Childhood Obesity

Cindy Devore, M.D., F.A.A.P.

OBESITY IS A PROBLEM OF EPIDEMIC PROPORTIONS IN

OUR YOUTH.

United States

Obesity related deaths in US are about 400,000/year.

This is about the same number of deaths due to tobacco use in the US.

Statistics on obesity

One out of four (24%) of African- American children is obese,

One out of five (22%) of Hispanic-American children is obese,

One out of six (16%) of Caucasian-American children is obese, and there is another one out of ten (10-15%) at risk of obesity based on their current weight.

Definitions of Obesity

Medical definition: Obesity is a Body Mass Index (BMI) of greater than the 95 percentile for age and gender; at risk for obesity is a BMI of greater than the 85 percentile for age and gender.

Lay definition: overweight; above normal weight; clothes fit too tightly

What Is Body Mass Index (BMI)?

Body mass index is a formula measuring height against weight (as kilograms divided by meters squared).

It is expressed as a number from about 17 through 60.

BMI differs for men and women, adults and children, and may not be as accurate in athletic or muscular children, but it is a very useful measure.

BMI INTERPRETATION

Underweight <19.0

Normal range 19.1- 26.9

Overweight (85th) 27.0 – 29.9 Obese (95th) >30

The Serious Nature of the Obesity in American Youth

American children are becoming more obese faster today than at any other time in our history!

Anticipated Outcome of this Trend

American children are expected to have a shorter life span than their parents. This is a first in the history of human life!

Yet, everyone is afraid to talk about it, as if to offend someone when what we are talking about is medical risk for our most precious resource: our children!

Purpose of This Talk: To provide an understanding of the scope and

causes of this leading nutritional disease in America

To discuss the risks of childhood obesity

To discuss the role of the parent and the possible things you can do as a parent to attack the problem

Causes of Childhood Obesity

THERE ARE TWO MAJOR AND BASIC CAUSES OF OBESITY:

Too many calories in

Too few calories out

However, that is a simplistic statement.

In reality, the problem is MULTIFACTORIAL, meaning there are many factors surrounding the causes of childhood obesity

Some causes are preventable. Some are not

Multifactorial Causes of Obesity

Increased eating

Decreased activity

Family history

Stress

Drugs

Genetics

Modest increases in intake not compensated by activity can result in large weight gain over time.

10 calories extra per day results in 1 lb of weight gain per year

150 calories extra per day = 15lbs/year

Cut out one cookie a day lose 15 lbs in a year

Causes: Increased Eating or Intake

Common causes of increased eating:

Excessive snacking

Sweet beverages Increased portions Limited variety

Fast food Multiple caretakers Holiday excesses Less supervision.

Common causes of decreased activity

Increased TV viewing, computer use, video game playing

Increased concerns of safety issues outdoors

Reduced physical education and recess in school

Over-scheduling so family life is disrupted

Decreased family activity time together

Decreased Activity

Today’s children are 4 times less active in their daily lives as were their grandparents

Homework burden greater at younger ages

Decreased intensity of daily living

Inactive families serve as role models

Exercise recommendations Children: 60 minutes a day five days a week of

vigorous physical activity that makes them sweat

Adults: 30 minutes of the same five days a week

Key point: find something you and your child enjoy and schedule it right into your day

Causes: Genetic Factors or Family History

Adoption studies found a high correlation between obesity in adopted children and their biologic parents

Twins reared together or apart have similar rates of obesity

Genetic Factors

Having two obese parents increases a child’s risk of obesity up to 80% compared to a risk of 9% for having lean parents

More than 200 genes or gene markers are associated in some way with obesity and research is working on this

Key Points GENETICS ARE A RARE CAUSE OF

OBESITY THAT WE CANNOT CONTROL.

WE CAN CONTROL OUR ENVIRONMENT

THEREFORE, OBESITY IN MOST CASES IS PREVENTABLE AND TREATABLE

Causes: Stress

Stress factors in the environment may trigger the onset of obesity. In children, these factors can include:

Death of a parent Parental divorce or separation Learning or school problems Emotional problems Medical illnesses Family discord

Why is stress a factor in overeating?

Eating is associated with feeling good and during times of stress, we want to feel better

Parents use food to soothe or reward children during times of stress

During stressful times we tend to eat out, eat fast food, or eat at different times rather than as a family unit

Causes: Drugs

Glucocorticoids: prednisone Antidepressants: Amitriptyline, desipramine,

fluoxetine Anticonvulsants: Valproic acid Antihypertensives: Clonidine, Prazosin,

Propranolol Major antipsycholitic drugs: Rispridol, Haldol Recreational drugs: marijuana

Obesity Related Health Problems Heart problems (hardening of arteries, high blood

pressure)

Metabolic (Hyperinsulinemia, non-insulin dependent type II diabetes)

Orthopedic (joint problems, arthritis)

Respiratory (Daytime sleepiness; Sleep disturbance; Snoring and sleep apnea; Inadequate ventilation; Asthma)

GI and Liver disease (fatty liver, cirrhosis)

Metabolic Syndrome: Obesity, Type II Diabetes, High Blood Pressure

In 1988 only 2% of all children diagnosed with diabetes had adult onset diabetes caused by obesity

In 2007 up to 40% of all new onset diabetics have Type II diabetes, a condition that can be eliminated by weight loss

Reality of the danger of Type II diabetes

It takes about 15 years from onset of diabetes to start seeing the severe complications.

