1. School Wellness in the Age of Pediatric Obesity School Wellness in the Age of Pediatric Obesity Aaron S. Kelly, Ph.D. Department of Pediatrics University of Minnesota Medical School

2. BMI Percentiles in Children and Adolescents Based upon age- and gender-specific cutoffs –<85 th percentile = normal weight –≥85 th <95 th percentile = overweight –≥95 th percentile = obese –≥1.2 times the 95 th percentile or 35 kg/m 2 = severe obesity

3. Severe Pediatric Obesity Fastest growing pediatric obesity category Approximately 4-6% of U.S. pediatric population is afflicted with sever obesity – that’s an average of 1 child in every U.S. classroom!

4. Pediatric Obesity 32% of children and adolescents are overweight; 16% are obese Excess adiposity is associated with risk factors for cardiovascular disease (CVD) and type 2 diabetes (T2DM) –Hypertension –Dyslipidemia –Insulin resistance/impaired glucose metabolism

5. Future Trends Lifespan of current generation may be shorten than parents Projections for future burden of CVD and T2DM, resulting from pediatric obesity, are dire Economic burden will be substantial

6. CVD Cost Projections Heidenreich et al. 2011

8. Cardiovascular Risk Factors From Freedman, DS et al. J Pediatr 2007

9. CVD Risk Factor Levels by BMI VariableNW (N = 126)OW (N = 41)OB (N = 36)SO (N = 37)P-trend Age (years)12.5 ± 4.812.9 ± 3.912.6 ± 3.412.7 ± 3.30.91 Gender (M/F)73 / 5322 / 1923 / 1321 / 160.83 BMI (kg/m 2 )19.6 ± 12.323.6 ± 3.628.2 ± 4.737.5 ± 7.0<0.001 SBP (mmHg)103.1 ± 11.0106.5 ± 8.9107.6 ± 11.8117.8 ± 13.7<0.001 DBP (mmHg)56.9 ± 8.360.0 ± 6.261.7 ± 7.865.2 ± 10.2<0.001 Cholesterol (mg/dL)148.4 ± 24.8152.6 ± 27.8162.3 ± 27.0161.3 ± 25.0<0.003 LDL-C (mg/dL)84.8 ± 21.187.8 ± 24.198.7 ± 19.296.7 ± 19.8<0.001 HDL-C (mg/dL)50.3 ± 11.248.7 ± 12.643.7 ± 10.342.0 ± 11.0<0.001 Triglycerides (mg/dL)66.8 ± 26.380.4 ± 39.899.8 ± 65.0122.0 ± 78.1<0.001 Insulin (mU/L)7.9 ± 9.99.3 ± 5.611.9 ± 7.717.8 ± 12.0<0.001

10. Norris et al. Obesity 2011

11. BMI Tracking to Adulthood From Freedman, DS et al. J Pediatr 2007

12. Starting Early is Best Danielsson et al. Arch Pediatr Adolesc Med. In Press

13. Starting Early is Best Danielsson et al. Arch Pediatr Adolesc Med. In Press

15. There is no childhood obesity epidemic. This year we’ve heard a lot about childhood obesity, and people are saying that 1 in 3 of us are overweight or obese. Well, Mom and Dad, can you help us out here? We need more than reminders and threats. We need good examples. If you want us to play an hour a day, then come out and play with us. Take the first step toward accountability with a free 7-day trial membership to Anytime Fitness.

16. “Obesogenic” Environment Food marketing and availability High fat/sugar foods are cheaper Barriers to being active Screen time Stress Lack of sleep Innate desire for calorically dense foods

17. Research Evidence School-Based Interventions Starting earlier = better outcomes (6-12 years old) School curriculum: –Focused on healthy eating, physical activity, and body image (especially girls) –Improved nutritional quality of foods –Support for teachers/staff to implement health promotion strategies (LEE does this for cultural awareness, why not health?) –Parent support; home activities Waters et al. Cochrane Database Syst Rev 2011

18. Research Evidence Physical Activity and Learning Higher levels of activity during school associated with better academic outcomes “Investment” in more time for play will likely lead to academic payoff More recess and structured play during recess? Fedewa et al Res Quart Ex Sport 2011

19. Making School Less “Obesogenic” Shifting rewards from food-based to activity- based Incentives for eating healthy foods at lunch More time to eat lunch Integrating activity into learning Promotion of healthy foods and activity Using kids as conduits for teaching parents Creating a culture of wellness

20. Realistic Expectations Meta-analyses of school-based interventions report small and inconsistent reduction in BMI Multiple factors at play Targeting only 1 factor is too simplistic (i.e. current debate about high sugar drinks) Focus on small, concrete, achievable behaviors and set goals accordingly