Childhood Obesity, Epidemic of the New Millennium Meg Fisher, MD Medical Director, The Children’s Hospital Monmouth Medical Center An affiliate of the.

Childhood Obesity,Epidemic of the New Millennium

Meg Fisher, MDMedical Director,The Children’s Hospital

Monmouth Medical CenterAn affiliate of the Saint Barnabas Health Care System

Long Branch, NJ

Objectives

Following this presentation, the learner will be able to:

1. Calculate and plot the BMI

2. Counsel re: obesity prevention

3. Counsel re: active lifestyles

The Epidemic of Obesity

Read any magazine or medical journal

Weights are rising

Activity is falling

Obesity: DefinitionBody mass index (BMI):

Weight (kg) / Height (m)2

Adult: overweight - BMI 25 to 30; obese – BMI 30 and above

Pediatric: at risk – BMI 85th to 95th %; obese – BMI 95th % and above

Obesity Trends Among U.S. Adults, 1991

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. Adults, 1996

No Data <10% 10%–14% 15%–19%

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

Obesity Trends* Among U.S. Adults, 2001

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

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

Obesity Trends* Among U.S. Adults, 2005(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1995

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1995, 2005

(*BMI 30, or about 30 lbs overweight for 5’4” person)

2005

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

2007

Overweight adults: 60%

Obese children: 15%

New Jersey Sixth Graders: 20%

Why?

Intake exceeds Output

Genetics vs. Environment

Increased InputWorking parents

Out of home eating

Fast foods, soda

Supersized portions

Advertising, television

Decreased Output

Television

Computers

Safety issues

Working parents

Television

Average viewing time of children:

4 hours per day

Half of TV advertisements are for food

77% of children have a TV in their bedroom

SedentaryLess than 30 minutes of moderate activity per day

70% of adults

50% of children

Sedentary death syndrome

Consequences of Obesity

Type 2 diabetes Insulin resistance

Hypertension Hyperlipidemia

Psychosocial Steatohepatitis

Orthopedic Sleep apnea

Respiratory Gallstones

Acanthosis nigricans

Acanthosis nigricans

Obesity: Psychosocial Affects

Discrimination

Low self-esteem

Isolation

Stigmatism

PreventionAlways better and easier than cures

Limit television time

Encourage outdoor play

Encourage breastfeeding

Limit sugar-sweetened soft drinks

Role of Schools:A 2003

Questionnaire

The Group

Child Health Statewide Leadership Council

First meeting July 2002

Mission: advocate for children and families

Threats to Our ChildrenThe epidemic of childhood obesity

Lack of mental health services

Immunizations: access for all children

QuestionnaireDeveloped by consensus

Email very useful for the process

Input from a variety of physicians

Goal was to get information and raise awareness of the issues

ResultsOver 120 returned from over 90 zip codes

More than 200,000 students

Suburban, rural, urban areas

Breakfast rarely provided

Lunch almost always provided

ResultsDieticians and food services decide menu

About half have “special days”

Snack and candy machines in a third

Drink machines in two thirds

Less machines in elementary schools

Results

Snacks available in cafeteria

Chips, cookies, ice cream, pretzels, and popcorn often sold in the cafeteria

Recess occurs daily in grade school

Physical education occurs 1- 5 times/wk

ResultsSports rarely mandated

Physical fitness curriculum

Nutrition is taught to all

Consequences of obesity are discussed

Parental involvement varies

Barriers

Students: taste, habits, food from home

Costs: snack foods make money

Lack of parental support

State and Federal mandates

Food marketing

BarriersSeveral schools felt none existed

Candy and drink machines

Food allergies

Proximity to fast food outlets

Family concern; obesity

What Can Pediatricians Do?

Educate: parents, children, schools

Visit schools, provide speakers

Supply information to schools

Identify and treat overweight children

Advertise health!

NJ Public Health Association

2001 Survey: nutrition, oral health

Sent to school nurses; return rate 49%

Non-nutritive food in 79%

Beverage machines in 56 and 87%

Oral health program in 29%

Report RecommendationsStrengthen laws regarding sale of foods

Develop Healthy People 2010 objectives

Expand programs for healthy eating

such as “Team Nutrition”

Establish an Office of Oral Health

Obesity Prevention Program

Long Branch Early Education

Three and four year olds

Enroll family – family contract

Teachers, nurses, after school, Prevention First, pediatricians, Club Claude

Long Branch Program

Teachers already teach nutrition

School nurses measure BMIs

Activity level is after school increased

Family and child conferences

Visiting pediatricians at after school

Long Branch ProgramContract with the family

Prevention First curriculum:

Healthy life styles

Feeling good about yourself

Making good choices

IncentivesClub Claude, our vegetable eating

labradoodle and his sister

Fruits

Bouncing cows

Jump ropes, bouncing balloon balls

Now What?Change input:

Strive for 5 fruits and vegetables

3-A-Day dairy

Proper portion size

Increase energy expenditure:

Get and keep moving

What Can You Do?Understand importance of lunch and

breakfast choices

Remove soda and non-nutritious snacks

Substitute water and milk beverages

Advocate for a state wide program

Recognize the importance of activity

Your MissionYour mission:

Design a project which will result in increased activity and/or weight loss

among your children and their families

Your have 10 minutes

Projects

PreventionAlways better and easier than cures

Limit television time

Encourage outdoor play

Encourage breastfeeding

Limit sugar-sweetened soft drinks