Childhood Overweight in Sacramento County, 2001

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Childhood Overweight in Sacramento County, 2001
Cassius Lockett, Ph.D., MS Epidemiology Program
Manager Epidemiology Services Department of
Health and Human Services Sacramento County
2
Overview

• Public Health Importance
• Defining BMI
• Results
• Summarize

3
Public Health Importance

• Adult Obesity and Overweight among children is
  the largest health problem in the U.S.
• gt70 of overweight adolescents are expected to
  remain overweight into adulthood (Guo et al. Am J
  Clin Nutr 199459810-819)
• Prevalence U.S. adults, adolescents and children
  In 2002
• 55.9 of adults were overweight (BMI gt25 and
  lt29.9)
• 30.5 of adults were obese (BMI gt 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)
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Public Health Importance

• 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)
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Defining BMI

• Body Mass Index (BMI) is the recommended
  weight-for-height assessment method for all
  children gt2 years old and adults
• BMI weight (kg) / height2 (m2)
• Age and gender-specific cut-off values must be
  used for individuals lt 18 years of age

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Defining Overweight

• At-risk for overweight
• BMI gt 85th but lt 95th percentile for age and
  gender
• Overweight
• BMI gt 95th percentile for age and gender

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California Health Interview 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

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RESULTS
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Prevalence of Overweight Children by Age Group,
Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
10
Prevalence of Overweight Children by Age and Sex,
Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Physical Activity
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Prevalence of Overweight Adolescents by Activity
during the past 7 days, Sacramento County, 2001

• 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

Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Television Viewing and Video Game Hours
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Prevalence of Overweight Adolescents by
Television Viewing and Video Game Playing M-F,
Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Prevalence of Overweight by At Least 2 Hours of
Computer Use, M-F and Sat-Sun, Sacramento County,
2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Self Reported Food and Beverage Intake
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Prevalence of Food and Beverage Consumption,
Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Prevalence of Soda Consumption among Overweight
Children by Age Group, Sacramento, County 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
19
Prevalence of Food and Beverage Consumption by
Age Group, Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Prevalence of Overweight Adolescents by Soda
Consumption, Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Type of Insurance Poverty Level
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Prevalence of Overweight Adolescents by Type of
Insurance, Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Prevalence of Overweight among Children by
Federal Poverty Level, Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Prevalence of Adolescent Overweight by Federal
Poverty Level, Sacramento County, 2001
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Multivariate analysis, particularly Logistic
Regression

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

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Multiple Logistic Regression of Overweight Among
All Children aged 2-17 years, Sacramento County,
2001
Risk Markers AOR 95 CI
Federal Poverty Level (lt100) 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
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Multiple Logistic Regression for Overweight.
Children aged 2-11 years, Sacramento County, 2001
Risk Markers AOR 95 CI
Medi-Cal Insurance 11.67 10.60 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
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Multiple Logistic Regression of Overweight Among
Adolescents aged 12-17 years, Sacramento County,
2001
Risk Markers AOR 95 CI
Federal Poverty Level (lt100) 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
Source 2001 Sacramento County, CHIS, Adolescent
Public Use Files
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Limitations

• 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 sizethus 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)

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Summary

• 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)

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Summary

• Overall all children were more likely to be
  overweight if they were at lt100 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

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Summary

• Adolescents were more likely to be overweight
  compared to their at risk counterparts if were at
  lt 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

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Questions?