Program Plan: Obesity Among Youth in SF by Mercedes Alicia Vigil

How to Find the BMI in Youth

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Body mass index, or BMI, is used to check a child's weight in relation to their height. Since children are still growing, we look at BMI percentiles instead of fixed categories. Percentiles help compare a child's BMI to other children of the same age and sex.

To calculate BMI, you use this formula:

Formula: (Weight in pounds / (Height in inches)²) x 70

Step 1: Measure the child's weight in pounds and height in inches.
Step 2: Square the height by multiplying the height in inches by itself.
Step 3: Divide the weight in pounds by the result from Step 2.
Step 4: Multiply that result by 703.
Step 5: Round the final number to one decimal place

References:

Kirkilas, G., (2024). Body-Mass Index (BMI) in Children. Healthy Children.org. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/obesity/Pages/Body-Mass-Index-Formula.aspx

Unequal Neighborhood, Unequal health: The Community Role in Youth Obesity in San Francisco

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Children with limited access to supermarkets with fresh foods often eat convenience foods that have a longer shelf life and don't spoil as quickly as fresh food; these foods include starchy foods and frozen meals with preservatives (Mayo Clinic, n.d; Matsusaki, M. et al., 2023).
Lack of access to safe outdoor spaces and a shortage of green spaces hinder the ability of children from low-income families to engage in outdoor hobbies (Mayo Clinic, n.d.; Matsusaki, M., et al., 2023).
Children who attend schools located in low-income areas with a lack of surrounding restaurants, grocery stores, and community services are more likely to be affected by obesity (Matsusaki, M. et al., 2023).

When Systems Fails Children: The Systemic Causes of Obesity in SF Youth

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Food and beverage companies focus on creating advertisements of nutritionally poor food products to Latinx and Black/ African American youth, and these companies are unlikely to advertise healthier food products (City and County of San Francisco Board of Supervisors Policy Analysis Report, 2022).
Children in historically redlined communities are exposed to obesogenic chemicals that contribute to obesity due to their convenient proximity to air-polluting highways, refineries with obesogenic chemicals, and lack of green space that would otherwise help buffer this burden (Kowalski, K., 2023; Matsusaki, M., et al., 2023; Vrijheid, M., et al, 2020)

Childhood Obesity

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According to the CDC, obesity is defined as having a Body Mass Index (BMI) at or above the 95th percentile for age and sex.
Obesity in children and adolescents is typically defined in terms of body mass index (BMI) percentiles relative to age, weight, height, and sex (for example, ≥95th percentile for obesity, 85th–95th for overweight)

References:

CDC. (2024, April 2). Childhood Obesity Facts. Obesity. Retrieved from: https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html
World Health Organization (2025).Obesity. Retrieved from https://www.who.int/health-topics/obesity#tab=tab_1

How SF youth are affected by this problem

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Nationally (in the U.S.), among youth ages 6–17, about 17.0% had obesity in 2022–2023
https://stateofchildhoodobesity.org/demographic-data/ages-6-17/
All youth (children and adolescents) are at potential risk, but the prevalence is not uniform; demographic, socioeconomic, environmental, and racial/ethnic factors influence risk.
That rate, however, is not uniform: Non-Hispanic Black children have higher rates (~23.5%), Hispanic children ~22.2%, while Asian children are lower (~10.6%) in that same time period. In San Francisco specifically, data show that over 30% of 5th-grade students are classified as overweight or obese. https://sfhip.org/chna/community-health-data/overweight-or-obesity/
Latino youth made up approximately 48.3 percent of all hospitalizations, though Latinos make up only 22.9 percent of San Francisco’s child population (City and County of San Francisco Board of Supervisors Policy Analysis Report, 2022).
Because obesity is influenced by environments (food access, neighborhood design, socioeconomic status), youth in certain neighborhoods (especially lower-income or more disinvested areas) may be disproportionately affected in San Francisco (e.g. neighborhoods with limited access to fresh food, termed “food deserts” or “food swamps”). For example, Bayview–Hunters Point is often cited as having both high obesity rates and low fresh-produce availability.

Why San Francisco Youth Are at Risk

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Many kids in San Francisco are at risk for obesity because of what they eat and how active they are. High consumption of sugary drinks and processed snacks, combined with long periods of screen time, increases weight gain.

