How health care providers can understand and help our overweight children
Revitalize Our Children: Objectives: Review prevalence of pediatric obesity Identify co morbidities of overweight conditions in children Identify risk factors for pediatric obesity Suggest prevention and treatment strategies David B. Jack, M.D.
Corpulence Obesity now affects 17% of all children and adolescents in the United States - triple the rate from just one generation ago Since 1980, obesity prevalence among children and adolescents has almost tripled
Background Differences There are significant racial and ethnic disparities in obesity prevalence among U.S. children and adolescents. In 2007— 2008, Hispanic boys, aged 2 to 19 years, were significantly more likely to be obese than non-Hispanic white boys, and non- Hispanic black girls were significantly more likely to be obese than non- Hispanic white girls.
2009—2011 County Obesity Prevalence Among Low-Income Children Aged 2 to 4 Years
Washington ranks 18 in overall prevalence with 29.5% of children considered either overweight or obese.
Washington State: % Children Ages 6- 17 with TV in Bedroom: 32.0% % Children Ages 12-17 Not Eating Family Meals Most Days of Week: 25.8%
Sugar drinks and less healthy foods on school campuses. About 55 million school-aged children are enrolled in schools across the United States, and many eat and drink meals and snacks there More than half of U.S. middle and high schools still offer sugar drinks and less healthy foods for purchase Students have access to sugar drinks and less healthy foods at school throughout the day from vending machines and school canteens and at fundraising events, school parties, and sporting events
Advertising of less healthy foods. Nearly half of U.S. middle and high schools allow advertising of less healthy foods, which impacts students' ability to make healthy food choices Foods high in total calories, sugars, salt, and fat, and low in nutrients are highly advertised and marketed through media targeted to children and adolescents, while advertising for healthier foods is almost nonexistent in comparison
Lack of daily, quality physical activity Most adolescents fall short of the 2008 Physical Activity Guidelines for Americans recommendation of at least 60 minutes of aerobic physical activity each day, as only 18% of students in grades 9—12 met this recommendation in 20072008 Physical Activity Guidelines for Americans Daily, quality physical education in school can help students meet the Guidelines. However, in 2009 only 33% attended daily physical education classes
No safe and appealing place, in many communities, to play or be active. Many communities are built in ways that make it difficult or unsafe to be physically active. For some families, getting to parks and recreation centers may be difficult, and public transportation may not be available. For many children, safe routes for walking or biking to school or play may not exist. Half of the children in the United States do not have a park, community center, and sidewalk in their neighborhood. Only 27 states have policies directing community-scale design.
Limited access to healthy affordable foods Some people have less access to stores and supermarkets that sell healthy, affordable food such as fruits and vegetables, especially in rural, minority, and lower-income neighborhoods Supermarket access is associated with a reduced risk for obesity Choosing healthy foods is difficult for parents who live in areas with an overabundance of food retailers that tend to sell less healthy food, such as convenience stores and fast food restaurants
Greater availability of high-energy-dense foods and sugar drinks. High-energy-dense foods are ones that have a lot of calories in each bite A high-energy-dense diet is associated with a higher risk for excess body fat during childhood Sugar drinks are the largest source of added sugar and an important contributor of calories in the diets of children in the United States High consumption of sugar drinks, which have few, if any, nutrients, has been associated with obesity On a typical day, 80% of youth drink sugar drinks
Increasing portion sizes Portion sizes of less healthy foods and beverages have increased over time in restaurants, grocery stores, and vending machines Children eat more without realizing it if they are served larger portions
Lack of breastfeeding support. Breastfeeding protects against childhood overweight and obesity However, in the United States, while 75% of mothers start out breastfeeding, only 13% of babies are exclusively breastfed at the end of 6 months The success rate among mothers who want to breastfeed can be improved through active support from their families, friends, communities, clinicians, health care leaders, employers, and policymakers. Children who are breastfed for six months are less likely to become obese
Television and Media Children 8—18 years of age spend an average of 7.5 hours a day using entertainment media, including TV, computers, video games, cell phones, and movies. Of those 7.5 hours, about 4.5 hours is dedicated to viewing TV
Television and Media Eighty-three percent of children from 6 months to less than 6 years of age view TV or videos about 1 hour and 57 minutes a day
Television and Media TV viewing is a contributing factor to childhood obesity because it may take away from the time children spend in physical activities; lead to increased energy intake through snacking and eating meals in front of the TV; and, influence children to make unhealthy food choices through exposure to food advertisements
Health Risks Now Childhood obesity can have a harmful effect on the body in a variety of ways. Obese children are more likely to have– High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD). In one study, 70% of obese children had at least one CVD risk factor, and 39% had two or more Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes
Health Risks Now Childhood obesity can have a harmful effect on the body in a variety of ways. Obese children are more likely to have– Breathing problems, such as sleep apnea, and asthma Joint problems and musculoskeletal discomfort
Health Risks Now Childhood obesity can have a harmful effect on the body in a variety of ways. Obese children are more likely to have– Fatty liver disease, gallstones, and gastro- esophageal reflux (i.e., heartburn) 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
Health Risks Later In Life Obese children are more likely to become obese adults Adult obesity is associated with a number of serious health conditions including heart disease, diabetes, and some cancers If children are overweight, obesity in adulthood is likely to be more severe
Young children ages 2 to 5 have a lower prevalence of overweight and obesity than older youth.
