What’s Happening to Our Kids?

K. A. Earles, MD., MPH

“My doctor told me to stop

having intimate dinners for 4 unless there were 3 other

people.”• Orson Wells

What is Obesity?What is Obesity? Overweight=

– 85-95% of BMI Obesity=

– Greater than 95% of BMI What is BMI?

– Body Mass Index• Weight in kg/height in

meters 2• Your roundness

Severely obese– >99%

Harvard Medical Study– Healthy BMI & large waist & CAD

International Journal of Obesity– waist to height ratio

The Obesity EpidemicThe Obesity Epidemic

10% kids ages 2-5 15% kids 6-9 15.5 % overall of children

and adolescents 2007 YRBS 13% HS

overweight and 16% obese

32% of children and teens obese or overweight

Most common chronic disease of children

The Saga ContinuesThe Saga Continues

Greater in minority community– Increased by 21% in AA &

Hispanic kids– 12% in Caucasian kids

Greater in economically disadvantaged kids

PedNSS results– low income 2-5 years

• 15% obese vs 12% 7 states w/ highest poverty = top

10 obese sates 9/10 states in south

Greater in southern states– All states >20% EXCEPT

Greatest in states w/ highest % inactivity

U.S. Department of Health and Human Services 2010 Goal is…

The Saga ContinuesThe Saga Continues 20% greater chance

of obese toddler becoming obese adult

80% greater chance of obese adolescent becoming obese adult– obese 10-15 year

old=obese 25 year old– if obese at 8, worse

adulthood obesity Conclusion:

– Older you get, harder it becomes

Good NewsGood News

Pediatric Obesity has peaked!– CDC report

no increase from 2003-04 and 2005-06

Were You Listening?Were You Listening?

All of the following are true except– a. Obesity is

greater in African American children

– b. obesity is greater in economically disenfranchised communities

– c. Obesity is greater in the Hispanic population then in the Caucasian population

– d. The chance of being an obese child is less if your parents are obese

Why?Why?

Genetics Parental behavior Nutrition Sedentary

lifestyle Environment Media Economy

GeneticsGenetics

– Overweight parents have overweight kids

Parental HabitsParental Habits

NutritionNutrition Breast feeding advantages

– breast milk protective– lower insulin– less adipose– lower protein intake

– Dewey study 8/11 studies– Bergman tripled obesity by 6

yrs Higher fat, salt, sugar in foods

– 51% have< 1 fruit /day– 29% < 1 veg/day– 16% less milk– 16% more sodas– Fast food society

50% funds for food Columbia U study

– 500 feet fast food = 5% inc. obesity

Portion distortion & value sizing

Sedentary LifestyleSedentary Lifestyle

Less PE– 54% HS had PE 1x week– 30% daily– Emphasis on test scores

25% HS played video games, computer use, etc >3 hours on school day

35% HS watched > 3 hours TV on school days

EnvironmentEnvironment New community design

– fosters driving No sidewalks Limited parks and

recreation space Lack of affordable indoor

physical activity Security concerns 2003 study

– direct relationship w/ grocery store & USDA guidelines

– additional grocery stores = 32% increase in fruits and vegetables

MediaMedia

More TV=higher BMI Average kid watches 2-3 hours

TV/day AA kids watch more

– AA designed TV with even more overweight and obesity

Main characters are overweight

More commercials with high fat, salt foods– Journal of Law and Economics

article fast food ban advertising = 18%<

overweight 3-11 & 14% < 12-18

EconomyEconomy

Lack of Health insurance for obesity prevention

Value sizing is cheaper

Poorer access in lower income areas

Were You Listening?Were You Listening?

Obesity is defined as– a. Larger than

Naomi Campbell– b. Just plain fat– c. BMI>95%

Were You Listening?Were You Listening?