Extent of the problem

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A recent local study examined child BMI changes before vs during the COVID-19 pandemic in San Francisco, finding that BMI z-scores and rates of overweight/obesity increased more sharply during the pandemic period than in prior years.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-20311-4
Child obesity has grown from 5% rate in 1978 to 18.5% in 2016, the total incidence of obesity among children has tripled in the past almost 50 years. pattern.https://stateofchildhoodobesity.org/how-childhood-obesity-rates-have-changed-over-time/

Obesity in SF Bayview's youth is a result of their built environment and interpersonal relations

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According to a study by Vrijheid, M., et al (2020), states that children who are exposed to smoking in utero, exposure to indoor and outdoor air pollutants, passive smoke exposure, residence in more densely populated areas, and attendance at school in areas with fewer facilities were associated with an increase in child BMI.
Children who spend a lot of their time indoors have an increased risk of having higher BMIs because of increased indoor pollution created by PM10 absorbance and NO2, which are obesogenic chemicals (Vrijheid, M., et al, 2020).
Another key interpersonal factor contributing to youth obesity is how families manage meals and interact around food. Studies show that the way parents talk about food, set rules for eating, and structure mealtimes can strongly influence a child's weight. When families eat together regularly and promote healthy habits, children are more likely to maintain a balanced diet. However, households with frequent conflict during meals, limited structure, or inconsistent eating routines often see higher rates of obesity among children.

https://www.mdpi.com/2227-9067/10/6/952

Sleep, Stress, and Healthy Habits

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Obesity is not just about food.
In San Francisco, children’s sleep patterns, stress levels, and early life habits also affect weight.
Kids who don’t get enough sleep or experience high stress are more likely to gain weight.

(City of San Francisco, 2019; SFHIP, 2023)

Sources

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City and County of San Francisco Board of Supervisors Policy Analysis Report (2022). Budget and Legislative Analysis on Childhood Obesity. Retrieved from:
https://sfbos.org/sites/default/files/BLA.Childhood%20_Obesity.102622.pdf

Jones, B.L., Orton, A.L., & Tindall, J.T. (2023). Barriers to Healthy Family Dinners and Preventing Child Obesity: Focus Group Discussions with Parents of 5-to-8-Year-Old Children. Children 10 (6), 952. https://doi.org/10.3390/children10060952

Kirkilas, G., (2024). Body-Mass Index (BMI) in Children. Healthy Children.org. Retrieved from https://www.healthychildren.org/English/health-issues/conditions/obesity/Pages/Body-Mass-Index-Formula.aspx

Kowalski, K., Auerbach, J., & Martenies, S. E., (2023). Neighborhood walkability, historical redlining, and childhood obesity in Denver, Colorado. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 100(1), 103–117. https://doi.org/10.1007/s11524-022-00703-w

Marcus, C., Danielsson, P., & Hagman, E. (2022). Pediatric obesity-Long-term consequences and effect of weight loss. Journal of Internal Medicine, 292(6), 870–891. https://doi.org/10.1111/joim.13547

Matsuzaki, M., Sanchez-Vaznaugh, E. V., & Alexovitz, K., (2023). Trends in school-neighbourhood inequalities and youth obesity: Repeated cross-sectional analyses of the public schools in the state of California. Pediatric Obesity, 18(3), e12991. https://doi.org/10.1111/ijpo.12991

Maxwell, S.L., McCulloch, C.E., & Fernandez, A., (2024). Changes in BMI prior to and during the COVID-19 pandemic among children: a retrospective cohort study in San Francisco, CA. BMC Public Health Health, 24 (2962). https://doi.org/10.1186/s12889-024-20311-4

Mayo Clinic, n.d. Childhood Obesity. Retrieved from: https://www.mayoclinic.org/diseases-conditions/childhood-obesity/symptoms-causes/syc-20354827

San Francisco Community Health Improvement Partnership (2022). Overweight or Obesity. Retrieved from: https://sfhip.org/chna/community-health-data/overweight-or-obesity/

State of Childhood Obesity (2019). How Childhood Obesity Rates Have Changed Over Time. Retrieved from: https://stateofchildhoodobesity.org/how-childhood-obesity-rates-have-changed-over-time/

Vrijheid, M., Fossati, S., & Maitre, L. (2020). Early-life environmental exposures and childhood obesity: An exposome-wide approach. Environmental Health Perspectives, 128(6), 67009. https://doi.org/10.1289/EHP5975

[World Health Organization, (2025) Obesity. Retrieved from https://www.who.int/health-topics/obesity#tab=tab_1]

