Youth Obesity Causes, Youth Obesity Causes, Consequences, and SolutionsConsequences, and Solutions
Stephen Cook, MD, MPHStephen Cook, MD, MPHAssistant Professor, PediatricsAssistant Professor, Pediatrics
Golisano Children’s Hospital at StrongGolisano Children’s Hospital at Strong
Winter is almost over in Rochester; we Winter is almost over in Rochester; we can see the deer wandering around nowcan see the deer wandering around now
ConsequencesConsequences
The Metabolic Syndrome:The Metabolic Syndrome:Historical PerspectiveHistorical Perspective
Reaven G. Diabetes. 1988;37:1565-1607.
InsulinInsulinResistanceResistance
InsulinInsulinResistanceResistance
GlucoseGlucoseIntoleranceIntolerance
GlucoseGlucoseIntoleranceIntolerance HyperinsulinemiaHyperinsulinemiaHyperinsulinemiaHyperinsulinemia TGTG TGTG HDL-C HDL-C HypertensionHypertension
1988: Syndrome X1988: Syndrome X
CORONARY HEART DISEASECORONARY HEART DISEASECORONARY HEART DISEASECORONARY HEART DISEASE
Criteria for Metabolic Syndrome inCriteria for Metabolic Syndrome inAdults and AdolescentsAdults and Adolescents
Rates of Metabolic Syndrome by Increased Rates of Metabolic Syndrome by Increased Smoke Exposure in US teensSmoke Exposure in US teens
DyslipidemiaElevated BPAbnormal glucose-insulin metabolism
Pro-inflammatory factorsPro-thrombotic factors
Diabetes
Cardiovascular Disease
Obesity
Abdominal Obesity
Genetics, Peri-natal, Puberty, Diet, Physical Activity
Tobacco use/exposure
Potential Precursors:
AdiponectinOther inflammatory
cytokines
Bold = factors included in this study
Proposed Metabolic Syndrome Factors in the Life Proposed Metabolic Syndrome Factors in the Life Course from Obesity to Cardiovascular DiseaseCourse from Obesity to Cardiovascular Disease
Co-morbidities with Cardio-metabolic Risk among youth
Non Alcoholic Fatty Liver DiseaseNon Alcoholic Fatty Liver Disease
Polycystic Ovarian SyndromePolycystic Ovarian Syndrome
Obstructive Sleep ApneaObstructive Sleep Apnea
Polycystic Ovarian Syndrome
Menstrual Irregularities / InfertilityMenstrual Irregularities / Infertility
Small Cysts on OvariesSmall Cysts on Ovaries
Hyper-AndrogenismHyper-Androgenism
Insulin ResistanceInsulin Resistance
+/- obesity+/- obesity
Increased CVD riskIncreased CVD risk
Prevalence of Metabolic Syndrome and Prevalence of Metabolic Syndrome and Components among Obese Teen GirlsComponents among Obese Teen Girls
Rossi, et al. Journ of Clin Endo & Met 2008; 93:4780
Kotronen, A. et al. Arterioscler Thromb Vasc Biol 2008;28:27-38
A schematic representation of how components of the metabolic syndrome relate to fat accumulation in the liver
Cardiovascular Risk Factor Values by Liver Cardiovascular Risk Factor Values by Liver Status in Obese Children & AdolescentsStatus in Obese Children & Adolescents
Schwimmer, J. B. et al. Circulation 2008;118:277-283
Schwimmer, J. B. et al. Circulation 2008;118:277-283
Distribution of features of metabolic syndrome in obese youth with and without NAFLD
Solutions?Solutions?
