Youth Obesity

        Youth obesity is most commonly defined in terms of Body Mass Index (BMI), a ratio of height to weight. Overweight children have a BMI of 85th to 95th percentiles while obese chldren have  BMI at or above the 95th percentile, for children and teens of the same age and sex. 

        An individual’s BMI is a measure of body fat based on height and weight. In children and teens, BMI is used to find out if a child or teen is underweight, of a healthy weight, overweight, or obese. Once the BMI for an individual is calculated, it is expressed in relation to a percentile a child fits into according to both their age group and gender. Overweight children have a BMI between the 80-95th percentiles and obese children have a BMI higher than the 95th percentile. In 2019, the prevalence of obesity in the United States was 18.5% and affected 13.7 million children and adolescents. In 2018, 38% of Tennessee’s youth were either overweight or obese, which was higher than the national average of 31%.  

        Excessive calorie intake and inadequate physical activity significantly contribute to obesity by creating an energy imbalance. However, many other socioeconomic factors can influence youth obesity in a population including: parent obesity, educational attainment of the parents, breastfeeding, inadequate access to recreational parks, sedentary habits with increased screen time, maternal pre-pregnancy obesity, genetics, quality of sleep, and access to affordable nutrition and physical activity opportunities both at school and at home.  

        For children and teens, a high Body Mass Index can lead to weight-related diseases. In 2017, Tennessee was ranked 5th in the nation for most obese 10-17 year olds and unfortunately, the consequences last far beyond their teen years. Overweight and obese children are subject to several short- and long-term health effects such as chronic diseases (asthma, sleep apnea, and bone and joint issues), emotional health effects from being bullied and/or isolated by their peers, and long-term health issues later in life (adult obesity and heart disease). Obese children have twice the risk of cardiovascular disease and four times the risk of type-2 diabetes over their lifetime. Additionally, obese children are at a higher risk for cancer and have a shorter overall life expectancy. 

        Obesity disproportionately affects different communities— including communities of color, communities with high levels of poverty, and adults with lower education levels. Of the US population in 2019, Hispanics (25.8%) and non-Hispanic blacks (22.0%) had higher obesity prevalence than non-Hispanic whites (14.1%). The prevalence of obesity decreased with increasing level of education of the household head among children and adolescents aged 2-19 years. This was represented by obesity prevalence of 18.9% among children and adolescents aged 2-19 years in the lowest income group, 19.9% among those in the middle income group, and 10.9% among those in the highest income group.  

Vital Sign Actions Guide

The following are lists of intervention strategies that you, your health council, and other local stakeholders could use to address youth obesity in your community.  


1. Active Recess 

There is scientific evidence that structured or semi-structured active recess, as opposed to unstructured free time, increases the physical activity levels in children (most effective up to 10 years of age). Having updated playground equipment, painted signs and markings that encourage movement and portable equipment (balls, jump ropes, etc) all increase a child’s physical activity levels during school. The CDC and Robert Wood Johnson Foundation’s County Health Rankings recommend this intervention strategy as a way to combat youth obesity. 


2. Activity Breaks in the Classroom (GoNoodle, Morning Movement) 

Physical activity breaks in the classroom are scientifically supported and recommended by the Robert Wood Johnson Foundation. GoNoodle is an online program that uses short, engaging videos to get kids moving. These “brain breaks” include running, dancing, deep breathing, stretching, and other fun activities. This program can be used in the classroom, after-school programs, at home, and in child care settings. Morning Movement is a physical activity program that gets students moving for a few minutes every morning before school starts. 


3. After School Mile (Walk/Run) Clubs

Walk or Run clubs are physical activity programs designed to encourage students to run before or after school in a group with their peers. Unlike athletic teams, walk/run clubs allow students of any physical activity level or skill to join. By naming a program “Mile Club” or other, the club can be inclusive of students who might wish to walk or those who need wheelchairs or other assistive devices. 