Impact of Childhood Obesity

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Overweight and Obesity

In the long term, if this issue is not resolved it can lead to worse cases for that child's health in the future. It is associated with greater risk of obtaining chronic diseases like for example high blood pressure, cholesterol, heart disease, type 2 diabetes and breast and colon cancer, sleep apnea. https://sfhip.org/chna/community-health-data/overweight-or-obesity/

Economically

In San Francisco’s 2023 data report, the costs attributable to obesity and diabetes (especially linked to sugar-sweetened beverages) are estimated between $48.1 million and $61.8 million.
Untreated childhood obesity leads to chronic inflammation, often seen in preschool children, and affects children's vital systems, including endocrine, paracrine, and metabolic systems (Marcus, C., et al, 2022).
Type 2 diabetes is prevalent in adolescents, increasing children's mortality rate, and can be more damaging than type 1 diabetes if gone untreated in children (Marcus, C. et al, 2022).
Childhood obesity increases the risk of developing several autoimmune illnesses like Crohn’s disease, arthritis, cardiovascular disease, type 1 diabetes, and multiple sclerosis (Marcus, C., et al, 2022)
Childhood obesity increases the chances of children developing depression due to inflammation from obesity and/ or poor social stigma interactions, which increases the chances of eating disorders, social isolation, and reduced physical activity. (Marcus, C., et al., 2022).
Childhood obesity can cause cognitive disturbances, which may contribute to children experiencing a harder time engaging in school (Marcus, C., et al, 2022).
“The societal costs for childhood obesity are obvious, but difficult to estimate because many diseases caused by childhood obesity may not develop until adulthood, which makes it difficult to pinpoint the direct societal cost of childhood obesity, including clinical treatments, productivity loss (poor school attendance), disability, and premature mortality”(Marcus, C., et al, 2022).

Long Term Outcomes

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Decrease rates of obesity affecting low-income SF youth in the Bayview Hunters Point Neighborhood within the next 3 years

Short Term Outcomes

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Increase in the # of SF low-income youth in Bayview Hunter's Point who believe that getting quality sleep at night positively affects their overall health and productivity by 6 months (attitude).
Increase in the # of low-income SF youth in Bayview Hunters Point who will access healthy, natural, unprocessed snacks, beverages, and meals on their walks to and from school in the next 6 months. (circumstances).
Increase the number of low-income SF youth in Bayview-Hunters Point who understand the impact that sugary drinks and processed foods have on their health within the next 6 months.(Knowledge).
Increase in # of low-income SF youth's knowledge of where to access healthy nutritional items in Bayview Hunter's Point by 6 months (Knowledge) (Circumstances).
Increase in # of low-income SF youth residing in Bayview Hunters Point who know it’s ok to play outside within the next 6 months. (Knowledge) (Circumstances)

Medium Term Outcomes

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Increase in the # of hours slept (7 or more) for low-income SF youth residing in Bayview Hunters Point by the next 12 months(behavior)
Decrease in the # of sugary beverages and # of processed food items consumed by low-income SF youth residing in Bayview Hunter's Point by the next 12 months (circumstances) (behavior)
Increase in the # of low-income SF youth’s ability to access and eat nutritious food items in Bayview Hunters Point within the next 12 months (Skills) (Circumstances)
Increase in the # of times low-income SF youth residing in Bayview Hunters Point play outside by 12 months (behavior) (circumstances)

Program Name

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Program Participants

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Low-income youth from San Francisco’s Bayview Hunter’s Point

Building Cultural Wealth

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Nourish to Flourish believes in community cultural wealth. In alignment with Tara Yosso's Community Cultural Wealth, our program builds on the cultural wealth brought to the table by our Bayview youth participants by recognizing and valuing the knowledge, traditions, and community networks they already possess. Our participants will have a safe space to freely exchange thoughts with one another and with staff, empowering them on their path to health.

We will ask participants about their knowledge of sleep to gauge how our program can build on the skills they already have. Any pre-existing belief about sleep and physical health will be respected and incorporated into each participant's goals.
Our program will encourage ancestral meals and not displace those customs. Instead, our program will recreate these meals and identify the nutritional value in these meals. We will exchange meal ideas and identify nutritional and natural value. Then our program will collaborate with participants to build into their recipes food that has nutritional value.
Collaborate with participants to create a food item menu for the pop-up stand that will be located on a street frequently accessed by Bayview Hunters Point low-income youth.
Collaborate with participants and their families to identify streets where most youth reside, and in collaboration with the community and participants, set up an accessible outdoor play area to encourage a safe space for our participants to play outdoors.