If an adult is diagnosed at age 55, by the time they are 70, they may have kidney disease, damaged eyesight, etc.

If a 15 year old child is diagnosed, by the age of 30 their bodies can start to fail.

Small steps to healthier living

A journey of a thousand miles begins with a single first step.

Chinese proverb

Families need education and support to experience success and then must:

Prioritize need for change in family functioning.

Build skills in order to effect change.

Set realistic step-wise goals.

Families need to understand

Best success is in the pediatric age group.

Changes in behavior can overcome genetic influences.

As little as ten percent weight loss can lessen metabolic risk factors.

Parents are a role model

Where do parents begin?

Remember it took time for our children to gain weight, and it will take time for them to lose weight

Aim for small steps to begin the process

SMALL STEPS TO A HEALTHIER LIFESTYLE

PHYSICAL ACTIVITY

Small Steps Toward a Healthier Lifestyle: Get moving

Exercise regularly

Get active together

Decrease “screen” time

Increase exercise

Decrease barriers to exercise

Take the President’s Challenge

Exercise regularly

Walking is the key to good health Take the stairs instead of an elevator or

escalator when you can Get off a bus stop a little early and walk Park in a spot farther away and walk Step up the intensity of chores at home Feel good about working up a sweat

Get active together as a family Look at family over-scheduling and change Plan on family hikes, biking, swimming, skating,

skiing, dancing, anything active together Get more physical on the weekends Do a charity fun run or walk or car wash Practice sports at home Be a good role model Start in small steps, 10 minutes and build to 60

minutes

Decrease screen time

Limit TV, video games, or non-educational computer time to no more than 1 to 2 hours per day

Plan that for every hour or computer or TV or video games a child must have ½ hour of physical activity intense enough to make him/her sweat.

Decrease barriers to physical activity Work with community leaders to ensure safe

places for physical activity indoors and outdoors

Work with your legislators to insist that obesity is covered under health insurance policies

If your child is home alone, stock the house with healthy snacks and encourage kids to find something to do everyday that is physical like jumping jacks.

Take the President’s Challenge Every child needs 60 minutes of vigorous

physical activity five days a week

Every adult needs 30 minutes of vigorous physical activity five days a week

Log onto www.presidentschallenge.org and enter the challenge to do moderate physical activity. Chart your progress over six weeks and win an award.

Take the Body for Life Challenge

Register for Bill Phillips’ Body for Life Challenge at www.EAS.com

Take before photos Engage in 3 months of healthy living Take after pictures Submit the photos and short required essays

and win $1,000,000 if you are selected

SMALL STEPS TO A HEALTHY LIFESTYLE

EATING

Small Steps Toward a Healthier Lifestyle: Eating

Think portions

Switch it up

Offer healthy meals and snacks

Everything in moderation

Involve the entire family

Think portions; remember serving size

Meat: 2-3 oz. (a deck of cards) Pasta ½ cup (tennis ball) Bread 1 slice (1 post card) Peanut butter 2 T (ping pong ball) Cheese 1 oz. (four dice) Vegetables ½ cup (light bulb)

Portions when dining out Share or split a meal

Bring home half for another meal

Tell kids to listen to their bodies to know if their stomachs are empty or full and to stop eating when they feel full before they feel sick or stuffed

Never supersize it alone. EVER. Only if sharing half

Switch it up

Switch whole grains for white flour

Whole wheat for regular pasta

Whole wheat tortillas for white tortillas

Brown or wild rice for white rice

Offer Healthy Meals and Snacks

Decrease red meat and increase fish and poultry

Go from whole milk to 2% to skim milk Go from frying to steaming, baking, grilling Use low fat yogurt as a snack Use low fat crackers, pretzels, fruits Encourage drinking water or diet beverages

Everything in moderation

Don’t try to eliminate junk; just reduce it

Reduce it in stages

Look for small 100 calorie snacks, but stick to that size

Involve the entire family

Don’t focus on one child; involve the entire family in a get healthy together adventure

Have children help prepare meals and eat together as a family. Strengthen family life

Be a good role model

Parting words: Do not become discouraged. Become involved,

and be a good role model.

Remember small steps have enormous benefits: decrease 100 calories a day & increase physical activity to burn 100 calories a day to lose weight healthfully

Children can and do succeed at changing lifestyles