1. Assessing Behavioral Problems Among Overweight School Children in Tarrant County
Ramneek Manchanda, Brad Cannell, MPH and Jackie Meeks, DrPH
INTRODUCTION
METHODS
CONCLUSION
References
RESULTS DISCUSSION
In the United States, childhood obesity rates have
more than doubled over the past 30 years. In Tarrant
County, 19.2% of the children are either overweight
or obese, similar to the national rate of 18%. To
address this issue, the Cook Children’s Center for
Health issued the CCHAPS survey to families in
Tarrant and surrounding counties to assess the
health needs of children. Healthy lifestyle choices
can prevent the onset of obesity as well as resulting
health conditions. Schools have an important role in
providing a safe a supportive community for children.
Previous research indicates childhood obesity can
lead to physical and mental complications as children
progress through adolescence and adulthood.
Childhood obesity can lead to early diagnosis of
diabetes, asthma and high blood pressure.
Additionally, overweight children have been found to
have higher rates of depression as well as being
bullied by their classmates in a school environment.
The objective of this study was to assess whether or
not a child’s weight could possibly predict behavior in
a school environment.
Sample: The Cook Children’s Center for Health
distributed a Children’s Health Assessment and
Planning Survey (CCHAPS) to parents across
Tarrant and neighboring counties. The survey was
administered in 2012 by mail, e-mail and phone.
We narrowed our focus to 3536 Caucasian and
Hispanic Children aged 0-14 years old in Tarrant
County, as this constituted 84% of the responses.
Measures: The dependent variable measured is
behavioral problems in a school environment. This
dependent variable is sub-set by measuring
whether the child was bullied, bullied others, was
previously suspended, and whether the child had
academic or behavioral problems at school. The
measures have been stratified by race. The
independent variables measured are overall
health and obesity status.
Analysis: Data was analyzed by SAS software.
Descriptive analyses (Table 1) and odd ratios
were computed for each cross tabulation (Table
2).
Table 1. Descriptive Analysis By Race
Hispanic Caucasian
Gender
Male
Female
444 (52%)
410 (48%)
1087 (51%)
1045 (49%)
Age
Toddlers
Pre-School
Children
Young Teens
85 (10%)
110 (13%)
369 (43%)
290 (34%)
223 (10.5%)
243 (11.4%)
949 (44.5%)
717 (33.6%)
Household Income
< $35,000
$35,000-$99,000
$100,000 or more
328 (45%)
300 (41%)
105 (14%)
156 (8.6%)
766 (42%)
900 (49.4%)
Overall Health
Good/Fair/Poor
Excellent/Very Good
229 (27%)
623 (73%)
193 (9%)
1935 (91%)
Weight Status
Underweight
Normal
Overweight
Obese
65 (7.6%)
369 (43.2%)
117 (13.7%)
303 (35.5%)
194 (9%)
1245 (58.4%)
312 (14.6%)
381 (18%)
Physical Activity
3 or less days/week
4 or more days/week
170 (20%)
684 (80%)
264 (12%)
1868 (88%)
Table 2. Behavioral Descriptive Analysis By Race
Hispanic Caucasian
Academic Problems
Yes
No
80 (9%)
774 (91%)
173 (8%)
1959 (92%)
Behavior Problems while
at School
Yes
No
78 (9%)
776 (91%)
183 (9%)
1949 (91%)
School Suspension
Yes
No
29 (3.4%)
825 (96.6%)
52 (2.5%)
2080 (97.5%)
History of Being Bullied
Yes
No
104 (12%)
750 (88%)
269 (12.6%)
1863 (87.4%)
History of Bullying Others
Yes
No
30 (3.5%)
824 (96.5%)
56 (2.6%)
2076 (97.4%)
Social Behavior Problems
Yes
No
43 (5%)
807 (95%)
104 (5%)
2017 (95%)
Table 3. Odds Ratios of Behavioral Problems By Race among Overweight and Obese Children
Odds Ratio (p-value) 95% Confidence Interval
Has this child ever had academic problems at school?
Caucasian
Hispanic
1.35 (0.068)
1.1 (0.69)
0.9771 - 1.8541
0.6913 - 1.7365
Has this child ever had behavioral problems at school?
Caucasian
Hispanic
1.78 (0.0002)
1.04 (0.87)
1.3084 - 2.4159
0.6508 - 1.6515
Has this child ever been suspended due to behavioral problems?
Caucasian
Hispanic
1.31 (0.35)
1.72 (0.15)
0.7418 – 2.3017
0.8033 – 3.6907
Has the child ever been bullied or teased a lot at school?
Caucasian
Hispanic
1.31 (0.04)
1.48 (0.06)
1.0086 – 1.7133
0.9759 – 2.2361
Has this child ever bullied other children?
Caucasian
Hispanic
3.59 (<0.0001)
1.57 (0.22)
2.0746 – 6.2181
0.7490 – 3.3106
Does this child regularly exhibit problematic social behaviors?
Caucasian
Hispanic
1.99 (0.0005)
1.995 (0.5616)
1.3378 – 2.9531
0.6482 – 2.2185
Among Caucasian children, weight status was
found to be a significant factor in:
 Exhibiting behavioral problems at school
 Being bullied or teased at school
 Bullying other children at school.
 Regularly exhibiting problematic social
behaviors
Majority of the children were found to be in
excellent or very good health, as well as being
physically active.
Hispanic children were more likely to be
suspended than Caucasian children, but it was
found that this was not significant due to weight
status.
Overweight and obese Caucasian children were
three times more likely to bully others, than normal
weight Caucasian children.
Childhood obesity can lead to significant physical
and mental limitations in adolescence and
adulthood. Significant finding were found among
Caucasian children, indicating that weight status
(overweight or obesity) could be a factor in
developing behavioral problems at school, such as
bullying others. Behavioral problems can impact
the child’s academic and social development,
therefore further study could focus on the impact
on academic achievement and future employment,
possible future criminal activity and possible
development of chronic conditions at earlier
stages.
Limitations: The survey were administered to one
adult of the household. Although majority reported
they had an excellent relationship with their child,
the lack of input from the child could skew the
results. Additionally, since the responses were
parent-reported, reports of bullying and other
problems at school may be under-reported.
Additionally CCHAPS is a cross-sectional survey,
making it difficult to determine causation.
Adolescent and School Health- Childhood Obesity. (2013, July 10). Retrieved from Centers for
Disease Control and Prevention: http://www.cdc.gov/healthyyouth/obesity/facts.htm
Childhood Obesity - Complications. (2012, May 4). Retrieved from Mayo Clinic:
http://www.mayoclinic.com/health/childhood-obesity/DS00698/DSECTION=complications
Lu, E., Dayalu, R., Diop, H., Harvey, E. M., Manning, S. E., & Uzogara, S. G. (2010). Weight and
Mental Health Status in Massachusetts, National Survey of Children’s Health, 2007. Maternal and
Child Health .