Program Activity Phase 1: Program Development

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Train staff
Identify and gain access to a SFUSD after-school venue located in Bayview Hunters Point for our sleep workshop/ Dream Lab
Develop an MOU and curriculum with the participant school for the sleep workshop/ Dream Lab
Identify and schedule access to a Bayview Hunters Point community room for the cooking workshop/ Roots & Recipes
Identify a street most accessed by youth for the pop-up stand
Identify streets with the most families with youth to set up the outdoor play time
Create surveys to know how participants are doing before the start of each activity, which includes height and weight.
Capture information from the participants' survey to assess our participants' skills, strengths, assets, and challenges regarding obesity (sleep, nutrition, and physical activity) and to gather data on participants' starting BMI.
Create flyers and posters with dates of events for the program. Mail to Bayview Hunters Point families and post flyers at school, community room, pop-up stand, and on streets where the outdoor play events will take place.
Purchase materials for the Dream Lab, Roots & Recipe, Pop-up stand, & outdoor play

Program Activities Phase 2: Program implementation

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Sleep workshop "Dream Lab"

2 full-time health educators and 1 part-time peer educator will conduct 2 series of 6 sleep hygiene workshops for a total of 12 workshops.
The first workshop will run from month 4 to month 7 in the first year of the program, once a month at a participating SFUSD school in the Bayview Hunters Point Neighborhood
The second Workshop will run from month 13 to month 18 of the second year of the program, once a month at the same participating SFUSD school in the Bayview Hunters Point neighborhood
Each of the 12 workshops will last 1 hour, serving 40 students total

Our Approach

We will have guided discussions and reflections on sleep hygiene
We will set goals for improved sleep habits

Our Topics

Importance of consistent sleep schedules
Reducing screen time before bed
Creating a calm sleep environment
Understand the connection between sleep, mood, and learning

Cooking workshop "Roots & Recipe"

Our culturally responsive chef, 2 health educators, and 1 peer educator will conduct 6 cooking workshops once a month in a community facility
Roots & Recipe cooking workshop will operate in months 11-16 of the program
Each workshop will last 1 - 1.5 hours, serving 15 participants each time, serving a total of 90 participants.

Our Approach

We will have hands-on cooking classes in each workshop with the collaborative help of our 2 health educators, 1 peer educator, and our chef.

Our Topics

Healthy meals
Safety

Pop-Up Stand

Participants from the Roots & Recipe workshop will recommend and collaborate with the chef, health educators, and peer educators to build a menu of food items for the community pop-up stand
2 health Educators and 1 peer educator will alternate setting up and running the Nourish to Flourish pop-up stand on a street frequently accessed by low-income youth from Bayview Hunters Point
The pop-up stand will run once a month during months 18-21 of the program for a total of 4 pop-up stands

Outdoor Play Time

2 health educators and 1 peer educator will set up and run outdoor play time on alternating streets where most low-income Bayview Hunters Point youth reside every second week of the month to encourage a safe and engaging outdoor space to play and exercise
Outdoor play time will run from months 5 -21 of the 2-year program, on every second week of the month.
There will be outdoor games available to participants to encourage exercise with other participants and to feel safe in familiar areas.

Program Activities Phase 3: Closing

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Create a survey for participants to state what goals they achieved because of the program. The survey should also capture height and weight at the end of all programs.
Last day of the cooking workshop, participants can share their favorite cooking dish that they learn from the program
Appreciation day on the last day of each activity to thank participants for being a part of the Nourish to Flourish activities
Program debrief

Program Outputs

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12 Sleep lab workshops

40 Sleep lab workshop participants

6 Roots & Recipes workshops

90 Roots & recipes participants

4 pop-up stands

17 outdoor play events

170 outdoors play participants

300 flyers mailed and posted

GAANT Chart

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Nourish 2 Flourish Staffing Chart

rosalindasahar — 2025-11-18 20:32:22 UTC

• 1 Full-time Program Coordinator

• 2 Full-time Health Educators

• 1 Culture Responsive Nutrition Chef Consultant

• 1 Part-time Peer Educator

Nourish 2 Flourish Budget

rosalindasahar — 2025-11-18 20:33:27 UTC