The Arkansas Experience In Combating Childhood Obesity
The ArkansasExperience inCombatingChildhood ObesityJoseph W. Thompson, MD, MPHSurgeon General, State of ArkansasDirector, Arkansas Center for HealthImprovementAssociate Professor, University ofArkansas for Medical SciencesNew Approaches to StateSurveillance of Children’s BMISeptember 15, 2008
84th General Assembly Act 1220 of 2003An act to create a Child Health Advisory Committee; tocoordinate statewide efforts to combat childhoodobesity and related illnesses; to improve the health ofthe next generation of Arkansans; and for other purposes.Goals: Change the environment within which children go toschool and learn health habits everyday Engage the community to support parents and build asystem that encourages health Enhance awareness of child and adolescent obesityto mobilize resources and establish supportstructures
Act 1220 Requirements1. Establishment of an Arkansas Child HealthAdvisory Committee2. Vending machine content and access changes3. Physical activity / education requirements4. Requirement of professional education for allcafeteria workers5. Public disclosure of “pouring contracts”6. Establishment of local parent advisorycommittees for all schools7. Confidential child health report deliveredannually to parents with body mass index (BMI)assessment
National Childhood Obesity TrendsPercent Overweight25201510US 12-19 yr5US 6-11 yr01963-651971-741966-701976-801988-9401-0299-00 03-04NHANES data sources: Ogden et al. Prevalence and Trends in Overweight Among US Children andAdolescents, 1999-2000. JAMA 2002;288(14):1728-1732. Ogden et al. Prevalence of Overweightand Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555.
Percentage of Arkansas Students byWeight Classification (Grades K–12)CategoryYear 1(’03–’04)Year 2(’04–’05)Year 3(’05–’06)Year 4(’06–’07)Overweight20.9%20.8%20.5%20.6%At risk foroverweight17.2%17.2%17.1%17.2%Healthy 68,871369,416366,801UnderweightTotal studentsassessed**Results include all data available for years 1, 2 and 3 for grades K–12 and data received by June 6, 2007 for year 4. Data source:Arkansas Center for Health Improvement. Year Four Assessment of Childhood and Adolescent Obesity in Arkansas (Fall 2006–Spring 2007), Little Rock, AR: ACHI, September 2007.
National and Arkansas Childhood Obesity Trends22.02521.521.02020.019.515AR grades 7-12AR grades K-620.5Avg N 150,881Avg N 212,011AR grades K-6AR grades 7-1203-04 N 98103-04 N 2,15919.0200420052006200710US 12-19 yr5US 6-11 yr01963-651971-741966-701976-801988-9401-02 04 0699-00 03-04 05 07NHANES data sources: Ogden et al. Prevalence and Trends in Overweight Among US Children and Adolescents,1999-2000. JAMA 2002;288(14):1728-1732. Ogden et al. Prevalence of Overweight and Obesity in the UnitedStates, 1999-2004. JAMA 2006;295(13):1549-1555.Arkansas data source: Arkansas Center for Health Improvement, Little Rock, AR, September 2007.
Child Health Report (2004)Spanish-language versionswere made available in 2005Source: Arkansas Center for Health Improvement, Little Rock, AR, 2004.
Participation in Arkansas BMI Assessments (Grades K–12)Year 1 (’03–’04)CategoryYear 2 (’04–’05)Year 3 (’05–’06)Year 4 Student dataValid foranalysisInvalidUnable 622.2%105,110*Results include all data available for years 1, 2 and 3 for grades K–12 and data received by June 6, 2007 for year 4. Some public schools and districtsmerged after year 2. The most common reason students were not assessed for BMI was absence from school (of total reporting 6.3 percent in year 1, 7.6percent in year 2, 6.7 percent in year 3 and 8.1 percent in year 4). Annually up to 6 percent of students or their parents refuse to participate. Data source:Arkansas Center for Health Improvement. Year Four Assessment of Childhood and Adolescent Obesity in Arkansas (Fall 2006–Spring 2007), Little Rock,AR: ACHI, September 2007.
