Curbing the Appetite of the Obesity Epidemic

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Curbing the Appetite of the Obesity Epidemic
Linda Gillis, M.Sc., RD Childrens Exercise
Nutrition Centre, McMaster Childrens
Hospital Hamilton
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Outline

• Nutrition and Obesity
• Nutrient Inadequacies
• State of Malnutrition
• Calcium, Iron
• Curbing the Appetite
• 14 curbs, twice as many tips

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Nutrition and Obesity
Not much
What do we know?
3500
E n e r g y I n t a k e (kCal)
1500
1950
1990
2000
Ye a r
French et al 2001, Stephen 2001
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The NAF Study
Activity
Nutrition
Fun
NAF Study
90 non-obese children/adolescents
n 181
91 obese children/adolescents
Childrens Exercise Nutrition Centre
Question Does energy or fat contribute most to
juvenile obesity?
E N E R G Y
Gillis et al 2002
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The NAF Study

• Junk Food-not different

• Food Groups-obese consume
• higher grains and meats

Binkley 2000, Gillis et al 2003
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The NAF Study

• Sweet Drinks
• -higher in obese

• Food Away From Home
• -higher in obese

McCrory et al 1999, Ludwig 2001, Gillis et al
2003
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Healthy Food
Mystery Meal? Contains 79 of Potassium 52 of
Vitamin C 25 of Calcium 74 of Iron 53 of
B1 109 of B2 124 of B3 45 of Folate 38 of
Fibre
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Healthy Food?
Forgot to mention 1140 Calories, 59 grams of Fat
and 1400 mg Sodium
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Nutrient Inadequacies
Question If overweight children are consuming
higher energy and fat diets, are they meeting
their micronutrient needs?

• on average, diets of overweight children
• meet recommendations (except for Vitamin E)

Gillis Gillis 2005
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Nutrient Inadequacies

• Percentage of obese children not meeting dietary
  
• recommendations
• Folate 47
• Vitamin D 46
• Calcium 55
• Vitamin E 81

• Other nutrient intakes were
• adequate (vitamin A, vitamin B1,
• vitamin B2, vitamin B3, vitamin B6,
• vitamin B12, vitamin C, iron, zinc,
• magnesium, phosphorus)

Gillis Gillis 2005
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State of Malnutrition?
But

• Many nutrients in the plasma of overweight
  individuals
• are less than non-obese and are at deficient
  levels
• Zinc, selenium, magnesium, iron, lutein,
  B-carotene,
• vitamin C, vitamin E, vitamin D, vitamin B12,
  folate,
• vitamin B1

• Not always related to diet

Gillis 2008
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Iron Obesity

• Ferritin (a measure of body iron stores)
• 29 have low iron stores indicating
• iron deficiency

• No relationship between ferritin
• and diet in obese children

Gillis 2008, Institute of Medicine 2001,
Pinhas-Hamiel 2003, Nead 2004
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Iron Obesity

• Ferritin increases with obesity, diabetes,
• metabolic syndrome, liver disease, etc.

R 0.22, p lt 0.01
Gillis 2008
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Iron Obesity

• Need to assess iron deficiency
• with iron models
• e.g. MCV model
• MCV-mean cell volume
• transferrin saturation
• erythrocyte protoporphyrin

Institute of Medicine 2001
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State of Malnutrition?
Question Do we supplement?

• Higher rates of supplement use
• in lean individuals

• Little evidence that supplementing with a simple
• multivitamin will help or harm

Block 2007
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State of Malnutrition?
Question Do we supplement?

• Help?

• Obese children taking a multivitamin had higher
  B-carotene
• levels than obese not taking one (similar to
  non-obese)

• Obese subjects on vitamin C lost more weight
• than those that were not (not replicated)

• Obese subjects supplemented with calcium
• lost more weight

Naylor 1985, Strauss 1999, Teegarden 2003, Heaney
2002
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State of Malnutrition?
Question Do we supplement?

