There has been an increasing rate of obesity in the United States over the past two

decades. It has shown to be a nationwide issue and is very alarming. Recent studies show that

one in six children have been or will become obese (CDC, 2017). This rise in obesity has been

linked to serious health effects among children including cardiovascular disease, diabetes, and

many other chronic health conditions (WHO, 2012). Obesity is defined as having large amounts

of extra weight from adipose fat tissue. This added adipose tissue is gained from either eating

large amounts of unhealthy food that are saturated in fats, or empty calories from a sedentary

lifestyle (CDC, 2017). Body mass index (BMI) is one of the more commonly used screening

tools for measuring and analyzing obesity. It is a calculation that requires height and weight that

is easy and inexpensive to use for clinicians and professionals. Having a high BMI can be an

indicator of high body fatness, but it is not the diagnostic of the body fatness or health of an

individual (CDC, 2017). A common misconception is that being overweight and obese are the

same, although they are not. Both deal with having more weight on your body than what is

considered healthy for your body type, height, and age range. With the rise of technology, people

are constantly walking around with their faces down in their devices. This technology gives rise

to the most sedentary lifestyle in human history (Cai et al., 2017).

Changes must be made in the environments where these middle school students live,

study, and play (Clark, 2015). Having adjustments in these core areas can make it easier to

achieve in order to have a sustainable healthy lifestyle, and to maintain childhood weight.

Hopefully this can lead to better health and lifestyle choices in the future. Schools must create

policies and practices that help students in their classes and in their community to eat more fruits

and vegetables. They should learn to incorporate them into their daily meals and get at least one
hour of play or physical activity daily (Cai, 2017). Lastly, they should eat fewer empty calorie

foods and avoid beverages that contain high levels of sugar.

According to the World Health Organization (WHO, 2012), obesity and being

overweight takes a worldwide epidemic. Childhood obesity has been rising rapidly in all

population groups (Lanigan, 2010). Their eating behaviors could be influenced by placement and

availability of restaurants and retail food stores (Morland et al., 2009). Obesity in children is

driven largely by environmental factors such as fast food consumption, inadequate neighborhood

access to healthy affordable foods and school nutrition.

According to the CDC, one-third of American kids eat fast food on a typical day. Fast

food restaurants all over the United States create a fast, easy, and convenient dinner. In Duval

County, 21.7% of middle school students reported that they ate at least one meal or snack from a

fast food restaurant on three or more days (YRBS, 2015). Cantor et al. found that fast food meals

with sugar-sweetened beverages had, on average, 179 more calories compared with meals with

non- sugar sweetened beverages.

Food deserts are defined as low-income areas more than one mile from a supermarket or

large grocery store in urban areas and more than 10 miles from a supermarket or large grocery

store in rural areas (UF Health Jax, 2015). According to the UF Health Jax’s Community Health

Needs Assessment, the area of highest need within the community are located in central

Jacksonville. Residents that do live in a food desert are then forced to buy groceries from a

convenient store that may be located around the corner. Typically, the local neighborhood stores

do not sell fresh produce and nutritious foods.

Duval County middle school students have poor dietary intake and engage in unhealthy

eating habits (YRBS, 2015). Children are not consuming the recommended amount of fruits and
vegetables. According to the 2015 YRBS, 77% of middle school students have reported not

getting the sufficient amount of fruits and vegetable intake. Places such as child-care centers,

schools, or communities can affect diet and activity through the foods and drinks they offer and

the opportunities for physical activity they provide (CDC 2016).

Physical activity in children is crucial for preventing illness and maintaining a healthy

weight (CDC, 2018). Unfortunately, huge portions of children in the United States are not

participating in the recommended amount. The recommended amount of physical activity for

youths is defined as at least 60 minutes a day for at least five days out of the week (CDC, 2018).

In 2015, less than 50% of the nations children reported participating in at least 60 minutes of

activity daily for 5 out of 7 days previous to the survey (YRBS, 2015). In addition, more than

40% of the nations children reported using a computer for non-school related activities for more

than three hours on an average school day (YRBS, 2015). It is found that children who are

physically active typically have better grades, school attendance, cognitive performance, and

better classroom behavior (CDC, 2018). If the amount of time children are spending in front of

technology screens could be lessened, they would have more time to increase physical activity

and in turn see improvements in behavior and school performance.

On a state level, Florida has higher rates of obesity, less physical activity and higher

amounts of screen time used than the United States as a whole. Only 25% of the states

adolescents were physically active for the recommended amount of time and 26% of students

were either obese or overweight (CDC, 2015).

The lack of physical activity and amount of screen time are huge determining factors in

the obesity levels of children aged 10-14 living in Duval County Florida. Data taken from the

2015 YRBS survey indicates that less than 40% of middle school students in Duval County got
sufficient physical activity (YRBS, 2015). A huge factor deterring children from engaging in

physical activity, is the abundance and easy access to technology. One in three children reported

that they watch at least three hours of television on a given school day (YRBS, 2015). On top of

this, the use of non-school related screen time has increased by 22% amongst this age range in

just four years (YRBS, 2011). The statistics are even more staggering when it is broken down by

gender. Only one in three females participated in the recommended activity levels; compared to

one in two males (YRBS, 2015). As a whole, one in 5 students rarely or never got the

recommended daily activity levels (YRBS, 2015).

