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Nutrition and Obesity David Freestone, DO PGY 1 UNSOM Dept. of Pediatrics.

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Presentation on theme: "Nutrition and Obesity David Freestone, DO PGY 1 UNSOM Dept. of Pediatrics."— Presentation transcript:

1 Nutrition and Obesity David Freestone, DO PGY 1 UNSOM Dept. of Pediatrics

2 ACGME Patient Care Medical Knowledge Practice Based Learning and Improvement Systems Based Practice Professionalism Interpersonal Skills and Communication

3 Objectives Brief overview of general nutrition Understand consequences of poor diet Understand what components of diet most contribute to obesity in pediatrics Know what AAP guidelines are regarding prevention and treatment of obesity Know local resources available to us in helping overweight/obese in Las Vegas

4 Nutrition Who here has taken a course on nutrition? A class? A lecture? Heard the word nutrition in medical school?

5 Nutrition Yet who feels that good nutrition correlates with good health? Who here feels that they have a healthy lifestyle with good nutrition?

6 Why I am interested in nutrition Undergraduate Ethnobotany Study of culture and botany A whole new world opened up to me describing how we use plants with focus on agriculture and medicine Shamans use of plants and herbs for healing is basis for a lot of medicinal compounds used today. Instead of a pill they would use mixtures of plants in belief that there would be a synergistic effect to the desired primary healing component. This really made me think about what I put in my body

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8 The Western Diet Processed Foods Refined grains Saturated fats and transfats Lots of meat High starch Low fiber High fructose corn syrup in everything

9 The Western Diet Google search: How Western Diets are Making the World Sick Western Diet Ups Heart, Diabetes Risk The western diet and lifestyle and diseases of civilization Western Diet Tied to Intestinal Disease and Allergies Western diet changes gut bacteria and triggers colitis in those at risk Western Diet Linked to Inflammatory Bowel Disease

10 Diet Related Conditions (Not an all encompassing list) Behavior Allergies Malnutrition/deficiencies Cancers CAD Obesity Metabolic syndrome

11 Government Recommendations (USDA) SuperTracker: My foods. Get your personalized nutrition and physical activity plan. My fitness. Track your foods and physical activities to see how they stack up. My health. Get tips and support to help you make healthier choices and plan ahead.

12 Government Recommendations The thing to keep in mind about the USDA [recommendations] is that it comes from the Department of Agriculture, the agency responsible for promoting American agriculture, not from agencies established to monitor and protect our health…. Whats good for some agricultural interests is not necessarily good for the people who eat their products. – Chair of the Department of Nutrition at Harvard School of Public Health

13 Nutrition & Research Where does nutrition fit? NIH distributes funds for research. Out of 27 institutes and centers… Nothing is dedicated to nutrition alone. Under Health information on Child and Teen the closest topic to nutrition is Alcohol abuse.

14 AAP Guidelines Nutrition and obesity-related Policy Statements: Breastfeeding and the Use of Human Milk Expert Committee Recommendations on Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity Dietary Recommendations for Children and Adolescents (By AHA endorsed by AAP) Prevention of Pediatric Overweight and Obesity Active Healthy Living Bright Bodies – Promoting Healthy Nutrition These are a few of many helpful documents

15 Obesity

16 Skin Acanthosis nigricans

17 Major dietary contributors of obesity and metabolic syndrome Toward a Unifying Hypothesis of Metabolic Syndrome. Pediatrics. Feb Branched Chain Amino Acids, Trans-fats, Ethanol Fructose Consumption trends parallel raise of obesity and metabolic syndrome Partially converted to glucose, mainly converted to Fructose-1- phosphate (insulin independent) Lipogenic precursors are created in liver leading to steatosis. All 4 macronutrients overwhelm mitochondrial function resulting in ROS generation, excessive Denovo Lipogenesis, and impaired β oxidation.

18 Major dietary contributors of obesity and metabolic syndrome Toward a Unifying Hypothesis of Metabolic Syndrome. Pediatrics. Feb Branched Chain Amino Acids, Trans-fats, Ethanol Fructose Consumption trends parallel raise of obesity and metabolic syndrome Partially converted to glucose, mainly converted to Fructose-1- phosphate (insulin independent) Lipogenic precursors are created in liver leading to steatosis. All 4 macronutrients overwhelm mitochondrial function resulting in ROS generation, excessive Denovo Lipogenesis, and impaired β oxidation.

19 Prevention of Metabolic Syndrome Decrease substrate consumption Particularly lipogenic substrate Reduction in hepatic substrate flux Increase fiber Glycemic load (glycemic index × CHO (gm) /100) lipogenesis and hepatic lipid export Increase substrate clearance Exercise

20 DRI Macronutrient Requirements Age/GroupCarbohydrates (g/d)Fiber (g/d)Fat (g/d)Protein (g/d) 0-6 mo60ND mo95ND y13019ND y13025ND19 Male 3-13 y13031ND y13038ND52 Female 9-13 y13026ND y13026ND46 ND = Not determinable due to lack of data of adverse effects in this age group and concern with regard to lack of ability to handle excess amounts. Source of intake should be from food only to prevent high levels of intake.

