Appendix D

Presentation of Findings

This appendix contains tables summarizing the committee’s review of the evidence. From the collection of 137 recent published reports (the selection of reports is described in Appendix C), associated manuals, protocols, training materials, and other intructions for directly measuring height and weight were identified. Tables D-1, D-2, and D-3 outline the height, weight, and data collector procedures, respectively, across 32 different protocols. Next, Tables D-4, D-5, and D-6 outline the different ways race and ethnicity, socioeconomic status, and age have been categorized and presented in the collection of recent published reports. Table D-7 summarizes the statistical approaches taken in the published reports to arrive at an estimate of prevalence, change, or trend, or assess differences between groups or other reports. Table D-8 presents a simulation demonstrating that the current FitnessGram’s®¹ “Needs Improvement-Health Risk” cut points correspond to the 95th percentile on the 2000 Centers for Disease Control and Prevention (CDC) sex-specific body mass index (BMI)-for-age growth charts. Finally, references for all eight tables can be found at the end of this appendix.

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¹ The FitnessGram® was developed and is a registered trademark of The Cooper Institute®, Dallas, Texas.

LIST OF TABLES

• Table D-1 Examples of Protocols for Directly Measuring Height
• Table D-2 Examples of Protocols for Directly Measuring Weight
• Table D-3 Examples of Protocols for Data Collectors
• Table D-4 Race and Ethnicity Categories, as Presented in a Collection of Recent Published Reports
• Table D-5 Individual and Community-Level Socioeconomic Status (SES) Categories, as Presented in a Collection of Recent Published Reports
• Table D-6 Variables and Categories Related to Age, as Presented in a Collection of Recent Published Reports
• Table D-7 Summary of Statistical Approaches Taken in a Collection of Recent Published Reports
• Table D-8 2000 CDC Body Mass Index-for-Age Percentiles Corresponding to the 2015 FitnessGram’s® Needs Improvement-Health Risk (NI-HR) Cut Points, by Age and Sex

TABLE D-1 Examples of Protocols for Directly Measuring Height

NOTE: This table presents only information available given in the source study’s methods. If a general anthropometric measurement manual was referenced, it is noted in the footnotes; cm, centimeter; in, inch; all study and dataset acronyms are listed in Appendix A.

^a The manuals and measurement protocolsin this table are from the data sources included in the committee’s review of recent reports. If the publication did not specifically name the data source that was used, but provided details about data collection protocol, it is labeled as “Not Specified” in the table.

^b Common contact points with stadiometer include back of head, shoulder blades, buttocks, and heels.

^c Carpenter’s square and steel tape measure used for measurement.

^d Used both manual and electronic measuring board.

^e Measurement protocol based on Economos et al., 2007. A community intervention reduces BMI z-score in children: Shape up Somerville first year results. Obesity (Silver Spring) 15(5):1325-1336 and Lohman, 1993. Advances in body composition assessment. Current Issues in Exercise Science (Monograph No. 3) 5(2):200-201.

^f Measurement protocol based on Gibson, 1990. Principles of nutritional assessment. New York: Oxford University Press.

^g Measurement protocol is based on Lohman, et al., 1988. Anthropometric standardization reference manual. Champaign, IL: Human Kinetics Books.

^h Standardized measurement technique where a horizontal line drawn from the ear canal to the lower border of the orbit of the eye is parallel to the floor and perpendicular to the vertical backboard; also called the Frankfort horizontal plane.

ⁱ Duplicate measures required to be within 0.10 cm of each other.

^j For individuals who were not able to stand, arm span was used as a proxy for height.

^k Measurement protocol is based on Lohman et al., 1991. Anthropometric standardization reference manual: Abridged edition. Champaign, IL: Human Kinetics Books.

^l For children who had difficulty standing fully erect because of weakness or knee flexion contractures, recumbent height was measured with use of a flexible tape measure.

TABLE D-2 Examples of Protocols for Directly Measuring Weight

NOTE: This table presents only information available given in the source study’s methods. If a general anthropometric measurement manual was referenced, it is noted in the footnotes; kg, kilogram; lb, pound; all study and dataset acronyms are listed in Appendix A.

^a The manuals and measurement protocols in this table are from the data sources included in the committee’s review of recent reports. If the publication did not specifically name the data source that was used, but provided details about data collection protocol, it is labeled as “Not Specified” in the table.

