A conversation with Kentucky’s top doc, Steven Stack, MD
Editor’s introduction: Long-term health for the people of Kentucky must include addressing the health needs of Kentucky’s children. We asked Steven J. Stack, MD, MBA, commissioner for public health and chief medical officer for the Commonwealth of Kentucky for the past four years, to share his thoughts and describe what the Department of Public Health is doing for Kentucky’s children
MDU On the scale of health problems in Kentucky, where do you put addressing childhood obesity?
STACK Childhood obesity is a serious challenge in Kentucky. In terms of negative longterm impact on the health of Kentuckians, increased future burden of disease, and escalating healthcare costs, it ranks high as a population-level concern.
MDU Please describe childhood obesity in Kentucky. How is it defined?
STACK Body mass index, or BMI, describes a person’s weight adjusted for their height. The formula is weight in kilograms divided by the square of their height in meters.
Data tables show BMI percentiles based on sex and age-specific cohorts. There are two terms commonly used to describe the high side of the BMI gradation — overweight and obese.
- Overweight is between the 85th to 95th percentile.
- Obese is 95th percentile or greater.
MDU What trends have been found by measuring childhood obesity in Kentucky in the last 10-20 years?
STACK While the rate of overweight children has stayed relatively stable, the rate of obese children has increased over this time period. More specifically, 19.3% of Kentucky children age 0–17 were obese in the 2016–2017 school year. In 2021–2022, the most recent year of data, 24.6% of Kentucky children 0–17 years old were obese. That’s a worrisome trend.
MDU Can you talk about it by regions as well as statewide? Are there differences?
STACK The available data is obtained mostly from the Youth Behavioral Risk Survey (YBRS), a self-reported survey of middle and high school students. The study provides invaluable information, but there are limitations to the geographical detail it provides.
Even at the state level, though, the data shows Kentucky children are not faring as well as the rest of the nation. Kentucky’s childhood obesity rate of 24.6% is markedly higher than the national average of 18.1% and is second only to West Virginia at 24.8%. Said differently, Kentucky children have the second highest rate of obesity in the nation when compared to all other states.
MDU What are the most problematic, stubborn, and fundamental causes of childhood obesity in Kentucky?
STACK Our dietary and physical activity environment is fundamentally different than it was 100 years ago. We now have abundant access to calorie-dense, nutrient-poor food coupled with machines and technology that make our daily routines less physically demanding. Increased calories plus decreased physical activity means increased obesity.
MDU What policies, procedures, and actions can the Kentucky Department for Public Health perform to reduce childhood obesity in Kentucky?
STACK For the Kentucky population overall, surveys have found that 31% of Kentuckians did not engage in any non-work exercise in the prior 30 days; 45% ate fruit less than once per day; and 20% ate a vegetable less than once per day. Add to this the frequent intake of processed foods and snacks along with sugary sodas and beverages, and we have a recipe for obesity and declining health.
It is essential that we find ways to change our lived environments and daily routines in a couple simple to say, but devilishly difficult to do, ways:
- Increase physical activity to at least three to four days of moderate physical activity (i.e., walking) for 30–45 minutes.
- Eat at least two fresh fruits or vegetables every day.
There are certainly many other things we could do, but I think it is most important that we start with things that are achievable and sustainable. If we lay a solid foundation of improved habits, we can later build on that foundation.
Additionally, Kentucky is one of 17 states to have received a State Physical Activity and Nutrition (SPAN) grant from the CDC to address obesity. This program is pursuing five focus areas:
- Creating community bike/walk plans to increase active transportation.
- Providing guidelines to increase fresh produce and reduce processed, high sodium, high fat, and high sugar foods offered in food pantries, cafeterias, parks, and recreational settings, etc.
- Promoting food prescription and voucher programs.
- Training for early childhood educators to improve nutrition standards, reduce digital screen time, and increase physical activity.
- Promoting newborn breastfeeding.
MDU Where is Kentucky in pediatric vaccination rates nationally in comparison to recent years?
STACK Kentucky’s kindergarten age children lag behind both the national and many of our border state averages for routine immunizations. For the 2022–23 school year, Kentucky kindergarten age children had a roughly 90% vaccination rate for MMR, varicella, and DTaP; by comparison, the national average for these is about 93% and the rates in Tennessee, Virginia, and West Virginia are generally 95% or higher. To keep our children safe from vaccine preventable illnesses, it is important that we get these rates higher.
On a good note, however, we are making improvement. In 2021–22, Kentucky’s kindergarten age vaccination rates for MMR, varicella, and DTaP were less than 87%, so we have had a 3% or greater absolute improvement in just one year. It will take sustained effort, though, to maintain and further improve these rates.
Unfortunately, we are a victim to our own success. Generally high vaccination rates have made many of these diseases uncommon or even rare. As vaccination rates have decreased in recent years, however, we have seen measles, for example, appearing with increasing frequency in communities with particularly low immunization rates. This translates into young and medically vulnerable children at higher risk for serious illness that could result in long-term harm.
Our partners in immunization outreach are:
- – Foundation For A Healthy Kentucky
- -Kentucky Association Of Health Plans
- -Kentucky Chapter Of American
- Academy Of Pediatrics
- -KY Department Of Education
- -KY High School Athletics Association
- -KY Hospital Association
- -KY Medical Association
- -KY Nurses Association
- -KY Pharmacist’s Association
- -KY Primary Care Association
- -KY Voices For Health
- – High Five For Health
MDU What are the other major health problems that Kentuckians face that the Department for Public Health is addressing?
STACK Reducing smoking rates, helping people living with substance use disorder reduce their risks of harm, and striving to eliminate overdose deaths.