A Rhode Island Department of Health study that found that 11 percent of high school students had BMIs above the 95th percentile, qualifying them as obese. 16 percent of high school students had BMIs between the 85th and 95th percentiles, putting them in the overweight category. The study’s results were published by child advocacy and policy group Rhode Island KIDS COUNT in a report earlier this month on the prevalence of overweight and obese children and adolescents across the state.
Among the 42 states that were ranked in 2013, Rhode Island has the seventh lowest rate of adolescent obesity, according to a surveillance report from the Centers for Disease Control and Prevention. But the state’s percentage of overweight adolescents places it in the bottom 15th percentile nationally.
“It is a serious situation. We know that students who are reporting themselves as overweight could get worse,” said Executive Director of KIDS COUNT Elizabeth Burke Bryant, an adjunct lecturer in public policy at the Taubman Center for Public Policy and American Institutions.
Citing the adverse health effects of obesity and the increased health care costs on young people as they age, Bryant said she hopes the report will serve as “a call to action” for community members to work to improve Rhode Island’s performance on the issue.
Bryant also credits Rhode Island’s relatively low rates of adolescent obesity to successful policy measures, mainly the 2007 Rhode Island General Assembly bill that limits the sale and advertisement of candy and snack foods in Rhode Island schools. In addition, the Healthy, Hunger-Free Kids Act of 2010 provides national guidelines for state schools to improve nutritional options for students, particularly those on federally-subsidized school lunch programs, the report noted.
The school-based food policies help stabilize the rates of overweight and obesity and may also induce healthier eating patterns for students, Bryant said, citing data published in the KIDS COUNT report that demonstrates the availability of healthy food options such as fruit and salad in schools.
The report found that 49 percent of Rhode Island schools have a salad bar in the cafeteria and 32 percent have food or vegetable gardens on the grounds.
Though interventions to improve adolescents’ diets have been effective, efforts to improve their physical activity have been less successful, said Elissa Jelalian, associate professor of psychiatry and human behavior and pediatrics.
Both Bryant and Jelalian said they believe that policy changes to increase the amount that students exercise each week could help improve future outcomes.
Jelalian pointed out that the weekly 100 minutes of state-required physical and health education combines physical activity and classroom health education.
The report notes that this standard is below the recommendation of 150 minutes of physical education for elementary school students and 225 minutes of exercise for middle and high school students. Students also have quarters during which they are only in health class and do not have scheduled physical activities, she added.
“Even when policy has taken hold, we have to be vigilant,” Bryant said. “If that policy change went through, it would be high-quality physical education that could contribute in a positive way to the issue of overweight students.”
The report also presents comprehensive data related to factors contributing to childhood obesity, including eating habits, levels of physical activity, issues of access to recreational space and healthy food, as well as complications associated with socioeconomic status and sexual orientation.
Jelalian said she believes one of the major strengths of the report is the breakdown of data across each town in Rhode Island. “There’s a lot of specificity at the town level, which is quite interesting, and has clear implications for action items.”
Jelalian said she believes that the use of BMI as a metric, particularly the self-reported numbers, may have an effect on the data presented. “The difference between half an inch or a centimeter can mean the difference between one categorization or the other,” Jelalian said, adding she would like to see more precise metrics of where many teenagers fall on the scale of BMI percentiles.
The introduction to the report covers some of the limitations of using BMI as a metric, including focusing on different body fat compositions across individuals and ethnic groups.
The report includes data demonstrating higher overweight and obesity rates in black and Hispanic adolescents, as well as lesbian, gay, bisexual and transgender adolescents. While the racial disparity in rates of obesity has been well documented, Jelalian said she was surprised that there was data to support the higher rates of obesity in LGBT adolescents, which she has observed in clinical practice.
Bryant said she believes that these numbers reflect the many layers and factors that contribute to adolescent obesity.
Responses “need to be culturally sensitive,” Bryant said, adding that “everything should be done with real connections to the community.”
Bryant said she thought the report could encourage educators, health professionals, policy makers and parents to act on a national issue that remains pertinent in Rhode Island.
“I appreciated that the recommendations fit along that continuum from individual family level to physicians or health care systems to community,” Jelalian said, noting that “multi-level interventions” hold great potential to improve adolescent health.