1. Results, cont. - Ethnicity x Weight
Conclusions and Future Directions
Energy Balance
Energy Balance Composite Components:
Background
o Child and adolescent obesity is a rising health crisis [1]
o More than one-third of children and adolescents are
overweight/obese, with minority groups
disproportionately affected [1]
o Obesity correlates with negative long term health
outcomes such as cardiovascular disease, diabetes,
psychosocial difficulties, and various other
complications [2]
o Energy Balance (EB)- the relationship between
energy intake and expenditure- is the key to
maintaining weight[3]
o Contributing factors to youth obesity are: limited
physical activity, excessive sedentary activity, reduced
low energy dense food intake and excessive high
energy food intake[4]
o No other studies have explored Energy Balance
Theory using data from the YRBS CDC Survey
Results
•n= 11,690 with complete data (49.1% male 50.9% female)
•Demographic data including race/ethnicity available on
CDC/YRBS website and are weighted to reflect the general
population http://www.cdc.gov/healthyyouth/data/yrbs/results.htm
Associations between BMI & Energy Balance
Component & Composite Scores (r):
Hypothesis: EB scores will vary based on weight
status category. One-way ANOVA yielded a strong
main effect for weight category on energy balance
composite score, F (3, 38) =33.24, p <.001.
References
Objectives & Hypotheses
• Based on YRBS data, develop composite score
reflecting energy balance. Examine association between
each component of EB composite and BMI.
• Examine differences... It was hypothesized that EB
scores would vary based on weight category, with those
from the healthy weight class evidencing lower Energy
In, higher Energy Out, and lower Energy Composite
scores (relative to overweight/obese classes).
• Examine ethnic x weight differences in EB scores. No a
priori hypotheses were asserted in this area.
Method
YRBS: 2013 CDC Youth Risk Behavior Survey
o Secondary data analysis of 2013 Youth Risk Behavior
Survey (YRBS) – national survey of 13,583 US
adolescents[5]
o The YRBS examines six health risk behaviors found in
youth including violence, unsafe sexual behaviors,
alcohol and drug use, tobacco use, unhealthy eating
habits, and physical activity [5]
o The YRBS is self-administered (biennially) for school
age students from grades 9-12 [5]
o Demographic data and YRBS items within newly
developed Energy Balance composite were analyzed
[5]
Data Analytic Treatment: SPSS Complex Samples v.23
(IBM) used for descriptives, correlations, and ANOVAs.
ENERGY *IN* ENERGY *OUT*
Low Energy Dense (LED)
(High Nutrient/Low Calorie)
YRBS ITEMS:
Specific Fruit and Vegetable
Consumption
High Energy Dense (HED)
(Low Nutrient/High Calorie)
YRBS ITEMS:
Fruit Juice, Soda, &
Alcohol Intake
Physical Activity (PA)
(Energy Burning Activities)
YRBS ITEMS:
Days of Aerobic Activity
Days Spent in P.E Class
Sedentary Activity (SA)
(Very Low Energy Activities)
YRBS ITEMS:
# Hours Spent Watching TV &
Playing Video Games
Limitations
Acknowledgements
Creating an Energy Balance Composite from YRBS Data: An Exploratory Study
Alexander Salinas, Sarah Dow, Gabrielle Santander, Heidi Weinborg & Janelle Garcia, BSN Students
Laura M. Anderson, PhD (Asst Professor, Licensed Psychologist, & Director - PULSE Healthy Weight Research Team)
pulse@buffalo.edu
School of Nursing, The State University of New York at Buffalo, Buffalo, NY 14214
1. National Heart, Lung and Blood Institute (NHLBI). Why Obesity Is a Health Problem. Obesity Health Problem,
Healthy Weight Basics, NHLBI, NIH 2013. http://www.nhlbi.nih.gov/health/educational/wecan/healthy-weight-
basics/obesity.htm. Accessed March 27, 2016
2. Center for Disease Control and Prevention (CDC) The Health Effects of Overweight and Obesity. Centers for
Disease Control and Prevention 2015. http://www.cdc.gov/healthyweight/effects/. Accessed March 27, 2016.
