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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
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