1. C5, D5 - Obesity Prevention and Treatment Laura Brey, MS, Training Director lbrey@nasbhc.org 919-866-0920

2. Ice Breaker 2

3. Objectives Describe the magnitude of the child and adolescent obesity epidemic in the US Summarize the national recommendations for child and adolescent prevention, assessment, and intervention Utilize the national resources available to providers for assisting in implementation of the national recommendations and guidelines List the 4 stages of pediatric overweight treatment List for the 4 stages of pediatric blood pressure/ hypertension management Utilize motivational interviewing in the treatment of overweight children and adolescents 3

4. Obesity Trends* Among U.S. Adults BRFSS, 1986 ) (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14 No Data <10% 10%–14 % www.cdc.gov 4

5. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person ) www.cdc.gov No Data <10% 10%–14% 5

6. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% www.cdc.gov 6

7. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% www.cdc.gov 7

8. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% www.cdc.gov 8

9. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19 % www.cdc.gov 9

10. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person ) No Data <10% 10%–14% 15%–19% ≥20% www.cdc.gov 10

11. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% www.cdc.gov 11

12. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov 12

13. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov 13

14. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov 14

15. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov 15

16. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov 16

17. Prevalence of At-Risk & Overweight Among Children and Adolescents Ogden, et al. (2006). JAMA, 295(13), 1549-1555. ≥ 95% ≥ 85% 17

18. Suicide Risk Suicide Risk Actual and perceived overweight is an important risk factor for suicidal behaviors in youth Risk factor for suicidality even after controlling for alcohol and illicit drug use More studies needed to better understand association between perceived and actual overweight and risk for suicide attempts (Swahn, M., Reynolds, M., Tice, M., et. al, Journal of Adolescent Health, 2009.) 18

19. Health Risks: Psychosocial Obese children and their parents rate the quality of life as similar to pediatric cancer patients. Schimmer, Burwinkle, & Varni, 2003

20. Ethnic Disparity: At Risk for Overweight or Overweight 2003-2004 Ogden, C et al. (2006). JAMA, 295(13), 1549-1555. ≥ 85% ≥ 95% 20

21. Health Risks of Obesity Pulmonary –Sleep disorders –Asthma –Obesity-linked hypoventilations Neurologic –Pseudotumor cerebri 21

22. Health Risks of Obesity Orthopedic –Slipped capital epiphysis –Tibia vara (Blount’s disease) –Tibial torsion –Flat feet –Ankle sprain –Fractures 22

23. Health Risks of Obesity Cardiovascular –Hypertension –Dyslidemia –Fatty deposits –Left ventricular hypertrophy Other –Systemic inflammation 23

24. Health Risks of Obesity GastrointestinalGastrointestinal –Cholelithiasis –Non-alcoholic fatty liver disease –Gastro-esophageal reflux EndocrineEndocrine –Insulin resistance/Type II Diabetes Acanthosis nigricansAcanthosis nigricans –Menstrual abnormalities –Polycystic ovary syndrome –Hypercoricism 24

25. Significance of Problem 80% of obese adolescents will become obese adults80% of obese adolescents will become obese adults 25

26. Significance:What about their future? Leading Causes of Death in the US Cause of Death Death rate/100,000 Heart disease258.2 Cancer200.9 Cerebrovascular disease 60.9 Minino, Arias, Kochanek, Murphy, & Smith 2002 26

27. Economic Consequences Obesity increased 30% in last 20 years Medical expenses for obesity = 9.1% of US medical expenditure Direct and indirect costs in US –$78.5 billion in 1998 –$92.6 billion in 2002 Finkelstein, Fiebelkorn, & Wang(2003). Health Affairs (Millwood). 27

28. Etiology: Family Whitaker, et al.(1997). NEJM, 337(13). Cohort of 854 mostly white subjects followed up to age 21-29 years Odds Ratio Maternal obesity 3.6 (2.1-5.9) Paternal obesity 2.9 (1.7-4.9) Two obese parents 13.6 ( 3.7-50.4) 28

29. Etiology: Decreased Activity Etiology: Decreased Activity 29% of US children have daily PE 50% of 12-21 year olds have no regular physical activity Foster, et al., 2003; Ogden, et al., 2002 29

30. Etiology: Portion Size Comparisons Young and Nestle (2002) Am J Public Health. 2(2):246-249. 30

31. Rozin et al., (2003).Physiological Science. 14(5):450-4. On average, American portions were 25% larger! Etiology Portion Sizes: Paris vs. Philadelphia 31

32. Etiology: Inactivity TV Viewing Predicts Childhood Overweight Gortmaker et al. (1996) Arch Pediatr Adolesc Med. 150(4):356- 62 Gortmaker et al. (1996) Arch Pediatr Adolesc Med. 150(4):356- 62. 32

34. What’s happening in primary care? Time for Anticipatory Guidance during WCC Average visit length17.8 minutes Average time in advisement 2.4 minutes Nutrition 31.7 seconds Growth 6.4 seconds Exercise 1.6 seconds Goldstein, Dworkin, & Bernstein, 1999 34