Transcript What’s Happening to Our Kids? K. A. Earles, MD., MPH

 What’s
Happening to
Our Kids?
K. A. Earles, MD., MPH

“My doctor told me
to stop having
intimate dinners
for 4 unless there
were 3 other
people.”
• Orson Wells
What is Obesity?
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Overweight=
–
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Obesity=
–
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85-95% of BMI
Greater than 95% of BMI
 What is BMI?
– Body Mass Index
• Weight in kg/height in meters 2
• Your roundness
Severely obese
– >99%
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Harvard Medical Study
– Healthy BMI & large waist & CAD
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International Journal of Obesity
– waist to height ratio
The Obesity Epidemic
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10% kids ages 2-5
15% kids 6-9
15.5 % overall of children and
adolescents
2007 YRBS 13% HS
overweight and 16% obese
32% of children and teens
obese or overweight
Most common chronic
disease of children
The Saga Continues
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Greater in minority community
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Increased by 21% in AA & Hispanic kids
12% in Caucasian kids
Greater in economically disadvantaged
kids
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PedNSS results
– low income 2-5 years
• 15% obese vs 12%
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Greater in southern states
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7 states w/ highest poverty = top 10 obese
sates
9/10 states in south
All states >20% EXCEPT
Greatest in states w/ highest % inactivity
U.S. Department of Health and Human Services 2010 Goal is…
The Saga Continues
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20% greater chance of
obese toddler becoming
obese adult
80% greater chance of
obese adolescent
becoming obese adult
– obese 10-15 year old=obese
25 year old
– if obese at 8, worse
adulthood obesity
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Conclusion:
– Older you get, harder
it becomes
Good News
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Pediatric Obesity has
peaked!
– CDC report
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no increase from 200304 and 2005-06
Were You Listening?

