DefinitionPercentage of adolescents (students in grades 9-12) who provided height and weight on the [http://www.cdc.gov/healthyyouth/data/yrbs/index.htm Youth Risk Behavior Survey (YRBS)] with a body mass index (BMI) at or above the sex- and age-specific 95th percentile based on the CDC Growth Charts. Obesity is determined by calculating the individual's BMI and comparing it to age and sex standardized growth charts distributed by the Centers for Disease Control and Prevention.^1^ Adolescents are considered obese if their BMI is greater than the 95th percentile for BMI. Weight status is computed on the Youth Risk Behavior survey (YRBS) using two questions: "How tall are you without your shoes on?" (responses in feet and inches) and "How much do you weigh without your shoes on?" (responses in pounds).[[br]]
1. U.S. Centers for Disease Control and Prevention. National Center for Health Statistics. Growth Charts. [http://www.cdc.gov/growthcharts/clinical_charts.htm].
NumeratorWeighted number of adolescents (students in grades 9-12) whose responses for height and weight on the YRBS indicate a BMI at or above the sex- and age-specific 95th percentile based on the CDC Growth Charts.
DenominatorWeighted number of adolescents (students in grades 9-12) with complete and valid responses for height, weight, age, and sex on the YRBS.
Data Interpretation IssuesAlaska has conducted a statewide Youth Risk Behavior Survey in 1995 and biennially from 2003. Weighted data were not obtained in 2005 and therefore no statewide estimates are available for that year. A YRBS survey conducted in 1999 did not include the Anchorage School District and therefore was not considered a valid statewide estimate. No YRBS survey was conducted in Alaska in 1997 and 2001.
Traditional high schools are sometimes called comprehensive high schools. They are public high schools that are distinct from alternative high schools, which serve students at risk of not graduating, charter schools, correspondence schools, and students enrolled in high school in correctional facilities.
Responses are weighted to reflect youth attending public traditional high schools in Alaska.
The ability to compute BMI has been present on the YRBS since 2003.
Why Is This Important?Overweight and obesity affect a large proportion of the Alaska population and there has been an increase in the number of obese persons over the last decade. Many diseases and adverse health outcomes are associated with overweight and obesity, including high blood pressure, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and some types of cancer. An unhealthy diet and a lack of physical activity are both key contributors to rising obesity rates.^2^ It has been projected that, due to obesity, today's children may be the first generation to have a shorter life expectancy than their parents.^3^[[br]]
2. U.S. Department of Health and Human Services. The Surgeon General's Vision for a Healthy and Fit Nation. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, January 2010. [http://www.ncbi.nlm.nih.gov/books/NBK44660/pdf/Bookshelf_NBK44660.pdf].
3. Olshansky SJ, Passaro DJ, Hershow RC et al. A potential decline in life expectancy in the United States in the 21st century. NEJM 2005;352(11):1138-45.
Other ObjectivesHealthy Alaskans 2020 Leading Health Indicator 5.a.ii: Reduce the percentage of adolescents (high school students in grades 9-12) who meet criteria for obesity (age- and sex-specific body mass index of >=95th percentile) to 10% by 2020.
Healthy People Objective NWS-10.3:
Reduce the proportion of children and adolescents who are considered obese: Adolescents aged 12 to 19 years
U.S. Target: 16.1% as measured by the National Health and Nutrition Examination Survey (NHANES) for adolescents aged 12 to 19 years.
Different surveillance systems are used to monitor Healthy Alaskans and Healthy People objectives, therefore the targets and rates cannot be compared. The Healthy People objective, based on NHANES, for adolescent obesity is based upon a clinical examination of height and weight. The Healthy Alaskans objective, based on YRBS, uses self-reported measures. The reporting years for the two surveillance systems differ as does the definition of adolescents with NHANES using individuals aged 12 to 19 years and YRBS defining adolescents as students attending grades 9-12.
How Are We Doing?In 2017, rates of obesity among adolescents (high school students in grades 9-12) were 13.7% for all Alaska adolescents and 14.2% for Alaska Native adolescents, both above the Healthy Alaskans 2020 goal of 10%.
How Do We Compare With the U.S.?In 2017, the obesity rate was 14.8% for the national average compared to 13.7% for the average Alaskan adolescent (grades 9-12) and 14.2% for Alaska Native individuals. The national adolescent rate of obesity recorded by the YRBS has been slowly increasing since 2009.
