Transcript CHILDHOOD OBESITY - Oklahoma Academy of Physician

L. Janelle Whitt, DO
OU-Tulsa School of Community Medicine
45th in
adult
obesity
19th in
pediatric
obesity
• 30% of students thought of themselves as
overweight
• More female than male
• More Hispanic than white or black
• 43% students reported that they were trying to lose
weight
• Using of exercise to lose weight or avoid gaining
weight
• Eating less food, fewer calories, low fat foods
• Fasting > 24 hours
• Taking diet pills or supplements without doctors advice
• Vomiting or abusing laxatives
• OVERALL, KIDS ARE DOING CRAZY STUFF TO TRY
AND LOSE OR MAINTAIN THEIR WEIGHT
• Among six choices of
greatest risk to their
children’s long-term
health and quality of
life
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Illegal drugs 24%
Violence 20%
Smoking 13%
STD 10%
Alcohol 6.1%
Obesity 5.6%
• Majority of parents do not believe that PE/recess
should be reduced or replaced with academics
• 1/3 are concerned with their child’s weight
• ~ 10% consider their children overweight
• Compared to themselves:
• ¼ think their children eat less nutritiously
• ¼ say their children are less active than they were
• 1/3 rate their school programs for teaching healthy
eating/activities as “poor” or “non-existent”
• Serious health concern for children and
adolescents
• 28% of Oklahoma kids 10-17yo are
overweight or obese
• Increased health risks during youth and as
adults
• Overwhelmingly more likely to become
obese as adults
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$147 billion spent in 2009 (direct & indirect)
Almost 10% of all healthcare expenditures
Lost productivity, missed work/school days
In 2006, obese pts spend $1429 more for
medical care (42% increase).
• In relation to its effects, obesity research
funding is dismal
• Most widely used
method to screen for
overweight
• Easy, non-invasive,
way to obtain height
and weight
• BMI correlates with
body fatness, but is
not a direct measure
of fatness
• BMI is practical measure used to define
overweight.
• In children, BMI is based on age and sex
specific percentiles for BMI, not the usual adult
BMI categories.
• Overweight is at/above the 95th % for age.
• At risk for overweight is 85 to 95% for age.
• Increasing dramatically
• Since the 1970’s the incidence has more than
doubled in the 2-5yo age group, and almost
tripled in the 6-19yo age group
• Healthy people 2010 called for a reduction in
the proportion of children who are overweight
or obese…but we are making little progress
• 1/3 Oklahoma adults
are overweight or obese
• The obesity rate in
Oklahoma has doubled
in last 15 years
• 1/3 Oklahoma kids are
overweight
• Increased odds of being
obese if poor and
uneducated
15%–<20%
20%–<25%
25%–<30%
30%–<35%
≥35%
• Overweight is the result of an imbalance
between the calories consumed as
food/beverage and the calories used to
support normal growth, development,
metabolism and physical activity
• Imbalance can result from a number of
factors: genetic, behavioral and
environmental.
• Genetic characteristics may increase a
child’s chance of overweight
• May need to exist in conjunction with nongenetic factors
• Genetic factors alone play a role in rare
Prader-Willi syndrome
• Mutations change activity of ‘fat hormone’
leptin
• Not possible to isolate one specific
behavior leading to overweight
• Energy intake
• Physical (in)activity
• Sedentary behavior
• Important in body weight, blood pressure and
bone strength
• Active children are more likely to remain active
through adolescence and into adulthood
• Children are spending less time in PE during
school
• Daily PE dropped >10% in last 13 years
• Less than 1/3 high school students get
recommended levels of physical activity
• “Super-sized” portions
• Eating meals out
• Snacking on energy-dense
foods
• High-sugar beverages
• High in calories
• May not compensate at
meal time for extra
calories
• Liquid calories less satiating
than solid form and lead to
higher caloric intake.
