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L. Janelle Whitt, DO OU-Tulsa School of Community Medicine.

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Presentation on theme: "L. Janelle Whitt, DO OU-Tulsa School of Community Medicine."— Presentation transcript:

1 L. Janelle Whitt, DO OU-Tulsa School of Community Medicine

2 45 th in adult obesity 19 th in pediatric obesity

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4 30% of students thought of themselves as overweight More female than male More Hispanic than white or black

5 43% students reported that they were trying to lose weight Using of exercise to lose weight or avoid gaining weight Eating less food, fewer calories, low fat foods Fasting > 24 hours Taking diet pills or supplements without doctors advice Vomiting or abusing laxatives OVERALL, KIDS ARE DOING CRAZY STUFF TO TRY AND LOSE OR MAINTAIN THEIR WEIGHT

6 Among six choices of greatest risk to their children’s long-term health and quality of life Illegal drugs 24% Violence 20% Smoking 13% STD 10% Alcohol 6.1% Obesity 5.6%

7 Majority of parents do not believe that PE/recess should be reduced or replaced with academics 1/3 are concerned with their child’s weight ~ 10% consider their children overweight Compared to themselves: ¼ think their children eat less nutritiously ¼ say their children are less active than they were 1/3 rate their school programs for teaching healthy eating/activities as “poor” or “non-existent”

8 Serious health concern for children and adolescents 28% of Oklahoma kids 10-17yo are overweight or obese Increased health risks during youth and as adults Overwhelmingly more likely to become obese as adults

9 $147 billion spent in 2009 (direct & indirect) Almost 10% of all healthcare expenditures Lost productivity, missed work/school days In 2006, obese pts spend $1429 more for medical care (42% increase). In relation to its effects, obesity research funding is dismal

10 Most widely used method to screen for overweight Easy, non-invasive, way to obtain height and weight BMI correlates with body fatness, but is not a direct measure of fatness

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12 BMI is practical measure used to define overweight. In children, BMI is based on age and sex specific percentiles for BMI, not the usual adult BMI categories. Overweight is at/above the 95 th % for age. At risk for overweight is 85 to 95% for age.

13 Increasing dramatically Since the 1970’s the incidence has more than doubled in the 2-5yo age group, and almost tripled in the 6-19yo age group Healthy people 2010 called for a reduction in the proportion of children who are overweight or obese…but we are making little progress

14 1/3 Oklahoma adults are overweight or obese The obesity rate in Oklahoma has doubled in last 15 years 1/3 Oklahoma kids are overweight Increased odds of being obese if poor and uneducated

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16 15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%

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19 Overweight is the result of an imbalance between the calories consumed as food/beverage and the calories used to support normal growth, development, metabolism and physical activity Imbalance can result from a number of factors: genetic, behavioral and environmental.

20 Genetic characteristics may increase a child’s chance of overweight May need to exist in conjunction with non- genetic factors Genetic factors alone play a role in rare Prader-Willi syndrome Mutations change activity of ‘fat hormone’ leptin

21 Not possible to isolate one specific behavior leading to overweight Energy intake Physical (in)activity Sedentary behavior

22 Important in body weight, blood pressure and bone strength Active children are more likely to remain active through adolescence and into adulthood Children are spending less time in PE during school Daily PE dropped >10% in last 13 years Less than 1/3 high school students get recommended levels of physical activity

23 “Super-sized” portions Eating meals out Snacking on energy-dense foods High-sugar beverages High in calories May not compensate at meal time for extra calories Liquid calories less satiating than solid form and lead to higher caloric intake.

24 Child’s odds of becoming obese increase with each additional daily serving of sugar-sweetened drinks Suggests independent link between soda consumption and obesity

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26 Children spend considerable amount of time with media Children aged 8-18 spend over 3 hours a day with media Studies find a positive association between screen time and increased overweight

27 Decrease time children spend in active, physical play Contribute to increased energy consumption through mindless snacking Influence children to make unhealthy food choices due to advertisements Lower children’s metabolic rate

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29 At home Parents as role models, positive or negative At school Ideal setting for teaching healthy eating and physical activity In the community Access to sidewalks, bike paths, parks Access to affordable, healthy food choices

30 Various health-related consequences, may be immediate or long-term Psychosocial risks Early social discrimination Low self-esteem, decreased academic performance Cardiovascular risks High cholesterol High blood pressure

31 Asthma NASH- Non-alcoholic steatohepatitis Orthopedic problems Sleep apnea Occurs in 7% of overweight children Type II diabetes “Adult-onset” Increasingly reported among children May lead to advanced long-term complications

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33 Prevention plus PCP Structured weight management PCP plus dietician Comprehensive multidisciplinary intervention PCP plus behavioral counselor, dietician, exercise specialist Tertiary care intervention Meds: sibutramine and orlistat Gastric bypass surgery

34 Check Ht/Wt and BMI at EVERY visit Explain graphs to caregivers Check BP at every visit Use pediatric BP tables Labs: Glucose/HgA1c Lipids LFT’s Frequent monitoring

35 Education about healthy food/drink choices and physical activity Focus on weight maintenance, not loss Weight checks in between well child visits Consults for kids with HTN, high chol, DM Shapedown/Cowboys Get Healthy, Get Fit Encourage activity Sports, karate, biking, walking, trampoline

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37 Nutrition standards Vending machine usage BMI measured in schools Recess/physical education Obesity programs and education Obesity research Obesity treatment in health insurance Obesity commissions Oklahoma Fit Kids Coalition The UB Obesity Report Card: An Overview

38 Physical education Nutrition in schools School health councils Identify funding sources

39 An advisory group of at least 6 individuals. Work to create healthy school environments so that students can maximize their learning potential. It’s required by law for public schools- SB 1627 Provide advice to the school regarding school health issues and assess the school’s needs in the 8 areas of the Coordinated School Health Program.

40 Establish policies that promote enjoyable, lifelong physical activity Provide physical and social environments that encourage young people to engage in safe and enjoyable physical activity Implement physical education curricula and healthy lifestyle instruction in grades K-12 Implement health education that allow students to develop the knowledge, attitudes and skills they need to maintain a healthy lifestyle

41 Provide extracurricular physical activities that are diverse, developmentally-appropriate and both competitive and non-competitive Encourage parents to support their children’s participation in physical activity and to be physically active role models Provide training to school staff to promote lifelong activity among young people Assess the activity patterns of students and refer to activities Provide a range of community sports and rec programs

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