Childhood Obesity in Tyler, Texas: Ages 6–11 Community Analysis

Introduction and Description of the Aggregate

Obesity is associated with a condition of caloric imbalance in which the ratio of calories consumed to calories expended is skewed, such that the amount spent is much lower than the amount consumed. The condition is influenced by a range of factors that include genetics, behavioral patterns, and environmental influences. According to data from the Centers for Disease Control and Prevention (CDC), children between the ages of 6 and 11 with obesity stood at 7% in 1980 and increased to almost 18% by 2012. In 2014, the CDC's Obesity Prevalence Map showed that all states had obesity prevalence rates of 20% or above. Three states reflected an alarming prevalence rate exceeding 35% of their populations. Texas was rated as having 30 to 35% of its population affected by obesity, and two of the three states above the 35% mark were in the neighboring region.

The aggregate population targeted in this study is all obese and overweight children in the eastern part of Texas. A study from the Children's Hospital Association of Texas found that one in every three children in Texas is either obese or overweight, and that nearly half of Hispanic children in the state are obese. The aggregate population in the Tyler area consists of approximately 50% non-Hispanic White, 23% non-Hispanic Black, 22.8% Hispanic, and 2.1% non-Hispanic Asian residents. The study aims at identifying overweight and obese cases among children aged 6 to 11 years from all racial groups in the Tyler area of Texas. It also seeks to establish a partnership based on collaboration between community members and inter-professional networks in order to address needs and initiate meaningful change for the people of the targeted area.

Obesity is a result of caloric imbalance or very low expenditure of consumed calories, and is influenced by genetic, behavioral, and environmental factors (CDC, 2015). Children who develop obesity or overweight are likely to carry the condition into adulthood and are more vulnerable to stroke, heart disease, diabetes, certain types of cancer, and osteoarthritis. Obesity and overweight are associated with a heightened risk of developing a range of cancers, including breast cancer, endometrial cancer, colon cancer, kidney cancer, esophageal cancer, gallbladder cancer, pancreatic cancer, cervical cancer, ovarian cancer, prostate cancer, Hodgkin's lymphoma, and myeloma (CDC, 2015).

CDC figures show that the percentage of children with obesity and overweight complications increased from 7% in 1980 to 18% in 2012 (CDC, 2015). Overweight is defined as having a Body Mass Index (BMI) above the 85th percentile and below the 95th percentile. Obesity, by contrast, is defined as having a body weight above the 95th percentile for children of the same age and sex as shown on standardized growth charts (Stanhope & Lancaster, 2012). CDC statistics from 2014 confirm that no state showed less than 20% obesity or overweight prevalence, and three states exceeded 35%. Texas fell within the 30–35% range, while two neighboring states exceeded 35%.

The Children's Hospital Association of Texas found that one in every three children in Texas is already obese or overweight, and that nearly half of Hispanic children are obese (Arons, 2011). These children face more than a two-thirds risk of remaining obese beyond age 35. Obesity treatment costs Texas in excess of $3.3 billion each year, and the obese children of today are projected to triple the adult obese population in Texas by 2040, with a corresponding increase in expenditure (Arons, 2011; Stanhope & Lancaster, 2012).

Obesity during childhood increases the likelihood of developing other health complications both during childhood and in later adult life. Common conditions include, but are not limited to, type II diabetes, hypertension, sleep apnea, cardiovascular disease, asthma, and osteoarthritis (Gungor, 2014). Glucose intolerance is a common indicator of the onset of type II diabetes. Cardiovascular disease is also a common complex condition among children and adults who suffer from long-term obesity. In type II diabetes, insulin resistance affects glucose uptake and produces glucose intolerance, which is particularly common among overweight and obese children (Reinehr, 2013).

The demographic composition of the aggregate population selected for this study is 50% non-Hispanic White, 23.5% non-Hispanic Black, 22.8% Hispanic, and 2.1% non-Hispanic Asian (city-data.com, n.d.). The city of Tyler ranked higher than the state average in the number of college graduates at the associate, bachelor's, and professional and doctoral levels, while remaining slightly below the state average in the number of people pursuing master's programs. Among lower-income families, the breakdown by household structure was: married-couple families (27.3%), male householder with no spouse present (19.7%), and female householder with no husband present (53%).

The median household income in Tyler in 2013 was $44,467, significantly lower than the state figure of $51,704. The poverty rate in Tyler stood at 16.8%, higher than the Texas state figure of 15.4% (city-data.com, n.d.). The adult obesity rate in Tyler was slightly higher than the state average at 26.7%.

