Wellness Obesity 30

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Pediatric ObesityPediatric ObesityJohn Moissidis, MDJohn Moissidis, MD

Pediatrics &Pediatrics &Allergy/ImmunologyAllergy/Immunology

Athens, GreeceAthens, Greece


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Pediatric ObesityPediatric Obesity

A Growing ProblemA Growing Problem

Since 1970, childhood obesitySince 1970, childhood obesity

has almost quadrupledhas almost quadrupledamong children aged 6-11among children aged 6-11and more than doubledand more than doubled

among adolescents aged 12-among adolescents aged 12-19.19.

As of 2003-04, 17.1% ofAs of 2003-04, 17.1% of

children aged 2-19 arechildren aged 2-19 are

clinically overweightclinically overweight This is more than three timesThis is more than three times

greater than thegreater than the Healthy PeopleHealthy People20102010goal of 5%.goal of 5%.
http://www.shirleys-wellness-cafe.com/kids_nutrition.htmhttp://www.shirleys-wellness-cafe.com/kids_nutrition.htmhttp://www.shirleys-wellness-cafe.com/kids_nutrition.htmhttp://www.shirleys-wellness-cafe.com/kids_nutrition.htmhttp://www.shirleys-wellness-cafe.com/kids_nutrition.htm


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Today Obese Children,Today Obese Children,

TomorrowTomorrow Obese youth are likelyObese youth are likely

to become obeseto become obese

adultsadults

In a study followingIn a study followingchildren for an average ofchildren for an average of17 years, 77% of those17 years, 77% of those

who were overweight aswho were overweight aschildren remained obesechildren remained obese

as adults, compared withas adults, compared with7% who were normal7% who were normalweight as children becameweight as children became

obese in adulthood.obese in adulthood.


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Percent of obese children andPercent of obese children and

adolescentsadolescents

0

2

4

6

8

10

12

14

16

1963-70

1971-74

1976-80

1988-94

1999-02

6-11 years

12-19 years


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Child Overweight and InterventionChild Overweight and Intervention

OverweightOverweight is defined asis defined as >> 9595thth percentilepercentilebased on CDC BMI chartbased on CDC BMI chart

At risk of OverweightAt risk of Overweight is defined asis defined as >> 8585ththbut < 95but < 95thth percentile based on BMI chartspercentile based on BMI charts

The prevalence of overweight among childrenThe prevalence of overweight among children

varies by gender and race/ethnicityvaries by gender and race/ethnicity Primary aim of overweight intervention isPrimary aim of overweight intervention is energyenergy

balancebalance (energy intake versus energy(energy intake versus energyexpenditure)expenditure) and normal growthand normal growth


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What is BMI?What is BMI?

Body mass index (BMI)=Body mass index (BMI)=WEIGHT (kg)/heightWEIGHT (kg)/height (m)2


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Correlation of BMI WithCorrelation of BMI With

Total Body FatTotal Body Fat

0

1 0

2 0

3 0

4 0

5 06 0

7 0

8 0

9 0

1 0 0

0 1 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 0 1 0 01 1 01 2 01 3 01 4 01 5 01 6 0

Bo

dyM

as s

In

dex

Adipose Tissue (kg)

Zumoff, B et al.J Clin Endocrinol Metab. 1990; 70:929-931.


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Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1995 and 2000

(*BMI 30, or ~ 30 lbs overweight for 54 woman)

1991 1995

2000

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,

No Data


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Consequences ofConsequences of

Pediatric ObesityPediatric Obesity

Pediatric obesity impacts:Pediatric obesity impacts: Physical healthPhysical health Mental healthMental health

Obese children were found toObese children were found tohave a poor quality of life,have a poor quality of life,comparable to that of pediatriccomparable to that of pediatricchemotherapy patientschemotherapy patients

Medical care costsMedical care costs

MortalityMortality

www.obesityhelp.com


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Health Risks of Excess Body FatHealth Risks of Excess Body Fat

Obese people have overallObese people have overall

mortality rate almost twice that ofmortality rate almost twice that ofnon-obese peoplenon-obese people


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PSYCHOSOCIALPSYCHOSOCIAL

Most common complication of childhood obesityMost common complication of childhood obesity Increased rates of depressionIncreased rates of depression Poor self esteemPoor self esteem

May carry over into adulthoodMay carry over into adulthood

Children are sensitized to obesity at young ageChildren are sensitized to obesity at young age Mellbin, 1989Mellbin, 1989

