Tackling the Childhood Obesity Problem - Adults as Role Models Claudia Raya, RD Massachusetts Department of Education, Nutrition Programs and Services.

Tackling the Childhood Obesity Problem -

Adults as Role Models

Tackling the Childhood Obesity Problem -

Adults as Role Models

Claudia Raya, RDMassachusetts

Department of Education, Nutrition Programs

and Services

Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10

No Data <10% 10%-14% 15-19% 20%

Are we facing a problem with

overweight and obesity in the United States?

4%

7%

11%

13%

15%

5% 5% 5%

11%

14%

16%

4%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

1963-70 1971-74 1976-80 1988-94 1999 2000

Prevalence of overweight among children and adolescents ages 6-

19 years

Notes: Excludes pregnant women starting from 1971-1974. Pregnancy status not available for 1963-65 and 1966-70. Data for 1963-65 are for children 6-11 years of age; data for 1966-70 are for adolescents 12-17 years of age, not 12-19. Source: CDCNHCS, NHES, NHANES.

Age in Years6-11 12-19

Contributing factors to obesity crisis in U.S.

• Environment

• Genetics– metabolism, predisposition

• Diet/Nutrition Intake

• Physical Activity

• Cultural/Psychological

• Toxic Food Environment

Shifts in Food Practices in the United

States• Use of the microwave• Fast food consumption• Consumption of soft drinks -

increased from 27 to 44 gal/y from 1972-92

• 30,000 products in supermarkets (doubled since 1981)

• 12,000 new food products/year (doubled since 1986)

Contributing Environmental Factors

•Environment of “Ease”– cars– decrease in safe walking

paths/sidewalks– drive thru society– remote control– internet/TV

Hypothesized Impact of Television Viewing on

Obesity

ObesityTelevisionViewing

DietaryIntake

Inactivity

Prevalence of Obesity by Hours of TV perDay; NHES Youth Aged 12-17 in 1967-70 and

NLSY Youth Aged 10-15 in 1990

05

10152025

303540

0-1 1-2 2-3 3-4 4-5 5 or more

TV Hours Per Day (Youth Report)

Prevalence (%)

NHES 1967-70

NLSY 1990

Dietz WH, Gortmaker SL.  Do we fatten our children at the tv set?  Obesity and television viewing in children and adolescents. Pediatrics, 1985; 75:807-812.Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Archives of Pediatrics and Adolescent Medicine, 1996;150:356-362.

Consequences of overweight / obesity

crisis in U.S.• Overweight

children will grow into overweight adults

• Medical conditions– chronic

diseases– mental disease

Evaluation Checklist

Adult Risk of Associated Disease According to

BMI

• 25.0 - 29.9 = Overweight

• 30.0 - 34.9 = Obese, High

• 35.0 - 39.9 = Obese, Very High Very High

• 40 or greater= Extremely Obese

Children Risk of Associated Disease According to BMI

BMI-for age at or above the 95th percentile of CDC Growth Charts

BMI for age > 95th = Overweight

BMI for age > 85th and > 95th = At Risk of Overweight

http://www.cdc.gov/nccdphp/dnpa/growthcharts/00binaries/growthchart.pdf

What Do the Numbers Mean?

• Risk of Associated Disease According to BMI and Waist Size

• Risk of death increases as BMI over 30 increases

• Obese adults have a 50 - 100 % increased risk of premature death

• If classified as overweight, losing 5- 10 % of current body weight and keeping it off can begin to alleviate symptoms associated with chronic diseases ( i.e. high blood pressure) and lower risk of developing chronic diseases

Surgeon General asks Communities to Address Obesity, healthlink.mcw.edu/article

Health Implications of Overweight and

Obesity• Increases Risk for

Developing Chronic Diseases– Diabetes– Heart Disease (CVD)– Stroke– High Blood Pressure – Gall bladder disease– Some types of Cancer– Osteoarthritis– Sleep apnea/other

breathing problems

• High blood cholesterol• Complications of

pregnancy• Menstrual

irregularities• Psychological

disorders• Increased surgical risk

Health Care Costs for Overweight/Obese

Children?• Adult diseases are showing up in children

• States and your taxes are paying for their healthcare?– 4 million obese children are recipients of Medicare

Economic Consequences of Overweight and Obesity

• Workplace– absenteeism– lost of

productivity– depression – anxiety– higher healthcare

premiums

• US Govt.,States and YOU are paying for healthcare costs– Total cost as of 1995: $99.2

billionhttp://www.niddk.nih.gov.health.nutrit/pubs/

statobes.htm

Children 6-17 y.o.• 1979-81 $35 million

• 1997-99 $127 million

300 % increase in costs over 20 years.

Wang G and Dietz WH, Pediatrics, 2002, 109 (5)

What Can I Do?

• Look at you own programs• What does your food resemble?

– Are you serving USDA fast food– Is it enough to meet USDA recommended

guidelines?– Evaluate your menu

Surgeon General asks Communities to Address Obesity,healthlink.mcw.edu/article

What Can I Do?

• Look around lunch room?• Do you have vending machines a la carte

sales?– Are they in direct competition with school

meals program?

• Promotions & Fund raisers with food?• What are your school communities’ eating

habits?• Surgeon General asks Communities to Address

Obesity,healthlink.mcw.edu/article

What Can I Do?

• Survey the students, parents, teachers• Invite parents to come eat with kids• Team-up with teachers to encourage

healthy eating and PA• Start exercise program at school• Change perception of obesity to focus

on improved long-term health

Surgeon General asks Communities to Address Obesity ,healthlink.mcw.edu/article

References and Resources

• SHPPS, 2000. Department of Health and Human Services, Center for Disease Control and Prevention. http://www.cdc.gov/shpps.

• Flegal K; Carroll MD; Ogden CL; et al.

Prevalence and Trends in Obesity Among US Adults, 1999-2000. JAMA 2002;288:1723-1727

• The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity

• http://www.doe.mass.edu/cnp• http://www.fns.usda.gov/cnd/Default.htm• http://www.fns.usda.gov/cnd/PowerPanther/

power.panther.htm

Fighting Obesity

with our Forks and our Feet…

Bite by Bite and Step by

Step

Fighting Obesity

with our Forks and our Feet…

Bite by Bite and Step by

Step

Erin Coffield, RD, LDN

Alarming Trends

• Diets are falling short of the mark

• Desirable physical activity levels arenot being met

• Obesity rates are skyrocketing

• Adult diseases are showing up inchildren

Actual Causes of Death in the United States, 1990

Source: McGinnis JM, Foege WH. JAMA 1993;270:2207-12.

400,000

300,000

100,000 90,000

30,000 20,000

0

100,000

200,000

300,000

400,000

500,000

Tobacco Diet/Activity Alcohol Microbialagents

Sexualbehavior

Illicit use ofdrugs

Percent of children, aged 5-10, with 1 or more adverse CVD risk factor levels:

27.1%27.1%

Adverse CVD Risk FactorLevels in Children

Source: Freedman DS et al. Pediatrics 1999; 103:1175-82

Percent of overweight children, aged 5-10,with 1 or more adverse CVD risk factor levels:

60.6%60.6%

Challenges in the Diets of U.S. Children

High intakes – energy – total fat– saturated fat– added

sugars

Low intakes – calcium– fiber– fruits– vegetables– dairy– whole

grains

Munoz et al. Pediatrics 1997;100:323-329.

Percent of Children Meeting Recommended Intakes

Actual: All children 2-19 31.6 Percent

Recommended: 6-11 ServingsSource: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.

Recommended: 3-5 Servings

Actual: All Children 2-19

36.4 Percent

Percent of Children Meeting Recommended Intakes

Source: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.

Actual: All Children 2-19

26.0 Percent

Recommended: 2-4 Servings

Percent of Children Meeting Recommended Intakes

Source: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.

Consumption • Present

– 31% of adults (BRFSS 2000)– 13% of high school students (2001 YRBSS) consume 5

or more servings of fruits and vegetables a day

• Future – National goals

• By 2010, 75% meet recommendations– MA 5 A Day Coalition Vision

• All residents meet recommendations

5 A Day in Massachusetts

Recommended: 2-3 Servings

Actual: All Children 2-19

33.2 Percent

Percent of Children Meeting Recommended Intakes

Source: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.

Mean calcium (mg) intakes ofU.S. children

0

200

400

600

800

1000

1200

1400

3-5 years 6-11 years 12-19 years

MalesFemales

USDA CSFII 1994-96, 1998

1997 DRI

Children’s milk consumption and calcium intake

• Only children who consume milk at the noon-time meal meet their calcium requirements

Johnson et al. Child Nutr and Mngt,1998;2:95-100

Children’s beverage consumption patterns

0

50

100

150

200

250

300

350

Soft Drinks Fluid Milk Fruit Juice Fruit Drink

1977-781994-96

Grams

US Department of Agriculture

Recommended: 5-7 Ounces

Actual: All Children 2-19

28.0 Percent

Percent of Children Meeting Recommended Intakes

Source: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.

