International Perspectives Childh d Ob ion Childhood Obesity

Ian Janssen, Ph.D.School of Kinesiology & Health Studies, and

Department of Community Health & Epidemiology,

Kingston, Ontario, Canada

Outline

1 Definition and Diagnosis of Obesity1. Definition and Diagnosis of Obesity

2 P l f Ob it2. Prevalence of Obesity

3. Prevention & Treatment Strategies

Classification of Overweight and Obesityin Adults According to BMIin Adults According to BMI

Health RiskBMI (kg/m2)

Underweight < 18.5 Increased

N l 18 5 24 9 L tNormal 18.5 – 24.9 Least

Overweight 25.0 – 29.9 Increased

Obese ≥ 30.0 High

Relationship Between BMI andM t lit i WMortality in Women

����� �� ��., � ���� � ��� 1999;341:1097-105

BMI i Child d Ad l t BMI in Children and Adolescents

U.S. Centers for Disease ControlBMI Growth Charts for Girls

33

BMI Growth Charts for Girls

29

31

33

Obese(95th %)

25

27

29

Overweight(85th %)BMI

(k / 2)

21

23

( )(kg/m2)

17

19

152 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

AAge

International Obesity Task ForceBMI Thresholds for ChildrenBMI Thresholds for Children

Boys Girls

30

m2 )

30

25

BM

I (kg

/m 25

Age Age

Source: T Cole et al., BMJ 2000;320:1240-3

Comparison of CDC and IOTFBMI Thresholds for Girls BMI Thresholds for Girls

33IOTF CDC

27

29

31obese

2 )

2325

27overweight

I (kg

/m2

19

21BM

I

15

17

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 182 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Age (years)

Outline

1 Definition and Diagnosis of Obesity1. Definition and Diagnosis of Obesity

2 P l f Ob it2. Prevalence of Obesity

3. Prevention & Treatment Strategies

Secular Changes in the Prevalence of Obesity in American ChildrenObesity in American Children

National Health and Nutrition Examination Surveys

20

2-5 years 6-11 years 12-19 years

14161820

101214

468

024

����� �� ��., ���� 2008;299:2401Ð2405

1971-1974 1976-1980 1988-1994 1999-2002 2003-2006

28%

Regional Variation in the Prevalence of Obesity in American ChildrenObesity in American Children

The National Survey of Children’s Health, 2005

Prevalence of Obesity in 10-17 Year Olds

National Average = 14.8%

State of Louisiana* = 17.2%

*T l h i t i f 2 241 t*Telephone interview of 2,241 parents

How do American children compare?

Prevalence of Overweight (IOTF) in School-Aged Youth in North America in ~2005Aged Youth in North America in 2005

Boys 32%Girls 26%

Boys 35%Girls 36%

Boys31%

GirlsGirls32%

Prevalence of Overweight (IOTF) in Youth from 34 Industrialized Countriesfrom 34 Industrialized Countries

2002 Health Behaviour in School-Aged Children Survey

20

25 U.S.A.

15

20

10

5

0

Malta

U.S.A

.Wales

Greenland

Canada

SpainEnglan

dPortu

galIta

lyGree

ceSco

tland

Slovenia

Finland

Irelan

dHungar

y

Macedon

iaAustri

aNorw

ayCro

atia

um (Fre

nch)

France

DenmarkGerm

any

Sweden

Israe

l

m (Flem

ish)

ch R

epublic

Switzerla

ndPoland

Netherlan

dsEsto

niaUkrai

neLatv

iaRussia

Lithuan

ia

G M

Belgium

BelgiumCze

ch Sw Ne

������� �� ��., ������� ������� 2005;6:123-32

Overweight

no data<10%

OverweightPrevalence

<10%10-14.9%15-19.9%20%20%

������� �� ��., ������� ������� 2005;6:123-32

Prevalence of Overweight (IOTF) inYouth from 41 Industrialized CountriesYouth from 41 Industrialized Countries

2006 Health Behaviour in School-Aged Children Survey

• Average of 41 countries = 13% U it d St t 30%United States = 30%

• American youth were the most overweight and obese

• United States in 2002 = 25% United States in 2006 = 30%

Outline

1 Definition and Diagnosis of Obesity1. Definition and Diagnosis of Obesity

2 P l f Ob it2. Prevalence of Obesity

3. Prevention & Treatment Strategies

ENVIRONMENT

PhysicalActivity OBESITYy

andDiet

OBESITY

Diet

Relation Between Physical Activity and Overweight in Youth from 34 CountriesOverweight in Youth from 34 Countries