3. National Heart, Lung and Blood Institute (NHLBI). Balance Food and Activity. Energy Balance and Obesity, Healthy
Weight Basics, NHLBI, NIH 2013. http://www.nhlbi.nih.gov/health/educational/wecan/healthy-weight-
basics/balance.htm. Accessed March 27, 2016.
4. Center for Disease Control and Prevention (CDC). Defining Adult Overweight and Obesity. Centers for Disease
Control and Prevention 2012. http://www.cdc.gov/obesity/adult/defining.html. Accessed March 27, 2016.
5. Center for Disease Control and Prevention (CDC). Youth Risk Behavior Surveillance Survey. Centers for Disease
Control and Prevention 2013. file:///C:/Users/Gabrielle/Downloads/YRBS_2013_National_User_Guide%20.pdf
o PULSE Healthy Weight Research Team
o Center for Nursing Research (CNR), University at Buffalo SON
o Center for Disease Control and Prevention (CDC) 2013 Youth Risk
Behavior Surveillance Survey (YRBSS)
o Center for Undergraduate Research & Creative Activities (CURCA)
2.8 2.72 2.79 2.9
3.4 3.23
2.87
2.6
Healthy Weight Overweight Obese I Obese II
Mean EB Composite Component Scores
by Weight Category
ENERGY IN ENERGY OUT
• Age- & sex-specific
• Plot BMI on growth chart to find percentile
• Weight status determined by percentile
Weight Status Category Percentile Range
Severely Obese (Obese II) ≥ 99th percentile
Obese (Obese I) 95th - < 99th percentile
Overweight 85th to <95th percentile
Healthy Weight 5th to <85th percentile
Adolescent Body Mass Index (BMI)
Energy Balance (EB) is the the relationship
between the amount of energy taken in from
food/drink and the energy expended through
daily living and physical activity
Weight Status Category Percentage (n=11,690)
Severely Obese (Obese II) 2.9%
Obese (Obese I) 11.3%
Overweight 16.5%
Healthy Weight 69.2%
* p<.05
** p <.01
LED HED IN PA SA OUT EB
BMI -.002 .02* .02* -.06** -.06** -.08** -.08**
-0.76
-0.6
0.09 0.13
-0.9
-0.8
-0.7
-0.6
-0.5
-0.4
-0.3
-0.2
-0.1
0
0.1
0.2
Healthy
Weight
Overweight Obese I Obese II
Mean EB Composite Score by Weight
Category
Note. Statistically significant main effects (for weight
class) obtained for Energy Out- F (3, 38) =19.28, p <.01
- but NOT Energy In, F (3, 38) =2.73, p= .06.
A two-way ANOVA
examined the influence
of ethnicity and weight
class (healthy vs.
overweight/obese) on
EB composite scores.
There were significant
main effects for
ethnicity- F (7, 34) =
8.76, p<.01 - and weight-
F (1, 40) = 21.75, p <.001
. No ethnicity x weight
interaction was
obtained.
Mean Energy Balance Composite
Scores by Ethnicity & Weight Class
• Energy Balance Theory supported, in part, through results.
• Despite weak correlations, the components of EB composite - (Energy In:
LED + HED) + (Energy Out: PA + SA) - are linked to BMI/weight.
• “Energy In” factors were weaker predictors of BMI than “Energy Out”
components.
• EB composite and Energy Out scores varied meaningfully and
systematically based on weight class.
• Racial/ethnic differences were observed in EB composite scores, with (a)
similar patterns of racial differences across weight classes & (b) weight
class being more strongly associated with EB scores.
• This work aims to inform an EB composite scale for health care.
• If nurses obtain an EB composite snapshot, they could target specific
intervention points (In vs. Out) without restrictive diets (& better
understand obesity). Increased likelihood of intervention compliance by
adolescents.
• MANY food groups unavailable on YRBS – HED foods, in particular.
• Validity of composite completely linked to specific, limited items on YRBS.
• Students from low-income and/or diverse backgrounds may be
disadvantaged: certain foods not represented, sports team/physical activity
participation linked to SES and potentially popularity, etc.
Energy Balance  Calories Consumed = Calories Used
Positive Energy Balance  Calories Consumed > Calories Used
Negative Energy Balance  Calories Consumed < Calories Used