All of the following are true
except
– a.
Obesity is greater
in African American children
– b.
obesity is greater
in economically
disenfranchised communities
– c. Obesity is greater in the
Hispanic population then in
the Caucasian population
– d.
The chance of
being an obese child is less if
your parents are obese
Why?
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Genetics
Parental behavior
Nutrition
Sedentary lifestyle
Environment
Media
Economy
Genetics
– Overweight parents
have overweight kids
Parental Habits
Nutrition
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Breast feeding advantages
–
breast milk protective
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Dewey study 8/11 studies
Bergman tripled obesity by 6 yrs
Higher fat, salt, sugar in foods
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51% have< 1 fruit /day
29% < 1 veg/day
16% less milk
16% more sodas
Fast food society
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50% funds for food
Columbia U study
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lower insulin
less adipose
lower protein intake
500 feet fast food = 5% inc. obesity
Portion distortion & value sizing
Sedentary Lifestyle
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Less PE
– 54% HS had PE 1x week
– 30% daily
– Emphasis on test scores
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25% HS played video games,
computer use, etc >3 hours on
school day
35% HS watched > 3 hours TV
on school days
Environment
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New community design
– fosters driving
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No sidewalks
Limited parks and recreation
space
Lack of affordable indoor
physical activity
Security concerns
2003 study
– direct relationship w/ grocery
store & USDA guidelines
– additional grocery stores =
32% increase in fruits and
vegetables
Media
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More TV=higher BMI
Average kid watches 2-3 hours TV/day
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AA kids watch more
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– AA designed TV with even more
overweight and obesity
 Main characters are overweight
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More commercials with high fat,
salt foods
– Journal of Law and Economics article
 fast food ban advertising = 18%<
overweight 3-11 & 14% < 12-18
Economy
Lack of Health
insurance for obesity
prevention
 Value sizing is cheaper
 Poorer access in lower
income areas
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Were You Listening?
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Obesity is defined as
– a.
Larger than
Naomi Campbell
– b.
Just plain fat
– c.
BMI>95%
Were You Listening?
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All of the following
contribute to obesity
EXCEPT
– a. Poverty
– b. Sedentary lifestyle
– c. Poor nutrition
– d. Triathelon training
Effects of Obesity on kids
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Heart disease
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Hypertension (60% obese)
High cholesterol
Greater adult heart attacks, heart failure, angina
Institute of Medicine Study
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60% 5-10 w/ 1 CVD risk
25% w/ 2
AAP guidelines
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cholesterol screening at 2
• cholesterol, DM, HTN, obesity, Ht disease, unknown
Cancers in adulthood
Other effects arthritis
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sleep problems
asthma
menstrual irregularities
eating disorders
scfe
hepatic steatosis (25-80%)
Pseudotmor Cerebri
Alzheimers
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Obesity Review
Diabetes Type II
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8-45% of new pediatric
diabetics
– 94% minority
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Complications
– Blindness
– Foot ulcers-diabetic
neuropathy, amputations
– Diabetic nephropathy
– Cardiovascular disease
Diabetes Today: An Epidemic
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In 2005, 20.8 million Americans
(7% of the population) were diagnosed with
diabetes1
– 1.5 million new cases in adults aged 20
years1
– ~4100 new diagnoses each day2
cases of blindness each year
57 million prediabetics
Two million adolescents with prediabetes
Total cost in the United States in 2002: $132
billion1
The majority of patients with diabetes are
treated by primary care physicians
Were You Listening?
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Probable causes of
obesity include
– a.
Lack of
physical activity
– b.
Excessive
intake of foods high in
fat
– c.
Purposeful
inactivity to result in
ridicule and rejection
– d.
a and b
Emotional Effect
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More behavior problems
– School performance
– Early sexual initiation
60> anxiety & depression
 Social stigma and isolation
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– More with more weight
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40%> being bullied
Teens 32% > suicide
Overweight kids have poor
self-esteem
– Less in AA kids
– More in Hispanic & Caucasian
females & males
What To Do?
Pediatric Obesity Screen
Barlow, S. E. et al. Pediatrics 1998;102:e29
Copyright ©1998 American Academy of Pediatrics
What To Do?
Weight Loss or Not
Were You Listening?
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Obesity has been
linked to
– a.
Hyperlipidemia
– b.
Type 2
diabetes
– c.
BMI>95%Prostate
cancer
– d.
All of the
above
What To Do?
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Intervention should begin early
The family must be ready for change
Educate families about complications of obesity
Involve all caregivers
Family should learn to monitor eating and activity
– Parents or caregivers should determine what
food is offered and when, and the child should
decide whether to eat
– Model good eating habits and physical activity
Help family make small, gradual changes
Encourage not criticize
Use a variety of experienced professionals
What To Do?
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Encourage healthy
eating habits
– Fruits vegetables with
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–
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each meal
Limit fast foods
Avoid promoting
feeling full
Watch portions
Avoid rewards of
candy
Were You Listening?
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Effective parenting skills
include
– a.
Spanking a child
atleast 5 minutes for every
pound above 85%BMI
– b.
Placing on water
only diet
– c.Promoting the master
cleanse diet to children
– d.
Modeling
healthy activity and eating
habits
What To Do?
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Physical activity
– 30-60 minutes activity
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toddler/day
60 minutes structured
No expense needed!
Organized sports for
older kids
Promote outdoor
activity if possible
What To Do?
Less sedentary behavior
 TURN OFF THE TV!
 Remove TV in kids room
 When TV is a must…
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– Avoid fat, salty, sugar
snacks
– Limit TV
– No TV<2years
Summary
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Overweight shortens life, probably on
the principle that God summons you
after you’ve eaten your share.
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Encourage parents to be a role model
Encourage exercise
Turn off TV
Encourage eating responsibly
EDUCATE, EDUCATE, EDUCATE
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“I’ve spent 2 years being politically correct
about parents , but it’s time to say if you’re
giving your kids fizzy drinks then you’re a
total @#$% hole and a loser”.

Jaime Oliver
References upon request