1. Obesity Amongst America’s Youth By Brittney King

2. What is Obesity? A formal definition:  Overweight - BMI score of 25-29  Obese - BMI score of 30 or above BMI- Body mass index- A height versus weight measurement used to calculate body fat percentages. Definition from the Nation Institute of Health (NIH) and the Center for Disease Control and Prevention (CDC) (Schneider, 2014) Brittney King, 2014

3. Recognizing the Problem  Over the last three decades, the population of American’s suffering from obesity has tripled (Let’s Move, 2014)  17% of children and adolescents in the United States are currently obese (CDCa, 2013).  33 billion dollars per year are being spent on weight- loss products from gym memberships and exercise tapes; to diet books and food plans; yet obesity continues to increase (Schneider, 2014). Statistics like this show us that a change needs to be made and soon! Brittney King, 2014

4. Epidemiology- Risk Factors of Becoming Obese Brittney King, 2014 Lack of daily physical activity (CDCb, 2013) High daily intake of sugar- sweetened beverages and foods (AHA, 2013a) High calorie diet low in fruits and vegetables (CDCb, 2013) Repeated high stress levels from surrounding environments (Caprio et al., 2008) Combinations of these factors are causing more and more American children to become obese each year!

5. Brittney King, 2014 Epidemiology- Distribution of Obesity Obesity affects all children regardless of race, age, gender, or background  However, trends have found obesity to be more prevalent in boys than girls ages 2- 19(HSPHb, 2012).  Non-Hispanic and non-Hispanic black children ages 2 to 19 have a higher risk of obesity than non-Hispanic white youth of the same age (HSPHb, 2012).

6.  When researched by the Center for Science in the Public Interest (CSPI), dichotomous data showed that 91% of kids meal options at 50 food chain restaurants did not meet National Restaurant Association Kid’s Live Well Standards of health (CSPI, 2013).  Yet 25% of an average American family’s meals come from fast food restaurants (CSPI, 2013). Brittney King, 2014 Statistics- Their Role in Battling Obesity Statistics like this allow organizations such as the CSPI to hold restaurants accountable for offering adequate nutrition for children.

7.  The American Public Health Association found that for each sugar-sweetened beverage a child consumes, they are 60% more likely to become obese (APHA, 2012).  This is in fact affecting a large population of children, because 44% of children 19-24 months, and 70% of children ages 2-5 do in fact drink a sugary beverage daily (APHA, 2012). Brittney King, 2014 Statistics- Their Role in Battling Obesity Statistics like this are necessary for parents and children to realize the impact of their negative nutritional choices and encourage them to make necessary change in their lives.

8. Some disorders in children have been found to cause disruptions in communication from the Leptin Receptor Gene (LPR) gene to the hypothalamus. But how does that relate to being overweight or obese? Leptin is a hormone produced by adipocytes that influences food intake and metabolic rates by having a direct affect on the hypothalamus (Greenberg & Obin, 2006). The Leptin Receptor Gene (LPR) sends signals to the hypothalamus, reporting leptin secretions, and is regulated based on body fat mass (Dias et al., 2012). When the LPR gene is damaged, a child’s body does not produce the correct amount of leptin. This causes increased appetite, leading to potential weight gain and obesity. Brittney King, 2014 Biomedical Basis- The Molecular Side of Obesity: Leptin

9. Elevated Stress Levels Prolonged or reoccurring stress will raise plasma cortisol levels, which has been linked to development of obesity (Caprio et al., 2008). Brittney King, 2014 Biomedical Basis- The Molecular Side of Obesity: Stress Exposure to stress varies by race, ethnicity, and culture Factors that cause this stress for parents include socioeconomic status, environmental factors such as housing conditions, and income, which can have a direct impact on their children’s stress levels (Caprio et al., 2008). For children, stressors include pressure from school, to perform well on sports teams, or even to play a contributing role in their family.

