School-Based Physical Fitness Testing Identifies Large Disparities in Childhood Overweight in Los Angeles

doi:10.1016/j.jada.2005.09.053

Journal of the American Dietetic Association

Volume 106, Issue 1, January 2006, Pages 118-121

https://doi.org/10.1016/j.jada.2005.09.053 Get rights and content

Abstract

Few data are available on the epidemic of childhood overweight in local jurisdictions. To determine the prevalence and identify demographic and socioeconomic correlates of childhood overweight, we assessed height and weight data on 281,630 Los Angeles County, CA, public school students collected during school-based physical fitness testing in 2001. Overweight prevalence was 20.6% overall and varied by race/ethnicity: 25.2% among Latinos, 20.0% among Pacific Islanders, 19.4% among blacks, 17.6% among American Indians, 13.0% among whites, and 11.9% among Asians. By using multilevel analysis, we found that school-level percentage of students enrolled in free or reduced-price meal programs was independently associated with overweight, after controlling for school-level median household income and student-level demographic characteristics. When local overweight prevalence data are unavailable, percentage enrollment in free or reduced-price meal programs might be a useful indicator to identify schools where focused overweight prevention and control interventions are most needed.

Section snippets

Methods

We followed policy of the US Department of Health and Human Services for protection of human subjects. The study was determined to be exempt from Institutional Review Board review because the analysis constituted public health surveillance and utilized a secondary data set that did not include personally identifying information. The study population consisted of Los Angeles County public school children in grades 5, 7, and 9 who underwent physical fitness testing during March through May 2001.

Results and Discussion

The demographic characteristics of the study population were similar to the characteristics of all enrolled children except that students in grade 5 were overrepresented in the study group (40.0% of the study population vs 34.5% of enrolled students) and students in grade 9 were underrepresented (27.6% of the study population vs 34.3% of enrolled students).

We found rates of overweight among Los Angeles County public school students that exceeded the rates reported nationally among children in

Multilevel Analysis

In the multilevel analysis, racial/ethnic disparities in overweight persisted and overweight was inversely associated with SES. With increasing quartiles, census tract household income was negatively associated with overweight (Model 1, Table 2) and the percentage of students enrolled in free or reduced-price meal programs was positively associated with overweight (Model 2, Table 2), controlling for sex, race/ethnicity, grade level, and hierarchical interdependency among students by school.

Conclusion

School-based physical fitness testing represents a valuable source of local surveillance data unavailable elsewhere. These data are an important resource for identifying demographic and socioeconomic disparities in childhood overweight and can be used to inform local efforts to control and reverse the epidemic of childhood overweight.

Our findings suggest that the percentage of students enrolled in free or reduced-price meal programs might be a useful school-level indicator to identify high-risk

N. E. Lee was an epidemic intelligence service officer, Epidemiology Program Office, Centers for Disease Control and Prevention, assigned to the Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services, Los Angeles, CA.

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In both urban and rural but not suburban areas, majority Latino schools are associated with highest availability of unhealthy food outlets and, in rural areas, with clustering of outlets near schools. Our findings extend prior work (Lee et al., 2006), by highlighting that socioeconomic disparities in the food environment are more pronounced in urban areas. Future studies should examine the relative effects of distance and quantity on children’s purchases, consumption of unhealthy foods and beverages, and prevalence of obesity and related disparities.
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Latinos, one of the fastest-growing population groups,1 experience higher rates of obesity and its serious physical and mental health consequences than their non-Latino white peers.2–6 They also are more likely to be sedentary and physically unfit.7–15 A local survey of 515 high school students in the target community (New Britain CT) found that Latinas had significantly higher rates of obesity, lower levels of physical activity, and a greater likelihood of receiving a failing grade in physical education than their African-American or non-Latino white peers (SM, unpublished observations, 2008).
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These limitations notwithstanding, our findings raise a concern that the significant efforts made in recent years to improve nutrition environments within schools, including policies mandating more rigorous nutrition standards for school meals and restrictions on foods and beverages sold in vending machines, may potentially be diminished if attention is not given to fast food outlets directly surrounding schools, especially in low income communities. These efforts are particularly important given the disproportionately high rates of childhood obesity in low income communities (Lee et al., 2006). In addition, the findings underscore the need for further research to assess the relationship between fast food proximity to schools and student dietary practices and obesity risk.
To investigate the proximity of fast food restaurants to public schools and examine proximity by neighborhood income and school level (elementary, middle, or high school).
Geocoded school and restaurant databases from 2005 and 2003, respectively, were used to determine the percentage of schools with one or more fast food restaurants within 400 m and 800 m of all public schools in Los Angeles County, California. Single-factor analysis of variance (ANOVA) models were run to examine fast food restaurant proximity to schools by median household income of the surrounding census tract and by school level. Two-factor ANOVA models were run to assess the additional influence of neighborhood level of commercialization.
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A. K. De is a biostatistician, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA.

P. A. Simon is director, Office of Health Assessment and Epidemiology, Los Angeles County Department of Health Services, Los Angeles, CA.

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ResearchResearch and Professional BriefSchool-Based Physical Fitness Testing Identifies Large Disparities in Childhood Overweight in Los Angeles

Abstract

Section snippets

Methods

Results and Discussion

Multilevel Analysis

Conclusion

J Am Diet Assoc

Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002

JAMA

Fitnessgram Reference Guide

California Physical Fitness Test 2001Report to the Governor and Legislature

CDC growth chartsUnited States

Adv Data

Epidemic increase in childhood overweight, 1986-1998

JAMA

Research
Research and Professional Brief
School-Based Physical Fitness Testing Identifies Large Disparities in Childhood Overweight in Los Angeles