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Original Research

Prevalence and correlates of high body mass index in rural Appalachian children aged 6-11 years

Submitted: 15 May 2009
Revised: 25 August 2009
Published: 16 October 2009

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Author(s) : Montgomery-Reagan K, Bianco JA, Heh V, Rettos J, Huston RS.

Karen Montgomery-ReaganJoseph BiancoVictor HehJean RettosRebecca Huston

Citation: Montgomery-Reagan K, Bianco JA, Heh V, Rettos J, Huston RS.  Prevalence and correlates of high body mass index in rural Appalachian children aged 6-11 years. Rural and Remote Health (Internet) 2009; 9: 1234. Available: (Accessed 21 October 2017)


Introduction:  In rural regions of the United States of America, estimates of pediatric obesity often exceed national averages. This problem may be particularly pronounced in Appalachian regions, where significant health and economic disparities abound. This study presents the findings of a body mass index (BMI) screening program for 6–11 year old children living in a rural Appalachian community. County-wide estimates of high BMI (≥85th percentile) were obtained to understand the health status and needs of our pediatric community and to compare obesity prevalence rates with national averages. An additional aim was to identify subpopulations of children who may warrant clinical intervention due to demographic and behavioral risks factors of high BMI.
Methods:   A school-based BMI screening was conducted of 6–11 year old children in southeastern Ohio. Investigators collected 3 sets of height and weight measurements from approximately 2000 elementary school students between 2006 and 2007. Caregivers for a subset of this population also completed a health behaviors questionnaire.
Results:  Thirty-eight percent of children had high BMI, with 17% at risk for overweight and 20.9% overweight. Boys were 23% more likely than girls to be overweight (χ2(1) = 95% CI = 1.08, 1.40) and 11% more likely to become overweight with each year of age (OR = 1.11, 95% CI = 1.07, 1.15). Overweight children were more likely to view television, eat meals at school, and live with a caregiver who smokes.
Conclusions:  Consistent with expectations, prevalence of high BMI in this sample of rural Appalachian children exceeds national averages. Prevalence of overweight varied by age and sex; boys are particularly vulnerable to developing obesity, especially as they age. Preliminary survey data suggest that eating breakfast at home and at school and increased hours of television viewing may be associated with higher BMI, especially in younger boys.

Key words:  Appalachia USA, body mass index, epidemiology, pediatric obesity, school-based screening.

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