This inactivity appears to continue on with students as they enter high school and their

actions become lifestyle habits. The YRBS survey from 2015 shows that less than 30% of high

schoolers are participating in sufficient physical activity (YRBS, 2015) . If we can implement a

program to help find a way to limit students screen time and increase their desire to participate in

physical activity, the culture of Duval county schools as a whole could change.

Out of all of the health zones in Duval County, zone four is the most concerning. It is by

far the least active and has the most problems of concern. When looking at middle school

children, the students of this zone have the lowest levels of physical activity and the highest

usage of non-school related screen time (YRBS, 2015). As discussed earlier, these two problems

are directly correlated to one another. Increased screen time and use of electronics leads to a

decrease in physical activity in children. In high school students the problems become worse.

They have the most obese and overweight students, have the highest levels of screen time and

are the least physically active (YRBS, 2015). If work is not done in the middle schools of this

zone to increase activity, it can be safely assumed that within the next few years the statistics for

high school students in this area will worsen.

 In determining the population at greatest need of intervention, we first analyzed national,

state and local data on childhood obesity. Childhood obesity effects 17% of the United States

youth population affecting millions of children yearly. In the Youth Risk Behavior Survey

(YRBS) from 2015, over 25% of middle schoolers identified as overweight or obese. The Center

for Disease Control identifies the leading causes of childhood obesity in the United States as lack

of physical activity and poor nutrition. According to recent YRBS data, three in five middle

schools in Duval County reported not receiving enough physical activity (YRBS, 2015).

According to the Florida Department of Health in Duval County (FDHDC), nearly two dozen

areas in Duval County would be referred to as a food desert, communities that have limited

access to affordable and nutritious foods. In 2015, 21.7% of Duval County middle schoolers

reported consuming fast food one or more times within a week. In addition, 17.8 % of Duval

County middle schoolers reported going hungry due to lack of food in the home (YRBS,

2015).With data collected from Healthy Jacksonville Childhood Obesity Prevention Coalition’s

publication Healthy Kids, Health Jacksonville, all six of the health zones are in need of

improvement in school based nutrition and physical activity intervention.

With the rising rate of childhood obesity among children ages ten to twelve, our target

population is all seventh graders attending middle schools in Health Zone 4 in Duval County.

The middle schools in Health Zone 4 will be asked to take the Needs Assessment Survey. In

partnership with Duval County Public Schools (DCPS) the Needs Assessment Survey will be

administered to students by our health educator. Students will be given the assessment during

their health or physical education class. To ensure accurate data and responses, students will be

assured that answers will not have an effect on class grades or any classroom involvements. The

Needs Assessment Survey will consist of the School Physical Activity and Nutrition (SPAN)
survey, developed by University of Texas School of Public Health. Survey questions will assess

the student’s dietary and physical activity habits. After conducting and evaluating the

assessment, one middle school at the greatest need in each health zone will be selected to

participate in our program. Our program will focus on being administered to seventh graders of

the school year following our needs assessment as they show the most accurate depiction of the

needs of middle schoolers.

In conclusion, the lack of physical activity and proper nutrition are the biggest factors

that impede on a healthy lifestyle for the middle school students in Duval County. These changes

will increase awareness and allow for a reduction in childhood obesity. The literature shows that

getting students active is the biggest factor in battling obesity. Our goal is to increase the

prevention efforts and have a well established plan to reduce childhood obesity in Duval County.
 Sources

1. Cantor, J., Breck, A., & Elbel, B. (2016). Correlates of Sugar-Sweetened Beverages

Purchased for Children at Fast-food Restaurants. Am J Public Health. 2038-

2040.

2. Cai, Y., Zhu, X., & Wu, X. (2017). Original article: Overweight, obesity, and screen-time

viewing among Chinese school-aged children: National prevalence estimates from

the 2016 Physical Activity and Fitness in China—The Youth Study. Journal Of

Sport And Health Science, 6404-409.

3. Clark, B. R., White, M. L., Royer, N. K., Burlis, T. L., DuPont, N. C., Wallendorf, M., &

Racette, S. B. (2015). Obesity and Aerobic Fitness among Urban Public School

Students in Elementary, Middle, and High School. Plos ONE, 10(9), 1-11.

4. Healthy Schools. (2018, January 29). Retrieved from

https://www.cdc.gov/healthyschools/obesity/facts.html.

5. Li, Y., Robinson, L., Carter, W., Gupta, R. (2014). Childhood Obesity and Community

Food Environments in Alabama’s Black Belt Region. Child: Care, Health and

Development. 669-670.

6. Overweight & Obesity. (2016, December 15). Retrieved from

http://www.cdc.gov/obesity

/childhood/causes/html.

7. UF Health Jax Community Needs Assessment. (2015). Retrieved from https://ufhealthjax

.org/community/documents/chna2015.pdf.

8. Vanderhulst, E., Faik, A., Vansintejan, J., Rossem, I., Devroey, D. (2017). Association of

Dietary Habits and Interest for Food and Science versus Weight Status in
 Children Age 8 to 18 Years. Journal of Obesity.

9. Willeboordse, M., Kant, K., Velden, C., Schayck, C., Dompeling, E. (2016). Associations

between Asthma, Overweight and Physical Activity in Children. BMC Public

Health. 16: 919.

10. WHO. (2012). Population- Based Approaches to Childhood Obesity Prevention, World

Health Organization, Geneva, Switzerland.

11. Florida Department of Health in Duval County. (2015). Youth Risk Behavior Survey.

Retrieved from http://duval.floridahealth.gov/programs-and-services/community-

Health-planning-and-statistics/youth-risk-behavior-survey/index.html.