Transcript CDC Growth Charts 2000

Child Obesity
What is the family physician’s role?
Sheryl Rosenberg Thouin, MPH, RD, CDE
Health Consequences of Childhood Obesity
• Hypertension
• Hypercholesterolemia
• Increased risk of impaired glucose tolerance,
insulin resistance and type 2 diabetes.
• Sleep apnea
• Asthma
• Joint problems and musculoskeletal discomfort
• Fatty liver disease, gallstones, and GERD
• Obese children and adolescents have a greater risk
of social and psychological problems, such as
discrimination and poor self-esteem, which can
continue into adulthood
• Becoming obese Adults
2007 Rates of Overweight and Obese Children
http://childhealthdata.org/learn/NSCH
BMI
• = weight (kg)/height (m)2
= weight (lb)/[height (in)]2 x 703
• BMI is an effective screening tool
• For children, BMI is age and gender specific
Indicators of Pediatric Overweight
Plotting BMI-for-age
Obese
Overweight
>95th percentile
85th to 95th percentile
For Children, BMI Changes with Age
BMI
BMI
Example: 95th
Percentile Tracking
Boys: 2 to 20 years
BMI
BMI
Age
BMI
2 yrs
4 yrs
9 yrs
13 yrs
19.3
17.8
21.0
25.1
Example: “Sam”
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Name: Sam
Weight: 35 lbs 4 oz
Height: 35 inches
Age: 4 years old
BMI: 20
Is this child normal weight?
Sam’s BMI Plotted on Boy’s BMI-for-Age Chart
BMI
BMI
Boys: 2 to 20 years
Interpretation:
• Sam’s BMI-for-age is
significantly above the
95th %tile
BMI
BMI
If Sam were 11.5 years old...
BMI
BMI
Boys: 2 to 20 years
Interpretation:
• Sam’s BMI-for-age is
just below the 85th %tile
BMI
BMI
If Sam were 18 years old...
BMI
BMI
Boys: 2 to 20 years
Interpretation:
• Sam’s BMI-for-age is
just above the 10th %tile
BMI
BMI
Looking for the Cause
• Genetics
• Biological factors: hormonal and neurochemical mechanisms
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Growth hormone
Leptin
Ghrelin
Neuropeptide Y
melanocortin
• Psychological factors
• Socio-cultural factors
• Environmental factors
Looking for the Cause
• Genetics
• Biological factors: hormonal and neurochemical mechanisms
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Growth hormone
Leptin
Ghrelin
Neuropeptide Y
melanocortin
• Psychological factors
• Socio-cultural factors
• Environmental factors
Data Description
Comparisons are made among four groups
of 9- to 11-year-old children using federal
poverty level and CalFresh participation
(Table 1). Only statistically significant
differences are reported (p<.05).
Table 1: Categorization of Children
Data Sources
1
California Department of Public Health,
Network for a Healthy
California, 1999-2009 California
Children’s Healthy Eating and Exercise Practices Survey (CalCHEEPS). Background and Documentation: 2009 CalCHEEPS.
www.cdph.ca.gov/programs/cpns/Documents/REU-CalCHEEPSBackground_and_ Documentation2009.pdf. Accessed
April 7, 2011.
2 California Department of Education. DataQuest: 2009-2010 Free or Reduced Price Meals Data.
http://data1.cde.ca.gov/dataquest/. Accessed April 7, 2011.
This material was produced by the California Department of Public Health’s Network for a Healthy
California with funding from USDA SNAP, known in California as CalFresh (formerly Food Stamps). These
institutions are equal opportunity providers and employers. CalFresh provides assistance to low-income
households and can help buy nutritious foods for better health. For CalFresh information, call 1-877-8473663. For important nutrition information, visit www.cachampionsforchange.net.
fact
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Low-income children are more likely
to be overweight.
Nearly two out of five children in California are overweight or
obese. The rate is over 60 percent higher among children from
very low-income homes compared to those from average and
higher income households. Over half of these children are
overweight and of those, up to two-thirds are already obese.
fact
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Children do not get the recommended
amount of
physical activity.
Fewer than half (48%) of the 9- to 11-year-old children in
California meet the guideline to engage in at least 60 minutes
of moderate and vigorous physical activity daily. Only two out
of five (40%) children who reside in very low-income CalFresh
households meet this guideline.
fact
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Children eat too few fruits and
vegetables.
