Promoting Healthy Lifestyles

childhood_obesity_and_cardiovascular_healthThe AISD Administrative Supervisor for Physical Education, Administrative Supervisor of Student Health Services, SHS Medical Director and Student Health Services Clinical Managers all work in close collaboration to address the issue of childhood obesity and its prevention. The School Health Advisory Council (SHAC) provides additional community input, feedback and support. The SHAC is a legislatively mandated body in Texas, with members appointed by local school boards to advise administration and school boards on issues pertaining to comprehensive health education and health issues. A number of community partners are also involved in these efforts.

There are two state-mandated measures intended to identify students at risk for obesity-related chronic disease, particularly Type 2 Diabetes. AISD Fitnessgram data is collected by AISD Physical Educators on students in grades 3-12. A key measure taken is the Body Mass Index (BMI), which is based on a student’s height, weight, gender and age. A BMI percentile between the 5th and85th and < 95th percentile are considered overweight, >95th percentile obese, and >99th percentile severely obese. These measures indicate that 38% of elementary and middle school students and 30% of high school students (35% of AISD students overall) are overweight or obese and at risk of chronic disease. Rates vary by campus, grade, ethnicity, gender and economic disadvantage. For instance, in SY 2008-09 the obesity rate (BMI>95%ile) at middle schools ranged from 8.6% on one campus to 32.1% on another. Use of Fitnessgram data has helped guide systemic change including policy, curriculum, health system and community interventions to support the health of all students.

In addition, the state has mandated that school nurses screen students for Acanthosis Nigricans, a skin discoloration associated with insulin resistance and vulnerability for Type 2 Diabetes. Students with the skin discoloration receive additional health assessments such as body mass index and blood pressure. Those students with a grade 4 skin discoloration or the discoloration in combination with another factor such as elevated blood pressure are referred for medical follow-up. This screening has recently been re-named the Type 2 Diabetes Screening. D 2011-12, of the 24,612 students screened, 1,546 were referred to health providers. Results of referrals were available for 125 students of 120 (96% of those for whom results were available) had medical findings, with treatment plans developed.

Children’s/AISD Stuchildhood_obesity_and_cardiovascular_health_2-300x264dent Health Services, working collaboratively with the AISD Supervisor of Health Services, Physical Educators and 504 Coordinators, has been developing an obesity case management program and is targeting its use for the more than 3000 students who are severely obese (BMI>99th %ile). During SY 2010-11 and SY 2011-12, case management pilots have been implemented. In SY 2011-12 a pilot program at one middle school was implemented, intended to assist students in improving healthy nutrition and physical activity through coordinated activities with their PE Teacher, school nurse, counselor and cafeteria manager as well as parent involvement. The program was well-received by participants who found group support and reduced stigma helpful. Process analysis reflects that it is very time-intensive to secure physician orders and parental consent to provide obesity case management in the schools.

Student Fitnessgram data has been integrated into the student’s health record via the Student Health Information System (SHIS). School nurses now have access to the student’s BMI measures. Progress has also been made in improving the collaboration process between AISD Physical Educators and nurses for referring students to medical care who are identified with a BMI> 99th percentile.

A Program of AISD: Systemic Approach to Child Obesity Reduction

Elementary School Coordinated School Health (CSH)

  • Teachers provide 5 health and/or 5 Coordinated Approach to Child Health (CATCH) lessons every 9 weeks.
  • Campuses will show evidence of an environmental change using Coordinated School Health (CATCH) materials (announcements, newsletters, posters, go/slow/whoa signage, etc. around campus and in classrooms).
  • Campuses have two family fitness fun nights per year (Fall/Spring). ACTION: May utilize existing events to incorporate a CSH/CATCH message.
  • All elementary teachers will participate in providing students with 135 min weekly or 30 minutes per day of physical activity.
  • Elementary teachers will use the Workout for Wellness (WOW) activities. ACTION: Beginning in SY 2012-13, health and structured physical activity are separate grades on the Elementary report card under personal development

Middle School Coordinated School Health

  • Middle school science, advisory, and PE teachers will teach CATCH/health lessons through their respective subject areas.
  • All middle school students will be enrolled and participate in four semesters overall of physical education.

Fitnessgram

  • 100% of students in grades 3-8 regular PE class will be assessed using Fitnessgram. ACTION: Students are measured once in the fall and spring, or at the beginning and end of semester courses.
  • The campus, through the school nurse, will communicate with parents and students if they are overweight or obese > 85th % ile BMI.
  • Students with a multiyear BMI >99th% ile will, through a pilot program dependent on available resources, have the opportunity to be case managed for obesity, and if interested, receive interventions through the 504 program.
  • Principals will provide the campuses Fitnessgram report to teachers, parents, and CAC annually.

Nutrition and Wellness Policy

  • Campuses will comply with nutrition policy and wellness policy (AISD FAA local).
  • Campuses will identify three events in which the campus will be exempt from the Texas Public School Nutrition Policy TPSNP.
  • Teachers will use alternative rewards instead of food.

A Program of Children’s Optimal Health

childhood_obesity_and_cardiovascular_health_3-300x249Through collaboration with Children’s Optimal Health, AISD and the Austin community can now identify neighborhoods where health-challenged students are concentrated, based on measures of body mass index and cardiovascular health. This knowledge can assist the community in partnerships with AISD to focus resources to improve the health of its children. The SHS Medical Director, Quality Improvement contractor and the AISD Administrative Supervisor for Health Services are close collaborators with Children’s Optimal Health.

For Middle School students in SY 2009-10, the most recent year for which analyzed data is available, some neighborhoods have high proportions of students who are overweight/obese and who failed the cardiovascular component of the Fitnessgram. These neighborhoods could benefit from focused community effort to improve the health status of children.

The maps below reflect a three year series (SY 2007-08 to SY 2009-10) of AISD middle school student cardiovascular (CV) health by neighborhood of residence. The series identifies improvements in CV scores over time, within neighborhoods. Improvements appear as reductions in the proportion of students who fail CV testing. This improvement could be due to a combination of improvement in students’ cardiovascular fitness and due to increased motivation to complete the test. Both would be seen as a significant improvement over time. More information is available at www.cohtx.org.

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Twenty students have been identified by their parent/guardian as having Type 2 Diabetes in AISD in SY 2011-12. According to the Texas Diabetes Council, studies show that, regardless of ethnicity, more than 20 percent of severely overweight children and adolescents have Impaired Glucose Tolerance, or pre-diabetes (http://www.dshs.state.tx.us/diabetes/dcyouth.shtm). This suggests under-diagnosis in the medical community and/or under-reporting by parents to school nurses that their student has the condition. There are over 3000 students in AISD whose BMI is >99th percentile. Children’s/AISD Student Health Services, working with the AISD Health Coordinator and Physical Educators, is beginning to implement obesity care plans to address the school health needs of extremely obese students. Many of these students are already experiencing impaired health due to their obesity.