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 2014-15, 39% of AISD students overall are overweight, obese or severely 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. Over 2000 students (4%) were identified as severely obese and thus at the highest risk for chronic disease. 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 conduct a risk assessment for Type 2 Diabetes, based on 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 2014-15, of the 26,320 students in grades 1, 3, 5, and 7 screened, 1462 (5.6%) were referred to health providers. The likelihood of having the skin discoloration increases with age, so students in high school likely have a higher prevalence, but they are not screened under the mandate. For more information, 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 which indicates 34,000 AISD students are challenged by overweight or obesity.
Based on findings returned from medical providers, only 8.3% of students referred to a medical provider are found to be within normal limits, 23.3% were found to have a diabetes risk, and 5.0% of the students referred are found to be obese.
AISD has over time implemented sustainable systems based on operational guidelines to prevent and address childhood obesity. These include a Coordinated Approach to Child Health (CATCH), nutrition and wellness policies, in addition to the use of Fitnessgram as a metric for monitoring student health status. 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 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 consultant 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, and improvement is observed across many neighborhoods. 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 Mendez Middle 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.
Only 24 students have been identified by their parent/guardian as having Type 2 Diabetes in AISD in SY 2014-15, 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). School nurses referred 70 students for health risk management and 78 students for obesity reduction in School Year 2013-14. Following a pilot, Children’s/AISD Student Health Services is beginning to implement obesity care plans to address the school health needs of extremely obese students. Clinical Managers will provide reinforcement training to RNs related to referral processes for students in need.
The maps below reflect neighborhood hot spots where high proportions of students are at health risk due to overweight or obesity, as measured by body mass index (BMI). The maps reflect BMI measures of AISD middle school students annually, over a 6 year period. Yellow, orange and red areas indicate where more than 50%, 60% and 70% of students are overweight/obese. These neighborhoods could benefit from focused community efforts to improve the health status of children.