Fewer than one out of three (31%) California children meet
the fruit recommendation for good health and only one in ten
(9%) eat the recommended cups of vegetables.
fact
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Low-income children get more screen
time.
Children from lower income households spend up to 30
minutes more daily watching television and playing video or
computer games compared to children from average and
higher income homes. They are up to 50 percent more likely to
have a television in their bedroom. California children with
televisions in their bedrooms average 30 minutes more screen
time and are 20 percent less likely to meet the recommended
two or fewer hours a day of screen time, when compared to
children without a television in their bedroom.
fact
5
More parents can be role models for a
healthy lifestyle.
Almost two-thirds of children who reside in CalFresh
households agree that their parents eat high calorie, low
nutrient foods compared to about two-fifths of the children
from other groups. California children who agree with this
statement report more daily servings of high-fat snacks (0.9
vs. 0.7 servings) and high calorie, low nutrient foods (3.8 vs.
3.3 servings), compared to those who disagree. Parents and
other adults can support healthy eating by being role models.
fact
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Few low-income children participate
in organized sports to support an
active lifestyle.
Low-income children are up to 50 percent less likely to
participate in organized sports. California children who
participate in organized sports are 34 percent more likely to
meet the physical activity recommendation on a typical day.
Organized sports, offered outside of the school day, support
physically active lifestyles among low-income children.
fact
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Many students get high calorie, low
nutrient foods as rewards in the
classroom.
Just under half of California children report that their teachers
reward students by giving out high calorie, low nutrient
rewards like candy, cookies, chips, or soda.
fact
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Higher participation in the school
breakfast program may help increase
fruit and vegetable intake.
Children participating in school breakfast average 0.6 to 1.3
servings more fruits and vegetables in every survey year from
1999 through 2009.
fact
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Low-income children have less access
to nutrition lessons.
Children from average and higher income households are up
to 27 percent more likely to report access to nutrition lessons
at school compared to children from lower income homes.
fact
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School nutrition lessons empower
children to
make healthy food choices.
Participating in nutrition lessons at school is positively related
to fruit and vegetable consumption in most survey years.
The physician’s role:
AAFP Prevention of Pediatric Overweight and Obesity
• Calculate and plot BMI once a year in all children and
adolescents.
• Encourage parents and caregivers to promote healthy eating
patterns
• Encourage children’s autonomy in self-regulation of food
intake and setting appropriate limits on choices;
• Encourage modeling of healthy food choices.
• Routinely promote physical activity, including unstructured
play at home and in school;
• Recommend limitation of television and video time to a
maximum of 2 hours per day.
• Recognize and monitor changes in obesity-associated risk
factors for adult chronic disease, such as hypertension,
dyslipidemia, hyperinsulinemia, impaired glucose tolerance,
and symptoms of obstructive sleep apnea syndrome.
How Can I Possibly Do This?
The Division of Responsibility
adapted from Ellen Satter, MSW, RD
Parental Responsibilities
What is accessible
What food is available
When kitchen is open/closed
When food is available
TV/computer/cell phone time
Where food is consumed
What beverages are allowed
Physical activity/play time
Being a nutrition role model
All adults on ‘same page’
Child Responsibilities
How much is eaten
How their body turns out
Parental Feeding Responsibilities:
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Establish predictable eating schedules.
Determine when kitchen is open/closed.
Plan the same menu for all family members.
Involve the child in meal planning/preparation/label reading
Model positive eating behaviors.
– Enthusiastic about new foods
– Focused eating
– Slow-paced
Make exercise part of daily life.
Limit media viewing/video games.
Provide non-food rewards.
Parents ARE NOT responsible for:
– How much the child decides to eat
– Child’s eventual body size
Helpful Assessment Questions
• When did the excessive weight gain
– Any major events/changes in the child’s life at that
time?
• What is the child eating?
– Beverages?
• Where does eating take place?
– Does the child eat with the family?
– At a table?
• When does eating take place?
• Who is in charge of food decisions?
• Is the television on during meals? Snacks?
• Who is in charge of TV/computer/video game time?
• Are weekends different?
Recommended Resources
• www.dietconsultpro.com
• www.medi-diets.com
• www.ellynsatter.com