Assessing Overweight and Obesity among Adolescents in Ypsilanti, Michigan

Jenna Gorlick
November 13, 2017
Nutrition 642
 Obesity is a major public health concern, as 70.2% of adult men and women in the United States
have overweight or obesity (1). Among youth, 30% in the United States have overweight or obesity (2).
Overweight in children is defined as having a “Body Mass Index between the 85th and 94th percentile for
children and teens of the same age and sex” (3). Obesity in children is defined as a “Body Mass Index at
or above the 95th percentile for children and teens of the same age and sex” (3). By this definition, 20.6 %
of adolescents in the United States have obesity (4). When taking a closer look at the state of Michigan, in
2016, 32% of children ages 10-17 had overweight or obesity, which is above the national average (5).
Although this rate has remained relatively stable since 2011, it has increased from 28.8% in 2004 (5).
The increase in prevalence of overweight and obesity is concerning, as overweight and obesity
can have lasting impacts continuing through adulthood. Obesity is associated with heightened risk for a
number of negative physical health outcomes. Adolescents who have overweight or obesity are more
likely to have obesity as adults (6). They may also be at greater risk for developing some forms of cancer
later in life, for example colon cancer (7). Additionally, as Body Mass Index increases among adolescents
with overweight and obesity, they are at greater risk for insulin resistance and components of the
metabolic syndrome (8). Further, adolescents with obesity or a family history of obesity have been more
frequently diagnosed with type 2 diabetes in recent years, with youth being diagnosed at younger ages (9).
In addition to negative physical health outcomes, obesity is also associated with psychological
and interpersonal problems. According to van Geel and colleagues, youth with obesity are more likely to
experience bullying or teasing when compared to their normal weight peers (10). Additional studies have
found that youth with obesity are more likely to report depressive symptoms, lower self-esteem, lower
quality of life, and are at heightened risk for developing eating disorders (11-13).
There are genetic, environmental, and behavioral factors that can contribute to weight gain, and
thus, the prevalence of overweight and obesity among adolescents. This needs assessment will focus on
the environmental and behavioral factors because they are modifiable. The food environment in the
United States has changed drastically in recent years. From increased portion sizes to targeted food
marketing of highly palatable foods to children and adolescents, the food environment is saturated with
messages promoting increased food consumption (14,15). Moreover, access to nutritious and affordable
healthy foods may be limited, making it difficult to maintain a healthy diet (16). This may be especially
challenging for families living close to convenience stores because they typically have lower quality and
less availability of healthier food options compared to grocery stores (17). Lack of physical activity is
also contributing to the prevalence of overweight and obesity. Data from the National Health and
Nutrition Examination Survey has shown that on average, adolescents ages 12-19 spent 7.5 hours/day
sitting (18). Further, research has shown that only 21.6% of 6 to 19 year olds in the United States were
physically active for 60 minutes at least five days per week (19).
Given the prevalence of overweight and obesity among adolescents in Michigan and the negative
impacts overweight and obesity can have on physical and mental health, the current needs assessment will
evaluate overweight and obesity in adolescents in Ypsilanti, Michigan. Ypsilanti is a suburban city in
Washtenaw County, Michigan that is 4.4 square miles in size (20). In 2016, Ypsilanti had a population of
approximately 21,018 (21). The median household household income is $31,061 (21). The city is
approximately 61.5% White and 29.2% Black / African American (21). More details regarding the racial
breakdown of the community will be described later in this assessment. Key community stakeholders in
this needs assessment are the Coordinated School Healthy Team with Ypsilanti Community Schools,
Chartwells, Washtenaw County Food Policy Council, Healthy Kids Healthy Michigan, Project Healthy
Schools, Girls on the Run, and the PTA at Grand Blanc Community High School (one of the larger high
schools in Ypsilanti).
 The current needs assessment will focus on the demographics, health, and nutrition in Ypsilanti,
Michigan, with a particular emphasis on adolescents. Throughout this needs assessment, data for
Washtenaw County, Michigan as a whole may be used as a proxy for Ypsilanti if data was unavailable.

