1. Childhood Obesity: Causes, Consequences, and Solutions Relatives As Parents Program Grantees The Brookdale Foundation Jana R. Kicklighter, PhD,RD Associate Professor Division of Nutrition Georgia State University Atlanta, Georgia June 17, 2009

2. Objectives: Participants will…  Describe how to determine a child’s weight status  Identify trends in childhood obesity  Explain the causes and consequences of childhood obesity  Interpret results of a healthy habits quiz  Describe potential solutions to the childhood obesity problem  Identify goals for change to address weight issues in childhood

3. Determination of Healthy Weights for Children  Use Body Mass Index (BMI) as screening tool  Calculated from child’s weight and height  Indicator of body fatness  Use for children 2 years of age and older

4. CDC Growth Chart Example

5. CDC: Weight Definitions for Children based on BMI  >5 th percentile, < 85 th percentile  >85 th percentile, < 94 th percentile  >95 th percentile  Healthy weight  Overweight  Obese

6. Prevalence of Childhood Overweight: National Health and Nutrition Examination Surveys (NHANES) NHANES 1976-1980 NHANES 2003-2004 2-5 year olds5.0%13.9% 6-11 year olds6.5%18.8% 12-19 year olds5.0%17.4%

7. Consequences of Childhood Overweight  Cancer  Heart disease  Stroke  Type 2 diabetes  High blood pressure  High blood cholesterol  Asthma  Bone and joint problems  Fatty liver  Emotional pain  Obese adult

8. Cause of Childhood Obesity Energy Imbalance Food/Beverages Activity Energy Imbalance

9. Socioecological Model  To promote healthy weight incorporate strategies at four levels: Individual: increase individuals’ knowledge and skills Relationships: use family, friends and social networks as positive influences Community: work for positive changes in schools and neighborhoods Societal level: advocate for educational and social policies to support positive changes

10. Factors Contributing to Energy Imbalance and Weight Problems (Last 2-3 Decades)  Heredity: Plays a small role  Way we live, eat and play has changed dramatically: Greater variety of readily available, low cost energy dense foods Larger portion sizes Increase in eating out: fast food More exposure to food and beverage advertisements Increased screen time Decreased physical activity

11. Healthy Habits Quiz Do you and your family… Yes (2 pts) No (0 pt) Some- times (1 pt) Have regularly scheduled meals when you are at home? Eat meals together at least once a day? Plan snacks? Tailor portion sizes to each person’s needs? Plan and prepare meals together once a day? Eat three meals every day? Try to make mealtimes enjoyable?

12. Healthy Habits Quiz (cont) Do you and your family… Yes (2 pts) No (0 pt) Some- times (1 pt) Avoid making everyone eat everything on their plate? Make meals last more than fifteen minutes? Eat only in designated areas of the house? Avoid using food to punish or reward? Enjoy physical activities together once or twice a week? Source: Kosharek SM. If Your Child is Overweight: A Guide for Parents. 3rd ed. Chicago, IL: American Dietetic Association; 2006.

13. Healthy Habits Quiz Scores  Add up total points and interpret as follows: 20-24: Your family is on the right track. 13-19: Your family is doing well but could work on areas where you answered “no” or sometimes.” <12: The next section on solutions should be very helpful as you help your grandchild(ren) toward healthier habits.

14. Solutions: Eat regular meals and increase family meals  Eat meals 3 times/day and only in designated areas  Eat together as a family one time/day  Keep meals simple, easy and nutritious  Get everyone involved in planning, shopping and preparing meals  Make mealtimes relaxed, pleasurable, enjoyable and engaging  Get creative and be flexible: a family meal could be a picnic prior to a sports event

15. Benefits of Family Meals  More healthful diets  Better school performance  Grandparents serve as role models for healthful attitudes toward food and eating  Grandparents can model healthy food habits  Promotes psychological wellness: Lower rates of smoking, drinking and drug use, getting in fights, later initiation of sexual activity

16. Grandparent/Grandchildren Responsibilities  Grandparents are responsible for the what, when and where of feeding Nutritionally and developmentally appropriate foods Opportunity to eat every 2 1/2 – 3 hours Provide support  Grandchildren are responsible for whether, what and how much to eat from those provided Source: Satter E. Secrets of Feeding a Healthy Family. Madison, WI: Kelcy Press; 1999.

