In our research in West Virginia, we have documented high rates of overweight and obesity in our youth, the presence of escalating health risks as youth BMI increases, a significant underrecognition of children’s weight status by parents, and a concerning absence of weight-related guidance by primary care providers. These findings parallel the work by numerous others across the United States. Fortunately, we have also demonstrated that health assessments in the West Virginia school setting are generally accepted, even appreciated, by the majority of parents, at least in the context of comprehensive screenings and an active-consent process. We have also found encouraging evidence that parents positively modified lifestyle (diet and physical activity) within the home in response to learning of their child’s risk status. We feel that a careful examination of the health beliefs in our population has enabled us to provide culturally sensitive materials to promote health screenings and has facilitated acceptance of the screening reports. However, many questions about how best to address the West Virginia obesity epidemic remain.
In the ongoing lifestyles project, we will be expanding the knowledge base for addressing obesity in West Virginia by determining the acceptability of BMI-only assessment in schools, the impact of BMI health reports on children and families, the perceptions and practices of health care providers related to childhood obesity and the Healthy Lifestyles legislation, and the impact of the legislated changes on nutrition, physical activity, and health education in the schools. If the CARDIAC project adopts a passive-consent process for BMI screenings in the next year, we will also be in a position to compare the impact of BMI-only screenings conducted under both active-and passive-consent conditions. If the CARDIAC project continues with active consent, we will have additional information on the acceptability and impact of this process.
A decade of comprehensive risk-factor screening in West Virginia seems to have affected public policy at the state and local levels. The legislature has provided line-item support for CARDIAC screening and intervention programs since 2001. Documentation of the severity of the obesity problem, considerably exceeding that obtained through the Youth Risk Behavior Surveillance System, contributed to the adoption of the Healthy Lifestyle Act. In addition, in 2007 the West Virginia Board of Education became the first in the nation to adopt many of the Institute of Medicine’s most recent recommendations for healthier school nutrition.
Passage of the Healthy Lifestyles Act, strong state support for the lifestyles project evaluating the legislation, and the recent adoption of new Institute of Medicine– based child nutrition policies by the Board of Education30
are solid indicators of a serious effort to address childhood obesity in West Virginia. Also underway are a redesign of the state Medicaid program as a patient-centered system that emphasizes prevention, personal responsibility, and coordinated health care. This will support the movement toward a “chronic-care” model for obesity recently suggested by an expert panel.31
We believe that both comprehensive health screenings and BMI-only screenings have a significant role to play in evaluating the success of these strategies and helping to sustain the larger movement to improve health in West Virginia. The key issue is how best to use the screening data to support these initiatives.
During the 2007–2008 academic year, we began integrating screening data with local school wellness policies (required by the Child Nutrition and WIC [Supplemental Nutrition Program for Women, Infants, and Children] Reauthorization Act of 2004). Providing data directly to the wellness councils informs those most responsible at the local level for addressing childhood obesity and sets the stage for increased dialogue about best practices and strategies that have been implemented in other school districts. Importantly, the West Virginia Department of Education has been a key partner in our work. Before the collaboration with local wellness councils and continuing this year, aggregate data were distributed to school administrators and relevant state agencies in the form of an annual governor and legislative report, “Findings From the CARDIAC Project.” Our current lifestyles project is also designed for dissemination, including scheduled presentation of findings to the governor and state legislature.
The personal, health, and economic costs of obesity in West Virginia and the nation will inexorably rise as the alarming number of overweight and obese youth become adults. The increase in the prevalence of obesity among children and adults, accepted by many as an inevitable “social norm,” clearly calls for a different kind of individualized and public health response. We are hopeful that the data being collected through our projects, and the model of providing regular, quantitative feedback on health indices and policy impact to both families and policy makers, will continue to build the evidence base and stimulate progress in reversing the obesity epidemic in West Virginia.