Among young people ages 2 to 19: About 31.8 percent are considered to be either overweight or obese, and 16.9 percent are considered to be obese About 1 in 3 boys (33 percent) are considered to be overweight or obese, compared with 30.4 percent of girls About 18.6 percent of boys and 15 percent of girls are considered to be obese
Children and Adolescents Ages 6 to 19: Almost 1 in 3 (33.2 percent) are considered to be overweight or obese, and 18.2 percent are considered to be obese More than 2 in 5 black and Hispanic youth (more than 41 percent) are considered to be overweight or obese* About 25.7 percent of black, 22.9 percent of Hispanic, and 15.2 percent of white youth are considered to be obese* Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. Journal of the American Medical Association. 2012; 307(5):483–90.
Childhood Obesity Obesity now affects 17% of all children and adolescents in the United States - triple the rate from just one generation ago Since 1980, obesity prevalence among children and adolescents has almost tripled
Build a Healthy Plate With Fruits Build a Healthy Plate With Vegetables Build a Healthy Plate With Dry Beans and Peas Meat and Meat Alternates Build a Healthy Plate With Whole Grains Build a Healthy Plate With Less Salt and Sodium Fats and Oils: Build a Healthy Plate With Options Low in Solid Fats Build a Healthy Plate With Less Added Sugars Make Water Available Throughout the Day Provide Opportunities for Active Play Every Day Encourage Active Play and Participate With Children Promote Active Play Through Written Policies and Practices Limit Screen Time Appendix B: Care for Children With Food Allergies (updated 1/17/13) Build a Healthy Plate With FruitsBuild a Healthy Plate With VegetablesBuild a Healthy Plate With Dry Beans and PeasBuild a Healthy Plate With Whole GrainsBuild a Healthy Plate With Less Salt and SodiumFats and Oils: Build a Healthy Plate With Options Low in Solid FatsBuild a Healthy Plate With Less Added SugarsMake Water Available Throughout the DayProvide Opportunities for Active Play Every DayEncourage Active Play and Participate With ChildrenPromote Active Play Through Written Policies and PracticesLimit Screen TimeAppendix B: Care for Children With Food Allergies
Beans and Peas Help children feel full longer and maintain a healthy weight Promote proper digestion and make children’s “potty time” easier by providing dietary fiber Add shape, texture, and flavor to children’s plates
Fruits, Vegetables Add color, texture, and flavor to children’s plates Give children the vitamins and minerals they need to grow and play Add color, crunch, and flavor to children’s plates Promote proper digestion, help children feel full, and provide fiber for fullness
Decreasing Solid Fats Make food fun “Kangaroo Pockets” (stuff half a whole-grain pita pocket with sliced chicken, romaine lettuce, shredded carrots, and a little salad dressing) Try “Crunchy Baked Chicken” (oven-baked chicken tenders coated in crushed whole-grain cereal or breadcrumbs)
Have children help with cooking and let them choose healthy foods
Decreasing Solid Fats Have children help cook Make a “fruit and yogurt parfait” by topping nonfat plain yogurt with whole-grain cereal and fresh or frozen berries, banana slices, fruit canned in 100% juice, a favorite fruit
Encourage Active Play Display posters and pictures of children and adults being physically active.
Encourage Active Play Make a chart for tracking physical activity with children’s and child care providers’ names Have children place a sticker or a stamp by their name every time they participate in active play
Having the TV on can disturb children’s sleep and play, even if it is on in the background
Limit Screen Time TV and some DVDs include advertisements for unhealthy foods
Limit Screen Time The more time children spend playing video games, the more likely they are to have difficulty concentrating in school
Limit Screen Time Many video games contain violence Computer games can impair children’s sleep at night, possibly causing them to spend less time in deep sleep. Sleep is important for children’s health and development
Limit Screen Time We know from research that, at least for boys, the more time they spend playing video games and watching TV, the less active they are
Mistreatment Almost 100% of obese teenage girls have been at least verbally abused about their weight Studies show discrimination in school and work settings and in dating and relationships
Body Image “Skinny” is the only good body type One quarter of all girls age 6 and 7 have dieted Dieting numbers nearly identical for average and overweight girls
Body Image “No one at school eats lunch because they don’t want to get fat.”
Food Discussions Emphasize health, not weight Discuss food in terms of its capacity to provide energy, and to improve thinking and strength Do not allow “fat talk” Love children and ourselves Support children in hobbies and passions that have nothing to do with weight Value their accomplishments
Change the Model Do not make parties about cupcakes, ice cream, brownies and Cheetos Try different kinds of foods as a treat Do not associate parties with sugar and fat food indulgences---fun does not just come with lots of sugar!
Personal Experience David Gourley Elementary School Disadvantaged neighborhood Half of students do not speak English Attended by speaker 50 years ago when it first opened Little community support Became a “Health Mentor”
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