18. MyPyramid for Kids: Key Messages Be physically active every day Every color every day:5 different food groups Eat more from some food groups than others Choose healthier foods from each group Take one step at a time and start with small changes

19. Solution: Tips for Healthier Foods  Make half your grains whole  Vary your veggies  Focus on fruits  Get your calcium-rich foods  Go lean with protein  Change your oil  Don’t sugarcoat it  Know your portions

20. Recommended Number of Servings By Age and Sex 2-3 years4-8 years9-13 years Milk/dairy (c)223 Lean meat & beans (oz) 25  Female3  Male4 Fruits (c)11.5 Vegetables (c)1  Female12  Male1.52.5 Grains (oz)3  Female45  Male56

21. 3 Star Meal and Snack Guidelines  Include more than one food group  Limit fat and sugar  Include fruits, vegetables, and foods made with whole grains

22. Solution: Appropriate Portion Sizes ServingWhat it Looks Like Grains (oz)1 slice bread 1 c dry cereal ½ c rice, pasta or cereal Vegetables (cup)½ c chopped 1 c lettuce Fruits (cup)3/4 c juice 1/2 c chopped 1 medium fruit 1/4 c raisins

23. Solution: Appropriate Portion Sizes ServingWhat it Looks Like Milk and Dairy (cup) 1 c milk or yogurt 1 1/2 oz cheese Lean Meat and Beans (oz) 3 oz cooked meat, fish and poultry 2 eggs 1 c cooked dried beans 2 tablespoons peanut butter 1/2 c nuts

24. Solution: Be Aware of Portion Distortion  Portion sizes have increased over past 20 years  Larger portions add up  100 extra calories/day can lead to weight gain of 10 pounds/year  Examples that follow are from the National Heart, Lung and Blood Institute website

25. Portion Distortion: 257 More Calories  20 years ago  333 calories  Today  590 calories

26. Portion Distortion: 350 More Calories  20 years ago  500 calories  Today  850 calories

27. Portion Distortion: 525 More Calories  20 years ago  1 cup spaghetti with sauce; 3 small meatballs;500 calories  Today  2 cups spaghetti with sauce; 3 large meatballs;1,025 calories

28. Portion Distortion: 165 More Calories  20 years ago  6.5 oz; 85 calories  Today  20 oz;250 calories

29. Portion Distortion: 290 More Calories  20 years ago  1.5 oz; 210 calories  Today  4 oz; 500 calories

30. Portion Distortion: 400 More Calories  20 years ago  2.4 oz;210 calories  Today  6.9 oz;610 calories

31. Effect of Eating Out on Children  Consume more: Calories Fat Added sugar Sugar sweetened beverages  Consume fewer: Fruits Non-starchy vegetables  Consume less: Fiber Milk

32. Characteristics of Children’s Meals at Chain Restaurants  Dominated by burgers, chicken nuggets, macaroni & cheese, French fries and soft drinks Most common entrée – fried chicken Most common side order – fries Most popular beverage – soft drinks Source: Wootan MG, Batada A, Marchlewicz E. Kid’s Meals: Obesity on the Menu. Center for Science in the Public Interest. Available at: www.cspinet.org/kidsmeals.www.cspinet.org/kidsmeals

33. Children’s Menu Hall of Shame  Chili’s Country-fried chicken crispers, cinnamon apples & chocolate milk  Chili’s Cheese pizza, homestyle fries & lemonade  KFC Popcorn chicken, baked beans, biscuit, fruit punch & Teddy Grahams  Burger King Double cheeseburger, fries & chocolate milk  Sonic Grilled cheese, fries & slushie  1020 calories  1000 calories  940 calories  910 calories  830 calories

34. Healthier Restaurant Choices  Subway  Chili’s  Arby’s  Ham mini-sub with juice box & apple slices or raisins  Grilled chicken sandwich with apple juice, corn kernels or mandarin oranges or pineapple  Popcorn chicken or Jr. roast beef sandwich with fruit cup and fruit juice