1 1

1.05

1.1

ght

0.95

1

r Ove

rwei

0.85

0.9

Rat

io fo

r

0.75

0.8

Odd

s

0.7

Austria

BelgiumCanad

aCro

atiah Repub

licDenmarkEnglan

dEsto

niaFinlan

dFran

ceGerm

any

Greece

Greenland

Hungary

Irelan

dIsr

ael

Italy

Latvia

Lithuan

iaMac

edonia

Malta

etherlan

dsNorw

ayPolandPortu

galRussia

Scotla

ndSloven

iaSpain

Sweden

witzerla

ndUkrai

neted S

tates

Wales

Czech

R D G Gr L Ma

Neth S S

SwitUnite

������� �� ��., ������� ������� 2005;6:123-32

Relation Between T.V. Viewing and Overweight in Youth from 34 CountriesOverweight in Youth from 34 Countries

1 35

1.25

1.3

1.35

ght

1.15

1.2

r Ove

rwei

1

1.05

1.1

Rat

io fo

r

0.9

0.95

1

Odd

s

0.85

Austria

BelgiumCanad

aCro

atiah Repub

licDenmarkEnglan

dEsto

niaFinlan

dFran

ceGerm

any

Greece

Greenland

Hungary

Irelan

dIsr

ael

Italy

Latvia

Lithuan

ia

Macedon

iaMalt

atherl

ands

Norway

PolandPortu

galRussia

Scotla

ndSloven

iaSpain

Sweden

witzerla

ndUkrai

neted S

tates

Wales

Czech

R D G Gr L Ma

Neth S S

SwitUnite

������� �� ��., ������� ������� 2005;6:123-32

ENVIRONMENT

PhysicalActivity Obesityy

andDiet

Obesity

Diet

Association Between Family Affluence and Soft Drink Consumption in

10-15 Year Olds from 41 Countries

NORTHNORTH

SOUTH WEST EAST

Prevalence of Daily Soft Drink Consumption in 10 16 Year Olds from 34 Countries

60

in 10-16 Year Olds from 34 Countries

50U.S.A.

30

40

20

0

10

0

Israe

lSco

tland

Netherlan

dsUSA

Slovenia

ium (Flem

ish)Englan

d

lgium (Fre

nch)

Irelan

dWales

Greenland

Macedon

iaPortu

gal

Switzerla

ndHungar

yCro

atiaGerm

any

SpainFran

ce

zech

Repub

licPoland Ita

lyMalt

aCanad

aRussiaNorw

ayAustri

aGree

ceUkrai

neLatv

iaSwed

enLith

uania

DenmarkEsto

niaFinlan

d

Belgiu

Belg Cze

������� �� ��., ������� ������� 2005;6:123-32

Potential Strategies for Reducing Soft Drink Consumption in SchoolsConsumption in Schools

United States- limit vending machine choices- manipulate pricing in cafeterias and canteens- promote alternative sources (e.g., water)

MexicoMexico- control street venders- increase awarenessc ease a a e ess- provide alternative sources (e.g., bottled water)

Summaryy

1. Childhood obesity is a global pandemic. The United States is leading the way.g y

2. The behavioural determinants of childhood obesity are similar internationally. However, the social and environmental determinants may vary.

3. Priorities and strategies for combating childhood obesity differ considerably acrosschildhood obesity differ considerably across the globe.

In Closing….g

Canada’s 2009 Report CardF grade for physical activityg p y y

Saskatchewan 2009 Report CardSaskatchewan 2009 Report CardF grade for physical activity

South Africa’s 2007 Report CardpC- grade for physical activity

Questions ?Questions ?

Relation Between Computer Use & Overweight in Youth from 34 CountriesOverweight in Youth from 34 Countries

1.2

1.25

1.3

ght

1.1

1.15

1.2

Ove

rwei

g

0 95

1

1.05

Rat

io fo

r

0.85

0.9

0.95

Odd

s R

0.8

Austria

m(Flem

ish)

m(Fre

nch)

Canada

Croatia

h Republic

DenmarkEnglan

dEsto

niaFinlan

dFran

ceGerm

any

Greece

Greenland

Hungary

Israe

lIta

lyLatv

iaLith

uania

Macedon

iaMalt

aetherl

ands

Norway

PolandPortu

galRussia

Scotla

ndSloven

iaSpain

Sweden

witzerla

ndUkrai

neite

d Stat

esWales

Belgium (Belgium

Czech

G L Ma

Net

Sw

Unite

������� �� ��., ������� ������� 2005;6:123-32

World Health OrganizationBMI Growth Standards for ChildrenBMI Growth Standards for Children

http://www.who.int/childgrowth/en/

Longitudinal sample of 8,440 children from 6 countries that describe how children h ldshould grow.

The 8,440 children were raised in environments that promote healthy growth such as breastfeeding, good diets and prevention and control of infections. Their pmothers followed health practices such as not smoking and ensuring adequate healthcare for the childrenhealthcare for the children

World Health OrganizationBMI Growth Standards for Boys (birth 5 years)BMI Growth Standards for Boys (birth – 5 years)