All of the following contribute to obesity EXCEPT– a. Poverty– b. Sedentary

lifestyle– c. Poor nutrition– d. Triathelon

training

Effects of Obesity on kidsEffects of Obesity on kids

Heart disease– Hypertension (60% obese)– High cholesterol– Greater adult heart attacks, heart failure, angina– Institute of Medicine Study

60% 5-10 w/ 1 CVD risk 25% w/ 2 AAP guidelines

– cholesterol screening at 2• cholesterol, DM, HTN, obesity, Ht disease,

unknown

Cancers in adulthood Other effects arthritis

– sleep problems– asthma– menstrual irregularities– eating disorders– scfe– hepatic steatosis (25-80%)– Pseudotmor Cerebri– Alzheimers

Obesity Review

Diabetes Type IIDiabetes Type II

8-45% of new pediatric diabetics– 94% minority

Complications– Blindness – Foot ulcers-diabetic

neuropathy, amputations

– Diabetic nephropathy– Cardiovascular

disease

Diabetes Today: An EpidemicDiabetes Today: An Epidemic

In 2005, 20.8 million Americans (7% of the population) were diagnosed with diabetes1 – 1.5 million new cases in adults

aged 20 years1

– ~4100 new diagnoses each day2

cases of blindness each year 57 million prediabetics Two million adolescents with

prediabetes Total cost in the United States in

2002: $132 billion1

The majority of patients with diabetes are treated by primary care physicians

Were You Listening?Were You Listening?

Probable causes of obesity include– a. Lack of

physical activity– b. Excessive

intake of foods high in fat

– c. Purposeful inactivity to result in ridicule and rejection

– d. a and b

Emotional EffectEmotional Effect More behavior problems

– School performance– Early sexual initiation

60> anxiety & depression Social stigma and isolation

– More with more weight 40%> being bullied Teens 32% > suicide Overweight kids have poor

self-esteem– Less in AA kids– More in Hispanic & Caucasian

females & males

Copyright ©1998 American Academy of Pediatrics

Barlow, S. E. et al. Pediatrics 1998;102:e29

What To Do?What To Do? Pediatric Obesity Screen

What To Do? What To Do? Weight Loss or NotWeight Loss or Not

Were You Listening?Were You Listening?

Obesity has been linked to– a.

Hyperlipidemia– b. Type 2

diabetes– c.

BMI>95%Prostate cancer

– d. All of the above

What To Do?What To Do? Intervention should begin early The family must be ready for change Educate families about complications of

obesity Involve all caregivers Family should learn to monitor eating and

activity – Parents or caregivers should determine

what food is offered and when, and the child should decide whether to eat

– Model good eating habits and physical activity

Help family make small, gradual changes Encourage not criticize Use a variety of experienced professionals

What To Do? What To Do?

Encourage healthy eating habits– Fruits vegetables

with each meal– Limit fast foods– Avoid promoting

feeling full– Watch portions– Avoid rewards of

candy

Were You Listening?Were You Listening?

Effective parenting skills include– a. Spanking a

child atleast 5 minutes for every pound above 85%BMI

– b. Placing on water only diet

– c. Promoting the master cleanse diet to children

– d. Modeling healthy activity and eating habits

What To Do?What To Do? Physical activity

– 30-60 minutes activity toddler/day

– 60 minutes structured

– No expense needed!

– Organized sports for older kids

– Promote outdoor activity if possible

What To Do?What To Do?

Less sedentary behavior

TURN OFF THE TV! Remove TV in kids

room When TV is a must…

– Avoid fat, salty, sugar snacks

– Limit TV– No TV<2years

SummarySummary Overweight shortens life,

probably on the principle that God summons you after you’ve eaten your share.– Encourage parents to be a role

model– Encourage exercise– Turn off TV– Encourage eating responsibly– EDUCATE, EDUCATE, EDUCATE

“I’ve spent 2 years being politically correct about parents , but it’s time to say if you’re giving your kids fizzy drinks then you’re a total @#$% hole and a loser”.

Jaime Oliver

References upon request