• Child’s odds of becoming
obese increase with each
additional daily serving
of sugar-sweetened
drinks
• Suggests independent
link between soda
consumption and obesity
• Average teenager gets 15-20 teaspoons of
sugar from soft drinks alone
• One study involved 548 children ages 11-12 in
Boston from ’95 to ’97
• 57% kids increased their daily sugarsweetened drink consumption over the 19 month
period
• BMI increased with each additional serving
• 37 kids not considered obese at onset were
obese by the end of the study
• Children spend
considerable amount of
time with media
• Children aged 8-18
spend over 3 hours a
day with media
• Studies find a positive
association between
screen time and
increased overweight
• Decrease time children spend in active,
physical play
• Contribute to increased energy
consumption through mindless snacking
• Influence children to make unhealthy food
choices due to advertisements
• Lower children’s metabolic rate
• At home
• Parents as role models, positive or negative
• At school
•Ideal setting for teaching healthy eating and
physical activity
• In the community
•Access to sidewalks, bike paths, parks
• Access to affordable, healthy food choices
• Various health-related consequences, may be
immediate or long-term
• Psychosocial risks
•Early social discrimination
• Low self-esteem, decreased academic
performance
• Cardiovascular risks
• High cholesterol
• High blood pressure
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Asthma
NASH- Non-alcoholic steatohepatitis
Orthopedic problems
Sleep apnea
• Occurs in 7% of overweight children
• Type II diabetes “Adult-onset”
• Increasingly reported among children
• May lead to advanced long-term
complications
• Prevention plus
• PCP
• Structured weight management
• PCP plus dietician
• Comprehensive multidisciplinary intervention
• PCP plus behavioral counselor , dietician, exercise
specialist
• Tertiary care intervention
• Meds: sibutramine and orlistat
• Gastric bypass surgery
• Check Ht/Wt and BMI at EVERY visit
• Explain graphs to caregivers
• Check BP at every visit
• Use pediatric BP tables
• Labs:
• Glucose/HgA1c
• Lipids
•LFT’s
• Frequent monitoring
• Education about healthy food/drink choices and
physical activity
• Focus on weight maintenance, not loss
•Weight checks in between well child visits
• Consults for kids with HTN, high chol, DM
• Shapedown/Cowboys Get Healthy, Get Fit
• Encourage activity
• Sports, karate, biking, walking, trampoline
• Nutrition standards
• Vending machine
usage
• BMI measured in
schools
• Recess/physical
education
• Obesity programs and
education
• Obesity research
• Obesity treatment in
health insurance
• Obesity commissions
•Oklahoma Fit Kids
Coalition
The UB Obesity Report Card: An Overview
• Physical education
• Nutrition in schools
• School health councils
• Identify funding
sources
www.fitkidsok.org
• An advisory group of at least 6 individuals.
• Work to create healthy school environments so
that students can maximize their learning
potential.
• It’s required by law for public schools- SB 1627
• Provide advice to the school regarding school
health issues and assess the school’s needs in the
8 areas of the Coordinated School Health
Program.
www.fitkidsok.org
• Establish policies that promote enjoyable,
lifelong physical activity
• Provide physical and social environments that
encourage young people to engage in safe and
enjoyable physical activity
• Implement physical education curricula and
healthy lifestyle instruction in grades K-12
• Implement health education that allow students
to develop the knowledge, attitudes and skills
they need to maintain a healthy lifestyle
• Provide extracurricular physical activities that
are diverse, developmentally-appropriate and
both competitive and non-competitive
• Encourage parents to support their children’s
participation in physical activity and to be
physically active role models
• Provide training to school staff to promote
lifelong activity among young people
• Assess the activity patterns of students and
refer to activities
• Provide a range of community sports and rec
programs
“Every school day, 54 million young people
attend nearly 123,000 schools across the
country. Influencing and enhancing the
ability of schools to provide healthy
environments could be one of the most
effective ways to shape the health,
education and well-being of our next
generation.”
-President Bill Clinton