21 Expert Committee Recommendations: Eating, physical activity, and sedentary behaviors Limit consumption of sugar-sweetened beverages Encourage 9 servings a day of fruits and vegetables limit screen time. (AAP recommends <2 hours) Eat breakfast daily Limit eating out Encourage family meals Limit portion size Include high fiber diet Balance macronutrient intake 60 minutes of moderate to vigorous activity daily Limit consumption of energy-dense foods

22 Expert Committee Recommendations: Primary care providers Assess obesity risk of all patients Provide anticipatory guidance on healthy behavior Check BMI at each well-child visit Dont treat obesity like AOM Use the chronic care model

23 Chronic Care Model Family/Patient Self Management Environment Family School Worksite Community Medical System Information systems Decision support Delivery system design Self-management support

24 Expert Committee Studies since recommendations show that there is mixed adherence Mainly surveys and no RCT Obesity programs are following the expert committee recommendations while primary care is about 50% No data to support effectiveness of recommendations, but a lot of data are used to create recommendations We wont know if it works unless we try

25 Management programs Lets Move Bright Bodies Smart Moves 5, 2, 1, 0 Focus on a Fitter Future: A Survival Guide to Planning, Sustaining, and Building a Pediatric Obesity Program. Study assessing these programs declared: Effectiveness was greater when program objectives were specific, implemented across the school environments, extended into the community, and were culturally relevant

26 Local Resources Healthy Hearts Program Children's Heart Center Guide To A Healthy Lifestyle Achieving A Healthy Weight Healthy Meals In Minutes Recommended Reading For Parents What Do Healthy People Do? What's A Parent To Do? Preventive Cardiology For Children Healthy Lifestyles Newsletter

27 Criteria for referral BMI > 95 th percentile (obesity not a diagnosis) (Metabolic syndrome) Hyperlipidemia Hypertension Family history of cardiac risk factors Cardiac Rehab Ages Nutrition consult: 0-18 years 12-week program: ages 7-18

28 Laboratory Markers Glucose LFTs Fasting lipid panel Insulin HgA1C Thyroid panel High Sensitivity (Cardio) CRP

29 How it works… Referred to CHC by pediatrician OV with pediatric cardiologist (EKG, Echo, Labs) Nutrition Consult with R.D. F/U x 3 months with R.D. Enroll into 12-week program

30 Summery We have patients who are overweight, obese, and/or at risk of becoming overweight or obese. We need to be able to identify these patients We need to educate on proper nutrition and healthy lifestyle. We need to know resources available to us. We need to constantly reevaluate how our methods are working for our patients.

31 Things to watch for AAP Committee on Nutrition will release statement on nutrition recommendations for children 4 yrs for preventing obesity in the coming months.

32 References Cox P, Balik M. Plants, People, and Culture: The Science of Ethnobotany. New York : Scientific American Library;1997 Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st centery. Am J Clin Nutr 2005;81:341–54. re:western diet Greene A. Feeding Baby Green – The Earth-Friendly Program for Healthy, Safe Nutrition During Pregnancy, Childhood, and Beyond. San Francicso: Jossey-Bass; McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double- blinded, placebo-controlled trial(2007) Lancet, 370 (9598), pp Environmental and Nutritional Diseases. In: Robbins SL, Kumar V, Abbas AK, Cotran RS, Fausto N. Robbins and Cotran: Pathologic Basis of Disease ed. 8. Philadelphia: W.B. Saunders Company, eBook. AAP Policy Statement: Breastfeeding and the Use of Human Breast Milk. Pediatrics vol. 115: , Barlow SE. Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics vol. 120:S , Gidding SS, Dennison BA, Birch LL et al. Dietary Recommendations for Children and Adolescents, A Guide for Practitioners, Consensus Statement from the American Heart Association. Circulation vol112: , 2005 AAP Committee on Nutrition: Prevention of Pediatric Overweight and Obesity. Pediatrics vol. 112:424-30, AAP Council on Sport Medicine and Fitness and Council on School Health. Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity. Pediatrics. vol. 117: , Bremer AA, Mietus-Snyder M, Lustig R. Toward a unifying Hypothesis of Metabolic Syndrome. Pediatrics vol. 129: , Lustig R. Fructose: Metabolic, Hedonic, and Societal Parallels with Ethanol. Journal of the American Dietetic Association vol 110: , Johnson T, Weed LD, Touger-Decker R. School-based interventions for overweight and obesity in minority school children. J Sch Nurs Apr;28(2): Epub 2011 Oct 24. Kranz S, Brauchla M, Slavin JL, and Miller KB. What Do We Know about Dietary Fiber Intake in Children and Health? The Effects of Fiber Intake on Constipation, Obesity, and Diabetes in Children. Adv Nutr January 2012 Adv Nutr vol. 3: 47-53, Eisenmann JC. Assessment of Obese Children and Adolescents: A Survey of Pediatric Obesity-Management Programs. PEDIATRICS Vol. 128 No. S51-58, 2011 Rausch JC, Perito ER, Hametz P. Obesity Prevention, Screening, and Treatment: Practices of Pediatric Providers Since the 2007 Expert Committee Recommendations. CLIN PEDIATR vol. 50: , 2011

33 Questions?


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