Greater Rochester Health Foundation Greater Rochester Health Foundation Strategic Areas of FocusStrategic Areas of Focus
Neighborhood Health Status ImprovementNeighborhood Health Status Improvement
Health system improvementHealth system improvement
Prevention Prevention
GRHF Childhood StrategyGRHF Childhood Strategy
GOAL: Reduce the prevalence of overweight and obesity from 15% to 5% of Monroe County children
ages 2-10 by 2017
[from 12,144 kids to 4,081 kids]
Advance policy and practice solutions
Execute a community
communications campaign
Increase physical activity and improve
nutrition
Engage the clinical
community
Change is hardChange is hard
Most difficult steps: Most difficult steps:
– Increasing my own physical activity Increasing my own physical activity is difficult (68% moderate to very is difficult (68% moderate to very difficult)difficult)
– Reducing TV time for my children is Reducing TV time for my children is a challenge (63%)a challenge (63%)
– Getting my kids to eat healthier Getting my kids to eat healthier won’t be easy (61%)won’t be easy (61%)
OpportunitiesOpportunities
Getting my kids to be physically Getting my kids to be physically active is doable (70% Easy)active is doable (70% Easy)
I want my child’s school to offer I want my child’s school to offer more physical activity (84% Very more physical activity (84% Very Important)Important)
I trust health and nutrition I trust health and nutrition information from my doctor (63% information from my doctor (63% Trust a Lot), and pharmacist Trust a Lot), and pharmacist (37%), more than my family (20%) (37%), more than my family (20%) and the Internet (12%)and the Internet (12%)
I am willing to engage in physical I am willing to engage in physical activity to lead my children to be activity to lead my children to be more active (56% Easy)more active (56% Easy)
TownTown Normal / Normal / UnderweightUnderweight OverweightOverweight ObeseObese
RochesterRochester 60.6%60.6% 16.7%16.7% 22.7%22.7%
HamlinHamlin 62.3%62.3% 16.9%16.9% 20.8%20.8%
IrondequoitIrondequoit 63.9%63.9% 19.3%19.3% 16.8%16.8%
GatesGates 64.7%64.7% 15.2%15.2% 20.1%20.1%
ClarksonClarkson 64.8%64.8% 22.8%22.8% 12.3%12.3%
GreeceGreece 70.3%70.3% 16.4%16.4% 13.4%13.4%
SwedenSweden 70.6%70.6% 14.6%14.6% 14.8%14.8%
ChiliChili 72.1%72.1% 13.8%13.8% 14.1%14.1%
HenriettaHenrietta 72.5%72.5% 17.1%17.1% 10.4%10.4%
East RochesterEast Rochester 73.5%73.5% 8.7%8.7% 17.9%17.9%
RigaRiga 74.7%74.7% 12.8%12.8% 12.5%12.5%
WebsterWebster 74.7%74.7% 14.4%14.4% 10.9%10.9%
PerintonPerinton 74.8%74.8% 13.5%13.5% 11.8%11.8%
PenfieldPenfield 76.7%76.7% 13.0%13.0% 10.4%10.4%
OgdenOgden 76.9%76.9% 14.9%14.9% 8.2%8.2%
ParmaParma 77.5%77.5% 7.7%7.7% 14.8%14.8%
WheatlandWheatland 78.7%78.7% 8.0%8.0% 13.4%13.4%
BrightonBrighton 78.8%78.8% 13.8%13.8% 7.4%7.4%
PittsfordPittsford 80.3%80.3% 11.5%11.5% 8.2%8.2%
MendonMendon 83.7%83.7% 9.3%9.3% 7.0%7.0%
RushRush 83.8%83.8% 12.9%12.9% 3.4%3.4%
TotalTotal 69.9%69.9% 14.9%14.9% 15.1%15.1%
BMI categories for children living in BMI categories for children living in Rochester, by Race/EthnicityRochester, by Race/Ethnicity
BMI CategoryBMI Category
RaceRaceNormal / Normal / Under Under WeightWeight
Over Over weightweight ObeseObese
African-African-AmericanAmerican 61.8%61.8% 18.0%18.0% 20.2%20.2%
HispanicHispanic 53.4%53.4% 19.8%19.8% 26.8%26.8%
CaucasianCaucasian 62.3%62.3% 16.3%16.3% 21.4%21.4%
OverallOverall 59.9%59.9% 18.2%18.2% 21.9%21.9%
Funded activities forFunded activities fornext 3 yearsnext 3 years
Early childhood - $1.8 millionEarly childhood - $1.8 million
Clinical outreach - $750,000Clinical outreach - $750,000
Advocacy - $467,000Advocacy - $467,000
Suburban School projects - $820,000Suburban School projects - $820,000
Community Champions - $500-1000/eaCommunity Champions - $500-1000/ea
Media/Social Marketing CampaignMedia/Social Marketing Campaign– ~ $5 million over 3 years~ $5 million over 3 years