Community Description

One out of three children—and half of Hispanic children—in Texas suffer from obesity or overweight issues (Arons, 2011). More than two-thirds of these children are likely to carry their obesity into adulthood, placing a growing burden on Texas in terms of healthcare resources. Statistical data project that the healthcare cost burden will rise to $3.3 billion per year. Based on demographics, the allocation in Tyler is 50% non-Hispanic White, 23.5% non-Hispanic Black, 22.8% Hispanic, and 2.1% non-Hispanic Asian (city-data.com, n.d.).

Tyler was rated above average in health outcomes compared to cities of comparable size, but it ranked behind in certain specializations such as pediatric endocrinology, which manages overweight and obese children with medically related conditions. Tyler has a public transportation system that services all major routes; however, it is heavily focused on key thoroughfares in the city. Travel off those routes requires alternative means of transportation (city-data.com, n.d.).

Fortunately, school systems and health units in the area have recognized the problem and have taken steps to address the epidemic. With a concerted effort from all stakeholders, children in the future stand a better chance of living healthier lives (city-data.com, n.d.). Many schools and colleges have incorporated physical activity programs into their routine and increased the time allocated to those programs, though such adjustments are still considered incremental. Tyler ISD has developed a 5-2-1-0 program that promotes five fruits and vegetables per day, two or fewer hours of TV, one hour of physical exercise, and total avoidance of sugary drinks.

Texas has also developed strategies to prevent excessive healthcare expenditures by improving healthcare outcomes. Three senate bills addressing childhood obesity were passed over a six-year period. Senate Bill 19 of 2001 established minimum physical activity requirements in elementary schools and created coordinated school health programs including school health advisory councils for physical activity and nutrition. Senate Bill 42 of 2005 increased the minimum physical activity requirement to include middle school students. Senate Bill 530 of 2007 promoted physical activity programs for children in grades K–8 and mandated annual fitness testing covering aerobic capacity, strength, flexibility, and BMI—commonly referred to as the "FitnessGram"—for children in grades 3 through 12. The Texas Department of Agriculture also initiated guidelines for nutrition and vending machines in schools (Nyberg, Burns & Parker, 2009).

Description of the Problem and Rationale

After the 1970s, the number of children with obesity and overweight issues increased dramatically across all racial groups, age ranges, income levels, and ethnicities. National obesity rates doubled for children between ages 2–5 and 12–19 in the periods 1971–1974 and 1999–2000, respectively, and tripled for children between the ages of 6 and 11. While some indications suggest that childhood obesity has stabilized within the past decade, rates remain extremely high (Nyberg et al., 2009; Green, 2015).

Hispanic children have been noted to manifest the highest obesity and overweight rates. According to 2007 CDC data, 47% of Hispanic children in Texas suffered from overweight and obesity, compared to 26% of non-Hispanic Black children and 23% of non-Hispanic White children. Studies from the School Physical Activity and Nutrition (SPAN) program confirm these trends. Hispanic boys have the highest obesity rates among boys of the same age range from other racial and ethnic backgrounds nationally. Non-Hispanic Black girls showed the highest incidence of obesity among girls of the same age. These trends are particularly concerning given the rapidly growing size of the Hispanic child population in Texas (Skinner & Skelton, 2014).

Conclusion

In the population of 6- to 11-year-olds in Tyler, Texas, the demographic composition is 50% non-Hispanic White, 23.5% non-Hispanic Black, 2.1% non-Hispanic Asian, and 22.8% Hispanic. One-third of children in Tyler are obese or overweight, including half of all children of Hispanic origin. More than two-thirds of these children are likely to carry their obesity into adulthood, placing growing pressure on financial resources through increased healthcare costs currently estimated at $3.3 billion per year.

A decrease in energy expenditure combined with sustained caloric intake is the principal driver of obesity in children. Watching television, playing video games, and using computers occupy a large proportion of children's time, reducing the hours available for physical activity. Lack of physical activity has been identified by experts as a leading cause of obesity in both children and adults. Parenting practices also affect children's eating habits, including which foods are offered at home, how much unsupervised time children have, and the social context of mealtimes—all of which influence eating behavior throughout development.

There is considerable evidence supporting genetic influence as a key contributor to childhood obesity. Preventing obesity in children involves encouraging healthy eating and regular exercise for children aged 2 to 19. Community-wide holistic initiatives are essential to addressing the crisis. Policy change and environmental adjustments are necessary, as are programs that inform and educate communities about the importance of physical activity and healthy eating behaviors. Obesity prevention must encompass a range of programs spanning both nutrition and physical activity in order to achieve lasting results.

References

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Centers for Disease Control and Prevention (CDC). (2015). Childhood obesity facts. Retrieved from http://www.cdc.gov/obesity/data/childhood.html

City-data.com. (n.d.). Tyler, Texas. Retrieved from http://www.city-data.com/city/Tyler-Texas.html

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