Our Greatest Challenge:
Childhood Overweight & Obesity
San Joaquin County Public Health
CHDP Fact Sheet
November 2010
2009 CHDP data highlights ongoing epidemic
Did you know?
Nearly 1 in 3 San Joaquin Co.
preschoolers, aged 2 to < 5,
receiving CHDP health
assessments in 2009, were
overweight or obese.
More than 2 in 5 San Joaquin
Co. youth, aged 5 to < 20,
receiving CHDP assessments
in 2009, were overweight or
obese.2
What’s the difference between
overweight and obesity?
Body Mass Index (BMI) is a reliable indicator
of body fat for most children and
adolescents. Growth percentiles are used to
evaluate the size and growth patterns in
individual children. The percentile indicates
the relative position of the child's BMI
number among children of the same sex and
age. Risk for associated health conditions
r i s e s a s B M I -f o r- a g e p e r c e n t i l e
increases to the levels described as
“overweight” and “obesity”. Weight status
categories and the corresponding percentiles
are shown in the following table:
Weight Category
Body Mass Index-for-age
Percentile Range
Underweight
< 5th percentile
The high prevalence of overweight and obesity in the children and adolescents
of San Joaquin County (SJC) continues to be a major public health challenge.
Over the last ten years, the USA and SJC have made little progress towards
reducing this high prevalence.1 The latest data for SJC demonstrates that
among children who received CHDP health assessments in 2009, over 31 %
aged 2-<5 years and over 40% aged 5-<20 were overweight or obese.2 As
Body Mass Index-for-age percentile increases into the overweight or obese
range, so do serious risks for cardiovascular, endocrine, gastrointestinal,
orthopedic, psychological and pulmonary conditions.3 Examples of these
conditions with epidemic rates among the CHDP population in SJC include4:
high blood cholesterol
type 2 diabetes
depression; low self-esteem
asthma; sleep apnea.
The source of these statistics as well as those that follow is the Pediatric
Nutrition Surveillance System (PedNSS) at the Centers for Disease Control and
Prevention. PedNSS is the only source of nationally compiled obesity
surveillance data for preschool-aged children participating in federally funded
health and nutrition programs.5 In California, the data are submitted
exclusively from CHDP health screening exams. In addition, California is the
only state that submits data for adolescents, thus providing valuable
information about overweight and obesity in school-aged children
participating in federally funded programs. Data tables and reports are
published for the nation, state or tribal group, and by county or reporting area.
The most recent data for SJC is summarized in the two charts below.
Body Mass Index-for-Age Distribution in Low-income Children and Teens Receiving
CHDP Health Screening Exams in San Joaquin County in 20093
Combined overweight and obese
31.1%
2-<5 years
64.9%
4%
16.4%
14.7%
Combined overweight and obese
Healthy weight
Overweight
Obese
5th - 84th percentiles
85th - 94th percentiles
40.1%
5-<20 years
3%
56.9%
17.3%
22.8%
≥ 95th percentile
Underweight
Healthy weight
Overweight
Obese
Com bined Overw eight and Obese 5 - <20 Year Olds Receiving CHDP Health Screening Exam s in San
Joaquin County and in California, 2007, 2008 & 2009
50.00%
45.00%
40.00%
35.00%
2007
30.00%
2008
25.00%
2009
20.00%
15.00%
10.00%
5.00%
0.00%
White SJC
Black SJC
Hispanic
SJC
Asian SJC
Filipino SJC
All Other
SJC
TOTAL SJC TOTAL CA
Expected
Data from PedNSS and the National Health and Nutrition Examination Survey (NHANES)5 reveal that the upward
trend in the prevalence of childhood overweight and obesity in the United States and California may be leveling off.
They are leveling off, however, at rates 20 to 30 percentage points above “expected” rates (i.e., healthy populationwide distribution rates for overweight and obesity) for most racial and ethnic groups .6
In SJC, the trend among preschoolers has stabilized2. As the chart above shows, it may also be stabilizing among 5<20 year olds. Stabilized data suggests that prevention efforts begun in early childhood by CHDP providers and
their partners can help reduce the prevalence of childhood over weight and obesity. In 2009-2010, SJC’s CHDP
providers had some of the highest compliance rates and HEDIS scores in California regarding child weight. Of note
were their high scores for (1) recording and charting BMI measurements, and (2) providing referrals to
nutritionists and education to families with children with BMI’s over the 85 Percentile. If these and other
prevention efforts, such as kitchen gardening and adequate vegetable consumption, continue, and obesity rates fall,
children and future generations will thrive while local, state and national healthcare costs will decrease.