Increased rates of behavior and learning problems in those gainingIncreased rates of behavior and learning problems in those gaining

weight rapidlyweight rapidly

Etiology uncertain, ? Sleep apneaEtiology uncertain, ? Sleep apnea


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SOCIETAL DISCRIMINATIONSOCIETAL DISCRIMINATIONCanning, 1966Canning, 1966

Acceptance rates at college lowerAcceptance rates at college lowerfor obese than non-obese femalesfor obese than non-obese females

with the same credentialswith the same credentials

National Longitudinal Survey of YouthNational Longitudinal Survey of Youth19931993Obese adolescent females asObese adolescent females as

young adults had less education,young adults had less education,less income, higher poverty rate,less income, higher poverty rate,

and decreased rates of marriageand decreased rates of marriage


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Costs of ObesityCosts of Obesity

Severe overweight childrenSevere overweight children miss 4x as muchmiss 4x as muchschool as normal weight kids.school as normal weight kids. Obesity associatedObesity associated annual hospital costs forannual hospital costs for

children increased more than threefoldchildren increased more than threefold

from $35 million during 1979-1981 to $127 millionfrom $35 million during 1979-1981 to $127 millionduring 1997-1999.during 1997-1999.

National health expenditures related toNational health expenditures related to adultadultobesity range from $98-129 billion annually.obesity range from $98-129 billion annually.

No one can predict what the cost will be in theNo one can predict what the cost will be in thefuture with the increased number of medicalfuture with the increased number of medicalco-morbiditiesco-morbidities that we are seeing in our currentthat we are seeing in our currentpediatric population.pediatric population.


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Whos Problem Is It?Whos Problem Is It?

Prevention and Treatment of Pediatric ObesityPrevention and Treatment of Pediatric Obesity

HEALTHCARE

COMMUNITY

GOVERNMENT

FAMILYSCHOOL

ENVIRONMENT


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At least 30 minutes of moderate physical activity on mostAt least 30 minutes of moderate physical activity on most

days of the week is the recommended minimum.days of the week is the recommended minimum.

However, nearlyHowever, nearly 23 percent of children and23 percent of children andnearly 40 percent of adults get no free-timenearly 40 percent of adults get no free-time

physical activity at all.physical activity at all.(Physical activity levels among children aged 9-13 years United States, 2002. MMWR 2003;52[33]:785-8)and (National Center for Health Statistics. National Health Interview Survey, 1999-2001)

From the statistical sourcebook A Nation at Risk: Obesity in the United States. To order, call 1-800-AHA-USA1 or email [email protected]


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Obesity-associated annual hospital costs for childrenObesity-associated annual hospital costs for children

more than tripled between 1979 and 1999.more than tripled between 1979 and 1999.(Wang G, Dietz WH. Economic burden of obesity in youths aged 5 to 17 years: 1979-1999. Pediatrics2002;109(5):E81-E86)



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People who are obese or overweight also havePeople who are obese or overweight also have

a lower life expectancy:a lower life expectancy:

A 40-year-old nonsmoking male who is overweight will lose 3.1 years ofA 40-year-old nonsmoking male who is overweight will lose 3.1 years oflife expectancy; one who is obese will lose 5.8 years.life expectancy; one who is obese will lose 5.8 years.

A 40-year-old overweight nonsmoking female will lose 3.3 years of lifeA 40-year-old overweight nonsmoking female will lose 3.3 years of lifeexpectancy; one who is obese will lose 7.1 years.expectancy; one who is obese will lose 7.1 years.(Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. Overweight and obesity bymiddle age are associated with a shortened lifespan. Ann Intern Med 2003; 138:24-32)



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Between 1970 and 1980, the number of fast-food outlets in theBetween 1970 and 1980, the number of fast-food outlets in the

United StatesUnited States increased from aboutincreased from about 30,000 to30,000 to

140,000140,000,, and sales increased by about 300 percent.and sales increased by about 300 percent.

In 2001, there were about 222,000 fast-food outlets.In 2001, there were about 222,000 fast-food outlets.

(Paeratakul S, Ferdinand D, Champagne C, Ryan D, BrayG. Fast-food consumption among US adults andchildren. J Am Diet Assoc 2003:103:1332-8)



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Children eat nearly twice as manyChildren eat nearly twice as many

calories (770) at restaurants as theycalories (770) at restaurants as theydo during a meal at home (420).do during a meal at home (420).