4. Breastfeeding Support Groups and Peer Counseling 

Breastfeeding mothers benefit greatly from mother-to-mother sharing that occurs at support group meetings. Breastfeeding Counselors can set the stage for an effective meeting by selecting meeting topics and using discussion starters that put the participants at ease and encourage informative and supportive conversation. Support group meetings can include round table discussions, breastfeeding classes, or social events. Encouraging mothers to join or start a breastfeeding support group can help to destigmatize breastfeeding and educate mothers about the nutritional benefits of breastfeeding. Click here to find a breastfeeding expert,  a Le Leche League, or breastfeeding advocacy group near you. 


5. Chef Academy Cooking Program 

A program that teaches elementary and middle school students cooking techniques has the potential to establish healthy eating habits early in adolescence. One example of a cooking course for students is the Chef Academy in Murfreesboro City Schools. Students compete against teams from other Murfreesboro schools, and must adhere to USDA guidelines for sodium and fat content in all meals that they prepare. This program is a great opportunity to partner with Coordinated School Health or educate students and their families about preparing nutritious foods.  


6. Community School Garden 

Community school garden are a great way to introduce children to various fruits and vegetables while involving them in the process of planting and growing their own food. In addition to the physical activity gained through gardening, students may take home fresh fruits and vegetables and learn about the benefits of eating healthy foods. Evidence shows that school gardens increase the availability of fruits and vegetables in students’ homes, and increases students’ consumption of fruits and vegetables. Foods grown in the gardens can be served in the school cafeteria and cooking classes are a great way to teach students how to use the food they grew to make healthy, delicious meals.


7. Family Nutrition Education 

A child's eating habits are largely influenced by what food is available at home. Teaching parents and caregivers can be an effective tool in influencing a child's future nutritional habits. One program that aims to educate low-income families on healthy eating options is the Expanded Food and Nutrition Education Program (EFNEP) through the University of Tennessee Extension. By partnering with this program and others like it, more families can be served in a community and fewer children may suffer from overweight and obesity. 


8. Farm to School Program 

Farm to School programs are a part of an initiative to bring local, healthy food into schools. These programs aim to increase students’ access to fresh fruits and vegetables, while supporting local farmers and helping to develop health eating habits in children. See the source below for farm to school resources in Tennessee. 


9. Power of Produce (POP) Club

The PoP Club provides children’s education and programming at local farmer’s markets. A key component of this program is partnering with farmers to provide PoP vouchers for children to purchase their own produce, so they can learn more about different fresh fruits and vegetables and how to prepare them.


10. Prescribing Parks 

The national and State Parks Rx programs encourage providers to prescribe outdoor activity. In Tennessee, Park Rx pads, brochures, and other materials are available for free from the Healthy Parks Healthy Person Program. The national Park Rx program offers toolkits, reports and training webinars. Promoting this policy to pediatricians and in primary care settings may encourage families with young children to get outdoors and exercise more. 


11. Safe Routes to School and Walking School Bus 

Safe Routes to School is a federally funded program that aims to encourage students to walk or bike to school.  Its programs aim to improve safety for children and the community and provide opportunities to increase daily physical activity. Creating safe routes for children to walk can include mechanisms for enforcing traffic laws, changes to the built environment (complete streets, connecting sidewalks, etc.), walking school bus, and simply educating families on the importance of daily physical activity. Walking school buses are scientifically supported in increasing active transportation time.


12. Screen Time Reduction Initiatives 

The Community Guide recommends initiatives that reduce recreational screen time in children age 13 and younger. Interventions that were studied showed effective decreases in recreational screen time, increases in physical activity, diet improvement, and improving or maintaining weight (BMI). The American Academy of Pediatrics recommends that children ages 2-5 get no more than 1 hour of screen time per day of high quality programming and placing consistent limits and planning for children over 6.


