Transcript Pat - Cornell University

Youth Obesity Causes,
Consequences, and Solutions
Stephen Cook, MD, MPH
Assistant Professor, Pediatrics
Golisano Children’s Hospital at Strong
Winter is almost over in Rochester; we
can see the deer wandering around now
Consequences
The Metabolic Syndrome:
Historical Perspective
1988: Syndrome X
Insulin
Resistance
Glucose
Intolerance
Hyperinsulinemia
 TG
 HDL-C
CORONARY HEART DISEASE
Reaven G. Diabetes. 1988;37:1565-1607.
Hypertension
Criteria for Metabolic Syndrome in
Adults and Adolescents
% Teens with the MS
Rates of Metabolic Syndrome by Increased
Smoke Exposure in US teens
10
9
8
7
6
5
4
3
2
1
0
p for trend = 0.004
NonExposed*
ETS†
Lowest
Tercile
ETS
Middle
Tercile
ETS
Highest
Tercile
Active
Smokers‡
Proposed Metabolic Syndrome Factors in the Life
Course from Obesity to Cardiovascular Disease
Genetics, Peri-natal, Puberty, Diet, Physical Activity
Obesity
Diabetes
Potential
Precursors:
Adiponectin
Other inflammatory
cytokines
Abdominal
Obesity
Dyslipidemia
Elevated BP
Abnormal glucose-insulin
metabolism
Pro-inflammatory factors
Pro-thrombotic factors
Cardiovascular Disease
Bold = factors included in this study
Tobacco use/exposure
Co-morbidities with Cardio-metabolic
Risk among youth
Non Alcoholic Fatty Liver Disease
Polycystic Ovarian Syndrome
Obstructive Sleep Apnea
Polycystic Ovarian Syndrome
Menstrual Irregularities / Infertility
Small Cysts on Ovaries
Hyper-Androgenism
Insulin Resistance
+/- obesity
Increased CVD risk
Prevalence of Metabolic Syndrome and
Components among Obese Teen Girls
Rossi, et al. Journ of Clin Endo & Met 2008; 93:4780
A schematic representation of how components of the metabolic
syndrome relate to fat accumulation in the liver
Kotronen, A. et al. Arterioscler Thromb Vasc Biol 2008;28:27-38
Cardiovascular Risk Factor Values by Liver
Status in Obese Children & Adolescents
Schwimmer, J. B. et al. Circulation 2008;118:277-283
Distribution of features of metabolic syndrome in obese
youth with and without NAFLD
Schwimmer, J. B. et al. Circulation 2008;118:277-283
Solutions?
Greater Rochester Health Foundation
Strategic Areas of Focus
Neighborhood Health Status Improvement
Health system improvement
Prevention
GRHF 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]
Increase physical
activity and improve
nutrition
Engage the
clinical
community
Advance policy and
practice solutions
Execute a
community
communications
campaign
Change is hard
Most difficult steps:
– Increasing my own physical activity
is difficult (68% moderate to very
difficult)
– Reducing TV time for my children is
a challenge (63%)
– Getting my kids to eat healthier
won’t be easy (61%)
Opportunities
Getting my kids to be physically
active is doable (70% Easy)
I want my child’s school to offer
more physical activity (84% Very
Important)
I trust health and nutrition
information from my doctor (63%
Trust a Lot), and pharmacist
(37%), more than my family (20%)
and the Internet (12%)
I am willing to engage in physical
activity to lead my children to be
more active (56% Easy)
Normal /
Underweight
Overweight
Obese
Rochester
60.6%
16.7%
22.7%
Hamlin
62.3%
16.9%
20.8%
Irondequoit
63.9%
19.3%
16.8%
Gates
64.7%
15.2%
20.1%
Clarkson
64.8%
22.8%
12.3%
Greece
70.3%
16.4%
13.4%
Sweden
70.6%
14.6%
14.8%
Chili
72.1%
13.8%
14.1%
Henrietta
72.5%
17.1%
10.4%
East Rochester
73.5%
8.7%
17.9%
Riga
74.7%
12.8%
12.5%
Webster
74.7%
14.4%
10.9%
Perinton
74.8%
13.5%
11.8%
Penfield
76.7%
13.0%
10.4%
Ogden
76.9%
14.9%
8.2%
Parma
77.5%
7.7%
14.8%
Wheatland
78.7%
8.0%
13.4%
Brighton
78.8%
13.8%
7.4%
Pittsford
80.3%
11.5%
8.2%
Mendon
83.7%
9.3%
7.0%
Rush
83.8%
12.9%
3.4%
69.9%
14.9%
15.1%
Town
Total
BMI categories for children living in
Rochester, by Race/Ethnicity
BMI Category
Normal /
Under
Weight
Over
weight
Obese
AfricanAmerican
61.8%
18.0%
20.2%
Hispanic
53.4%
19.8%
26.8%
Caucasian
62.3%
16.3%
21.4%
59.9%
18.2%
21.9%
Race
Overall
Funded activities for
next 3 years
Early childhood - $1.8 million
Clinical outreach - $750,000
Advocacy - $467,000
Suburban School projects - $820,000
Community Champions - $500-1000/ea
Media/Social Marketing Campaign
– ~ $5 million over 3 years
Greater Rochester Healthy
Child Care 2010:
An early childhood overweight
and obesity prevention program
The Children’s Institute
Eat Well / Play Hard Enhanced
– Child Care Council & Centers
Hip Hop to Health Jr
– Rochester Childfirst Network & Home care providers
9 sites in each arm, 3 arms per year
3 years
Clinical Strategy:
Greater Rochester Obesity
Collaborative
Interactive, group training that promotes
collaborative learning, implementing small cycles
of changes, with practice feedback and sharing
lessons learned from other teams
Institute for Healthcare Improvement
Break Through Series (BTS) Model
G-ROC
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 & PARENT
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
Was BMI Plotted?
100%
90%
80%
95%
95%
95%
76%
Percentage
70%
60%
All Charts
50%
Goal
40%
30%
22%
20%
10%
3%
0%
Yes
No
Missing
Was Weight Status Discussed with the Family?
100%
90%
95%
95%
95%
80%
Percentage
70%
60%
50%
All Charts
42%
40%
Goal
37%
30%
21%
20%
10%
0%
Yes
No
Missing
Did Provider Counsel on Nutrition and Physical
Activity?
100%
90%
95%
95%
95%
95%
95%
80%
Percentage
70%
60%
All Charts
50%
39%
Goal
40%
30%
27%
20%
20%
13%
10%
1%
0%
Nutrition
Physical
Activity
Both
Neither
Missing
G-ROC
Practice and Overall results
For October 2008
Was BMI Plotted?
120%
100%
Percentage
100%
94%
95%
95%
95%
80%
Genesis
n = 17
60%
Overall Results
n = 135
Goal
40%
20%
0%
3%
0%
3%
0%
Yes
No
Missing
Policy Project
Finger Lakes Health Systems Agency
HEALTHI Kids:
Healthy Eating and Active Living
THrough policy and practice
Initiatives for Kids
Wade S. Norwood
Director of Community Engagement
(585) 461-3520 ext.110
[email protected]
45
Convening 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.
Questions
My Drive Home
Monroe County Obesity Rate
by Geography, 11 – 14 yr olds, 1999
30
25
20
% OBESE 15
23.1
16%
14.3
10
5
0
City
Suburbs