(Zoumas-Morse C, Rock CL, Sobo EJ, Neuhouser ML. Childrens patterns of macronutrient intake andassociations with restaurant and home eating. J Am Diet Assoc 2001;101-923-5)



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Statistics from the Centers for Disease Control andStatistics from the Centers for Disease Control and

Prevention (CDC) are alarming.Prevention (CDC) are alarming. Today, about 16Today, about 16percent of all children and teens in the Unitedpercent of all children and teens in the United

States are overweight.States are overweight.



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Studies have shown that, between 1977 and 1996,Studies have shown that, between 1977 and 1996, portion sizes forportion sizes for

key food groups grew markedly in the United States,key food groups grew markedly in the United States, notnotonly at fast-food outlets but also in homes and at conventionalonly at fast-food outlets but also in homes and at conventional

restaurants.restaurants.

One study of portion sizes for typicalOne study of portion sizes for typicalitems showed that:items showed that:

Salty snacks increased fromSalty snacks increased from

132 calories to 225 calories.132 calories to 225 calories.

Soft drinks increased from 144Soft drinks increased from 144

calories to 193 calories.calories to 193 calories.

French fries increased from 188French fries increased from 188

calories to 256 calories.calories to 256 calories.

Hamburgers increased from 389Hamburgers increased from 389calories to 486 caloriescalories to 486 calories..

n SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA 2003;289:450-3)



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2424Calorie difference: 525 calories

1,025 calories2 cups of pasta with

sauce and 3 largemeatballs

20 Years Ago Today

500 calories

1 cup spaghetti withsauce and 3 small

meatballs

SPAGHETTI AND MEATBALLS


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610 calories6.9 ounces

Calorie difference: 400 calories

FRENCH FRIES

20 Years Ago Today

210 calories

2.4 ounces


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250 calories20 ounces

85 calories6.5 ounces

SODA20 Years Ago Today


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PEPPERONI PIZZA

20 Years Ago Today

500 calories 850 calories



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20 Years Ago Today

270 calories5 cups

POPCORNPOPCORN

630 calories11 cups



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CHOCOLATE CHIP COOKIECHOCOLATE CHIP COOKIE

20 Years Ago Today

55 calories1.5 inchdiameter

275 calories3.5 inch diameter



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COMPLICATIONS ARE COMMONCOMPLICATIONS ARE COMMON

IN PEDIATRIC OBESITYIN PEDIATRIC OBESITY All children with BMI>All children with BMI>

95% should be95% should beevaluated forevaluated forassociated co-associated co-

morbiditiesmorbidities Physical examinationPhysical examination

BPBP

Fundiscopic examFundiscopic exam

Hip and kneeHip and kneeexaminationexamination

Acanthosis nigricansAcanthosis nigricans

Hirsutism / acneHirsutism / acne

HepatomegalyHepatomegaly

Laboratory evaluationLaboratory evaluation Fasting lipid profileFasting lipid profile Liver panelLiver panel

Fasting insulin andFasting insulin andglucoseglucose

Hgb A1CHgb A1C

To be consideredTo be considered PolysomnogramPolysomnogram Abdominal USAbdominal US


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PrincipalPrincipalTargetsTargets

Reduce energy intakeReduce energy intakeDecrease high and increase low EDecrease high and increase low EDD foodsfoods

Increase fruit and vegetable intakeIncrease fruit and vegetable intake

Reduce sugar-sweetened beveragesReduce sugar-sweetened beveragesDecrease television timeDecrease television time

BreastfeedingBreastfeeding

Increase energy expenditureIncrease energy expenditureIncrease daily physical activityIncrease daily physical activity


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Dieting and Eating HabitsDieting and Eating Habits

Follow these GENERAL suggestionsFollow these GENERAL suggestions

inin daily calorie intake:daily calorie intake:

1600 calories:1600 calories: many sedentary women &many sedentary women &some older adultssome older adults

2200 calories:2200 calories: most children, teen girls, activemost children, teen girls, activewomen, sedentary menwomen, sedentary men

2800 calories:2800 calories: teen boys, many active men,teen boys, many active men,some very active womensome very active women


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MyPyramid offersMyPyramid offers personalized eating plans,personalized eating plans,

interactive tools to help you plan andinteractive tools to help you plan and

assess your food choices,assess your food choices,and advice to help you:and advice to help you:Make smart choices from every food group.Make smart choices from every food group.

Find your balance between food and physical activity.Find your balance between food and physical activity.

Get the most nutrition out of your calories.Get the most nutrition out of your calories.