^b Calibrated weekly.

^c Calibrated after every 10th measurement.

^d “Calibrated.”

^e Measurement protocol based on World Health Organization, 2008. STEPS surveillance manual. Geneva: World Health Organization.

^f Measurement protocol based on Economos et al., 2007. A community intervention reduces BMI z-score in children: Shape up Somerville first year results. Obesity (Silver Spring) 15(5):1325-1336 and Lohman, 1993. Advances in body composition assessment. Current Issues in Exercise Science (Monograph No. 3) 5(2):200-201.

^g Measurement protocol based on Gibson, 1990. Principles of nutritional assessment. New York: Oxford University Press.

^h Measurement protocol is based on Lohman, et al., 1988. Anthropometric standardization reference manual. Champaign, IL: Human Kinetics Books.

ⁱ Portable scales were used in cases of power outage, malfunction of primary scale, or individuals over 440 pounds maximum weight. In the case of individuals over 440 pounds, two scales were used to determine weight.

^j Calibrated daily.

^k Duplicate measurements must be within 0.2 kg of each other.

^l Measurement protocol is based on Lohman, et al., 1991. Anthropometric standardization reference manual: Abridged edition. Champaign, IL: Human Kinetics Books.

TABLE D-3 Examples of Protocols for Data Collectors

NOTE: All study and dataset acronyms are listed in Appendix A.

^a The manuals and measurement protocols in this table are from the data sources included in the committee’s review of recent reports. If the publication did not specifically name the data source that was used, but provided details about data collection protocol, it is labeled as “Not Specified” in the table.

^b Schools have the option of participating in training and purchasing equipment for the FitnessGram®; however, documentation of school participation in training is not available.

^c The MOVE Project is a 12-month childhood obesity prevention program with a 24-month follow-up.

^d Training received through an NYC DOE-sponsored workshop, with additional reference material posted online.

^e System has built-in validation features that alert the teacher to possible data entry errors.

^f Integrated Survey Information System.

^g Staff were trained by a public health nurse and Indian Health Service physician.

TABLE D-4 Race and Ethnicity Categories, as Presented in a Collection of Recent Published Reports

NOTE: Table does not include reports where race/ethnicity was only presented as demographics table or adjusted for in statistical models. Reports listed in the table are individual reports. There is repetition of datasets.

^a Estimates were generated for school districts with a population above and below the median for percent non-white.

^b Primary dataset was NHANES.

^c Dichotomized as “White” and “Black” in NHANES 1971-1975, 1976-1980.

^d Presented in aggregate estimates, but did not have estimate separate from other racial/ethnic groups.

^e Claims to have categorized “Mexican American” and “other Hispanics” in separate groups in the methods section, but results are presented as “Hispanic.”

^f Primary dataset was PedNSS.

^g Primary dataset was YRBS; the number of participating states and cities varies with each YRBS cycle.

^h Study only included females.

ⁱ To protect the confidentiality of students, those responding “Pacific Islander” or “Filipino” were collapsed into the “Asian” category.

TABLE D-5 Individual and Community Level Socioeconomic Status (SES) Categories, as Presented in a Collection of Recent Published Reports

NOTE: Individual studies identified in literature search are represented in the table. Datasets are repeated across presented published reports. Reports often use multiple variables, SES or otherwise, in combination with each other.

^a Obesity prevalence or trend estimate was reported for these subgroup, rather than only being a demographic characteristic.

^b Actual cutoffs for this study were 0-100% FPL, 101-200% FPL, 201-400% FPL, >400% FPL.

^c Percent of FPL was used only in cases where study participants were income eligible but non-participants in assistance programs.

^d In the analysis, this variable was dichotomized to “some college and more” versus “no college.”

^e Used Medi-Cal in addition to Medicaid.

^f Used Child Health Plus in addition to Medicaid.

^g Study population only included those participating in the specificed assistance program.

^h Schools subdivided further into 2 groups: less than 50% of students receiving free/reduced lunch and more than 50% of students receiving free/reduced lunch.

ⁱ Study population groupings were <10%, 10% to <20%, 20% to <30%, ≥30%.

^j Refers to a standardized assessment, usually based on a combination of factors, used to better capture unique populations and fit study goals.