Percentageof studentsclassified asoverweightor at risk foroverweightby Arkansaspublicschooldistrict(’06–’07)Pea RidgePea RidgeOmahaCarrollBentonville Rogers Eureka Springs Green nWest ForkDeer/Mt. JudeaWashington GreenlandMountainburgCedarvilleJasperOzarkAlma MulberryClarksville LamarLavaca County leTwo RiversEast ntWoodruffMontgomeryPolkCaddo HillsVan roveGurdonFordyceBlevinsForemanHopeHempsteadSpring HillNevadaOuachitaTexarkanaStephensGenoa ottEmerson-TaylorHamburgEl DoradoParkers ChapelBradleyHermitageLakeside #1MagnoliaFoukeLafayetteDrewDrew CentralHamptonBradleyColumbiaJunction CityPhillipsMarvellPercentage of StudentsOverweight orAt Risk for Overweight(2006-2007):McGeheeCalhounSmackover NorphletHelenaW. exaWarrenCamden FairviewWest MemphisStuttgartStar CityClevelandHarmony GroveNevadaMarionCrittendenSt. eClevelandCountyPrescottMineral SpringsLittle ed Tree EastLee CountyLonokeLonoke CarlisleLittle yBrinkleyPrairieFountain LakeMountain PineEnglandBentonCutter MorningHarmony GroveHotBauxiteGarlandSpring StarGlen RoseLake HamiltonLakesideMagnet CoveJeffersonGrant White HallDollarwayPoyenBismarckSheridanHot SpringDollarwayCenterpointOuachita MalvernWatson Chapel Pine BluffMurfreesboroDeQueenManilaMississippiWeiner HarrisburgForrest CityPalestine/WheatleyDes ArcCabotArmorelBlythevilleAugustaRiverviewMount IdaMenaEastTrumann PoinsettCrossPulaskiOuachita RiverBayCross CountyViloniaNorth Little RockSalineJessievilleRiversideMcCroryPulaski County SpecialOuachita RiverNettletonValley rdWhiteConwayJonesboro reenbrier Mt. Vernon/EnolaSouth Conway CountyCraigheadPoinsettVan BurenPottsville AtkinsDardanelleMagazineJackson CountyCedar RidgeSouth SideWhitePangburn CountyQuitmanCentralWonderviewNemo VistaRose BudGuy-PerkinsBald KnobSearcyPopeParisLawrenceSouthsideHeber SpringsWestsideHartfordDover HectorJohnsonVan BurenHackett GreenwoodCleburneClintonGreeneGreene County TechHoxieIndependenceBatesvilleShirley West Side eParagouldLawrence CountyHillcrestCave CityCushmanMountain e CountySearcy CountyNewtonWest ForkRectorRandolphSharpMelbourneSearcyCorning ClayTwin RiversIzardJasperPiggottMaynardIzard County ConsolidatedNorforkCalico RockOzarkMountainHuntsvillePrairie GroveMammoth SpringSalemHighlandAlpenaHarrisonOzarkValley ippinHarrison rMarionBooneBergmanBentonGentryMountain HomeLead HillStrong-HuttigCrossettNo Data20 - 30%30 - 40%40 - 50%50 - 60%ChicotAshleyUnionSource: ACHI. Assessment of Childhood and Adolescent Obesity in Arkansas: Year 4 (Fall 2006–Spring 2007). Little Rock, AR:ACHI; September 2007.
Challenges Overcome Initiative viewed as an unfunded mandate onschools Concerns about use of academic time for healthscreenings Concerns about potential negative consequences(e.g., eating disorders, labeling of children) Responsibility for developing and implementingBMI assessments not outlined in legislation Issues related to conducting large-scalescreening: confidentiality; standardization ofprotocol, equipment, and reporting; dataoversight
Lessons Learned on Implementation Regular, reliable communication withstakeholders is essential Information exchange had to be multidirectional—program leaders, school staff, statedepartments, parents BMI assessments are fundamentally similar toother school-based health screens Standardized and simple measurement protocolis critical Equipment had to be readily attainable,affordable, and easy to use
UAMS College of Public HealthEvaluation of Act 1220 (2008) Surveys of school administrators and personnel, parents, andoverweight adolescents:– Assessments were helpful to parents– No substantial negative consequences of BMI assessments havebeen identified– Superintendents and principals did express concern about timetaken away from academics– Increase in school policies and practices, such as limiting “junkfoods” that support healthy eating in schools– Significant increase in percentage of parents who signed theirchildren up for sports or exercise classes– Parents did not report an increase in inappropriate dietingamong their children– Parents did report modest changes in family diet and nutritionpatterns– Students physical activity has increased since the first year;percentage in physical education has declined
Amending Act 1220 – Acts 201, 719, & 317of 2007 Child Health Advisory Committee with 5 newmembers and broadened scope. Changes BMI screening periodicity to every 2 yearsfor individuals (grades K, 2, 4, 6, 8, 10 annually);parallels other health screens. Parents must provide a written refusal to keepchild from participating. Protocol adherence required across schooldistricts. Eliminates physical activity for all but K-5. New Health Report to include all screenings.
Joe ThompsonDirector, ACHISurgeon General, State of Arkansas1401 West Capitol AvenueSuite 300, Victory BuildingLittle Rock, AR 72205E-mail: ThompsonJosephW@uams.edu(cc: DBertelin@uams.edu)www.achi.net
National and Arkansas Childhood Obesity Trends NHANES data sources: Ogden et al. Prevalence and Trends in Overweight Among US Children and Adolescents, 1999-2000.JAMA 2002;288(14):1728-1732. Ogden et al. Prevalence of Overweight and Obesity in the United States, 1999-2004.
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