Framework Component

Population Results – Trends and Reductions in Disparities

Indicator Description

This indicator measures change in the condition of being at a healthy weight, neither underweight nor overweight or obese, over time, from year to year of the low-income population of the state. R9 is intended to measure the proportion of the SNAP-Ed eligible population that is achieving the CDC recommendation. R9 is a population-level surveillance measure.

Background and Context

Obesity is a risk factor for a number of serious chronic diseases, among them coronary heart disease, hypertension, stroke, diabetes, and several cancers,¹ while significant underweight may be indicative of an eating disorder or underlying illness. Overweight and obese youth are at increased risk for developing high cholesterol, high blood pressure, and abnormal glucose tolerance, all increasing their risk for heart disease as they get older.² In 2011–2012, 69 percent of U.S adults and 32 percent of U.S. youth aged 2–19 years old were overweight or obese.^3,4

Outcome Measures

Increase in the following since the last surveillance period:

R9a.

Number or percentage of SNAP-Ed eligible persons at healthy weight, adults 18 and older

R9b.

Number or percentage of SNAP-Ed eligible persons at healthy weight, children and teens (ages 2 and older)

What to Measure

Adults

R9a. Number or percentage of adults whose body mass index (BMI) = 18.5–24.9 (self-reported or measured)

Children/Adolescents

R9b. Number or percentage of children/adolescents whose BMI for age percentile is from the 5th percentile to less than the 85th percentile or whose Fitnessgram Body Composition score is within the healthy fitness zone

Population

Children over 2 years old and Adults

Surveys and Data Collection Tools

ADULTS

Behavioral Risk Factor Surveillance System (national surveillance, annual, self-reported) height and weight used to calculate BMI [R9a] https://www.cdc.gov/brfss/data_tools.htm

About how much do you weigh without shoes?
About how tall are you without shoes?

Beam scale with height rod – for height and weight [R9a]

Be sure the scales are calibrated before using.

Beam scale without height rod – if height is known or stadiometer is available [R9a]

Be sure the scales are calibrated before using

High quality digital scale – if height is known or stadiometer is available [R9a]

Stadiometer – for height if no scale with height rod is available

CHILDREN & YOUTH

Youth Risk Behavior Surveillance System
https://www.cdc.gov/healthyyouth/data/yrbs/index.htm
(national surveillance, biennial, self-reported) height and weight used to calculate BMI [R9a] – middle and high school age youth; administered in the school setting

How tall are you without your shoes on?
How much do you weigh without your shoes on?

Fitnessgram
https://www.cooperinstitute.org/vault/2440/web/files/662.pdf
Annual body composition standards are available for youth as young as 5 years old, so can be used for elementary school data. [R9b]Fitnessgram is a set of physical fitness assessments used by California, Georgia, Texas, and New York City, and a number of school districts in other cities and states. One of the six assessments is body composition, which can be measured in several ways, including BMI from measured height and weight, skinfolds, and bioelectrical impedance. However, BMI from height and weight is most typical, and a student who is assessed as being “within the healthy fitness zone” by any of the measures can be assumed to fall within the BMI healthy weight criteria.

See Adult Other Instruments for Measured BMI

Additional evaluation tools to measure R9 can be found in the SNAP-Ed Library.

Key Glossary Terms

Body mass index (BMI)
Population-based data collection
Healthy fitness zone
SNAP-Ed eligible persons
Surveillance

Additional Resources or Supporting Citations

Adult BMI General Information: https://www.cdc.gov/healthyweight/assessing/index.html

Calculating BMI for adults manually
BMI = Weight (kg) / (Height (m))2
BMI = (Weight (lbs.) / (Height (in))2 x 703 (kg/m2)/(lb./in2)

Adult BMI Table: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_tbl.pdf
Adult BMI Calculator: https://www.cooperinstitute.org/vault/2440/web/files/662.pdf

CDC Growth Charts for identifying healthy BMI range for youth:
https://www.cdc.gov/growthcharts/percentile_data_files.htm
https//www.cdc.gov/growthcharts/data/zscore/bmiagerev.xls
https://www.cdc.gov/growthcharts/data/zscore/bmiagerev.csv

BMI-for-age charts, 2 to 20 years, LMS (lambda-mu-sigma) parameters, and selected smoothed BMI (kilograms/meters squared) percentiles, by sex and age (1 = female)

500 Cities Project data and map books
https://www.cdc.gov/500Cities/
Data analysis of 27 chronic disease measures, including one on nutrition, physical activity, and weight status, for the 500 largest American cities and the census tracts within them.

References:
¹Must A, McKeown NM. The Disease Burden Associated with Overweight and Obesity. [Updated 2012 Aug 8]. In: De Groot LJ, Beck-Peccoz P, Chrousos G, Dungan K, Grossman A, Hershman JM, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. https://www.ncbi.nlm.nih.gov/books/NBK279095/
²Dietz WH. Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease. Pediatrics 1998;101:518–525.
³ National Center for Health Statistics. Health, United States, 2014: with Special Feature on Adults Aged 55–64. Table 59. Hyattsville, MD. 2015.
⁴ Fryar CD, Carroll MD, Ogden CL. Prevalence of Overweight and Obesity Among Children and Adolescents: United States, 1963–1965 Through 2011–2012, Table 2. National Center for Health Statistics E-Stat. Hyattsville, MD. 2014.