Forsyth County Health Summit Child and Adolescent Obesity

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Forsyth County Health Summit Child
and Adolescent Obesity

• Robert P. Schwartz, MD
• Wake Forest University School of Medicine

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Prevalence of Obesity in Adults

• 1988-1994
  2003-2004
• Obese 22.9 32.2
• Overweight and Obese 55.9
  66.3
• 4431 adult men and women NHANES
• Ogden CL et al. JAMA 2006 295 1549-1555.

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Prevalence of Overweight in ChildrenBMI-for-Age
-Percentiles

• 95th percentile 85th percentile
• 1971-1974 2003-2004 2003-2004
• 2-5 years 5.0 13.9 26.2
• 6-11 years 4.0 18.8 37.2
• 12-19 years 6.1 17.4
  34.3
• 3958 children from NHANES.
• Ogden CL, et al. JAMA 2006 2951549-1555.

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Complications of Obesity

• Cardiovascular - hypertension, atherosclerosis
• Metabolic - type 2 diabetes, dyslipidemia
• Pulmonary - sleep apnea
• Skeletal - leg deformities, fractures
• Liver - fatty liver (steatohepatitis)
• Kidney - glomerulosclerosis
• Reproductive hirsutism, polycystic ovary
  disease
• Psychological - low self esteem, depression

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TYPE 2 DIABETES - CINCINNATI

• Before 1992 type 2 diabetes accounted for 3-10
  of new cases of diabetes among children 10-19
  years old in Cincinnati
• In 1994 type 2 diabetes accounted for 33 of new
  cases of diabetes in this age group
• All of the patients with type 2 diabetes were
  obese
• 69 were African American (14.5 of general
  population in Cincinnati are African Americans)
• Pinhas-Hamiel O. et al. J Pediatr
  1996128608-615

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Factors Increasing Obesity

• Factors Affecting Energy Intake
• Increased number of meals away from home
• Larger portion sizes
• Increased consumption of calorie dense fast
  foods/snacks
• Sugar sweetened drinks
• Factors Affecting Energy Expenditure
• Decreased physical activity at school and at
  home.
• Increased inactivity TV and video games

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THE CHOICE OF NEW GENERATION

• Percent drinking
• Age (yrs) soft drinks daily
• 8 56
• 9 to 13 70-73
• 14 (girls) 78
• 14 (boys) 85
• One-third of teenage boys consume at least
  three 12-ounce servings of soft drinks daily.
• Source USDA

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Relation Between Soft Drinks and Childhood Obesity

• Study Design 548 ethnically diverse 6th-7th
  grade children
• (11-12 yrs) in public schools in Boston
  (1995-97)
• Children studied prospectively for 19 months
• Odds ratio of becoming overweight increased 1.6
  
• times (60) for each additional can of
  sugar-sweetened drink consumed every day
• Ludwig DS, Peterson KE, Gortmaker SL. Lancet
  2001357505-08.

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Fast Food Consumption and Obesity

• 6212 children and adolescents 4-19 years old
• 30 consumed fast food on typical day
• Children eating fast food consumed additional
  187
• kcal/day
• Fast food consumption had adverse effect on diet
  quality
• Bowman SA et al. Pediatrics 2004 113 112-118

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McDonalds French Fries

• 
  Calories
• 1950-60s one size 200
• 1970s large 320
• 1980s large 400
• 1990s large 450
• super size
  540
• 2000 super size 610

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Physical Activity

• Only 50 of U.S. young people 12-21 years
• regularly participate in rigorous physical
  activity
• 25 report no physical activity
• From 1991-1995 daily attendance in school
• PE classes decreased from 42 to 24
• Nesmith J D Pediatrics in Review 200122147-52.

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Physical Activity in Adolescent Girls

• 1213 African American girls and 166 white girls
  followed for 10 years from ages 9 -10 to ages 18
  19 years.
• By age 16-17 years, 56 of African American girls
  and 31 of white girls reported no leisure time
  activity (outside of school PE class).
• Kim S et al, N. Engl J Med 2002347709-715.

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Children and Television

• The average child or adolescent watches 3 hours
  
• of television per day (does not include
  videotapes
• or video games)
• 32 of 2-7 year olds and 65 of 8-18 year olds
• have a TV set in their bedrooms.
• Committee on Public Education. Pediatrics
• 2001107423-426.

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Obese
Time Spent Watching Television(hrs/day)Crespo
CJ et al. Arch Pediatr Adolesc Med 2001
155360-365.
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Approaches to the Obesity Epidemic

• Home, individual, family
• School
• Workplace
• Community
• Government (Legislative)
• Food and beverage industry
• Media
• Advocacy

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Role of Health-Care Professionals

• Measure height and weight, calculate BMI and plot
  on BMI growth chart and track BMI at every health
  supervision visit (www.cdc.gov/growthcharts/)
• Identify Comorbidities
• Communicate results to parents
• Provide evidence-based counseling and guidance to
  children and their families
• Serve as role models and advocates in community
  for healthy eating and regular physical activity
• http//www.iom.edu/obesity

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Healthy Lifestyles for Children and Families
Involve entire family in lifestyle change 5
servings of fruits and vegetables 2 hours or
less of screen time No more than 2 times
dining out per week 1 hour of moderate to
vigorous physical activity daily One
portion size
0 servings of sugar sweetened drinks