References:
1. HP 2010 Midcourse Review. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2009.
www.healthypeople.bov/data/midcourse/
2. Pediatric Nutrition Surveillance System (PedNSS). State of California, Department of Health Care Services, CHDP, 2010.
www.dhcs.ca.gov/services/chdp/Pages/PedNSS2009.aspx.
3. The Diabetes and Cardiovascular Disease Provider Reference Guide, www.thecmafoundation.org/projects/aped/
Provider_DiabetesRefGuide2010.html.
4. Children in Jeopardy, Central California Children’s Institute, California State University, Fresno. CHDP Health Assessment Survey of San
Joaquin County, 2009.
5 Nutrition Surveillance System. US Department of Health and Human Services, Centers for Disease Control and Prevention, 2009.
www.cdc.gov/pednss/
6. Ogden CL, Carroll MD, Flegal KM. High Body Mass Index for Age Among US Children and Adolescents, 2003-2006. JAMA 2008;299:24012405. jama.ama-assn.org/cgi/reprint/299/20/2401.
7. Childhood Obesity. National Initiative for Children’s Healthcare Quality, 2008. www.nichq.org/childhood_obesity/index.html.
Promote Fitness, Healthy Weight & Nutrition
Incorporate the following five points B-B-2-1-07 into your health assessments,
guidance, and education for patient and parents:
B
B
2
1
0
Join CHDP Providers in
Meeting the Challenge
Breastfeeding— encourage, teach, and support it.
Body Mass Index— use it in screening for overweight and obesity.
2 Hr. limit on screen time per day — promote it to minimize sedentary kids.
1 Hr. or More rigorous physical activity per day— promote and support it.
0 Sugar-sweetened beverages and sodas — teach it and promote tap water.
Make Referrals and Use Health Resources
Directory: Pediatric Referral Resources to Prevent & Treat Childhood Overweight
& Obesity. Tools: My Healthy Lifestyle Goal Tracker (Spanish and English).
Available from CHDP dstern@sjcphs.org or 209-468-8918.
Adolescent Fitness Activities at Community Medical Centers. Contact Joan Singson
at 209-373-2821.
Puentes Community Garden Project in Boggs Tract. Contact Jeremy Tereme at
www.puentesamericas.org or 209-478-4380.
Join the San Joaquin County Obesity and Chronic Disease Prevention Taskforce,
contact Shené Bowie at sbowie@sjcphs.org or 209-468-3649. For information about
the diabetes and obesity prevention programs, contact Ingrid Glenn at
iaglenn@sjcphs.org or 209-468-3868.
http://www.cdc.gov/obesity/ and www.cdc.gov/nutrition/everyone/basics/
carbs.html for individual and family guides to healthy living and obesity prevention.
What is CHDP?
CHDP stands for Child Health & Disability Prevention. The San Joaquin County Public Health CHDP Program supports CHDP medical providers
who give complete health assessments according to Federal and State recommended guidelines for the early detection and prevention of disease
and disabilities for low-income children and teens. CHDP screening exam consists of:
physical and mental health history
vital signs, measurements, BMI calculations
head to toe physical by a physician
developmental and nutritional assessments
dental assessment
vision and hearing tests
tuberculosis risk assessment
laboratory tests
immunizations
age and health status-appropriate anticipatory guidance
health education for patients and parents
referrals for further diagnosis , treatment, and/or education
Health assessments are provided by State certified CHDP physicians in private practices, public clinics and some public school clinics.
In July 2003, San Joaquin County CHDP began using the CHDP GATEWAY, a statewide, automated pre-enrollment process for uninsured
children. The CHDP Gateway serves as the entry point for these children to enroll in ongoing health care coverage through MediCal, Healthy
Families, or other available public-sponsored health plans.
Child Health and Disability Prevention (CHDP) Program of San Joaquin County Public Health Services
420 S. Wilson Way, Stockton, 95205
Mailing Address: P.O. Box 2009, Stockton, 95201-2009
Phone: 209-468-8335 Fax: 209-468-2072
Public Health Educator: Dianna Stern, M.Ed, MPH - dstern@sjcphs.org