Community Profile Data

Demographic & Economic Data

Table 1 shows the age distribution of people living in Ypsilanti in 2010. The population is 49.1%
male and 50.3% female (21). The population subgroups of interest for this particular needs assessment are
the 10 to 14 years group and 15 to 19 years group, which make up 3.2% and 14.1% of Ypsilanti’s
population, respectively (21).

Number Percent
Total population 19,435 100.0
Under 5 years 946 4.9
5 to 9 years 759 3.9
10 to 14 years 628 3.2
15 to 19 years 2,745 14.1
20 to 24 years 4,622 23.8
25 to 29 years 1,850 9.5
30 to 34 years 1,196 6.2
35 to 39 years 944 4.9
40 to 44 years 914 4.7
45 to 49 years 851 4.4
50 to 54 years 887 4.6
55 to 59 years 818 4.2
60 to 64 years 666 3.4
65 to 69 years 468 2.4
70 to 74 years 349 1.8
75 to 79 years 248 1.3
80 to 84 years 262 1.3
85 years and over 282 1.5
Table 1 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml)

The majority of the population in Ypsilanti identifies as White or Black/ African American,
61.5% and 29.2% respectively (21). When compared to the state of Michigan, Ypsilanti has a slightly
smaller proportion of the population who identify as White, and a slightly larger proportion of the
population who identify as Black or African American (21, 22). The racial breakdown of both Ypsilanti
and Michigan can be seen in Figure 1. In terms of ethnicity, 3.9% of the Ypsilanti population identifies as
Hispanic or Latino compared to 4.4% of the state of Michigan (21, 22).
 Racial Distribution of Population
Percent of Population 100
80
60
40
20
0
White Black or American Asian Native Other Two or More
African Indian or Hawaiian and
American Alaska Native Other Pacific
Islander

Ypsilanti Michigan

Figure 1 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml; Adapted from Census Viewer, Census
2010 and 2000 Interactive Map, Demographics, Statistics, Quick Facts; data available at
http://censusviewer.com/state/MI)

Figure 2 compares the education levels achieved by people in Ypsilanti compared to the state of
Michigan. In Ypsilanti, 7.3% of the population has less than a high school degree, 11.6% graduated high
school, 55.5% attended some college or attained an associate’s degree, and 25.6% obtained a Bachelor’s
degree or higher (21). In general, when compared to the state of Michigan, Ypsilanti’s population has
higher education levels (21).

Education in Population 18 years or older

Bachelor's degree or higher

Some college or associate's degree

High school graduation

Less than high school

0 0.1 0.2 0.3 0.4 0.5 0.6

Proportion of Population

Michigan Ypsilanti

Figure 2 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml)

Figure 3 shows the distribution of occupations in Ypsilanti. The most common occupational
classifications within this population are educational services, accommodation & food service, retail
trade, and health care & social assistance (21). This may be attributed to the fact that Eastern Michigan
University and St. Joseph Mercy Hospital are located in Ypsilanti, and provide employment opportunities
within the health care and education fields. Additionally, the University of Michigan and Hospital are
located nearby. The second most common occupational classification in Ypsilanti is arts, entertainment,
recreation, accommodation and foodservices, with 18.5% of the population in this group (21).

35 Occupation in Population over Age 16 in

30 Ypsilanti, Michigan
Percent of Population

25
20
15
10
5
0

entertainment,recreati…
Information
fishing, hunting, mining

Construction

Manufacturing

Education, health care,

Wholesale trade

Other services
Retail trade

Public administration
warehousing, utilities

Finance, insurance, real

Professional, scientific,
estate, rental, leasing
Agriculture, forestry,

management,…
Transportation,

social assistance

Arts,
Classification of Occupation

Figure 3 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF)

The unemployment rate in Ypsilanti is 8.6%, which is higher than the unemployment rates in
Michigan and the United States (21). In Michigan, the unemployment rate is 4.3% and the national
unemployment rate is 4.1% (23, 24). A comparison of the unemployment rates is shown in Figure 4.