Greater Rochester Healthy Greater Rochester Healthy Child Care 2010:Child Care 2010:An early childhood overweight An early childhood overweight and obesity prevention programand obesity prevention program
The Children’s InstituteThe Children’s Institute
Eat Well / Play Hard EnhancedEat Well / Play Hard Enhanced– Child Care Council & CentersChild Care Council & Centers
Hip Hop to Health JrHip Hop to Health Jr– Rochester Childfirst Network & Home care providersRochester Childfirst Network & Home care providers
9 sites in each arm, 3 arms per year9 sites in each arm, 3 arms per year
3 years3 years
Interactive, group training that promotes collaborative learning, implementing small cycles of changes, with practice feedback and sharing lessons learned from other teams
Clinical Strategy:
Greater Rochester Obesity Collaborative
Institute for Healthcare Improvement Break Through Series (BTS) Model
Use a Learning Collaborative approach to train pediatric primary care providers
Collaborate with Expert Consultants from NICHQ and AAP
Recruit motivated practice teams: physician, nurse, off mgr & PARENTPARENT
Adapt AMA/CDC Expert Recommendations for local community
Conduct 4 training workshops with follow-up conference calls and
individual practice visits over ~ 12 months, conduct 3 cycles over 3
years
Provide on-line/free access simple practice tools and link to local
resources
Create a Community-wide toolkit and Region-specific resource guide
G-ROC
Was BMI Plotted?
76%
22%
3%
95% 95% 95%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No Missing
Perc
en
tag
e
All Charts
Goal
Was Weight Status Discussed with the Family?
42%37%
21%
95% 95% 95%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Yes No Missing
Perc
en
tag
e
All Charts
Goal
Did Provider Counsel on Nutrition and Physical Activity?
27%
1%
39%
20%13%
95% 95% 95% 95% 95%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Nutrition PhysicalActivity
Both Neither Missing
Perc
en
tag
e
All Charts
Goal
G-ROC
Practice and Overall results
For October 2008
Was BMI Plotted?
100%
0% 0%
94%
3% 3%
95% 95% 95%
0%
20%
40%
60%
80%
100%
120%
Yes No Missing
Perc
en
tag
e Genesis n = 17
Overall Resultsn = 135
Goal
Policy ProjectPolicy Project
HEALTHI Kids:HEALTHI Kids:Healthy Eating and Active Living Healthy Eating and Active Living
THrough policy and practice THrough policy and practice Initiatives for KidsInitiatives for Kids
45
Finger Lakes Health Systems Agency
Wade S. Norwood Director of Community Engagement
(585) 461-3520 [email protected]
Convening HEALTHi KidsConvening HEALTHi Kids
•Texas Obesity Policy Portfolio 2006, Texas Department of State Health Services, Center for Policy & Innovation
• Convene 27-member HEALTHi Kids Policy Team
•Examine public policy/practices that promote youth’s healthy eating and active living.
Eliminate the availability of food in schools that compete with the national school breakfast and lunch program. Mandate the development and execution of nutritional
standards so all food available on school campuses is consistent with a set of community standards.
Mandate the development and execution of nutritional standards for preschools, childcare centers, and school-age childcare programs, so that food and drinks
available comply with Dietary Guidelines for Americans or equivalent community standards.
Create policies that are supportive of breastfeeding throughout the community and all hospitals in Monroe County meet the
WHO Baby Friendly Hospital Criteria (Ten Steps to Successful Breastfeeding for Hospitals).
Improve the safety of, the perception of safety of, and access to recreational facilities, bike trails, parks, and green spaces, while expanding after-hour
access to schools and promoting safe play.
Require that K-12 grade students are provided with 45-minutes of moderate to intense physical activity daily.
QuestionsQuestions
My Drive HomeMy Drive Home
Monroe County Obesity Rate Monroe County Obesity Rate by Geography, 11 – 14 yr olds, 1999by Geography, 11 – 14 yr olds, 1999
14.3
23.1
0
5
10
15
20
25
30
City Suburbs
% OBESE16%16%