Childhood Obesity and Cardiovascular Health

The AISD Administrative Supervisor for Physical Education, AISD Assistant Director of Comprehensive 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. Congruent with the national Presidential Youth Fitness Program (presidentialchallenge.org), AISD uses the Fitnessgram to measure student health. 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 and <85th percentile is considered normal range, while scores > 85th and < 95th percentile are considered overweight, >95thpercentile obese, and >99th percentile severely obese. These measures indicate that for School Year 2011-12, 39% of AISD students overall are overweight or obese and at risk of chronic disease (they are not in the Fitnessgram Healthy Zone). Rates vary by campus, grade, ethnicity, gender, neighborhood 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 Texas legislature has mandated that school nurses screen students for Type 2 Diabetes vulnerability based on acanthosis nigricans (AN), a skin discoloration associated with insulin resistance. 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. During School Year 2012-13, of the 26,258 students in grades 1,3, 5, and 7 screened, 2276 (8.7%) were referred to health providers. This suggests that at a minimum over 7500 AISD students (8.7% of 86,500 students) have an identifiable risk factor for developing diabetes due to having acanthosis nigricans. However the likelihood of having acanthosis nigricans increases with age, so students in high school likely have an even higher prevalence of acanthosis nigricans. For more information on AN please refer to the state legislative report (https://rfes.utpa.edu/resources/TRAT2DC_Legislative_Report_2013.pdf). Children with overweight and obesity are also at risk for additional current and future medical problems. Children with overweight/obesity are identified through the Fitnessgram’s BMI assessment. This measure indicates 34,000 AISD students are challenged by overweight or obesity.

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Based on findings returned from medical providers, only about 6% of students referred to a medical provider are found to be within normal limits, 50% of the students referred are found to be obese, and about 20% are found to be vulnerable for type 2 diabetes.

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

Through 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 Assistant Director of Comprehensive Health Services and Administrative Supervisor of Physical and Health Education are close collaborators with Children’s Optimal Health.

The maps below reflect measures of AISD middle school student cardiovascular (CV) health by neighborhood of residence from SY 2007-08 through SY 2011-12. 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 followed implementation of a PE curriculum innovation known as Hop Sports at targeted schools. 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. The most recent map suggests a reversing of progress near MendezMiddle School.  More information is available at www.cohtx.org. The information also reflects the value of mapping as a means of monitoring community change over time.

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Only 7 students have been identified by their parent/guardian as having Type 2 Diabetes in AISD in SY 2012-13, although over 3000 students in AISD have a BMI that is >99th percentile, reflecting severe obesity. 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). Children’s/AISD Student Health Services is beginning to implement obesity care plans to address the school health needs of extremely obese students.

The maps below, reflecting data from school year 2011-12, identify neighborhoods where high proportions of elementary, middle school and high school students are overweight/obese based on body mass index. Yellow, orange and red areas indicate where more than 50%, 60% and 70% of students are overweight or obese, respectively. These neighborhoods could benefit from focused community efforts to improve the health status of children.

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