Unemployment Rates
10
Percent of Population

8
Unemployed

6
4
2
0
Ypsilanti Michigan US

Figure 4 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=C; Adapted from Bureau of Labor
Statistics; data available at https://www.bls.gov/eag/eag.mi.htm and https://data.bls.gov/timeseries/LNS14000000)

When considering income levels in Ypsilanti, the median income is $31,061 (21). As shown in
Figure 5, this is lower than the median incomes in Washtenaw County, Michigan, and the United States,
which are $61,003, $49,576, and $53,889, respectively (25). It is estimated that 33.4% of Ypsilanti’s
population is below the poverty line, which is significantly higher than the national average of 14.7%
(25). A high percentage of the population living below the poverty line may contribute to overweight and
obesity rates in adolescents, as research has shown that prevalence is higher among families with lower
SES (26).
Figure 5 (Adapted from DATAUSA; data available at https://datausa.io/profile/geo/ypsilanti-mi/)

Table 2 displays the percentage of housing units that are occupied by renters compared to owners
in Ypsilanti and Michigan. The percentage of renter-occupied housing units is much higher in Ypsilanti
compared to Michigan, which could be related to demand for rental properties among the college students
attending Eastern Michigan University in Ypsilanti (21).
Ypsilanti Michigan
Renter Occupied 69.1% 29.7%
Owner Occupied 30.9% 70.3%
Table 2 (Adapted from U.S. Census Bureau, American Fact Finder 2015; data available at
https://www.census.gov/quickfacts/fact/table/ypsilanticitymichigan/PST045216)

Health Statistic Data

The leading causes of death for Washtenaw County, Michigan, and the U.S. are shown in Table
3. The leading causes of death in Washtenaw County are cancer, heart disease, and unintentional injuries,
with rates of 24.5%, 23.3%, and 5.8% (27). In both Michigan and the U.S. as a whole, the three leading
causes of death are heart disease, cancer, and chronic lower respiratory disease, with specific rates shown
in Table 3 (27).
 Cause of Death Percent Mortality
Washtenaw Michigan U.S.
County
Heart Disease 23.3 26.0 23.4
Cancer 24.5 21.7 22.0
Chronic Lower 4.6 6.1 5.7
Respiratory Diseases
Stroke 5.5 4.9 5.2
Unintentional Injuries 5.8 4.8 5.4
Alzheimer’s Disease 3.7 4.0 4.1
Diabetes Mellitus 3.1 2.9 2.9
Kidney Disease 1.5 2.0 1.8
Pneumonia/Influenza 2.4 2.0 2.1
Intentional Self-harm 1.7 1.5 1.6
(Suicide)
Table 3 (Adapted from Michigan Department of Health & Human Services 2015; data available at
https://www.mdch.state.mi.us/osr/chi/Deaths/leadUS/LeadingUSObject2.asp?AreaCode=48&AreaType=L&JS=No)

