Transcript Preventive Services Improvement Initiative

C5, D5 - Obesity Prevention and
Treatment
Laura Brey, MS, Training Director
[email protected]
919-866-0920
Ice Breaker
2
Objectives
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Describe the magnitude of the child and
adolescent obesity epidemic in the US
Summarize the national recommendations for child
and adolescent prevention, assessment, and
intervention
Utilize the national resources available to providers
for assisting in implementation of the national
recommendations and guidelines
List the 4 stages of pediatric overweight treatment
List for the 4 stages of pediatric blood pressure/
hypertension management
Utilize motivational interviewing in the treatment of
overweight children and adolescents
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Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
www.cdc.gov
4
Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
www.cdc.gov
5
Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
www.cdc.gov
6
Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
www.cdc.gov
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Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
www.cdc.gov
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Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
www.cdc.gov
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Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
www.cdc.gov
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Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
www.cdc.gov
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Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
www.cdc.gov
25%–29%
≥30%
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Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
www.cdc.gov
25%–29%
≥30%
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Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
www.cdc.gov
25%–29%
≥30%
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Obesity Trends* Among U.S. Adults
BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
www.cdc.gov
25%–29%
≥30%
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Obesity Trends* Among U.S. Adults
BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
www.cdc.gov
25%–29%
≥30%
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Prevalence of At-Risk & Overweight
Among Children and Adolescents
≥ 95%
≥ 85%
20
40.0%
18
35.0%
16
30.0%
14
25.0%
12
2-5 yrs
6-11 yrs
12-19 yrs
10
8
6
4
15.0%
10.0%
5.0%
2
0
20.0%
0.0%
1963- 1971- 1976- 1988- 1999 20031970 1974 1980 1994
2004
19992000
20012002
20032004
Ogden, et al. (2006). JAMA, 295(13), 1549-155517
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Suicide Risk
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Actual and perceived overweight is an
important risk factor for suicidal behaviors in
youth
Risk factor for suicidality even after
controlling for alcohol and illicit drug use
More studies needed to better understand
association between perceived and actual
overweight and risk for suicide attempts
(Swahn, M., Reynolds, M., Tice, M., et. al, Journal of Adolescent Health,
2009.)
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Health Risks: Psychosocial
Obese children and their parents rate the
quality of life as similar to pediatric cancer
patients.
Schimmer, Burwinkle, & Varni, 2003
Ethnic Disparity: At Risk for Overweight or
Overweight 2003-2004
≥ 85%
45.0%
40.0%
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
≥ 95%
25.0%
20.0%
Non-Hisp
15.0%
White
Non-Hisp
10.0%
Black
Mexican5.0%
American
2-5
yrs
6-11 12-19
yrs
yrs
0.0%
2-5 yrs
6-11 yrs 12-19 yrs
Ogden, C et al. (2006). JAMA, 295(13), 1549-1555.
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Health Risks of Obesity
• Pulmonary
– Sleep disorders
– Asthma
– Obesity-linked
hypoventilations
• Neurologic
– Pseudotumor cerebri
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Health Risks of Obesity
• Orthopedic
– Slipped capital
epiphysis
– Tibia vara (Blount’s
disease)
– Tibial torsion
– Flat feet
– Ankle sprain
– Fractures
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Health Risks of Obesity
• Cardiovascular
– Hypertension
– Dyslidemia
– Fatty deposits
– Left ventricular
hypertrophy
• Other
– Systemic
inflammation
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Health Risks of Obesity
• Gastrointestinal
– Cholelithiasis
– Non-alcoholic fatty liver
disease
– Gastro-esophageal
reflux
• Endocrine
– Insulin resistance/Type
II Diabetes
• Acanthosis nigricans
– Menstrual abnormalities
– Polycystic ovary
syndrome
– Hypercoricism
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Significance of Problem
• 80% of obese
adolescents will
become obese
adults
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Significance: What about their future?
Leading Causes of Death in the US
Cause of Death
rate/100,000
Heart disease
Cancer
Cerebrovascular disease
Minino, Arias, Kochanek, Murphy, &
Smith 2002
Death
258.2
200.9
60.9
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Economic Consequences
• Obesity increased 30% in last 20 years
• Medical expenses for obesity = 9.1% of
US medical expenditure
• Direct and indirect costs in US
– $78.5 billion in 1998
– $92.6 billion in 2002
Finkelstein, Fiebelkorn, &
Wang(2003). Health Affairs
(Millwood).
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Etiology: Family
Cohort of 854 mostly white subjects followed up
to age 21-29 years
Odds Ratio
Maternal obesity
3.6 (2.1-5.9)
Paternal obesity
2.9 (1.7-4.9)
Two obese parents
13.6 ( 3.7-50.4)
Whitaker, et al.(1997). NEJM,
337(13).
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Etiology: Decreased Activity
• 29% of US children
have daily PE
• 50% of 12-21 year
olds have no regular
physical activity
Foster, et al., 2003; Ogden, et al.,
2002
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Etiology: Portion Size Comparisons
Beer
Hamburger
Bagel
Steak
Muffin
Cooked Pasta
Ch.Chip Cookie
0
100 200 300 400 500 600 700
Actual vs. USDA Portion Sizes (%)
Young and Nestle (2002) Am J
Public Health. 2(2):246-249.
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Etiology Portion Sizes:
Paris vs. Philadelphia
Restaurant
McDonald’s
Hard Rock Café
Pizza Hut
Haagen Dazs
Local Chinese
French Bistro
Mean Size Ratio
(US/France)
1.28
0.92
1.32
1.42
1.72
1.17
On average, American portions were 25% larger!
Rozin et al., (2003).Physiological
Science. 14(5):450-4.
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Etiology: Inactivity
TV Viewing Predicts Childhood Overweight
Odd Overweight
5
4
3
2
1
0
0-2
>2-3
>3-4
>4-5
>5
TV Viewing (Hrs/day)
Gortmaker et al. (1996) Arch
Pediatr Adolesc Med. 150(4):356-
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What’s happening in
primary care?
Time for Anticipatory Guidance
during WCC
Average visit length
Average time in advisement
 Nutrition
 Growth
 Exercise
17.8 minutes
2.4 minutes
31.7 seconds
6.4 seconds
1.6 seconds
Goldstein, Dworkin, & Bernstein, 1999
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