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Child Obesity What is the family physicians role? Sheryl Rosenberg Thouin, MPH, RD, CDE What is the family physicians role? Sheryl Rosenberg Thouin, MPH,

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Presentation on theme: "Child Obesity What is the family physicians role? Sheryl Rosenberg Thouin, MPH, RD, CDE What is the family physicians role? Sheryl Rosenberg Thouin, MPH,"— Presentation transcript:

1 Child Obesity What is the family physicians role? Sheryl Rosenberg Thouin, MPH, RD, CDE What is the family physicians role? Sheryl Rosenberg Thouin, MPH, RD, CDE

2 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 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

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4 2007 Rates of Overweight and Obese Children

5 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 = 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

6 Indicators of Pediatric Overweight Plotting BMI-for-age Obese >95 th percentile Overweight 85 th to 95 th percentile

7 Example: 95th Percentile Tracking Age BMI 2 yrs yrs yrs yrs 25.1 For Children, BMI Changes with Age Boys: 2 to 20 years BMI

8 Example: Sam Name: Sam Weight: 35 lbs 4 oz Height: 35 inches Age: 4 years old BMI: 20 Is this child normal weight? Name: Sam Weight: 35 lbs 4 oz Height: 35 inches Age: 4 years old BMI: 20 Is this child normal weight?

9 Sams BMI Plotted on Boys BMI-for-Age Chart Interpretation: Sams BMI-for-age is significantly above the 95th %tile Boys: 2 to 20 years BMI

10 If Sam were 11.5 years old... Interpretation: Sams BMI-for-age is just below the 85th %tile Boys: 2 to 20 years BMI

11 If Sam were 18 years old... Interpretation: Sams BMI-for-age is just above the 10th %tile Boys: 2 to 20 years BMI

12 Looking for the Cause Genetics Biological factors: hormonal and neurochemical mechanisms –Growth hormone –Leptin –Ghrelin –Neuropeptide Y –melanocortin Psychological factors Socio-cultural factors Environmental factors Genetics Biological factors: hormonal and neurochemical mechanisms –Growth hormone –Leptin –Ghrelin –Neuropeptide Y –melanocortin Psychological factors Socio-cultural factors Environmental factors

13 Looking for the Cause Genetics Biological factors: hormonal and neurochemical mechanisms –Growth hormone –Leptin –Ghrelin –Neuropeptide Y –melanocortin Psychological factors Socio-cultural factors Environmental factors Genetics Biological factors: hormonal and neurochemical mechanisms –Growth hormone –Leptin –Ghrelin –Neuropeptide Y –melanocortin Psychological factors Socio-cultural factors Environmental factors

14 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). Data Sources 1 California Department of Public Health, Network for a Healthy California, California Childrens Healthy Eating and Exercise Practices Survey (CalCHEEPS). Background and Documentation: 2009 CalCHEEPS. Documentation2009.pdf. Accessed April 7, California Department of Education. DataQuest: Free or Reduced Price Meals Data. Accessed April 7, Table 1: Categorization of Children This material was produced by the California Department of Public Healths 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 For important nutrition information, visit

15 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. 1 fact

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17 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. 2 fact

18 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. 3 fact

19 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. 4 fact

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22 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. 5 fact

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24 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. 6 fact

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26 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. 7 fact

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28 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 fact

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30 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. 9 fact

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32 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. 1 fact 0

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35 The physicians 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 childrens 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. Calculate and plot BMI once a year in all children and adolescents. Encourage parents and caregivers to promote healthy eating patterns Encourage childrens 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.

36 How Can I Possibly Do This?

37 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

38 Parental Feeding Responsibilities: 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 –Childs eventual body size 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 –Childs eventual body size

39 Helpful Assessment Questions When did the excessive weight gain –Any major events/changes in the childs 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? When did the excessive weight gain –Any major events/changes in the childs 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?

40 Recommended Resources


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