Exercise and obesity in children

Rob Truax, DO

Assistant Professor, Family Medicine

University Hospitals Case Medical Center

What is my biggest health concern???

DECONDITIONINGThe gradual loss of ability to perform activities – from high-caliber activities to the

routine

Why are we talking about “obesity”?

The 4 fundamentals of Health:

Good Nutrition

Good Exercise

Good Sleep

Good Stress Management

Obesity is a disruption of the above fundamentals and, over time, causes severe deconditioning

For Example: There are very few obese individuals who exercise on a daily basis

Routine Physical: “So, Doc. How am I doing?”

What is often meant:

“Doc, do I have any diseases or conditions that will harm me now or in the future?”

Predicting the future is still a work in progress....

Gene and the Genome project – it is an attempt to predict the future

“So Doc, How am I doing?”Here are the things we can address:

Current Medical issues

Family History

Social history (smoking, alcohol, lifestyle)

Vaccinations

Only a few objective data

Blood Pressure

Height/Weight Body Mass Index

Blood Glucose

Cholesterol?

Objective Information at a Physical – the best we have at predicting your health future

Elevated Blood Pressure:

Hypertension, Heart Disease, Kidney Disease, Strokes

Elevated Blood Sugar

Diabetes, vascular disease

Elevated Body Mass Index

Obesity related problems (joint pain, skin damage)

Elevated Blood Pressure

Elevated Blood Sugar

Muscle Deconditioning

Obesity and Body Mass Index (BMI)

Adult BMI – weight/height x height

<20 – malnutrition

20-25 = normal

25 – 30 = overweight

30-35 = obesity

>35 = morbid obesity

Children BMI: age and gender are used to compare

<5% of age/gender – risk of malnutrition

5-85% age/gender – normal

85-95% age/gender – overweight

>95% age/gender - obese

BMI – predicts risk for future illnesses Alex Mack CC SabathiaBoth are at risk for Diabetes

6’4”/311# = 37.9 6’7”/305# = 34.4

LeBron BMI6;8”/250# = 27.5He is soo physically active, he probably is low risk for diabetes and high blood pressure

Fear of child being too thin, under-nourished can lead to over-feeding

Typical adolescent – they are not as active as professional athletes so the BMI is very helpful. But, many parents can state “my child is big-boned.”

That is really not a medical conditioned, being big-boned.

16 year-old girl

5’5’’/134# = (BMI) 22.3, 69%

5’5”/200# = (BMI) 33.3 >95%

For the same 200# girl to have a normal BMI, she would need to be 6’8”!!!

6’8”/200# = 22.0

So, what is the BIG deal about BMI?

BMI is one of the most useful means to PREDICT future health

Those who have elevated BMI have risks of:

Elevated sugars/diabetes

Elevated blood pressure/hypertension

Deconditioning/not exercising

Obesity: complex issue with multiple factors: biological, social, behavioral, environmental, economical

However, the BMI is the most MODIFIABLE risk factor!!!!

What do the experts have to say??

11% of children are obese

25% of children are overweight

American Heart Association: 1/3 of children are overweight/obese, triple from 1963

American Academy of Pediatrics: reducing childhood obesity is one of its top priority

Former Surgeon General Richard Carmona (3/2/2004)

Because of the increasing rates of obesity, unhealthy eating habits and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents.”

Surgeon General Richard Carmona – testimony given to HoR 7/16/2003

In the year 2000, the total annual cost of obesity in the United States was $117 billion. While extra value meals may save us some change at the counter, they’re costing us billions of dollars in health care and lost productivity. Physical inactivity and super-sized meals are leading to a nation of oversized people.

This year, more than 300,000 Americans will die from illnesses related to overweight and obesity.

Obesity contributes to the number-one cause of death in our nation: heart disease.

Excess weight has also led to an increase in the number of people suffering from Type 2 diabetes. There are at least 17 million Americans with diabetes, and another 16 million have pre-diabetes. Each year, diabetes costs America $132 billion. It can lead to eye diseases, cardiovascular problems, kidney failure, and early death.

Obesity

Obese Children are now developing Adult diseases

Elevated Cholesterol in children might now need medication

Elevated blood sugar/Diabetes being diagnosed in children

Juvenile-Onset Diabetes Type 1 diabetes: some adults get this

Adult-Onset Diabetes Type 2 Diabetes: children are now getting it

Mossberg, Lancet – 40-year follow-up of overweight children

Higher-than-expected illness and death in those adolescent who were excessively overweight

Obesity and Exercise

Delany, American Journal of Clinical Nutrition

Studies point to fatness associated with physical activity energy expenditure

Floriani, Current Opinions in Pediatrics,

Physical Activity protected children from accumulating fat

Improves cardiovascular health

Positive effects on behavioral and academic outcome

Exercise in kids – what are the benefits??

Strengthens muscles and bones reduces deconditioning, muscle wasting

Lowers blood pressure reduces heart disease and strokes

Controls sugar and insulin levels reduces diabetes risk

Increases life expectancy

Improves cognitive development

Improves motor skills

Exercise in Kids – how much?

Toddlers 5 years old: 2 hours a day of high activity

Adolescents 60 minutes a day of high activity

CDC:

60 minutes of high intensity of endurance activity every day (4 x 15 min)

Minimum of 3 days/week of muscle-building activity – push-ups, pull-ups

Bone strengthening activity mixed in – jumping rope

What is the purpose of school?

To prepare our kids for success in the future

Intellectually

Socially

Jobs

Physically??

Does a school athletic program equip all the students for a life-time of physical fitness??

Fitness Education is critical to keep our children healthy in the jobs our schools are preparing for them to do.

Thank you

References http://

www.heart.org/HEARTORG/GettingHealthy/HealthierKids/ChildhoodObesity/Overweight-in-Children_UCM_304054_Article.jsp?appName=MobileApp

http://www.cdc.gov/HealthyYouth/obesity/facts.htm

http://www.healthychildren.org/English/health-issues/conditions/obesity/Pages/default.aspx

Lambourne, K and Donnelly. The Role of Physical Activity in Pediatric Obesity. Pediatric Clinics of North America 58 (2011):1481-1491.

Floriani, V and Kennedy, C. Promotion of physical activity in primary care for obesity treatment/prevention in children. Current Opinions in Pediatrics. 2007, 19:99-103.

Mosseberg HO 40-year follow-up of overweight children.Lancet 1989;2:491-3.

Delany J Role of energy expenditure in the development of pediatric obesity American Journal of Clinical Nutrition 1998;68(supplement):950S-5S.