Childhood Overweight in Childhood Overweight in Sacramento County,Sacramento County, 2001 2001

Cassius Lockett, Ph.D., MSCassius Lockett, Ph.D., MS

Epidemiology Program ManagerEpidemiology Program Manager

Epidemiology ServicesEpidemiology Services

Department of Health and Human ServicesDepartment of Health and Human Services

Sacramento CountySacramento County

OverviewOverview

• Public Health Importance• Defining BMI • Results• Summarize

Public Health Public Health ImportanceImportance• Adult Obesity and Overweight among children

is the largest health problem in the U.S.• >70% of overweight adolescents are expected

to remain overweight into adulthood (Guo et al. Am J Clin Nutr 1994;59:810-819)

• Prevalence U.S. adults, adolescents and children In 2002:

• 55.9% of adults were overweight (BMI >25 and <29.9)• 30.5% of adults were obese (BMI > 30)• 16.1% of adolescents aged 12-19 were overweight• 15.8% of children aged 6-11 years were overweight• 15.3% of children aged 2-5 years were overweight (year

2000)

• (NHANES III, Centers for Disease Control and Prevention)

Source: CDC/NCHS: NHANES III (2002)

Public Health Public Health ImportanceImportance

• Trends in U.S. adults, adolescents and children increasing – From 1988-1994 to 1999-2000:

• Children aged 2-5 years-increased from 7.2% to 10.4%

– 44.4% increase• Children aged 6-11 years-increased from 11.3%

to 15.3%– 35.4% increase

• Children aged 12-19 years-increased from 10.5% to 15.5%

– 47.6% increase

Source: CDC/NCHS: NHANES III (1988-94, 1999-2000)

Defining BMIDefining BMI

• Body Mass Index (BMI) is the recommended weight-for-height assessment method for all children >2 years old and adults

• BMI = weight (kg) / height2 (m2) • Age and gender-specific cut-off

values must be used for individuals < 18 years of age

Defining OverweightDefining Overweight

• At-risk for overweight – BMI > 85th but < 95th percentile for

age and gender

• Overweight – BMI > 95th percentile for age and

gender

California Health Interview California Health Interview Survey (CHIS)Survey (CHIS)

• 2001 population based survey for CA civilian, non-institutionalized pop

• Largest health survey in California• Provides pop-based estimates for CA

Counties• Major content includes

– Health related behaviors, health status and conditions, health insurance coverage and access to health care services

RESULTSRESULTS

Prevalence of Overweight Children by Prevalence of Overweight Children by Age Group, Sacramento County, 2001Age Group, Sacramento County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

5.0

14.312.5

10.8

22.3

32.3

17.8

24.4

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

0-5 Yrs 6-11 Yrs 12-17 Yrs OverallAge Group

Percen

t

At Risk Overweight

Prevalence of Overweight Children by Prevalence of Overweight Children by Age and Sex, Sacramento County, Age and Sex, Sacramento County,

20012001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

4.8 5.223.4 21.312.0 17.3

28.4 37.3

16.0 8.9

22.8 12.5

0.0

10.0

20.0

30.040.0

50.0

60.0

70.0

80.0

Percen

t

0-5 Yrs 6-11 Yrs 12-17 Yrs

Physical ActivityPhysical Activity

Prevalence of Overweight Prevalence of Overweight Adolescents by Activity during the Adolescents by Activity during the past 7 days, Sacramento County, past 7 days, Sacramento County,

20012001• Moderate-at least 30

minutes of walking, slow skating, or household chores

• Vigorous-at least 20 minutes of basketball, soccer, running, fast dancing or aerobics

• Strengthen or muscle toning-(push-ups, sit ups or weight lifting

14.015.5

13.8

16.2

18.6

14.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

Vigorous Moderate Strengthen

Activity

At Risk Overweight

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

Television Viewing and Television Viewing and Video Game HoursVideo Game Hours

Prevalence of Overweight Adolescents by Prevalence of Overweight Adolescents by Television Viewing and Video Game Playing Television Viewing and Video Game Playing

M-F, Sacramento County, 2001M-F, Sacramento County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

66.2

33.8

26.1

73.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

1-2 Hrs 3 + HrsHour

At Risk Overweight

Prevalence of Overweight by At Least 2 Prevalence of Overweight by At Least 2 Hours of Computer Use, M-F and Sat-Sun, Hours of Computer Use, M-F and Sat-Sun,

Sacramento County, 2001Sacramento County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

32.2

20.6

46.5

38.4

0.05.0

10.015.020.025.030.035.040.045.050.0

M-F Sat-Sun

Pe

rce

nt

At Risk Overweight

Self Reported Food and Self Reported Food and Beverage IntakeBeverage Intake

Prevalence of Food and Beverage Prevalence of Food and Beverage Consumption, Sacramento County, 2001Consumption, Sacramento County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

67.560.8

24.2

49.853.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Prevalence of Soda Consumption among Prevalence of Soda Consumption among Overweight Children by Age Group, Overweight Children by Age Group,

Sacramento, County 2001Sacramento, County 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

14.5

28.6

23.7

47.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

2-5 Years 6-11 Years

Pe

rce

nt

At Risk Overweight

Prevalence of Food and BeveragePrevalence of Food and Beverage Consumption by Age Group, Sacramento Consumption by Age Group, Sacramento

