Numerator: Public school students in grade 5 with body composition falling above the "Healthy Fitness Zone" of California's physical fitness test, the FitnessGram assessment.

Denominator: Public school students in grade 5 who completed California's fitness trest, the FitnessGram assessment.

Percentage of public school students in grades 5 with body composition falling above the "Healthy Fitness Zone" of the FitnessGram assessment (e.g., in 2018, 40.5% of California 5th graders were overweight or obese). Years presented are the final year of a school year (e.g., 2017-2018 is shown as 2018). These data are based on body mass index or other measure of body composition. A large majority of schools use body mass index, which aligns with standards from the U.S. Centers for Disease Control and Prevention, but some schools may use skinfold measurements or bioelectrical impedance to measure body composition.  

The 2018 California Department of Education (CDE) FitnessGram data show that 40.5% of California children in the 5th grade were overweight or obese, down from 40.7% in 2017. Over the last several years, childhood overweight and obesity rates have escalated and reached epidemic proportions, constituting a major public health priority and challenge. Simply defining obesity as a caloric imbalance diminishes the fact that it is complex and involves the interplay of genetics, the obesogenic environment, and individual/caregiver understanding, values and behaviors.[i]

• improve access to healthy foods and drinks in school meals, a la carte lines, stores, vending machines and more;
• require schools to set aside time for physical activity during the school day;
• create new state-wide programs to get local produce to schools and help schools get the equipment they need to prepare fresh foods; and
• make it easier for WIC and Supplemental Nutrition Assistance Program participants to use their benefits to buy fresh fruits and vegetables at farmers' market.

• Increased public awareness of early childhood obesity as an early marker for lifelong health problems
• Improvement in legal supports for breastfeeding mothers at the state and national levels
• National Let’s Move campaign
• Expanded coverage for lactation supports and services in the Affordable Care Act
• Increase in the amount of the WIC cash value benefit for fruits and vegetables for children
• Champions for Change Program - an ongoing effort to improve the health of families and communities in California, especially those that are at greater risk of obesity, high blood pressure, and type 2 diabetes.

[i] Daniels LA, Mallan KM, Nicholson JM, Thorpe K, et al. An Early Feeding Practices Intervention for Obesity Prevention.  Pediatrics 136(1): e40-49. July 2015. doi:https://doi.org/10.11542/peds.2014-4108.

[ii] Finkelstein EA, Graham WCK, Malhotra R. Pediatrics 133(f): 854-862. May 2014. doi:10.1542/peds.2014-0063.

[iii] Perez-Escamilla R, Segura-Perez S, Lott M on behalf of the RWJF HER Expert Panel on Best Practices for Promoting Healthy Nutrition, Feeding Patterns, and Weight Status for Infants and Toddlers from Birth to 24 Months. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Durham, NC: Healthy Eating Research, 2017. Available at https://healthyeatingresearch.org/wp-content/uploads/2017/02/her_feeding_guidelines_report_021416-1.pdf.

[iv] Lanigan J, Tee L, Brandreth R. Childhood Obesity. Medicine 47(3): 109-193. March 2019. doi:https://doi.org/10.1016/j.mpmed.2018.12.007.

[v] Pan L, Blanck HM, Park S, Galuska DA, Freedman DS, Potter A, Petersen R. State-Specific Prevalence of obesity Among Children Aged 2-4 Years Enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children—United States, 2010-2016. Morbidity and Mortality Weekly Report 68(46):1057-1061. November 22, 2019.

[vi] Voerman E, Santos S, Golab BP, Aminano P, Ballester F, Barrios H, et al. Maternal Body Mass Index, Gestational Weight Gain, and the Risk of Overweight and Obesity across Childhood: An Individual Participant Data Meta-Analysis. PLoS Med 16(2):e1002744. Published online February 11, 2019. Doi:10.1371/journal.pmed.1002744.

[vii] Josey MJ, McCullough LE, Hoyo C, et al. Overall Gestational Weight Gain Mediates the Relationship Between Maternal and Child Obesity. BMC Public Health 19, 1062. August 7, 2019. doi:10.1186/s12889-019-7349-1.

[viii] Dubois I, Girard M. Early Determinants of Overweight at 4.5 Years in a Population-based Longitudinal Study. Internal Journal of Obesity 30(4):610-617. April 30, 2006. doi:10.1038/sj.ijo.0803141.

[ix] Salahuddin M, Perez A, Ranjit N, Kelder SH, Barlow SE, Pont SJ, Butte NF, Hoelscher DM. Predictors of Severe Obesity in Low-Income, Predominantly Hispanic/Latino Children: The Texas Childhood Obesity Research Demonstration Study. Prev Chronic Dis 14:E141. Published online December 28, 2017. doi:10.5888/pcd14.170129.

[x] Eriksson J, Forsen T, Tuomilehto J, Osmond C, Barker D. Size At Birth, Fat-Free Mass and Resting Metabolic Rate in Adult Life. Horm Metab Res 34(2):72-6. February 2002. doi:10.1055/s-2002-20518.

[xi] Simic BS. Childhood Obesity as a Risk Factor in Adulthood and Its Prevention. Prev med 12(1):47-51.January 1983. doi:10.1016/0091-7435(83)90107-6.

[xii] Complete reference list available upon request.

[xiii] ___________. State of Childhood Obesity Helping all Children Grow Up Healthy. Robert Wood Johnson Foundation. Princeton, New Jersey. October 2019.

[xiv] Mukhopadhyay S, Mondal S, Chatterjee S. 2019. Strategies for Prevention of Childhood Obesity. In Bagchi, D, editor. Global Perspectives on Childhood Obesity. 2nd ed. San Diego (CA):.Academia Press. p. p 299-312.

Nutrition Education Obesity Prevention Program, Department of Social Services, Department of Education, WIC Farmers’ Market Nutrition Program, WIC Local Agencies, Local Health Jurisdictions, California WIC Association, USDA-FNS, HAB45, Clinicians, Community Based Organizations, Just for Kids!

Experts agree that prevention and early intervention are the most efficacious approaches to combat overweight and obesity in infants, toddlers, and preschool-aged children. Several characteristics for this age group reinforce the use of prevention strategies, such as the establishment of dietary habits, eating patterns and flavor preferences occurs in this critical growth and development period; surgery and medication interventions are contraindicated;  and the period of rapid growth provides an opportunity to slow the rate of weight gain as the child grows taller.

California WIC Program

WIC’s core services address many of the risk factors for childhood overweight and obesity. In addition, WIC’s nutrition messages align with the 2020 Dietary Guidelines for Americans. Because of the substantial numbers of pregnant women, infants and children WIC reaches, the potential impact of WIC interventions is vast. WIC employs numerous strategies to that end, including:

• Nutrition education at least quarterly
• Encouraging developmentally appropriate and recommended amounts of physical activity
• Infant and children follow-up
• Use of patient centered education, including motivational interviewing, reflective listening
• Baby Behavior Campaign—working with parents to identify how infants communicate hunger and satiety cues, reasons babies cry (besides hunger), infant sleep patterns, and responsive parenting including the feeding relationship
• Targeting Overfeeding in Toddlers (TOTTs Campaign)—builds on the baby behavior campaign and helps parents understand the needs of toddlers, including routines, eating patterns, sleeping patterns, and the meaning of crying and tantrums in toddlers
• Referrals to medical and health services, food pantries, shelters, and other community programs and resources

Nutrition Education and Obesity Prevention Branch

NEOPB addresses rising obesity rates through statewide, regional, and local programs and partnerships that promote healthy eating, physical activity, and food security with an emphasis on communities with the greatest health disparities.