The infant mortality rate in Washtenaw County is 5.7%, which is lower than Michigan’s infant
mortality rate of 6.3% (28). Leading diagnoses for hospitalizations in Michigan Residents was used as a
proxy for morbidity data. The top three leading diagnoses for hospitalizations in Michigan Residents
under the age of 18 were newborns and neonates, injury and poisoning, and asthma (29). Specific
numbers of hospitalizations and percentages of hospitalizations broken down by diagnoses in Michigan in
2014 for both sexes under 18 are shown in Table 4.
Principal Diagnosis Number of Percent of Total
Hospitalizations in 2014 Hospitalizations in 2014
All Hospitalizations 163,907 n/a
Newborns and Neonates 115,987 70.8
Injury and Poisoning 5,039 3.1
Asthma 3,233 2.0
Pneumonia 2,953 1.8
Congenital Anomalies 2,195 1.3
Acute Bronchitis and Bronchiolitis 2,095 1.3
Psychoses 1,944 1.2
Females with Deliveries 1,799 1.1
Diseases of Skin and Subcutaneous Tissue 1,725 1.1
All infectious and Parasitic Diseases except 1,578 1.0
Septicemia
Diseases of the Blood & Blood Forming Organs 1,534 0.9
Diabetes Mellitus 1,222 0.7
Conditions Originating in the Perinatal Period 1,038 0.6
Appendicitis 1,013 0.6
Kidney/Urinary Infections 957 0.6
Septicemia 764 0.5
Dehydration 667 0.4
Convulsions 589 0.4
Noninfectious Enteritis and Colitis 541 0.3
Cancer (Malignant Neoplasms) 528 0.3
All other Hospitalization Conditions 18,848 11.5
Table 4 (Adapted from Michigan Department of Community Health 2014; data available at
https://www.mdch.state.mi.us/osr/CHI/hospdx/frame.html)
 Among Ypsilanti adults, 34.8% have overweight and 26.8% have obesity (30). When compared
to Washtenaw County as a whole, these rates are higher than the 34.4% of adults with overweight and
21.7% with obesity (30). Although the obesity rate is lower than the 32.5% obesity rate for the state of
Michigan, the fact that these rates are slightly higher than the county is reason for concern (5).
For the purpose of this needs assessment, it is especially important to consider rates of overweight
and obesity in youth. In Washtenaw County children ages 2-17, 26% have either overweight or obesity
(31). Among adolescents ages 11-13 and 14-17, 30% had either overweight or obesity in 2014, which is
equivalent to the national overweight and obesity prevalence (31).
Data suggests that some populations may be at heightened risk for overweight and obesity in
Washtenaw County, specifically African American and Hispanic youth (31). In Washtenaw County, the
overall prevalence of overweight and obesity in African American children is 37%. When considering
African American children ages 11 to 13 and 14 to 17, we see the highest prevalence of overweight and
obesity, particularly among girls, as shown in Figure 6 (31). 47% of African American girls ages 11 to 13
and 49% of African American girls ages 14 to 17 have overweight or obesity, compared to 41% of
African American boys ages 11 to 13, and 40% of boys ages 14 to 17 (31).

Figure 6 (Adapted from Washtenaw County Public Health Department ; data available at
http://www.ewashtenaw.org/government/departments/public_health/family_health/family-health-
services/childhood-obesity-content-1/content-2014/ChildhoodBMIWashCo2014.pdf)

Among Hispanic children in Washtenaw County, 34% have overweight or obesity (31). When
compared to data from 2013, there was a 31% increase in Hispanic children with overweight and obesity,
which is quite concerning (31). This increasing trend in overweight and obesity is consistent across
Hispanic boys and girls, however, girls over the age of 8 are at higher risk for overweight or obesity (31).
The highest prevalence of overweight and obesity in girls and boys is among the 14 to 17 age group, with
44% of girls and 39% of boys having overweight and obesity, as shown in Figure 7 (31).
Figure 7 (Adapted from Washtenaw County Public Health Department ; data available at
http://www.ewashtenaw.org/government/departments/public_health/family_health/family-health-
services/childhood-obesity-content-1/content-2014/ChildhoodBMIWashCo2014.pdf)

In Ypsilanti, 7.3% of adults lack health insurance coverage, which is lower than the national 8.8%
of the population that lack health insurance (30, 32).

Nutrition / Physical Activity Data

39.7% of adults in Michigan report consuming fruit less than one time daily, while 24.7% of them
consume vegetables less than one time daily (33). In Ypsilanti, 40.2% of adults report not consuming fruit
one or more times daily, and 26.9% of adults report not consuming vegetables at least once daily (30).
Among Michigan adolescents, 37.8% consume fruits less than one time daily, and 36.8% report
consuming vegetables less than one time daily (34). In Ypsilanti, 17.3% of children eat 0-1 servings of
fruits and vegetables daily, 72.9% eat 2-4 servings daily, and 9.8% eat 5 or more servings daily (30).
When broken down by race, African American youth are consuming fewer servings of fruits and
vegetables daily, compared to their White peers, as shown in Table 5. This may be a factor contributing
to increased rates of overweight and obesity among African American youth in Ypsilanti, as research
suggests that vegetable intake may be protective against the risk of overweight (35). Rates of vegetable
consumption among Hispanic youth in Washtenaw County were similar to their White peers (36).