TABLE D-6 Variables and Categories Related to Age, as Presented in a Collection of Recent Published Reports

NOTES: Each reference corresponds to a published report. There is repetition of datasets (e.g., National Health and Nutrition Examination Survey); K, Kindergarten.

^a Assessed the same child at each age given.

^b Estimate of obesity prevalence or trend reported by age groupings given.

^c Ages based on cohort birth year.

^d This age categorization is clinical and not data based; it was used because the Tanner index of sexual maturation was not measured at all periods.

^e Age at last birthday.

^f Ages at onset of study, assessed again at additional time interval.

^g Groupings used in bivariate analysis.

^h Groupings used in multivariate analysis.

ⁱ Aged 8-<18 years at assessment.

TABLE D-7 Summary of Statistical Approaches Taken in a Collection of Recent Published Reports

NOTES: CI, confidence interval; NR, not reported in published report; * indicates interactions in analysis; all study and dataset acronyms are listed in Appendix A.

^a Study or data source name provided in text of the publication. If the publication did not specifically name the data source that was used, but provided details about data collection protocol, it is labeled as “Not Specified” in the table.

^b The 2008-2009 data came from routine measurements of students from the middle school (grades 6-8) and high school (grades 9-12), which enrolls ~81% of students in the community.

^c Percent in the body composition “Healthy Fitness Zone.”

^d Birth cohort years; end year of data collection not specified in the published report.

^e Presented as overweight and obese at age 10 years.

^f The MOVE project is a 12-month childhood obesity prevention program with a 24-month follow-up.

^g Includes NHANES (1959-1962, 1966-1970, 1971-1975, 1976-1980, 1988-1994, 1999-2000, 2001-2002); Add Health (Wave 1: 1994-1995; Wave 2: 1996; Wave 3: 2001-2002); NHIS (1980, 1990, 2000-2003); NLSY79 (1981-1982, 1985); NLSY97 (1997, 2001).

^h Includes National Longitudinal Survey of Youth (1997-2011); National Survey of Family Growth (2006, 2007, 2008, 2009); National Longitudinal Survey of Adolescent Health (1994); International Social Survey Programme (ISSP) (2012); National Health Measurement

Survey (2006); National Survey on Drug Abuse (1995); NHANES (1988, 1999, 2001, 2003, 2005, 2007, 2009, 2011); BRFSS (1984-2012); National Longitudinal Survey - Child/Young Adult (1986, 1988, 1990, 1992, 1992, 1996, 1998, 200, 2002, 2004, 2006, 2008, 2010); Health Behavior in School-Aged Children (2001, 2005, 2009); National Health Interview Survey (NHIS) (1980-2012); PedNSS (1980-2012).

ⁱ U.S. data included in the “developed” country age-birth cohort trend.

^j Includes Cohort of Mexican School Age Children and Adolescents (2004-2006); Mano a Mano Cohort (2001-2003); and From Mother to Child Project (2004-2007).

^k Includes previously published NHANES data; published aggregate data from Switzerland (Zurich [1960/1965; 1980/1990]; national data [2002]); and raw data from Seychelles (1998-2004).

^l Only assessed children at or above the 85th percentile on the 2000 Centers for Disease Control and Prevention BMI-for-age growth charts; prevalence presented by gradation of obesity categories.

^m Oklahoma did not report to national PedNSS during this time.

ⁿ Obesity prevalence is presented in the text, but the figures and tables describe overweight rather than obesity.

TABLE D-8 2000 CDC Body Mass Index-for-Age Percentiles Corresponding to the 2015 FitnessGram’s®/sup> Needs Improvement-Health Risk (NI-HR) Cut Points, by Age and Sex

NOTE: NI-HR, Needs Improvement-Health Risk.

^a For ease of calculation of the BMI corresponding to the 2015 FitnessGram’s^® NI-HR cut points, all heights were set to 48 inches.

^b Values are weights in pounds that correspond to the NI-HR BMI cut point, based on a height of 48 inches.

^c BMI cut points correspond to the values used in the 2015-2016 California Physical Fitness Test (California Department of Education, 2015).

^d Percentiles correspond to the 2000 CDC sex-specific BMI-for-age growth charts. BMI-for-age percentile calculated using the CDC Children’s BMI Tool for Schools spreadsheet (CDC, 2015).

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