Childhood Obesity

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Childhood Obesity

• Cindy Devore, M.D., F.A.A.P.

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OBESITY IS A PROBLEM OF EPIDEMIC PROPORTIONS IN
OUR YOUTH.
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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.

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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.

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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

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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.

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BMI INTERPRETATION

• Underweight lt19.0
• Normal range 19.1- 26.9
• Overweight (85th) 27.0 29.9
• Obese (95th) gt30

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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!

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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!

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• 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!

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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

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Causes of Childhood Obesity

• THERE ARE TWO MAJOR AND BASIC CAUSES OF OBESITY
  
• Too many calories in
• Too few calories out

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• 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

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Multifactorial Causes of Obesity

• Increased eating
• Decreased activity
• Family history

• Stress
• Drugs
• Genetics

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Causes Increased Eating or Intake

• 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

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Common causes of increased eating

• Excessive snacking
• Sweet beverages
• Increased portions
• Limited variety

• Fast food
• Multiple caretakers
• Holiday excesses
• Less supervision.

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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

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Decreased Activity

• Todays 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

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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

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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

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Genetic Factors

• Having two obese parents increases a childs 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

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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

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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

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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

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Causes Drugs

• Glucocorticoids prednisone
• Antidepressants Amitriptyline, desipramine,
  fluoxetine
• Anticonvulsants Valproic acid
• Antihypertensives Clonidine, Prazosin,
  Propranolol
• Major antipsycholitic drugs Rispridol, Haldol
• Recreational drugs marijuana

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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)

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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

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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.

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Small steps to healthier living

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

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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.

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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

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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

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SMALL STEPS TO A HEALTHIER LIFESTYLE

• PHYSICAL ACTIVITY

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Small Steps Toward a Healthier Lifestyle Get
moving

• Exercise regularly
• Get active together
• Decrease screen time
• Increase exercise
• Decrease barriers to exercise
• Take the Presidents Challenge

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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

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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

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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.

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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.

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Take the Presidents 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.

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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

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SMALL STEPS TO A HEALTHY LIFESTYLE

• EATING

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Small Steps Toward a Healthier Lifestyle Eating

• Think portions
• Switch it up
• Offer healthy meals and snacks
• Everything in moderation
• Involve the entire family

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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)

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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

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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

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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

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Everything in moderation

• Dont try to eliminate junk just reduce it
• Reduce it in stages
• Look for small 100 calorie snacks, but stick to
  that size

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Involve the entire family

• Dont 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

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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