated from measured height and weight, triceps skin fold thickness, or bioelectrical impedance.(8) Children who exceeded the Healthy Fitness Zone were considered to be overweight. In this study, overweight is generally equivalent to the 90th percentile of BMI-for-age, and is slightly lower than the commonly used Centers for Disease Control and Prevention (CDC) definition of overweight as a BMI-for-age at or above the 95th percentile.(9)

Results

Overall, more than one in four (28.1%) children enrolled in grades 5, 7, and 9 in California were overweight in 2004. Boys (33.9%) were more likely to be overweight than girls (22.0%). The percentage of children who were overweight decreased with increasing grade level, from almost one out of three in grades 5 and 7 to one out of four in grade 9.

The percentage of children who were overweight was highest among Pacific Islanders (35.9%), followed by Latino (35.4%), American Indian/Alaskan Native (31.7%), and African-American (28.7%) children. Lower percentages of overweight were found among non-Latino white children (20.6%) and Asian children (17.9%).
Statewide, the percentage of children enrolled in grades 5, 7, and 9 who were overweight increased from 26.5% in 2001 to 28.1% in 2004. The percentage of overweight children increased among both boys and girls, among children in all three grade levels, and among children of all racial/ethnic backgrounds.

Policy Recommendations

The California Center for Public Health Advocacy’s policy recommendations released with the study called on policy makers throughout the state to take immediate action. Eight specific recommendations which were based on recommendations of a national Scientific Panel brought together by CCPHA and the Strategic Alliance for Healthy Food and Activity Environments (of which CPRS is a member) called for changes in communities and schools. The recommendations of the study that may be of particular interest to park and recreation advocates include:

1. Institute healthy food and beverage standards for all items available in pre-school, school, and after-school programs. Standards should address levels of fat, sugar, and calories.
2. Make school recreational facilities available for after-hours use by children and families, especially in neighborhoods that lack adequate, safe, and accessible park and recreational facilities.
3. Adopt and implement “complete streets” policies to provide safe and convenient roadway access for people who walk, bicycle, or use wheelchairs.
4. Provide financial incentives for establishing physical activity facilities, grocery stores, and farmers markets, and improving walkability, particularly in low-income communities.

Study findings by county and city (as well as state legislative district) are available on CCPHA’s web site, http://www.publichealthadvocacy.org/policy_briefs/overweight2004.html. The web site includes a mapping tool. Questions about the study can be directed to info@publichealthadvocacy.org or 530/297-6000.

Endnotes

1. Additional information about the California Physical Fitness Test is available on-line at http://www.cde.ca.gov/ta/tg/pf/index.asp.
2. National Center for Health Statistics. Health, United States, 2004 with chartbook on trends in the health of Americans. Hyattsville, MD: 2004. Available on-line at http://www.cdc.gov/nchs/data/hus/hus04.pdf. Accessed on May 11, 2005.
3. Reilly JJ, Metheven E, McDowell ZC, et al. Health consequences of obesity. Arch Dis Child. 2003; 88:748-52.
4. Institute of Medicine (United States). Preventing childhood obesity: health in the balance (Committee on Prevention of Obesity in Youth, Food and Nutrition Board, Board on Health Promotion and Disease Prevention). 2005. Washington, D.C.
5. Freedman DS, Khan LK, Serdula MK, et al. The relation of childhood BMI to adult adiposity: the Bogalusa heart study. Pediatrics. 2005; 115:22-7.
6. Guo SS, Wu W, Chumlea WC, Roche AF. Predicting overweight and obesity in adulthood from body mass index values in adolescence. Am J Clin Nutr. 2002; 76:653-8.
7. Additional information about FITNESSGRAM is available on-line at http://www.fitnessgram.net.
8. Body mass index is a ration measurement of weight to height, reported as Kg/m2. For most persons, the body mass index is a reliable proxy for fatness. Skinfold thickness and bioelectrical impedance are both estimates of body fatness.
9. Centers for Disease Control and Prevention. BMI for children and teens. Atlanta, Georgia, 2005. Available on-line at: http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm.