Overweight Children Prevalence, Problems, and Solutions (?) David L. Gee, PhD FCSN 547 – Nutrition Update Summer 2004.
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Overweight ChildrenPrevalence, Problems, and Solutions
(?)
David L. Gee, PhDFCSN 547 – Nutrition Update
Summer 2004
Assessment of Overweight in Children 1997 Expert Panel
The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services
PEDIATRICS Vol. 102 No. 3 September 1998, p. e29 Recommends that BMI be routinely used to
screen children for overweight Defined
Overweight as a BMI for age over the 95th percentile
Risk for overweight as a BMI for age between the 85th and 95th percentile
Is a child’s BMI useful in predicting adult obesity?
Prevalence of Overweight Children in the US
Prevalence of Overweight and Obesity Among US
Children, Adolescents, and Adults, 1999-2002
A. Hedley et al.JAMA 2004; 291: 2847-2850
(June 16)
Prevalence of Overweight and Obesity Among US Children, Adolescents, and
Adults, 1999-2002
NHANES 1999-2000
N=4115 adults N=4018 children
2001-2002 N=4390 adults N=4258 children
Adult prevalence 65.1% overweight or obese 30.4% obese 5.1% extreme obese (BMI>40)
Prevalence of Overweight and Obesity Among US Children, Adolescents, and
Adults, 1999-2002
Children 6-19 yrs 31% at risk for overweight or overweight 16% overweight
At risk for overweight or overweight by age 2-5 = 22.6% 6-11 = 31.2% 12-19 = 30.9%
Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-2002
At risk for overweight or overweight by gender Boys = 31.8% Girls = 30.3%
At risk for overweight or overweight By ethnicity White = 28.2% (29.2%b, 27%g) Black = 35.4% (31%b, 40%g) Mexican-American = 39.9% (42.8%b, 36.6%g)
Type 2 Diabetes in the Young
The evolving epidemic(review article)
Z. BloomgardenDiabetes Care 2004 (Apr);
27:998-1010
Type 2 Diabetes in the YoungThe evolving epidemic
Prevalence
NHANES III (1988-1994) ~3000 subjects, 12-19 yo IFG: 17.6 per 1000 HbA1c>6%: 3.9 per 1000 Diabetes (all types): 4.1 per 1000 Extrapolate: ~600,000 US adolescents
with some degree of glycemic abnormality
How many with Type 2 diabetes?
Type 2 Diabetes in the YoungThe evolving epidemic
Prevalence
Sinha et al., NEJM 346:802-810, 2002 167 obese adolescents and children 4% prevalence of Type 2 DM
All in Hispanic and black adolescents IGT
16% obese white 27% obese black 26% obese Hispanic
(UK study found risk of Type 2 DM 13.5 times greater in Asian than white children)
Prevalence of T2 diabetes has increased significantly (2-3X)among Indian children in the past 30 years.
Type 2 Diabetes in the YoungThe evolving epidemic
Prevalence Trends
10 fold increase from 1982-1994 in Cincinnati J. Ped. 128:608-615, 1996
% of diabetic children w/ T2 increased from 9.4% (1994) to 20% (1998) (Florida) Pub. Health Rep. 117:373-379, 2002
~1/3rd of children w/ diabetes have T2 in OH, AR, CA(Hispanics) Diabetes Care 22:345-354, 1999
Type 2 Diabetes in the YoungThe evolving epidemic
Prevalence
Other factors: Gender
Girls 1.7 times more likely than boys Diabetes Care 22:345-354, 1999
Family History 2/3rd of children w/ T2DM with at least
one parent with T2DM Diabetes Care 23:381-389, 2000
Type 2 Diabetes in the YoungThe evolving epidemic
Prevalence Other factors (1998 study from India)
Low birthweight High prepubertal weight
Type 2 Diabetes in the YoungThe evolving epidemic
Screening Prevalence of T2DM in young low but
growing Prevalence of overweight growing rapidly Screening of all children not cost effective
~$10,000 per case found (Japan/Taiwan study) ADA/AAP Consensus Position
Diabetes Care 2000 Testing >10yr if BMI > 85th pct with 1o or 2o
relative with DM, at risk ethnic group, or signs of insulin resistance (metabolic syndrome)
Obesity and the Metabolic Syndrome in Children and
Adolescents
R. Weiss et al.NEJM 350:2362-74,2004
Obesity and the Metabolic Syndrome in Children and
Adolescents Metabolic Syndrome
Cluster of metabolic abnormalities associated with insulin resistance
Diagnosis of Metabolic Syndrome in Adults Three or more of the following: Abdominal Obesity
men > 40” waist circumference women > 35” waist circumference
Hypertriglyceridemia (>150 mg/dl) Low HDL
men < 40 mg/dl women < 50 mg/dl
Pre-hypertension (>130/>85 mmHg) Pre-diabetes (> 110 mg/dl)
Obesity and the Metabolic Syndrome in Children and Adolescents
