Iowa State University Extension

Problem:
Childhood overweight in American children is at an epidemic level. Data on childhood weight is available nationally and for some specific groups at state level but local data is difficult to find. Additionally, local data that is available may not have been gathered in a consistent manner, making it difficult to merge and quantify childhood weight in a county or school district.

A second concern for childhood overweight is the reaction parents have when told they have an overweight child. When weight data is gathered in a school setting by the school nurse, just like any health screening, schools feel responsible to share the data with parents. With most screening results, parents are appreciative of the information and willingly use the information to benefit their child. When weight information is provided, especially overweight, parents often respond negatively. For a variety of reasons, they feel it is their fault that a child is overweight.

Response:
In November 2006, Healthy Polk 2010 held a town hall meeting to discuss childhood overweight and its impact on the citizens of Polk County. As a result of this community discussion, it was determined there was a need for a base-line study of the current level of childhood overweight in the county. The Body Mass Index Baseline Study (BMI Project) focused on two aspects of childhood overweight:

1. BMI—collecting BMI data for a baseline understanding of childhood overweight in Polk County. BMI was collected for first and fifth graders in four school districts in Polk County. Children in first grade were measured because this is the age with the largest overall change in BMI. Early disposition of fat can also predispose youth to have future weight issues. Children in fifth grade were measured to provide a second point of data that may reflect their BMI status as they approach the adolescent growth spurt.

December 2007, nurses in Des Moines, West Des Moines, Saydel and Southeast Polk school districts were trained in standard measurement protocol by Dr. Greg Welk, Associate Professor in Health and Human Performance and Dr. Michelle Ihmels, Post-doctorate at Iowa State University. The training established procedures to ensure that the data was collected in a reliable and valid manner. A vital part of the project was providing a quality Stadiometer and scale for each school. Having the tools to keep is a great incentive for nurses to continue taking measurements and sharing with the BMI project. January-April 2008, school nurses measured students and provided the raw data to Drs. Welk and Ihmels. In June 2008, an initial report of BMI was provided for the Healthy Polk 2010 members.

2 . Focus Groups--Investigate how to work with parents when sharing BMI findings. Sharing of BMI data with parents has been controversial in many school districts so it is important to consider the most appropriate way to do this. Focus groups were conducted to obtain input from parents about how this information should be presented or used. Supporting families was the theme of the focus groups since many parents feel overly responsible for the overweight child. The findings from the focus groups will be used to help school districts determining how to share the individual data.

Two focus groups were held with one group recruited from Des Moines School District and the second from West Des Moines, Saydel and Southeast Polk Districts. Harvest Research Center, Des Moines, provided leadership with the focus groups by developing the focus group questions, recruiting participants, conducting focus groups and preparing a final report. The complete report is available on www.Healthypolk.org. ISU Extension led in securing funds for the project, chairing the planning meetings, recruiting schools to participate, worked with the researchers to secure findings and discrimination of findings.

Impact:
There were 6,378 students in the four districts within Polk County in 1st and 5th grades with computed BMI values which represent 94% of the total students in those grades. Of the 3,195 1st grade students, 66.3% of the BMI values were in the normal range based on the CDC standards. Another 2.3% were classified as underweight, while 16.0% were considered at-risk for overweight, and 15.5% of the students were classified as overweight. Of the 3,183 5th grade students, 58.9% of the BMI values were in the normal range based on the CDC standards. Another 3.3% were classified as underweight, while 17.0% were considered at-risk for overweight and 20.8% were classified as overweight. Unfortunately, there were fewer students in the 5th grade cohort classified as normal (7.4% less) while there were 6.3% more students classified as at-risk for overweight or overweight. These values reflect the national trend of children moving from normal weight to at-risk for overweight or overweight as they age.

Based on the assessment of the focus group research results, there were several key areas that will play a key role in how successful the schools will be in providing individual data to parents and helping them use the data. The key areas are:

Awareness of School Involvement in Weight Screening
Techniques for Dissemination of BMI Data
BMI Screening Incorporated into Lifestyle Changes
Communications and BMI Screening as a Partner
Education on the Use of the BMI Data for a Child

Presently, BMI data collected through this project will be managed by the Polk County Health Department. Requests for the data will be provided at the county level. School districts and individual school buildings will be able to access their specific data. While we have 65% of the targeted students in the first year data, we would like to recruit other districts to participate in the data collection. In late summer 2008, the findings will be presented to the Polk County School Nurse Consortium group. Included in the presentation will be an offer to schools not participating to join the project and receive training as well as the specific equipment needed to provide accurate data. Des Moines Schools report that they are committed to continuing to submit data on their first and fifth graders and have purchased equipment for their middle and high schools as well.

Using the focus group findings, we want to pursue a process that would allow a fitness report card feature that might be able to be used by Physical Education teachers at conferences or with the regular report card. This will mean involving and engaging Physical Education teachers in the development and planning process. We are discussing ways to encourage this next step in making the BMI data part of the lifestyle changes needed for our children.

Additional Team Members/Community Partners:
Polk County Health Department- Rick Kozin, Health Planner
ISU- Greg Welk, Asso. Prof. Health Human Performance

Contact:
Susan B. Klein
Polk County Extension
5201 NE 14th Street
Des Moines, IA 50313
515-261-4213
sklein@iastate.edu