Obesity disparities among elementary-aged children: data from school-based BMI surveillance.

OBJECTIVES To examine 3-year trends and spatial clustering in the prevalence of obesity among elementary-aged children in Pennsylvania. METHODS Height and weight were measured for ~980 000 children between ages 5 and 12 years, corresponding to kindergarten through grade 6 in 3 consecutive school years (2006-2007, 2007-2008, 2008-2009). These data were obtained at the school district level and reported to the Pennsylvania Department of Health in response to a state mandate requiring public schools to conduct annual surveillance of student growth. Analyses at the school district level (n = 501) regarding obesity prevalence (BMI ≥ 95th percentile) according to age and gender were conducted to examine associations over time and in relation to population density, geographic boundaries, and a calculated family distress index. RESULTS The mean prevalence of obesity remained stable over 3 years at ~17.6% of elementary-aged children. However, within the state, significant differences in the prevalence of obesity were identified. Schools in the most rural areas had adjusted obesity prevalence over 2 percentage points higher than urban schools. Consistent with secular findings for the nation in general, students with families living in socioeconomic distress exhibited upward trends in obesity risk. CONCLUSIONS School-based surveillance elucidates the disparate risk of obesity for younger students living in the most rural areas, a key finding for primarily rural states. Preventive interventions are needed to reach the most rural children with an emphasis on families where parents are single, are unemployed, have a lower income, and lower educational attainment.