How Much Do We Care About Our Health?

Although the United States leads the world in obesity rates (don’t worry, the world is catching up) a recent study indicates that the majority of Americans do care about their health and put effort into improving or maintaining it.  Data from a NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health survey conducted last fall indicate that just over 60 percent of those polled were concerned with their health and 74 percent reported exercising or participating in vigorous activity at least a few times a week (29 percent reported exercising every day). However, just 16 percent were currently dieting to lose weight.

Also from the March 2015 brief What Shapes Health, approximately 50 percent of Americans feel they have control over their own health, but proportions vary by demographic characteristics. For example, respondents who made more than $50,000 a year were twice as likely to feel that they had control over their health than their peers earning less (28 percent compared to 13 percent). Far more respondents with a college degree (27 percent) reported having control over their health compared to those with a high school diploma or less (15 percent).  Also, respondents in fair or poor health, or from a household making less than $25,000 a year, had the most concern for their own future health.

Respondents did not identify a single cause of American health problems, rather the responses clustered at the top included a lack of access to high quality care (42 percent), personal behavior (40 percent), and virus/bacteria (40 percent). The most popular responses regarding what could be done to improve health were also varied – increasing access to affordable, healthy food (57 percent), reducing illegal drug use (54 percent), reducing pollution and increasing access to high quality health care (both at 52 percent).

A Closer Look at Trends in Youth Obesity

After a period of aggressive growth, obesity rates among American youth have stabilized somewhat in the last decade. Unfortunately, this good news may distract from the trend data indicating that obesity remains a cause for concern among certain sub-groups of youth.

In the paper, Increasing socioeconomic disparities in adolescent obesity, authors Carl B. Frederick, Kaisa Snellman, and Robert D. Putnam discuss the idea of income level as a kind of dividing line in recent obesity trends. In the early 2000’s, obesity rates declined for youth in higher socioeconomic categories, while slowing down or increasing among lower-income groups.  The authors found that youth with college-educated parents also experienced a decline in obesity. Due to the national sample limitations, the interaction of race+class was not tested.

Examining weight management as an equation of calories taken in versus calories expended, these findings indicate that lower income youth and/or youth with parents who had a high school education consumed more calories than their higher income peers and reported less recreational activity or exercise.  Issues of transportation to markets that carry a wide variety of items including produce, budget limits and the lure of easy to prepare, tasty (but processed) foods all likely play a role in consumption habits, but that is only half of the equation.  The authors note that in 2003, 86.6 percent of adolescent children with college-educated parents reported playing a sport or exercising for at least 20 minutes during the past 7 days compared to 79.8 percent of youth with high-school educated parents.  In 2010, the gap in exercise/recreation time increased to 91 percent and 80.4 percent, respectively.  Also, at a time when high school sport participation is at record levels, Frederick et al., point out that participation in school sports is declining among lower-income students.

Is income level a factor in youth recreation?

An article in ESPN the Magazine by Bruce Kelley and Carl Carchia dives into the data on youth sports participation, citing research from Dr. Don Sabo, Professor at D’Youville College and Co-Director of their Center for Research on Physical Activity, Sport & Health (CRPASH), that points to household income as the primary factor in how early a child begins playing sports. The article refers to Sabo’s work again in noting that low-income boys (27 percent) and low-income girls (17 percent) were among the least likely groups to be on multiple teams (3 or more) during grades 3 through 8. In addition, the report Progress Without Equity: The Provision of High School Athletic Opportunity in the United States, by Gender 1993-94 through 2005-06, published by the Women’s Sports Foundation (Dr. Sabo is a co-author), found differences in access to recreation, noting that opportunities for athletic participation for students was lowest among urban schools (compared to town, suburban and rural) during the research period.

Trend data indicate that the message to eat healthier and move more is making an impact, but perhaps only among certain social classes, particularly those with the resources to enroll their children in school and club sports.  With childhood obesity linked to physical health risks as well as risk-taking behaviors such as drug and alcohol experimentation and conflicts with peers, is it time to lessen the focus on “awareness” and look at realistic ways to increase physical activity for all youth?