On Average, Adolescents Aged 12-17 Get:

*Soft drinks = carbonated beverages, fruit-flavored and part juice drinks, and sports drinksSource: USDA, Continuing Survey of Food Intake by Individuals, 1994-96

15 teaspoons of sugar per day

11% of their calories

from soft drinks*

Child health consequences of Child health consequences of soft drink consumptionsoft drink consumption

• Consumption of sugar-sweetened beverages is associated with childhood obesity*

• For every additional serving of sugar-sweetened drink consumed, the odds of becoming obese increased by 60 percent

* sugar-sweetened beverages defined as soda, Hawaiian punch, lemonade, Kool-Aid or other sweetened fruit drink, iced tea (not artificially sweetened)

Ludwig et al. The Lancet 2001;357:505-508

Nutritional consequences of soft drink consumption

Soft drink intake is associated with:

– higher energy intakes

– lower intakes of vit C, folate, protein, riboflavin, vitamin A, calcium and phosphorus

Harnack et al. JADA 1999;99:436-441

Mean intake of added sugars by U.S. children

0

5

10

15

20

25

30

35

40

2-5 yrs 6-11 yrs 12-17 girls 12-17 boys

tsp. added sugarsrecommended

Guthrie and Morton JADA 2000;100:43-48.

34%

16%19%

11%

9%

4%4% 3%

Soft DrinksSweets/candySweetened grainsFruit drinksMilk productsCerealsOther beveragesOther

Sources of added sugars in the U.S. diet

Guthrie and Morton, JADA 2000;100:43-48.

How to Eat a Healthy Diet

USDA Food Guide Pyramid

The Pyramid -- UnstackedThe Pyramid -- Unstacked

Food Groups & Key Nutrients Unlock the Pyramid

• Grain iron, fiber• Vegetables vit. A, vit. C, fiber• Fruit vit. A, vit. C, fiber• Meat protein, iron• Dairy protein, calcium

• Fats, Sweets and others

USDA Nutrients

• P rotein• I ron• C vitamin• C alcium• A vitamin

• Fat (<30% total fat)– Saturated fat (<10% saturated fat)

Variety

Moderation

Balance

Portions

It Adds UpConsumed twice a week for 36

weeks in addition to the 1/3 RDA

for calories provided by NSLP

½ cup of oven french fries

1 cup of oven french fries

1½ cup of oven french fries

Potential increase in body weight in one school year

2.3 lbs.

4.5 lbs.

7 lbs.

Do You Know Your Portions?

Who wants to

volunteer???

(Energy In) - (Energy Out)

= loss, balance or gain

* Balance exercise with portions

Popular DietsWho do I believe?

NO FAT

NO CARBS

HIGH PROTEIN

NO SUGAR

LOW FAT

HIGH FAT

CABBAGE SOUP DIET

Seriousness of the Issue

• Adverse health consequences• How quickly is weight lost• Will the weight stay off• Motivation and barriers to

losing/maintaining weight

USDA Nutrition Committee is researching the effectiveness of popular diets:

The AHA has declared “war” on fad diets

Red FlagsRecommendations that promise a quick fix.

Dire warnings of danger from a single product or regimen.

Claims that sound too good to be true.

Simplistic conclusions drawn from a complex study.

Recommendations based on a single study.

*Source: Food and Nutrition Science Alliance (FANSA) comprised of the American Dietetic Association, American Institute of Nutrition, American Society for Clinical Nutrition, and the Institute of Food Technologies.

Red Flags (cont.)Dramatic statements that are refuted by reputable scientific organizations.

Lists of “good” and “bad” foods.

Recommendations made to help sell a product.

Recommendations based on studies published without peer review.

Recommendations from studies that ignore differences among individuals or groups.*Source: Food and Nutrition Science Alliance (FANSA) comprised of the American Dietetic Association, American Institute of Nutrition, American Society for Clinical Nutrition, and the Institute of Food Technologies.

Physical Activity

“Late 20th century urban life is a paradise of energy conservation at the level of the individual. People never need to run, they rarely need to walk, and they can often sit.”

Int J Obes 1996; 20:S1-S8

C 2002 Health Management Resources Corporation, Boston, MA

Percentage of Children Involved in Daily Physical Education Programs

0

10

20

30

40

50

60

70

80

1969 1979 1989 1999

C 2002 Health Management Resources Corporation, Boston, MA

We Can Prevent This From Happening!