Methods 439 obese children/adolescents 31 overweight siblings 20 non-obese siblings 41% white, 31% black, 27% Hispanic
Administered oral GTT Measured BP, plasma lipids, C-
reactive protein
Obesity and the Metabolic Syndrome in Children and Adolescents
Criteria for Metabolic Syndrome in Children
Obesity (instead of waist circumference) Obese = z-score >2.0 for BMI
Moderate Obese = z-score 2.0-2.5 Severe Obese = z-score > 2.5
Metabolic values TG: > 95th pct HDL-C: < 5th pct Glucose intolerance following OGTT Insulin resistance = [fasting glu]x[fasting plasma
insulin]/22.5
Obesity and the Metabolic Syndrome in Children and Adolescents
Anthropometric & Metabolic Characteristics
Non-obese Overweight
Moderate Obese
Severe Obese
BMI 18.4 24.5 33.4 40.6Glucose(mg/dl,<0.05)
87.4 86.8 90.5 90.2
InsulinuU/ml,<.001
10.3 14.6 31.3 38.6
Insulin resistance<.001
2.2 3.12 7.05 8.69
TriglyceridesMg/dl, <.001
48.4 83.1 104.6 96.5
Obesity and the Metabolic Syndrome in Children and Adolescents
Anthropometric & Metabolic Characteristics
Non-obese Overweight
Moderate Obese
Severe Obese
HDL-CMg/dl,<.001
58.5 46.7 41.1 39.9
LDL-CMg/dl, p=.41
92.2 95.5 98.1 97.3
Systolic BPmmHg,<.001
106 116 121 124
IGT%, .01
0 3.23 14.4 19.9
CRPMg/dl, .001
.01 .05 .13 .33
Obesity and the Metabolic Syndrome in Children and Adolescents
Prevalence
Overall 38.7% in moderately obese 49.7% in severely obese
39% in severely obese blacks
“…metabolic syndrome is far more common among children and adolescents than previously reported…prevalence increases directly with the degree of obesity.”
Prevalence of metabolic syndrome increases with degree of insulin resistance
Health-Related Quality of Life of Severely Obese
Children and Adolescents
J. Schwimmer et alJAMA 289:1813-1819 (Apr 9,
2003)
Health-Related Quality of Life of Severely Obese Children and
Adolescents
Health-related QOL Physical functioning Emotional functioning Social functioning School functioning
106 children & adolescents mean age = 12 yrs (+3) Mean BMI = 34.9 (+9.3) (z-score=2.6) Compared with 401 healthy and 106 cancer
pediatric patients
Obese children and adolescents reported significantly lower health-related QOL in all domains compared with healthy controls.
Obese children were more likely to have impaired health-related QOL than healthy controls and were similar to children and adolescents with cancer.
Health-Related Quality of Life of Severely Obese Children and
AdolescentsConclusions:
Obese children and adolescents reported impairment of total and all domains of QOL Likelihood of impaired QOL was 5.5 times
greater in obese than healthy Obese children and adolescents reported
similar impairment of QOL as in cancer patients undergoing chemotherapy Lower than children with rheumatoid arthritis,
type 1 diabetes, congenital heart disease.
Children’s Food Consumption Patterns Have Changed over Two
Decades (1973-1994): The Bogalusa Heart Study
T. Nicklas et al., JADA 104:1127-1140 (2004)
Children’s Food Consumption Patterns Have Changed over Two Decades (1973-1994): The Bogalusa Heart Study
One 24-hr dietary recall Seven surveys of 10 yr-olds 1584 children surveyed
Amount of food consumed at schools and restaurants
Increased, while the amount consumed in ‘other’ decreased.
Grams of food consumed by source of consumption
0
200
400
600
800
1000
1200
1400
1600
1800
2000
1970 1975 1980 1985 1990 1995
Home
School***
Restaurant***
Other***
Total**
The amount of dessert and candy consumed decreased,While the amount of salty snacks increased.
0
10
20
30
40
50
60
70
80
90
100
Desserts**** Candy**** Condiments**** Salty snacks*** Seafood
gram
s/da
y 1974
1994
Egg and pork consumption decreased, while consumption of cheese, beef and poultry increased.
0
10
20
30
40
50
60
70
80
Egg*** Pork** Cheese**** Beef Poultry****
gram
s pe
r day 1974
1994
Consumption of fats/oils and breads/cereals decreased,while consumption of fruits/juices and mixed meats increased.
0
50
100
150
200
250
Fats/Oils* Fruits/Juices** Veg Bread/Grains* Mixed Meats****
gram
s pe
r day 1974
1994
Milk consumption decreased while consumption of sweetened beverages increased.
0
50
100
150
200
250
300
350
400
450
500
Milk** Sw eet Bev**
gram
s pe
r day 1974
1994
Total consumption and consumption at lunch and dinnerIncreased, while consumption of snacks decreased.