Report Citations:

 Social Sciences – Social Sciences – Biological Sciences – Medical Sciences: Carl B. Frederick, Kaisa Snellman, and Robert D. Putnam Increasing socioeconomic disparities in adolescent obesity PNAS 2014; published ahead of print January 13, 2014, doi:10.1073/pnas.1321355110

Sabo, D. and Veliz, P. (2011). Progress Without Equity: The Provision of High School Athletic Opportunity in the United States, by Gender 1993-94 through 2005-06. East Meadow, NY: Women’s Sports Foundation.

Preschooler Obesity Rates Drop in 19 states, Increase in Pennsylvania


Strategieis to combat childhood obesity include more education on nutrition, walking and biking programs, and improving outdoor parks.
Strategies to combat childhood obesity include nutrition education, walking and biking programs, and improving outdoor parks.

As has been widely reported over the past week,  obesity rates among preschoolers have declined nationwide according to the Center for Disease Control and Prevention (CDC), announcing the results of a study of children aged 2 to 4 in 40 states or territories who were enrolled in the Women, Infants and Children nutrition program. Three states, including Pennsylvania, have seen an increase, while 21 reported no change.  The trend of obesity in preschoolers increased in the early 2000’s, stabilized by 2008, and as of the latest data from 2011, has declined in 19 states/territories.

Although the increase is statistically significant, it should be noted that the rate in Pennsylvania has increased by less than 1 percent (.7%) since 2008 – with an additional 8,045 preschoolers classified as obese in 2011 than in 2008.  The trend appears to be stable but not yet reversed in Pennsylvania as other data  show little variability in obesity rates of school-age children over the last 5 years. According to the Growth Screens and BMI-for-Age data from the Pennsylvania Department of Health, statewide 16.7 percent of Kindergarten through Grade Six students were at or above the 95th percentile (considered obese) in the 2010-2011 school year – about the same proportion as in 2006-2007.  In the same year in the Southwestern district of the state, 16.7 percent of K-6 students were at or over the 95th  percentile in weight, 15.3 percent in Allegheny County.

Obesity rates among preschoolers and school-age youth matter as they not only impact one’s health but also have an economic impact. Children who are overweight are 5 times more likely to be overweight as adults than those within a healthy weight range.  The Pennsylvania Obesity Prevention and Wellness Program has introduced several initiatives and strategies to address this issue, including educating pediatricians, programs to increase walking and bicycling to schools, and partnerships to improve school nutrition, as well as campaigns to improve safety on walking paths and tobacco-free environments in parks and playgrounds.



Photo by Lisafern (Own work) [CC0], via Wikimedia Commons


Study Shows School Lunches are Healthier – Is it Enough to Impact the Youth Obesity Rate?

A follow-up report from Bridging the Gap on student health and fitness  shows small improvements in school lunch offerings over the past four years.  The report, Improving Children’s Health: National Elementary School Survey Results: School Years 2006–07 through 2009–10. Vol. 2.,  provides updated results from one of the most comprehensive studies of health-related policies and practices in U.S. elementary schools to date (released in November 2010).

The findings and trends discussed in the paper cover a range of issues related to childhood obesity from 2006–07 to 2009–10, including,

  •  The availability of  healthy food and drink selections increased in schools between the 2006/7 year and the 2009/10 school years, for example – availability of whole grains increased from 15 percent  to 21 percent during that time period, availability of low fat milk increased from 21 percent to 34 percent, and the availability of salad and fresh fruit remained stable with 40 percent of public elementary schools offering  packaged salads or a salad bar and 33 percent offering fresh fruit
  • Sales of lunchtime “extras” such as ice cream, chips and packaged pastries increased significantly, from 42 percent to 52 percent between 2006/7 and 2009/10. The researchers suggest that the increase is due to more elementary schools making these meal supplements (or substitutions) available in the cafeteria.
  •  There have been very few notable policy changes made to support physical activity in school since the 2006–07 study. There was no statistical change in elementary schools offering intramural or extramural sports during the time period (37 percent in 2006/7 versus 34 in 2009/10).


Communities, educational and child care professionals and parents can work together to slow the trend of childhood obesity by making small but consistent changes, such as monitoring the availability and nutritional value of snacks and drinks for students, increasing outdoor recreation activities, and keeping parks and neighborhood playgrounds well kept and safe for children and families to use regularly.



Report Citation:  Turner L, Chaloupka FJ and Sandoval A. School Policies and Practices for Improving Children’s Health: National Elementary School Survey Results: School Years 2006–07 through 2009–10. Vol. 2. Chicago, IL: Bridging the Gap Program, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, 2012.