Servings per day of Fruits and Vegetables among Children by Race

Race 0-1 servings 2-4 servings 5 or more servings
African American 24.2% 66.4% 9.3%
White 11.4% 76.6% 11.9%
Table 5 (Adapted from Washtenaw County Community Health Data; data available at
https://healthsurveys.ewashtenaw.org/#/survey/question/HIP/2015/ChFruit?category=Child&groupby=ChldRegion
&subgroup=RC_Race)

In Ypsilanti, 15.2% of children consumed at least one serving of sweetened beverages per day
(30). It is important to note that this only includes consumption of soda, sweetened carbonated and non-
carbonated beverages (such as Gatorade, Snapple, and energy drinks), but may not include juice. This is
lower than the state of Michigan as a whole where 27.6% of children reported drinking a can, bottle or
glass of soda at least one time during the previous week (37). This is shown graphically in Figure 8.
 Consumption of at least one Sugar
Sweetened Beverage Daily among
Adolescents
30

Percent 20

10

0
Michigan Ypsilanti

Figure 8 (Adapted from Washtenaw County Community Health Data; data available at
https://healthsurveys.ewashtenaw.org/#/survey/question/HIP/2015/ChSweet?category=Child&groupby=ChldRegion
; Adapted from CDC State Nutrition, Physical Activity, and Obesity Profile; available at
https://www.cdc.gov/obesity/stateprograms/fundedstates/pdf/michigan-state-profile.pdf)

According to the CDC, children and adolescents should have 60 minutes or more of physical
activity daily (38). In Ypsilanti, 51.5% of children ages 6 to 17 are getting at least 5 days of the
recommended amount of physical activity (30). Additionally, over half of the children in Ypsilanti spend
more than one hour in front of a screen daily, as shown in Figure 9. Both of these lifestyle factors may be
contributing to rates of overweight and obesity in adolescents in Ypsilanti.

Child Screen Time Per Day for Children

age 1 year or Older in Ypsilanti

5
17.1 38.9

39

1 hour or less Over 1 hour - 2 hours

Over 2 hours - 3 hours Over 3 hours

Figure 9 (Adapted from Washtenaw County Community Health Data; data available at
https://healthsurveys.ewashtenaw.org/#/survey/question/HIP/2015/ChScreen?category=Child&groupby=ChldRegio
n)

When asked how often the distance to a full service grocery store limited the ability to buy
variety and quality of fruits and vegetables, 7.2% of Ypsilanti adults said this was always or usually the
case (30). Figure 10 shows the distribution of the frequency of limited accessibility to grocery stores to
purchase a variety and quality of fresh fruits and vegetables. In Washtenaw County, the rate of food
insecurity is 14.3%, which is lower than both the Michigan and U.S rates, which are 15.7% and 15.4%,
respectively (39). In Washtenaw County, 14.1% of county children specifically live in food insecure
homes (39).
 Ypsilanti Adults with Limited Accessibility to Full
Service Grocery Stores to Purchase Fruits and
Vegatbles
80
60
Percent
40
20
0
Always or usually Sometimes or rarely Never
Frequency

Figure 10 (Adapted from Washtenaw County Community Health Data; data available at
https://healthsurveys.ewashtenaw.org/#/survey/question/HIP/2015/ChSweet?category=Child&groupby=ChldRegion
)

Rates of breastfeeding initiation in WIC participants in Washtenaw County have increased by

17% between 2007 and 2017 (40). In 2017, 80% of WIC babies in Washtenaw County started
breastfeeding after birth, compared to 65% in Michigan overall (40). The American Academy of
Pediatrics recommends that breastfeeding continue for at least 12 months, however, six months after
birth, 78% of the Washtenaw County WIC babies were no longer breastfeeding (40). Research suggests
that breastfeeding may be protective against overweight and obesity in children, so increasing rates of
continued breastfeeding may be an important intervention Washtenaw County (41).

