title: Obesity and health risk of children in the Mississippi Delta.
abstract: BACKGROUND
  Mississippi (MS) Delta adults and youth report obesity rates far exceeding those of the state and nation. State law requires in-school physical activity and nutrition practices to address childhood obesity but does not require evaluation of outcomes, specifically the impact on weight-related outcomes. This paper offers 3 things: (1) describes the weight status of elementary school-age children in the MS Delta; (2) explains the importance of including waist-to-height ratio (WHtR) values when reporting body mass index (BMI); and (3) provides impetus for policy that requires weight-related health risk, as measured by WHtR, to be assessed regularly as a means to evaluate school health policy.
  
  
  METHODS
  We took anthropometric measures in a cross-sectional investigation of 1136 children from 11 public elementary schools in the MS Delta. Measures included BMI, waist circumference (WC) and WHtR.
  
  
  RESULTS
  The prevalence of overweight and obesity (BMI ≥85th percentile) was 47.1% (18.3% overweight and 28.8% obese). In this sample, 59.9% and 42.0% were "at risk" for weight-related chronic disease based on WC (≥75th percentile) and WHtR (>0.5), respectively. The differences in these proportions were statistically significant. The predominantly black districts reported higher on all of the weight-related measures.
  
  
  CONCLUSIONS
  Investigators recommend the assessment of health policy include measures of health risk in addition to BMI, namely WHtR as it accounts for growth in both WC and height over age. Furthermore, WHtR is a more accurate indicator of fat distribution and health risk than WC alone.
authors.affiliation: The Mississippi Delta Health Collaborative, Mississippi State Department of Health, Greenwood, MS 38930, USA. activeabigail@yahoo.com
authors.forename: Abigail
authors.initials: A
authors.lastname: Gamble
authors.forename: Dwight
authors.initials: D
authors.lastname: Waddell
authors.forename: M Allison
authors.initials: MA
authors.lastname: Ford
authors.forename: John P
authors.initials: JP
authors.lastname: Bentley
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Woodyard
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hallam
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000886:Anthropometry; D015992:Body Mass Index; D002648:Child; D002908:Chronic Disease / Q000208:ethnology*; D003430:Cross-Sectional Studies; D004045:Dietary Services / Q000331:legislation & jurisprudence*; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008922:Mississippi / Q000453:epidemiology; D009043:Motor Activity; D009765:Obesity / Q000150:complications / Q000208:ethnology* / Q000517:prevention & control; D015995:Prevalence; D018570:Risk Assessment; D012574:Schools / Q000331:legislation & jurisprudence*; D012923:Social Class; D055105:Waist Circumference