Amount consumed by meal
0
200
400
600
800
1000
1200
1400
1600
1800
Breakfast Lunch**** Dinner**** Snacks**** Total**
gram
s pe
r day 1974
1994
Children’s Food Consumption Patterns Have Changed over Two
Decades (1973-1994): The Bogalusa Heart Study
Findings that may contribute to childhood obesity
More food consumed at restaurants More fruits and fruit juices More cheese, mixed meat, beef, and
poultry More salty snacks More sweetened beverages and less milk More food consumed at lunch and dinner More total food consumed
Children’s Food Consumption Patterns Have Changed over Two
Decades (1973-1994): The Bogalusa Heart Study
Surprising findings Less food consumed at places other
than home, school, restaurants Less fats and oils Less dessert and candy Less food consumed outside of
meals (snacks)
Parent Weight Change as a Predictor of Child Weight Change
in Family-Based Behavioral Obesity Treatment
B. Wrotniak et al.Arch. Pediatr. Adolesc. Med.158: 342-347 (Apr. 2004)
Parent Weight Change as a Predictor of Child Weight Change in Family-Based Behavioral
Obesity Treatment
Family-based behavioral treatment Parenting techniques
Reinforcement Stimulus control Environmental restructuring
Obese parents make similar behavioral changes
Parent Weight Change as a Predictor of Child Weight Change in Family-Based Behavioral Obesity Treatment
Participants 142 obese children (8-12yo) and at
least one parent attended family-based weight control program
2-year study with measurements at 6, 12, and 24 months
Parent Weight Change as a Predictor of Child Weight Change in Family-Based Behavioral Obesity Treatment
Both child and parents lost significant amounts of weight over 6 and 24 months
Parent Weight Change as a Predictor of Child Weight Change in Family-Based Behavioral Obesity Treatment
Parents who lost the most weight had children who lost the most weight.
Parent Weight Change as a Predictor of Child Weight Change in Family-Based Behavioral Obesity Treatment
Conclusions: “Parent z-BMI change was a
significant predictor of child z-BMI change over 6 and 24 months.”
“…youth benefit the most from parents who lose the most weight in family-based behavioral programs.”
“…support the inclusion of parents into family-based programs for their children.”
Reducing children’s television viewing to prevent obesity: A randomized controlled trial.
T. RobinsonJAMA 282:1561-1567 (1999)
Reducing children’s television viewing to prevent obesity: A randomized controlled
trial.
Many observational studies have found associations between television viewing and child/adolescent adiposity.
Reviewed in AAP’s Policy Statement Pediatrics 112:424-430 (2003) 25% children watch >4hrs TV/day BMI of children who watch >4hrs per day
significantly greater than those watching < 2hrs per day
TV in child’s bedroom significant predictor of overweight
Reducing children’s television viewing to prevent obesity: A randomized controlled trial.
192 3rd & 4th grade children in two matched public elementary school
Intervention group 18-lesson, 6-month classroom
curriculum to reduce TV, videotape, and videogame use
Measures at 0 and 8 months
Reducing children’s television viewing to prevent obesity: A randomized controlled trial.
Compared to controls, children in intervention group had statistically significant relative decreases in BMI, TSF, waist circumference, and W/H ratio.
Reducing children’s television viewing to prevent obesity: A randomized controlled trial.
The intervention significantly decrease children’s television viewing and video game use.
Reducing children’s television viewing to prevent obesity: A randomized controlled trial.
However, reducing television viewing did not significantly reduce: Frequency of snacking in front of TV Daily servings of high-fat foods
Or increase Overall physical activity Fitness
“Reducing television… may be a promising, population-based approach to help prevent childhood obesity.”
Useful references American Academy of Pediatrics – Policy
Statement Pediatrics 112:424-430(2003)
Society for Nutrition Education Guidelines for Childhood Obesity Prevention
Programs: Promoting Healthy Weight in Children J. Nutr. Ed. Behav. 35:1-3 (2003)
Childhood and Adolescent Overweight: The Health Professional’s Guide to Identification, Treatment, and Prevention. M Mullen & J Shield ADA 2004
Addressing the issues of childhood and adolescent
obesityJuly 25, Monday class debate
You are either a group of RD’s lobbying in support
for population-based approaches for preventing and treating overweight in children
Nay-sayers who support status quo and believe strongly in personal responsibility and individual freedom
Addressing the issues of childhood and adolescent
obesityJuly 25, Monday class debate
On Thursday, July 22, RD’s must provide a brief list of their proposed population-based approaches to the naysayers.
Debate format 10 minute presentation by RD’s 3-5 minute rebuttal by naysayers 3-5 minute response by RD’s
Addressing the issues of childhood and adolescent
obesityJuly 25, Monday class debate
School Board RDs: DO, AC, ED SQ: NA, KW
Community RDs: KL, CV, LenaG SQ: KD, LK
State/Federal RD’s: NS, LauraG, SL, SC SQ: DK, RS
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