Figure 11 (Adapted from Washtenaw County Public Health Data: Women, Infants, Children Breastfeeding Data;
data available at http://www.ewashtenaw.org/government/departments/public_health/health-
promotion/hip/pdfs/august-3-chc-meeting-pdfs/wic-breastfeeding-data)
Community Assets and Resources

Taken together, this information characterizes the community of Ypsilanti with a particular
emphasis on adolescents. Ypsilanti has many existing community assets and resources that will be useful
in addressing overweight and obesity in adolescents. Project Healthy Schools is a nutrition education
program in middle schools in Ypsilanti that teaches healthy habits to reduce childhood obesity and
associated long-term health risks. Healthy Kids Healthy Michigan is a statewide coalition that aims to
reduce childhood obesity through strategic policy initiatives. The Ypsilanti Community Schools
Coordinated School Health Team promotes education and academic achievement, which requires that
students are physically, mentally, and socially healthy. In addition to these programs, Washtenaw County
has two major medical centers, St. Joseph Mercy Health System and Michigan Medicine. These two
medical centers have Registered Dietitian Nutritionists on staff, and offer nutritional counseling.
Additionally, St. Joseph Mercy offers a program called ShapeDown, which is a weight management
program for families. Other existing community assets and resources that may be useful in addressing
overweight and obesity in Ypsilanti adolescents include:
 Food Gatherers
 Growing Hope
 Girls on the Run
 MPOWER Program
 Washtenaw County Public Health
 Washtenaw County Food Policy Council
 PTA at Grand Blanc Community High School
In addition to these community assets and resources, Ypsilanti has bike paths, sidewalks,
playgrounds, and recreation centers to promote physical activity and spending time outdoors. Ypsilanti
residents also have access to the Huron River, where they can participate in kayaking, canoeing,
swimming and other water activities. Ypsilanti has 12 public parks and 3 recreation facilities (42).
Washtenaw County’s Building Healthy Communities Initiative was designed to increase physical
activity by promoting active transportation around the community (43). This policy initiative was
implemented in 2011, and has since resulted in changes to the built environment including Safe Routes to
School, the development and improvement of trails, and installation of bike lanes and bike parking (43).
Also, the Michigan Health and Wellness 4x4 Plan is a tool that was designed to encourage Michiganders
to adopt health as a value (44). It promotes health through monitoring behaviors and measures. The Four
Healthy Behaviors discussed in the plan are to maintain a healthy diet, engage in regular exercise, get an
annual physical, and avoid tobacco use and exposure (44). The Four Health Measures addressed in the
plan are BMI, blood pressure, cholesterol level, and blood glucose level (44). These two initiatives are
examples of policies and initiatives already in place that could further influence the nutrition and health of
Ypsilanti adolescents.

Recommendation of Priorities Section

Rates of overweight and obesity among adolescents in Ypsilanti are comparable to national rates,
however, there are specific populations within Ypsilanti that are at heightened risk for overweight and
obesity. Specifically, overweight and obesity are more common among Hispanic and African American
adolescents, and targeted interventions for these populations should be prioritized. African American
adolescents are eating less fruits and vegetables daily when compared to White and Hispanic peers, which
may be contributing to elevated rates of overweight and obesity in this population (30). Additionally, only
half of children in Ypsilanti are getting close to the amount of daily physical activity recommendations
(30). Further, over half of children in Ypsilanti are spending more than one hour daily in front of a screen
(30). Finally, although Washtenaw County has a high rate of breastfeeding initiation, this is not sustained
during the first year of life, which could put infants at risk for overweight and obesity during childhood
and adolescence (40, 41). These behaviors have been associated with weight status previously, and may
be important targets of interventions to prevent overweight and obesity.
With these trends in mind, Ypsilanti should prioritize elevated rates of overweight and obesity
among Hispanic and African American adolescents. Ypsilanti should consider developing support
systems for Hispanic and African American families. This needs assessment did not find existing
organizations unique to these populations that could provide a platform for intervention. By developing
organizations for these populations, Ypsilanti would have an opportunity to deliver targeted, culturally
sensitive interventions to these groups that are at heightened risk. These interventions should consider
information on decreased screen time, increased physical activity, and promote consumption of fruits and
vegetables. Although overweight and obesity are influenced by other factors, by addressing and
prioritizing these behaviors, Ypsilanti may be able to prevent and reduce overweight and obesity in
adolescents.
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