10.  Although certain genes have been found to cause obesity in some youth, many children with the same gene continue to maintain health weights (HSPHc, 2013).  HSPH states that it takes a period of many years for a new gene mutation or polymorphism to spread across a population, and the dramatic increase in obesity in our nation has happened over a much shorter period of time than necessary for a gene mutation to be the root cause (HSPHc, 2013). Brittney King, 2014 Biomedical Basis- The Molecular Side of Obesity: Genetics

11. Social and Behavioral Factors- The Ecological Model: What is it? The ecological model of health behavior contains five levels that look at, “how social environment, including interpersonal, organizational, community, and public policy factors, supports and maintains unhealthy behaviors” (Schneider, 2014). Brittney King, 2014

12.  Public Policy: The Obama administration is currently working to improve American Food System by working with the Food and Drug Administration (FDA) to ban trans fat, require calorie listings for major food chains, and revamping nutritional facts on all food products sold (Evich, 2014).  Community/Organizational: National programs and organizations are taking action on a smaller, community based level. Let’s Move, created by Michelle Obama, Play 60, created by the NFL and National Dairy Council are doing just that.  Providing children with opportunities for movement and physical activity  Working to improve standards for school lunches Brittney King, 2014 Social and Behavioral Factors- Ecological Model: Battling the Obesity Epidemic

13.  Interpersonal: As children in America participate in programs like Let’s Move and Play 60, they are given a chance to make new friends and be active with other kids looking to be healthy in a fun way.  Interpersonal: Self-esteem and confidence increase as students realize their potential in making healthy choices in their lives with the food they eat and the activities they participate in. The positive social environment promotes inclusion and friendship among those involved. Brittney King, 2014 Social and Behavioral Factors- Ecological Model: Obesity

14. The transtheoretical health behavior model contains five stages that represent the path individuals take as they envision change in their life, and adopt the necessary health habits for that change (Schneider, 2014). Brittney King, 2014 Social and Behavioral Factors- Transtheoretical Model: What is it?

15. Stage Actions taken by parents to prevent obesity in their children Precontemplation Parent’s are usually misinformed, or do not fully understand the possible health repercussions from obesity (Mason, et al., 2008). Contemplation Parents begin to recognize the need for a change, and are beginning to explore possible steps that could be taken to make that change positive (Mason, et al., 2008). Preparation Parents begin taking steps toward their nutritional changes by recognizing where change is needed in their lives, making plans for physical activity, buying healthy foods, and replacing old habits. Brittney King, 2014 Social and Behavioral Factors- Transtheoretical Model: Battling the Obesity Epidemic

16. Stage Actions taken by parents to prevent obesity in their children Action Preparations made for the healthy lifestyle change are put in to motion. Parents begin to make healthier nutrition and lifestyle choices for their family. Maintenance Parents continue over time to maintain their healthy changes, and begin implementing new and even better strategies for health (Mason, et al., 2008). Transtheoretical Model: Battling Obesity Continued… Brittney King, 2014  There is often movement back and forth through various stages, as families fall short of their chosen health goals, but make additional attempts to improve in the future (Mason, et al., 2008).  Setbacks are common in making major lifestyle changes.  The important thing is that these setbacks are temporary, as families continue to move forward to improved health.

17. Why are American children and adolescents not moving as much as they used to? 1. Parents no longer feel safe letting their children walk to school, so they ride buses in place of it (CDCb, 2013) 2. Schools no longer provide quality time for physical activity (CDCb, 2013) 3. Children ages 8 to 18 spend approximately 7.5 hours a day using some form of technology (CDCb, 2013). 4. Portion sizes and caloric density of food consumed has increased (CDCb, 2013). Brittney King, 2014 Social and Behavioral Factors- Personal Behaviors: Obesity This change in focus from things that are active to those that are sedentary, and increase in high calories meals has caused a shift in the amount of calories our youth are ingesting versus burning off, which is causing an overall increase in weight (CDCb, 2013)

18. Health Policy and Management -Government action toward obesity  Obama administration and Food and Drug Administration  Working to improve the American Food System by banning trans fat, require calorie listings for major food chains, and revamping nutritional facts on all food products sold (Evich, 2014).  National Restaurant Association  Created Kid’s Live Well Standards of health (CSPI, 2013) to hold restaurants accountable for supplying healthy children’s menu options. Brittney King, 2014

19. The Outlook Where are we headed? Positive action steps have been taken to diminish the obesity epidemic among America’s youth, but there is still a lot of work to be done. Brittney King, 2014 Surgeon General Richard Carmona- “Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents” (AHA, Getting Healthy, 2013, paragraph 4) If this continues, 1/3 of children born after the year 2000 will suffer from diabetes at some point in their lives. Those who don’t will suffer from other affects like heart disease, high blood pressure, cancer, or asthma (Let’s Move, 2014).