County, 2001County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

65.0

86.6

12.519.6

45.9

78.4

18.8

39.3

0.010.020.030.040.050.060.070.080.090.0

100.0

Milk Intake Fruit or100% Juice

Vegetable Soda

Age 2-5 Age 6-11

Prevalence of Overweight Adolescents by Prevalence of Overweight Adolescents by Soda Consumption, Sacramento County, Soda Consumption, Sacramento County,

20012001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

60.2

32.0

6.9

37.4

45.5

17.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

No Soda 1-2 Cans 3+ Cans

Pe

rce

nt

At Risk Overweight

Type of Insurance & Type of Insurance & Poverty LevelPoverty Level

Prevalence of Overweight Adolescents by Prevalence of Overweight Adolescents by Type of Insurance, Sacramento County, Type of Insurance, Sacramento County,

20012001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

8.7

84.1

6.0

26.5

70.5

3.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Medi-Cal Private Other

Pe

rce

nt

At Risk Overweight

Prevalence of Overweight among Children Prevalence of Overweight among Children by Federal Poverty Level, Sacramento by Federal Poverty Level, Sacramento

County, 2001County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

5.2

27.9

20.6

46.2

20.3 18.416.2

45.2

0.05.0

10.015.0

20.025.0

30.035.0

40.045.0

50.0

Less than100%

100-199% 200-299% 300% &Above

Perc

en

t

Age 2-5 Age 6-11

Prevalence of Adolescent Overweight by Prevalence of Adolescent Overweight by Federal Poverty Level, Sacramento County, Federal Poverty Level, Sacramento County,

20012001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

3.48.5

35.3

52.8

25.321.8 22.1

30.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Less than100%

100-199% 200-299% 300% &Above

Perc

en

t

At Risk Overweight

Multivariate analysis, Multivariate analysis, particularly Logistic particularly Logistic

RegressionRegression

Why? Allows the estimation of risk or odds of overweight, while controlling for confounders such as age, sex, soda consumption,

etc SIMULTANEOUSLY

Multiple Logistic Regression of Overweight Multiple Logistic Regression of Overweight Among All Children aged 2-17 years, Among All Children aged 2-17 years,

Sacramento County, 2001 Sacramento County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

Risk MarkersRisk Markers AORAOR 95% CI95% CI

Federal Poverty Level (<100%)

3.05 2.74 – 3.38

Medi-Cal Insurance 2.97 2.74-3.22

Soda Intake (1+ Cans) 1.94 1.89 – 1.99

Fruit intake (3+ Servings)

0.86 0.84 – 0.89

Milk intake (4+ Servings)

0.77 0.74 – 0.80

Vegetable intake (3+ Servings)

0.76 0.72-0.79

Multiple Logistic Regression for Multiple Logistic Regression for Overweight. Children aged 2-11 years, Overweight. Children aged 2-11 years,

Sacramento County, 2001 Sacramento County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

Risk MarkersRisk Markers AORAOR 95% CI95% CI Medi-Cal InsuranceMedi-Cal Insurance 11.6711.67 10.60 – 12.8610.60 – 12.86

Soda Intake (1+ Cans)

1.70 1.64 – 1.76

Milk intake (4+ Servings)

0.77 0.74 – 0.81

Fruit Intake (3+ Servings)

0.53 0.51 – 0.55

Multiple Logistic Regression of Overweight Multiple Logistic Regression of Overweight Among Adolescents aged 12-17 years, Among Adolescents aged 12-17 years,

Sacramento County, 2001 Sacramento County, 2001

Source: 2001 Sacramento County, CHIS, Adolescent Public Use Files

Risk MarkersRisk Markers AORAOR 95% CI95% CI Federal Poverty Level (<100%)

15.82 14.66 – 17.80

Television Viewing M-F (2+ Hours)

5.84 5.44-6.26

Soda Intake (1+ Cans) 5.79 5.43 – 6.18

Computer Use M-F (2+ Hours)

2.79 2.63-2.96

Vegetable intake (3+ Servings)

0.88 0.81-0.95

Moderate Physical Activity (at least 30 minutes)

0.39 0.36-0.42

Milk intake (4+ Servings) 0.19 0.17 – 0.22

Muscle Strengthening Activity

0.17 0.16 – 0.19

LimitationsLimitations• Subject to at least 5 limitations

– First, CHIS excludes individuals without telephones, therefore may have underestimated percent overweight

– Second, data is self reported thus validity of data is unknown

– Third, small sample size—thus some comparable estimates may be unreliable (e.g. percentage of overweight Latino males not accurate)

– Fourth-excludes individuals with cell phones exclusively (younger, etc)

– Fifth-the response rate is low (less than 40%)

SummarySummary

• Overall, 24.4% of Children were Overweight– Of those the highest prevalence

occurred among children aged 6-11 (32.3%) followed by children aged 0-5 (22.3%) and adolescents (17.8%)

– Girls aged 6-11 had higher prevalence of overweight compared to boys (37.3% Vs 28.4%)

SummarySummary• Overall all children were more

likely to be overweight if they were at <100% of the FPL, had Medi-Cal insurance, and consumed at least one soda

• Children aged 2-11 years were more likely to be overweight compared to their at risk counterparts if they had Medi-Cal insurance and consumed at least 1 soda

SummarySummary• Adolescents were more likely to be

overweight compared to their at risk counterparts if were at < 100% of the FPL, viewed 2 or more hours of television or video games M-F, consumed at least one soda and used a computer at least 2 hours daily M-F.

• Milk intake, muscle strengthening, fruit intake, vegetable intake and moderate physical activity (at least 30 minutes daily) were associated with children being less likely to be overweight

Questions?Questions?