Stay within your daily calorie needs.Stay within your daily calorie needs.


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Key food group messages from the


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Focus on fruits.Focus on fruits.

Vary your veggies.Vary your veggies.

Get your calcium-rich foods.Get your calcium-rich foods.

Make half your grains whole.Make half your grains whole.

Go lean with protein.Go lean with protein.

Know the limits on fats, salt, andKnow the limits on fats, salt, andsu ars.su ars.

Key food group messages from theDietary Guidelines and MyPyramid:


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Print materials:Print materials: Mini PosterMini Poster

CUP = 1 CUP of TEA sizeCUP = 1 CUP of TEA size


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Message:Message: ProportionalityProportionalityIn the Dietary Guidelines:In the Dietary Guidelines:

Adopt a balanced eating pattern.Adopt a balanced eating pattern. Sufficient amount of fruits and vegetables,Sufficient amount of fruits and vegetables, 3 or more ounce equivalents of whole-3 or more ounce equivalents of whole-

grain products/daygrain products/day

3 cup equivalents per day of fat-free or3 cup equivalents per day of fat-free orlow-fat milk or milk products.low-fat milk or milk products.

In MyPyramid graphic:In MyPyramid graphic: Differing widths of the color bandsDiffering widths of the color bands

suggest about how much foodsuggest about how much foodshould be eaten from each group.should be eaten from each group.


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Message:Message: ModerationModeration

In the Dietary Guidelines:In the Dietary Guidelines: Limit intake of saturated andLimit intake of saturated and transtrans fats,fats, and chooseand choose

products low in these fats.products low in these fats. Make choices of meat, poultry, dry beans, and milk productsMake choices of meat, poultry, dry beans, and milk products

that arethat are lean, low-fat, or fat-free.lean, low-fat, or fat-free. Choose and prepare foods and beverages withChoose and prepare foods and beverages with little addedlittle added

sugars or calorie sweeteners.sugars or calorie sweeteners.

In MyPyramid graphic:In MyPyramid graphic: Food group bands narrow fromFood group bands narrow from

bottom to top suggesting to eatbottom to top suggesting to eat

nutrient-dense forms of foods.nutrient-dense forms of foods.

ys ca c v yys ca c v y


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ys ca c v yys ca c v yGuidelines for ChildrenGuidelines for Children

and Adolescentsand Adolescents1 hour physical activity daily, preferable1 hour physical activity daily, preferable

activities appropriate for age, enjoyable,activities appropriate for age, enjoyable,and offer varietyand offer variety

Moderate- or vigorous-intensityModerate- or vigorous-intensity

Vigorous-intensity, muscle-strengthening,Vigorous-intensity, muscle-strengthening,and bone-strengthening physical activityand bone-strengthening physical activity

3d/w3d/w


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Physical ActivityPhysical Activity

BurnsBurns calories and keepscalories and keepsmetabolism geared towardsmetabolism geared towards usingusing

food for energy instead of storing itfood for energy instead of storing it

for fatfor fatBegin slow and gradually increaseBegin slow and gradually increase

toto 30 minutes30 minutes per dayper day

Can include gardening, aerobics,Can include gardening, aerobics,walking, swimming, housework,walking, swimming, housework,

bowling, etc.bowling, etc.


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Cutting Back On CaloriesCutting Back On Calories

But Feeling FullBut Feeling FullEat several servings ofEat several servings offruitfruit per dayper day

beginning with breakfast and forbeginning with breakfast and for

dessertdessert

AddAdd vegetablesvegetables to as many things asto as many things as

possible (pizza, pasta, sandwiches)possible (pizza, pasta, sandwiches)

Snack onSnack on fruitsfruits rather than snack foodsrather than snack foodsLimitLimit servings of chocolate, fatty meats,servings of chocolate, fatty meats,

butter, snacks that arebutter, snacks that are friedfried


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Nutrition, Exercise, & WeightNutrition, Exercise, & Weight

management for Kidsmanagement for KidsMultidisciplinary ClinicMedical, Psychologist, Dietitian, Physical Therapist

Physician referredNeed secondary co-morbidity to be seen

Hospital based clinicIndividualized treatment

Family based

12 week educational curriculumPhysician referred

Overweight but no co-morbidityOffered at 4 YMCA locations

3-2-1-0 Blast Off to a Healthier Family!PMD Toolkit for use in office

Teaching for residents

Web Based Programs Parents and caregivers

Teens and school age children


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THE ENDTHE END

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Wellness Obesity 30