1. Access to Health Built Environment Grants (TDH)

Purpose: The Tennessee Department of Health offers two grants through the Office of Primary Prevention to increase options for daily physical activity—the Access to Health through Healthy Active Built Environment grants. One round is not competitive and is distributed to all 95 counties, and the other round is competitive and application based.  These grants can be used for park improvement, playgrounds, trails, outdoor fitness equipment and other projects that encourage outdoor physical activity through the built environment. 

Duration: 1 year (non-copetitive); two years (competitive)

Amount:  $20,000 per county (non-competitive); Up to $85,000 (competitive) 


2. BlueCross BlueShield Grants 

Purpose: BlueCross BlueShield of Tennessee awards funding for programs that help to create active, healthy spaces across the state. BCBS manages two funding opportunities—BlueCross Healthy Place and Community Trust grants. See the source below for specific funding criteria and exclusions. 

Duration: Varies

Amount: Varies


3. Community Foundations

Purpose: Community Foundations offer small grants that focus on community-driven change in Tennessee. The Community Foundations in Tennessee include Appalachian Community Fund, The Community Foundation of Greater Chattanooga, Community Foundation of Greater Memphis, Community Foundation of Middle Tennessee, Knox County Community Foundation, and East Tennessee Foundation. Most of these foundations consider healthy youth development as a focus area of grant funding.

Duration: Varies

Amount: Varies 


4. Cultivating Healthy Communities Grant

Purpose: The Cultivating Health Communities grant, administered by Aetna, provides funding for programs that make underserved communities healthier places to live, work, learn, and play. The primary focus of this grant program is addressing social determinants of health. Specific activities that are funded through the CHC program include walkability/bike-ability projects, school nutrition and physical activity programs, public safety, and built environment policy work.

Duration: 1-2 years

Amount: $50,000-$100,000 (total)


5. Fuel Up to Play 60: Jump Start Healthy Changes 

Purpose:  Fuel Up to Play 60 manages the Jump Start Healthy Changes grant that provides funding to K-12 schools to implement nutrition and physical activity “Plays” from the Fuel Up to Play 60 Playbook. To qualify, schools must participate in the National School Lunch Program.  

Duration: 1 year 

Amount: $300-$4,000


6. KaBOOM Playground Grants

Purpose: KaBOOM awards grant funding for communities to build safe, creative playgrounds for children. KaBOOM grants are rolling submission and open throughout the year. This funding program is a great opportunity to combine playground construction with literacy enhancing playground elements and universal design concepts to allow all children to play regardless of ability level.

Duration: Varies

Amount: Varies 


7. Robert Wood Johnson Foundation

Purpose: These grants are focused on healthy systems, "healthy children, healthy weight", healthy communities and healthy leadership.

Duration: One to three years

Amount: $100,000 to $300,000 (average)


8. Safe Routes to Parks/Safe Routes to Schools

Purpose: Safe Routes to Parks is a program that provides grants for communities who wish to increase safe access to parks. Safe Routes to School is a similar, federally funded program that provides grant funding to increase safe, walkable routes to schools. These programs aim to increase physical activity in communities across the U.S. while advancing racial and social equity. 

Duration: 1 year (SRTP)

Amount: $12,500 (SRTP)


9. Tennessee Project Diabetes 

Purpose: The Tennessee Department of Health administers Project Diabetes grants that focus on reducing the rate of Tennesseans who are overweight or obese. One goal of Project Diabetes is to encourage physical activity as an integral and routine part of life by enhancing the physical and built environment. Grants are administered in two categories, Category A and Category B.

Duration:  Up to 3 years (Cat. A); up to 2 years (Cat. B)

Amount: Up to $150,000 per year (Cat. A); up to $15,000 per year (Cat. B)


10. The HCA Foundation 

Purpose: The HCA Foundation promotes health and wellbeing, childhood and youth development, and the arts in middle Tennessee communities through grant funding administration. Organizations must be 501(c)3 nonprofits in the Middle Tennessee area (see the website for eligible counties) to apply. 