• Harm?
• No evidence that a multivitamin will hurt but
  individual supplements may

• Increased risk of cancer with folate
  supplementation

• Increased vascular events with calcium
  supplementation

• Increased cancer risk with beta-carotene
  supplementation

• Increased diabetes risk with selenium
  supplementation

Szolzenberg-Solomon 2006, Bolland 2008, Omenn
1996, Stranges 2007
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State of Malnutrition?
Question Do we supplement?
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Curbing the Appetite
Discover reasons why a child may be overeating

• 1) Not enough food or correct foods during the
  day
• Recommend 1) no meal skipping especially
  breakfast
• 2) three to four food groups at each meal
• 3) three balanced snacks with protein
  and
• carbohydrate (ideally a fruit or veggie)
• 4) healthy fats spread throughout meals
• and snacks

• 2) Not enough fibre
• Recommend whole grains, fruits veggies

Kimm 1995, Drummond et al 1996, Weigle et al
2005, Luscombe-Marsh et al 2005
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Education
Red Yellow Green

• Green foods healthy foods that can be eaten
  almost every day
• Examples fruits, vegetables, milk, chicken,
  fish, whole wheat
• bread, whole wheat pasta, whole grain cereal

• Yellow foods healthy foods but may be high in
  fat, sugar
• or low in fibre so eat only twice per week
• Examples juice, chocolate milk, cheese,
  hamburger, white bread

• Red foods foods that are not as healthy so eat
  less often, as treats
• Examples wieners, processed foods, chips,
  chocolate, cookies

Epstein et al 1998
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Curbing the Appetite
Discover reasons why a child may be overeating

• 3) Not enough fluid
• Recommend 6 to 8 cups of fluid per day
• (3-4 are milk, rest
  water)

• 4) Too much sugar and fat
• Recommend watch amount of treats

• 5) High Insulin Level
• Recommend diet to control high
• insulin

Boschmann et al 2003, Erlanson-Albertsson 2005,
Lustig 2006, Sharma 1992
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Curbing the Appetite
Discover reasons why a child may be overeating

• 6) Diet Beverages
• Recommend ?

• 7) Selective eating
• Recommend selective eating tools
• -Food Bingos
• -Food Mountain
• -Food Game

Bellisle Drewnowski 2007, Raynor Epstein
2001, Gillis 2003, Gillis 2008
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(No Transcript)
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NUTREEMO MOUNTAIN
My Reward _________________
1 SQUARE
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Start
THE
FOOD
Milk Milk Products Fruit
Veggies Meats Alternatives Grains
GAME
End
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Curbing the Appetite

• 8) Boredom
• Recommend activity plan

• 9) Long time habit
• Recommend goal setting

Sperduto 1986
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Goal Setting

• What, when, where, how often?

• Who will help? Control issues.

• What will get in the way of
• achieving goal?

• Self monitoring - required not just recommended

• Provide positive reinforcement

Foreyt Cousins 1989, Epstein et al 1998
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Goal Setting

• Set positive non-penalizing goals e.g. increase
  fruit

• Try to set behavioral goals instead of food
  goals
• e.g. 20 minute rule instead of eat less
  seconds
• e.g. no food in front of TV instead of eat
  less after school

Epstein et al 2001, Coon 2001
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Curbing the Appetite
Discover reasons why a child may be overeating

• 10) Not enough sleep
• Recommend more sleep

• 11) Other siblings/parents eating more
• Recommend discussion of needs
• family goals
• modelling
• family meeting

Chen 2008, Birch Davison 2001
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Curbing the Appetite
Discover reasons why a child may be overeating

• 12) Parents too restrictive (leads to sneaking)
• Recommend more choice by child/teen
• -snack basket
• -family treat night

• 13) Too tempting to resist
• Recommend less treats in the house
• less tv (so less tempting commercials)

Faith Kerns 2005, Francis Birch 2006, Halford
et al 2004
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Curbing the Appetite
Discover reasons why a child may be overeating

• 14) Low activity level
• Recommend daily activity

Blundell King 1999, Mayer 1956
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Questions?
E-mail gillisl_at_hhsc.ca