Healthy Weight

Assessment

Project (HWAP)

New Mexico Public Health Association Annual

Conference

4/2/14

Andrea Cantarero, BSEH

Tom Scharmen, MPH

Elizabeth Yakes Jimenez, PhD, RD

Peter Kinyua, PhD

Tom Genne, MA

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

Underweight Normal Weight Overweight Obese

80%10%5% 5%

The latest trends in

childhood obesity…

Source: Ogden et al. 2014

NATIONAL DATA (N=3355)

Source: New Mexico Childhood Obesity 2013 Update

NEW MEXICO DATA (N=7731)

5.0

0%

10%

20%

30%

40%

50%

60%

70%

80%

2 YRS 3 YRS 4 YRS

HEALTHY WEIGHT (5th - 85th)

OVERWEIGHT OR OBESE (>85th)

OBESE (>95th)

OVERWEIGHT (85th - 95th)

EXTREMELY OBESE (>97th)

UNDERWEIGHT (<5th)

PERCENT LOW INCOME TODDLERS IN BMI PERCENTILE CATEGORIES, BY AGE, 2013DOH-WIC STATEWIDE, 2013 DATASET

NEW MEXICO DATA (N=20973)

0%

10%

20%

30%

40%

50%

60%

70%

80%

5 YRS 6 YRS 7 YRS 8 YRS 9 YRS 10 YRS 11 YRS 12 YRS 13 YRS 14 YRS

HEALTHY WEIGHT (5th - 85th)

OVERWEIGHT OR OBESE (>85th)

OBESE (>95th)

OVERWEIGHT (85th - 95th)

EXTREMELY OBESE (>97th)

UNDERWEIGHT (<5th)

ALBUQUERQUE DATA (N=141773)

PERCENT STUDENTS IN BMI PERCENTILE CATEGORIES, BY AGE, 2008-2013DOH-APS 2008-2013 TREND DATASET

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

CommunitySES, food access, crime, safety,

walkability

Schoolphysical activity and nutrition policies,

curriculum, menus, food vendors

Family

household makeup, location, SES, language use

Childage, 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

NHANES 2011-2012

N=3355 (ages 2-19)

Healthy Kids NM

N=7731 (K & 3rd)

School Year Sample Size

2007-2008 22278

2008-2009 24851

2009-2010 25982

2010-2011 26137

2011-2012 24595

2012-2013 18818

…because it is longitudinal

102,229 individual students

37385 repeat measures

10 longitudinal cohorts

2978 measured 3 times

2 longitudinal cohortsStudents 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

Enrollment Cohorts

Percent of Students in Weight Categories Over Time

NM 3rd Grade

2013 cross-sectional

NM K Grade

2010 cross-sectional

Different students from different samples across the state

3.6

3.8

69.0

62.9

14.4

15.4

12.9

17.9

Kindergarten

Third GradeAPS 3rd Grade

2010-2013

APS K Grade

2007-2010

Same students measured 3 years later

5.0 80.0 10.0 5.0Standard Reference

(Healthy Goal)

A closer look at APS weight progression from K to 3rd…

K Grade BMI% 3rd Grade BMI%

2400

2000

1600

1200

800

400

Nu

mb

er o

f Stu

den

ts

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

Obese 3rd graders =

Healthy Weight and Equity

in Albuquerque

How is student weight status related to…?

Income

Race/ethnicity

Disability

Academic achievement

School attendance

And more…

3.5%

63.5%

15.8%

33.0%

17.2%

12.1%

3.9%

58.7%

16.0%

37.4%

21.4%

15.7%

0%

10%

20%

30%

40%

50%

60%

70%

UNDERWEIGHT (<5th) HEALTHY WEIGHT (5th- 85th)

OVERWEIGHT (85th -95th)

OVERWEIGHT OROBESE (>85th)

OBESE (>95th) EXTREMELY OBESE(>97th)

NO DISABILITY

DISABILITY

PERCENT STUDENTS IN BMI PERCENTILE CATEGORIES, BY DISABILITY STATUS, 2008-2013DOH-APS 2008-2013 TREND DATASET; N= 142,661

DISABILITY

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