35. Solution: Emphasize Healthy Eating Out  Plan ahead where to go  Look beyond the child’s menu: Consider appetizers, soups, salads and side dishes  Be a good role model  Make portion control a priority: split a sandwich, share an entrée, or take home a doggy bag  Build a healthier food: choose whole wheat bread and lean ham for a sandwich; load up the pizza with veggies and lean meats

36. Solution: Limit Exposure to Advertisements Geared to Children  Typical child watches > 40,000 TV commercials each year  > $12 billion per year is spent on marketing to children  Most heavily advertised: Fast foods Snack foods Highly sugared foods Source: Ritchie LD, Welk G, Styne D, Gerstein DE, Crawford PB. Family environment and pediatric overweight: What is a parent to do? J Am Diet Assoc. 2005; 105: S70-S79.

37. Solution: Decrease Screen Time  Negative effects of TV Snacking on sweets, chips, pizza, fast foods Advertisements encourage unhealthy foods Lower intake of fruits and vegetables Increased inactivity  Limit screen time < 2 hours/day No TV for child < 2 years old Remove TV and computers from bedroom Establish family rules Source: American Academy of Pediatrics

38. Solution: Increase Family Physical Activity  Benefits of physical activity Strengthens bones Decreases blood pressure Relieves stress Increases self-esteem Helps with weight management

39. Physical Activity Recommendations for Children  One hour or more of moderate or vigorous physical activity per day  Examples of moderate activities Hiking; skateboarding; bicycle riding; brisk walking  Examples of vigorous activities Jumping rope; running; soccer; basketball Sources: American Academy of Pediatrics; American Heart Association; Centers for Disease Control and Prevention

40. Tips for Getting the Family more Active  Build into family routines  Focus on fun activities and use them as rewards for good behavior  Encourage children to play outside with other children  Include in daily routines

41. Solution: Identify What to Change How many of these describe your family?  Little physical activity (< 15 minutes/day)?  Snacks frequently on high fat, high calorie foods (chips, cookies, candy, ice cream)?  Does not eat at regular mealtimes?  Skips meals and snacks throughout the day?

42. Solution: Identify What to Change (Cont) How many of these describe your family?  Watches > 2 hours TV/day?  Spends several hours each day playing videogames or using computer?  Snacks while watching TV or playing videogames?  Eats a lot of sugary or fried foods?  Eats fast food more than 1 time/week?  Drinks sweetened beverages daily (soda, juice drinks, fruit juice, sweetened milk drinks)?

43. Identify Specific Behaviors to Change  Examine the behavioral statements answered with a yes  Identify 2-3 behaviors you would like your family to change  Start with those

44. Solution: Identify Barriers to Change and Brainstorm Ways to Overcome  Do barriers include: Lack of skills? Lack of time? Lack of money? Or a combination of these?

45. Solution: How to Change  Make it a family affair  Start with small changes  Write down realistic and measurable goals (2-3)  Make weekly goals and track progress  Don’t expect perfection  Reward with nonfood prizes

46. Solution: Become an Advocate for Community and Societal Change  More sidewalks in neighborhoods  Community gardens and farmers’ markets  “Walking school bus” program  Changes in schools Ban soft drinks and candy sales Teach nutrition Incorporate physical education Teach healthy cooking  Regulate advertising to children  Healthier menu options for kids  Post nutrition information in restaurants

47. In Summary: G - Grandparents can: R – role model good eating habits/attitudes A – arrange for family physical activities N – note the 3 star meal and snack guidelines D – decrease screen time P – plan and prepare regular family meals A – avoid using food to punish or reward R – restrict eating out E – encourage fruits, vegetables & whole grains N – note food label nutrition information T – tailor portion sizes to individual needs S – set realistic and measurable goals

48. Quote Grandparents are a family's greatest treasure, the founders of a loving legacy, The greatest storytellers, the keepers of traditions that linger on in cherished memory. Grandparents are the family's strong foundation. Their very special love sets them apart. Through happiness and sorrow, through their special love and caring, grandparents keep a family close at heart. ~author unknown