20. References American Heart Association (2013a). Facts: Decreasing sugar-sweetened beverage consumption: policy approaches to address obesity. Retrieved January 20, 2014, from https://www.heart.org/idc/groups/heart-public/@wcm/@adv/doc ument s/downloadableucm_453908.pdf American Heart Association (AHA) (2013b). Getting healthy: overweight in children. Retrieved January 14, 2014 from, http://www.heart.org/HEARTOR G/GettingHealthy/WeightManagement/Obesity/Overweight- inChildren_UCM_30405 4_Article.jsp American Public Health Association (APHA) (2012). Policy Statement Database. Taxes on sugar sweetened beverages. Retrieved January 20, 2014, from http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1437 Caprio, S., Daniels, S.R., Drewnowski, A., Kaufman F.R., Palinkas, L.A., Rosenbloom, A.L., Schwimmer J.B. (2008). Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment. Diabetes Care. Vol. 31(11). 221-2221. Retrieved January 30, 2014 from, http://care.diabetesjournals.org/content/31/11/2211.full.pdf+html Centers for Disease Control and Prevention (CDCa) (2013). Childhood overweight and obesity: Data and Statistics. Retrieved January 15, 2014 from, http://www.cdc.gov/obesity/childhood/basics.html Brittney King, 2014

21. Centers for Disease Control and Prevention (CDCb) (2013). Childhood overweight and obesity: A growing problem. Retrieved January 14, 2014 from,http://www.cdc.gov/obesity/childhood/problem.htmlhttp://www.cdc.gov/obesity/childhood/problem.html Center for Science and the Public Interest (CSPI) (2013). Kid’s meals II: obesity on the menu. Retrieved January 19, 2014 from, http://cspinet.org/new/pdf/cspi-kids-meals-2013.pdfhttp://cspinet.org/new/pdf/cspi-kids-meals-2013.pdf Dias, N.F., Frenandes, A.E, Melo, M.E., Reinhardt, H.L., Cercato C., Villares S.M., Halpern, A., & Mancini M.C. (2012). Lack of mutations in the leptin receptor gene in severely obese children. Arq Bras Endocrinol Metabol. Vol. 53(3). 178-83. Retrieved January 30, 2014 from, http://www.ncbi.nlm.nih.gov/pubmed/22666733 http://www.ncbi.nlm.nih.gov/pubmed/22666733 Evich, H.B. (2014). Politico Pro: Special report. Changing the way we eat. Retrieved February 5, 2014 from, http://www.politico.com/story/2014/01/changing-the-way-we-eat-102888.html Greenberg, A.S., Obin M.S. (2006). Obesity and the role of adipose tissue in inflammation and metabolism. The American Journal of Clinical Nutrition. Vol. 83(2). 4615-4655. Retrieved January 30, 2014 from, http://www.ncbi.nlm.nih.gov/pubmed/16470013 References Brittney King, 2014

22. Harvard School of Public Health (HSPHb) (2012). Obesity prevention source: Child obesity. Retrieved January 14, 2014 fromhttp://www.hsph.harvard.edu/obesity-preventionsource/obesity-trends/global- obesitytrends-in-children/http://www.hsph.harvard.edu/obesity-preventionsource/obesity-trends/global- obesitytrends-in-children/ Harvard School of Public Health (HSPHc) (2013). Obesity prevention source: genes are not destiny. Retrieved January 26, 2014 from, http://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/genes-and-obesity/ Let’s Move (2010). Let’s move: learn the facts. Retrieved February 10, 2014 from http://www.letsmove.gov/learn-facts/epidemic-childhood-obesity Mason H.N., Crabtree B., Caudill P., Topp R. (2008). Childhood obesity: a transtheoretical case management approach. Journal of Pediatric Medicine. Vol. 23(5). 237-244. Retrieved January 30, 2014 from, http://fataids.org/assets/pdf/s0882596308001152.pdf Schneider, M.J. (2014). Introduction to Public Health. (4 th ed.). Burlington, MA: Jones and Bartlett Learning. References Brittney King, 2014