SUZETTE M. DECASTRO, MS, RD, LD

NUTRITION COORDINATORWEST PALM BEACH HEAD START

What is considered obese?Obesity is defined an excessive accumulation

of body fatObesity is present when total body weight is

more than 25% fat in boys and more than 32% fat in girls.

Childhood Obesity is defined as a weight for height in excess of 120% of the ideal.

Growth Charts BMI( Body Mass Index)Greater than 95% for infants and children on

growth charts

CHILDHOOD OBESITYIS A SERIOUS MEDICAL CONDITION THAT

AFFECTS INFANTS, CHILDREN, AND ADOLESCENTS

OBESITY ON THE INCREASE IN THE USA. 5%-25% of children and teenagers in USVARIES WITH ETHNIC GROUP 5%-7% of

Black and white children12% of Hispanic boys19% of Hispanic girls (Office of Maternal and

Child Health, (1989)

CAUSES OF OBESITY1. FAMILY- genetic predisposition. The risk of

becoming obese is greatest among children who have two obese parents.

2. Low- energy EXPENDITURE. Obesity is greater among children and adolescents who frequently watch TV. Only 1/3 of elementary children have daily physical education, and fewer than 1/5 have extracurricular physical activity programs at schools.

3. Heredity- Infants born to overweight mothers have been found to be less active and to gain more weight.

Risk Factors

Diet- regular consumption of high calorie foods, such as fast foods, vending machine snacks and baked goods.

Inactivity.- Sedentary kids are more likely to gain weight because they don’t burn calorie through physical activity.

Genetics- If your child comes from a family of overweight people, the child may be genetically predisposed to put on excess weight, where high- calorie food is always available.

Risk Factors continuedPsychological factors. – Some children overeat

to cope with problems or deal with emotions, such as stress or boredom.

Family factors- Parents are responsible for putting healthy foods in the kitchen at home and leaving unhealthy foods in the store. Parents need to control access to unhealthy foods.

Socio- economic factors- Children from low income backgrounds are at greater risk of becoming obese. Poverty and obesity go hand in hand .

When to seek medical adviceNot all children carrying extra pounds are

overweight or obese. Some children have larger than average body frames.

If as a parent you are worried then talk to your doctor or health care provider. He or she can provide a complete weight assessment, your family’s weight for height history, and where your child lands on the growth charts

Determine if your child’s weight is in an unhealthy range.

Tests and DiagnosisDoctor calculates your child’s body mass index (BMI) And determines where it falls on the national BMI- for

age growth chart. The BMI indicates if your child is overweight for his or her age and height.

Cutoff points on these growth charts, established by CDC - BMI for age between 85th and 94th percentiles

Overweight. BMI for age 95th percentile or above- obesity

Diagnosis continuedDoctor evaluates your family’s history of

obesity and weight related health problems.

Your child’s eating habits and calorie intake.

Your child’s activity level

Other health conditions your child may have.

Medical ComplicationsType 2 DiabetesMetabolic syndromeHigh blood pressureAsthma and respiratory problemsSleep disordersLiver diseaseEarly puberty or menarcheEating disordersSkin infections

Social and Emotional FalloutLow self-esteem and bullying. Increased risk

of depressionBehavior and learning problems. Overweight

children tend to have more anxiety and poorer social skills than normal- weight children. Stress and anxiety can interfere with learning.

Depression.- Social isolation and low self-esteem create overwhelming feelings of hopelessness in some overweight children.

Treatment and DrugsBased on your child’s age and if he or she has other

medical conditionsChanges in child’s diet and level of physical activity. Treatment may include medications or weight loss

surgery.Children under age 7 who have no other health

concerns, the goal of treatment may be weight maintence rather than weight loss

Weight loss is typically recommended for children over age 7 or younger who have related health concerns.

Weight LossShould be slow and steady, anywhere from 1

pound a week to 1 pound a month, depending on your child’s situation.

Methods -1. Child needs to eat healthy diet and increase his or her physical activity. Parents need to be committed to helping your child make healthy diet changes.

Healthy eating. Parents are the ones who buy food, cook, the food and decide where the food is eaten.

Healthy EatingWhen buying groceries choose fruits and

vegetables over convenience foods high in sugar and fat. Always have healthy snacks available. Never use food as a reward or punishment

Limit sweetened beverages, including fruit juices. These drinks provide little nutritional value and make your child feel full to eat healthier foods.

Sit down together for family meals. Discourage eating in front of screen. This leads to fast eating and lowered awareness of how much you're eating.

Healthy Eating continuedLimit the number of times you eat out,

especially at fast- food restaurants. Many of the menu options are high in fat and calories.

Fasting or extreme caloric restriction is not advisable for children. Balanced diets with moderate caloric restriction, especially reduced dietary fat, used successfully in treating obesity.

Nutrition educationDiet management with exerciseBehavior modification, such as self- monitoring

Behavior ModificationsRecord food intake and physical activity

Slowing the rate of eating.

Limiting the time and place of eating

Using rewards and incentives for desirable behaviors.

Problem- solving training involved identifying possible weight control problems.

Physical activityLimit recreational screen time to fewer than two

hours a day. Other sedentary activities also should be limited.

Emphasize activity, not exercise. Doesn’t have to be structured exercise program. Free-play activities are encouraged.

Find activities your child likes to do, such as swimming, biking, dancing, cheerleading, and sports.

If you want an active child, be active yourself. Vary the activities, and get involved with your children.

MedicationsDrugs that can be used for adolescents Merida(sibutramine) Approved for adolescents

older than 16, makes the body feel fuller more quickly

Xenical (Orlistat) approved for adolescents older than 12 prevents the absorption of fat in the intestines.

Alli- nonprescription approved by FDA similar to Orlistat but lower in strength. Not approved for children or teenagers under age 18.

Weight loss surgerySafe and effective option for severely obese

adolescents who have been unable to lose weight using conventional methods.

Potential risks and long-term complications. Long-term effects of weight loss surgery on a child’s future growth and development are unknown.

Uncommon in adolescents, but may be considered if child’s weight poses greater health threat than do the risks of surgery.

No guarantee that your child loses all excess weight.

Coping and Support for ObesityParents play a crucial role in helping children

who are obese.Build your child’s self –esteem. Talk to your kids

directly, openly, and without being critical or judgmental.

Praise child’s efforts. Celebrate small incremental changes, but don’t reward with food.

Talk to child about his or her feelings Help child find ways to deal with emotions that don’t involve eating.

Help your child focus on positive goals

PreventionSchedule yearly well-child visits

SET A GOOD EXAMPLE- Eat healthy foods and exercise regularly to maintain your weight.

Avoid food related power struggles with your child.

Emphasize the positive, such as healthy lifestyle, the benefits of exercise

BE PATIENT

Prevention cont.Obesity is easier to prevent than treat. Prevention focuses in large on parent educationInfancy- Parent education should center on

promotion of breastfeeding, recognition of signals of satiety, and delayed introduction of solid foods.

Early childhood, education should include proper nutrition, selection of low-fat snacks, good exercise/activity habits, and monitoring of TV viewing

Where hereditary factors are involved, parent education should be on building self-esteem.