Duration: Varies

Amount: Varies


1. Women, Infants, and Children (WIC) Promotion

WIC is a federally funded program that provides supplemental food to low-income pregnant women and new mothers to children under the age of five. This program focuses on nutrition education, supplemental foods, breastfeeding support, and health care referrals. WIC has proven to be effective in preventing and improving nutrition related health problems, including youth obesity. Parents must meet financial eligibility requirements to enroll. By promoting enrollment of low-income mothers in the WIC program, fewer infants will experience nutrition-related health issues. 


2. Breastfeeding Welcomed Here

The Tennessee Department of Health recognizes businesses that support breastfeeding families through the “Breastfeeding Welcomed Here” campaign. Businesses can show their support for breastfeeding mothers by allowing and encouraging women to breastfeed their infants in the establishment and display a “Breastfeeding Welcomed Here” window decal to welcome these women. This program seeks to normalize the act of breastfeeding in public.


3. Bringing Tap Back/Rethink Your Drink Campaign 

A tap water campaign like Bringing Tap Back or Rethink Your Drink encourages students in schools to replace sugar sweetened beverages (SSB) with water and increase the use of refillable water bottles and drinking tap water. Adolescents who drink SSB every day are at much higher risk of obesity than peers who drink water. This campaign can include educational posters, student challenges and classroom prizes, and installing water bottle refill stations to encourage drinking water from reusable bottles.


4. Child Health Month

Child Health Month occurs in Tennessee each October, with Child Health Day occurring on the first Monday in October. Child Health Month is a great opportunity to promote activities and programs that improve the health of children in Tennessee communities. See the Tennessee Department of Health website for a calendar of events and toolkit from the 2019 CHM. 


5. Let's Go! 5-2-1-0 Campaign 

The Let’s Go! 5-2-1-0 campaign promotes healthy nutritional habits and physical activity in school-aged children. The premise of the campaign is to educate parents and teachers that children need at least 5 servings of fruits or vegetables, less than 2 hours of screen time, 1 hour or more of physical activity, and 0 sugar-sweetened beverages per day. One study has shown that children’s consumption of sugar-sweetened beverages decreased and consumption of fruits and vegetables increased after this campaign was implemented along with widespread policy changes in multiple settings in a community.  


6. National Nutrition Month 

National Nutrition Month is promoted by the Academy of Nutrition and Dietetics during the month of March. Click on the link for games, quizzes, handouts, and media materials that can be used to promote National nutrition Month. 


7. National Walk/Bike to School Day 

National Walk to School Day encourages children across the U.S. to walk or bike to school. By supporting a community walk, families and individuals are shown that walking or biking to school is possible and safe. This event may also spur changes to local policy about street design and traffic laws. Walk to School Day can be expanded to include adults as a Walk to Work Day.


8. Promote Breastfeeding Areas and Designated Breasfeeding Expert Services 

Community events are a great place to promote a breastfeeding area or room for mothers. Additionally, TN County Health Departments offer the services of a Designated Breastfeeding Expert. Promoting this free service to breastfeeding mothers encourages breastfeeding and can help to improve health outcomes for infants. 


9. Summer Food Service Program and Seamless Summer Option 

The SFSP program increases access to food for low-income families. Similarly, the Seamless Summer Option is a grant administered through the TN Department of Education that funds schools who wish to sponsor summer feeding programs. SSO and SFSP provide meals to adolescents who qualify for free or reduced lunch during the critical summer months when school is out. Promoting this program to families or potential SFSP sponsors could help to mitigate inadequate access to nutrition.


9. Tennessee Breastfeeding Hotline Number 

The Tennessee Breastfeeding Hotline, staffed by International Board Certified Lactation Consultants (IBCLC) and Certified Lactation Counselors (CLC), is available to nursing mothers and partners, their families, expectant mothers, and health care providers seeking breastfeeding support and information. The Hotline operates 7 days a week, 24 hours a day. The hotline number is 855-4BFMOMS and is available to mothers in more than 200 languages and to hearing-impaired callers. This service gives mothers the information and support they need to better breastfeed their infants.


