1. Pacific MBA S. Eric Anderson, PhD, MBA Chair, Department of Health Policy & Management Pacific MBA Program Director

2. Pediatric Obesity: What is it and what can we do about it? Kiti Freier Randall, PhD Kim Hamai, MD Loma Linda University Children’s Hospital

3. Pediatric Obesity Prevalence of pediatric overweight/obesity has tripled in the past several decades –Multivariate Problem Physical and psychosocial ramifications are becoming more marked and necessitate societal concern

4. US Epidemic Recent estimates indicate 15% of children ages 6-19 are considered obese Estimated that 25% are overweight Public health crisis with long-lasting medical and psychological implications. – (National Institute of Environmental Health Sciences (NIEHS) Office of Management, 2007)

5. Pandemic Nearly half of the children in North and South America will be overweight by 2010. In the European Union, about 38 percent of all children will be overweight if present trends continue. The percentages of overweight children are expected to increase significantly in the Middle East and Southeast Asia. Mexico, Chile, Brazil and Egypt have rates comparable to fully industrialized nations One in five children in China will be overweight by 2010 –Associated Press 2006

6. Pediatric Obesity: Medical Factors Overweight and Obese –What are they?

7. BMI (body mass index) BMI = wt (kg) = wt (lb) x 703 ht 2 (m2) ht 2 (in2) ->95% for age is obese -85-94% for age is overweight

8. Body Mass Index (BMI Boys 2-20 yrs)

9. Body Mass Index (BMI Girls 2-20 yrs)

10. Obesity evaluation BMI Physical examination Family history Laboratory evaluation

11. Abnormal physical Examination High blood pressure (for age) Acanthosis nigricans Increased waist circumference

12. High-risk Family History Type 2 diabetes Premature cardiovascular disease Hyperlipidemia

13. Laboratory evaluation Fasting blood sugar Fasting lipid panel (total cholesterol, HDL, LDL, TG) Liver enzymes (AST, ALT)

14. Metabolic Syndrome Excess abdominal fat High blood pressure High TG Low HDL High blood sugar

15. Pediatric Obesity: Medical Consequences Diabetes High blood pressure Osteoarthritis High total blood cholesterol Gastroesophageal reflux disease Back pain Increased risk for heart disease

16. Pediatric Obesity: Medical Consequences “This is going to be the first generation that’s going to have a lower life expectancy than their parents” –Associated Press, 2006

17. Pediatric Obesity: Psychological Consequences Depression Lower Self Esteem Behavioral Problems Psychological Distress

18. Pediatric Obesity: Psychological Consequences Suicidal Ideation & Intent

19. Pediatric Obesity: Family Factors Parenting values, beliefs, and practices Family physical activity Family television viewing. Gable and Lutz (2000)

20. Pediatric Obesity: Public Health Consequences Impact on health care systems –Premature illness High risk of obesity into adulthood Younger mortality rates Communities of poor mobility/health Effects on workforce and economics

21. Treatment Works Treatment programs, which encompass the child, the family, and a peer group, have achieved sustainable results. Obesity Prevention Center for Children & Youth

22. Growing Fit Program Pediatric overweight/obesity program 12 week Community-based Multidisciplinary Family-peer approach –Mental Health Screening –Medical Examination & Follow-up –Exercise –Support groups Child Parent –Nutrition education

23. Readiness for Change & Self-Esteem Children who feel more popular (feeling less teased and/or less isolated from peers, etc) showed a greater emotional readiness to change Children who perceived higher intellectual and school status (feeling competent and smart at school) demonstrated a greater cognitive readiness to change

26. Prevention works: What we can do? Monitor advertising Promote physical activity on a global scale Advocate for ‘safe’ outdoor play areas in the community Make healthy foods available to all communities –Educate families on healthy eating –promote healthy eating to dampen demand for junk food Encourage and offer non-sedentary activities TIME IN

27. LLU Children’s Hospital Growing Fit Program Director: Kiti Freier Randall, PhD Medical Director: Kim Hamai, MD Counseling Coordinator: Vidhya Krishnamurthy, PhD Exercise Coordination: LLU Drayson Center Nutrition Coordination: LLU School of Allied Health Professions Nutrition Department