According to data from the 2015-2016 National Health and Nutrition Examination Survey, adolescent (defined as 12-19 years of age for this survey) obesity was 20.6%, above the Healthy People 2020 objective of 16.1%.^4^[[br]]
4. Hales, CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS data brief, no 288. Hyattsville, MD: National Center for Health Statistics. 2017.
[https://www.cdc.gov/nchs/data/databriefs/db288.pdf]. Accessed July 20, 2018.
What Is Being Done?The mission of the Obesity Prevention and Control Program is to prevent and reduce obesity among Alaskans though the promotion of physical activity and good nutrition. The program:
[[br]]a) manages the Play Every Day campaign, Community Nutrition efforts, Early Care and Education (ECE) Obesity Prevention Partnerships, the Obesity Prevention School Partnerships and supports Healthy Futures;
[[br]]b) serves as a credible source of information on the causes, health and economic consequences of obesity;
[[br]]c) provides information to the public, health professionals, and the media;
[[br]]d) maintains systematic collection, analysis, evaluation and reporting of obesity prevalence and related physical activity and nutrition behaviors;
[[br]]e) identifies population groups at greatest risk for the health threats of obesity;
[[br]]f) develops partnerships with and provides leadership to a wide variety of private and public agencies;
[[br]]g) provides technical advice and support to partners in implementing obesity prevention strategies;
[[br]]h) facilitates the Alaska Alliance for Healthy Kids that works to prevent childhood obesity; and
[[br]]i) facilitates the Alaska Food Policy Council that works to strengthen Alaska's food systems to spur local economic development, increase food security, and improve nutrition and health.^5^[[br]]
5. Alaska Food Policy Council. [https://akfoodpolicycouncil.wordpress.com/].
Evidence-based PracticesAs part of the Healthy Alaskans 2020 health improvement process, groups of Alaska subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities.
[[br]]Implement a comprehensive social marketing campaign promoting nutrition and physical activity. Choose campaign topics strategically; examples include limiting sugary drinks and the importance of family meals.
[[br]]Citing The Community Guide and other reviews, the CDC recommends community-wide campaigns as effective in increasing physical activity, a contributing factor to maintaining a healthy weight.
[[br]]Centers for Disease Control and Prevention. Increasing physical activity: A report on recommendations of the Task Force on Community Preventive Services. MMWR. 2001; 50 (RR-18): 1-16.
[http://www.thecommunityguide.org/pa/index.html The Community Guide]
Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med. 2002; 22(4s): 73-107.
[[br]]Increase the number of breastfeeding-friendly maternity facilities.
A systematic review from the Agency for Healthcare Research and Quality (AHRQ) concluded that infants who are not breastfed are more likely than breastfed infants to experience a number of poor health outcomes, including obesity (Ip et al., 2007). A Cochrane review of studies found that one effective approach for increasing breastfeeding initiation and duration rates is through support for institutional changes in maternity care practices (Fairbank et al., 2000). Specifically, the Baby-Friendly Hospital Initiative has been demonstrated to lead to improved breastfeeding rates (Philipp et al., 2001).
Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess. 2007; (153): 1-186.
Fairbank L, O'Meara S, Renfrew MJ, Woolridge M, Sowden AJ, Lister Sharp D. A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding. Health Technol Assess. 2000; 4(25):1-171.
Philipp BL, Merewood A, Miller LW, et al. Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics. 2001; 108(3):677-681.
Adopt and implement new school physical activity and nutrition policies, also known as "wellness policies".
Many of the evidence-based strategies to address childhood obesity (such as promoting quality PE and health education, and establishing a Safe Routes to School program) depend on the support of schools, communities, and parents to implement. Therefore a strategy recommended by the CDC, US DHHS and the IOM is to support the adoption and implementation of school physical activity and nutrition policies (also known as "wellness policies") by school districts.
[http://www.cdc.gov/healthyyouth/npao/strategies.htm CDC School Health Guidelines]
Institute of Medicine. Progress in preventing childhood obesity: How do we measure up? Koplan JP, Liverman CT, Kraak VI, Wisham, SL editors. Washington: National Academies Press; 2007.
US Department of Health and Human Services. The Surgeon General's Vision for a Healthy and Fit Nation. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General, January 2010.
USDA Healthy, Hunger-Free Kids Act of 2010 SEC. 204 [http://www.gpo.gov/fdsys/pkg/PLAW-111publ296/pdf/PLAW-111publ296.pdf Local School Wellness Policy Implementation]
A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_5_Overweight_Youth.pdf].