10. "We Can!" Campaign 

The “We Can! (Ways to Enhance Children’s Activity and Nutrition)” campaign is promoted by the National Heart, Lung, and Blood Association and seeks to educate parents and caregivers about the importance of physical activity and healthy eating habits for young children. This initiative provides organizations with materials and recommendations to aid in community outreach efforts.  Click on the link for parent tip sheets, promotional materials, healthy recipes, policy resources, and more.


1. Adopt a Recess before Lunch Policy 

While the research results are preliminary, advocates of recess before lunch see the benefit of improved cafeteria behavior, students return to the classroom calmer and ready to learn, students eat more and throw away less, and fewer discipline issues. With this policy students would likely consume more food at school, which is statistically healthier than the rest of their meals. Another advantage of this policy is that it is backed by the National Education Association and supported by teachers. 


2. Adopt a School Wellness Committee Best Practices

School Wellness Committees are devoted to the health and wellbeing of students and school staff. These committees are important for the development and implementation of School Wellness Policies. These wellness committees can also promote activities and events that focus on student health that are outside of the school’s wellness policies. See the following source for a tool kit and best practices for an effective School Wellness Committee. 


3. Advocating for a Sugar-Sweetened Beverage Tax (Soda Tax) 

There are currently nine cities or counties in the United States that have implemented an excise tax on sugar-sweetened beverages. These taxes range from 1 cent to 2 cents per ounce of soda. Research supports soda taxes as a method to decrease consumption of sugar-sweetened beverages in a community. Sodas are a major driver of obesity in children and adults. Additionally, the increased tax revenue can be used by a local government to fund nutritional programs or other initiatives that help to mitigate the financial effects felt by low-income families who are more likely to consume sugar-sweetened beverages. 


4. Gold Sneaker Initiative 

The Gold Sneaker initiative is a voluntary certification program that provides policy and programming recommendations to licensed child care facilities in Tennessee. These policies aim to set standards regarding daily physical activity, nutrition requirements, screen time limits, and other health-promoting behaviors in schools and child care facilities. Gold Sneaker is managed and funded through the Department of Health and the Department of Human Services.


5. School Policies that Promote Health Food and Beverage Options 

Children spend the majority of their time at school and in after-school programs. Policies in these spaces can influence the majority of a child’s healthy behaviors through food options and beverages available during breakfast, lunch, snack time, and vending machines. School boards and individual schools can promote access to nutritional foods and beverages in a variety of ways. Some examples of school policies include pricing healthy food options at a lower cost, placing healthier food options in front of less healthy food options, ensuring access to water throughout the day, and placing point-of-decision signs promoting healthy choices. 


6. Updated School and Wellness Policy to Include additional measures 

Adding healthy priorities to the school district's wellness policy can increase the focus on student weight as it relates to health and wellness. Additions can include longer recesses, acticity breaks, access to water in the classroom, after-school sports, not using food as a reward, not withholding food as a punishment, and others. Community members can work with their school board district to implement changes. 


1. Implement Bright Future Recommendations 

The Health Resources and Services Administration along with the Academy of Pediatrics recommend that primary care providers address youth obesity in the clinical setting. Bright Futures provides guidelines and resources that providers can use to screen for obesity, prevent excessive weight gain, and guide patients to a healthy BMI range. By promoting this policy to hospitals and health departments, clinical providers can work together with parents and care takers to prevent youth obesity. 


2. Universal Physical Activity Assessment and Prescribing 

Provider policy in pediatric clinical settings should encourage assessing the physical activity level of all patients, and the use of physical activity prescription or the referral of patients to a certified fitness professional. Research shows that physical activity assessment and counseling in the clinical setting can lead to increased levels of physical activity in youth. The Exercise is Medicine Initiative supports health care providers in prescribing physical activity to patients as treatment and management of various chronic diseases. Exercise is Medicine provides exercise prescription pads, office flyers, and physician action guides for providers.


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This document is not a Department endorsement of legislative policy.