National Epidemic: Childhood Obesity

1. National Epidemic: Childhood Obesity An Overview September 2001 Joan Elledge Assistant Program Coordinator EFNEP/SCNEP Virginia Tech

2. Fat The major nutrition problems in the United States have changed since World War II. The diet related problem of growth retardation has changed to childhood obesity. Increase in consumption of: Decline in consumption of: Milk Calcium Iron

3. BEHAVIORS HAVE CHANGED : Snacking Increase Fruit and Vegetable Intake Physical Activity Decline Decline

4. CVD Diabetes Obesity In the 30 years since WWII chronic conditions have increased and are now being related to consumption patterns. Some Cancers Consumption Osteoporosis

5. Additional Trends Children are: • Skipping breakfast • Eating more food away from home • Consuming more snack foods • Making more decisions about food • Preparing more of what they eat • Consuming more grain based products

6. Sugar Consumption • According to USDA, people who are consuming 2,000 calories a day should eat no more than about 10 teaspoons of added sugar. • But USDA surveys show that the average American is consuming about 20 teaspoons of sugar per day.

7. Chronic Disease • Chronic diseases include the three leading causes of death in the United States--heart disease, cancer, and cerebrovascular--which account for nearly two thirds of all deaths. • Multiple behavioral risk factors such as smoking, poor diet, and lack of exercise often become habitual during youth or early adulthood and contribute to the development of these chronic diseases over long periods of time.

8. Childhood Health Issues Obesity Diabetes Mellitus Cancer Cardiovascular Disease Osteoporosis Food Safety Low Physical Activity

9. Obesity

10. Many obesity problems begin in childhood. Tucker The causes of obesity are those factors that promote energy intake in excess of expenditure or impair the regulation of energy balance. Dietz “The problem of childhood obesity is one we simply cannot ignore”.Agriculture Secretary Dan Glickman

11. Prevalence and Trends • Obesity is the most prevalent and serious nutritional disease in the United States. • From 5% to 25% of children and adolescents may be affected.

12. Prevalence • In the U.S. approximately one child in five is overweight. • The number of overweight children has increased by more that 50% in the last two decades. • The number of extremely overweight children has nearly doubled. Arch Pediatr Adolesc Med. 1995

13. Prevalence cond’t • Over half of US adults are currently overweight (BMI>25) or obese (BMI >30). • 22% of Children and adolescents fit the criteria for overweight (NHANES III) up from 15 since previous survey (NHANEA II).

14. Possible Causes and Effects • Genetic factors • Lifestyle, Inactivity, Cigarette smoking • Television, Computer, and Video Games • High fat Diet • Gender • Age

15. Causes and Factors • Genetics - Children with obese parents or siblings are more likely to be obese themselves, even if they don’t live together. - While genes do play a role in obesity, the recent increase in obesity prevalence cannot be explained on the basis of genetic mutations with in the general population.

16. Causes and Factors cont’d. • Lifestyle- “Energy In” • Between 1977and 1996, daily calories consumed by women increased 7% and calories consumed by men increased 10%. • Data about children’s caloric consumption have some accuracy limitations. • Soft drink and non-citrus juice consumption are at all time highs.

18. Causes and Factors cont’d • Lifestyle –” Energy Out” • The average American child spends almost 24 hours per week watching TV. • NHANES showed a direct relationship between TV-watching time and obesity. • Daily participation in high school physical education classes dropped from 42% in 1991 to 27% in 1997. • About 25% of the trips we make are less than one mile in distance, but we use our cars to make 75% of those trips.

19. Causes and Factors • Inadequate breakfast may contribute to the making of poor food choices over the rest of the day, and, in the long term, to an increased risk of obesity. Ortega RM, et al, Int.Journal of Vitamin Research • Sweets and snack consumption may be responsible for higher prevalence of disease such as dental caries, obesity and obesity-related diseases. Lopez VT, et al, Med Clin June1997

20. Television • TV viewing is a risk factor for developing obesity. • TV viewing creates an occasion to eat (calorie dense foods). • TV viewing should be limited to one hour or less per day for the purposes of good physical fitness.

21. Television cont’d • In a study of 387 children by Bernard-Bonnin: • In 54.5% of cases the TV was on during mealtime. • In 45.2% of cases children watched TV 7-16 hours per week. • Heavy viewers belonged to families with low levels of maternal education. • TV was turned on all day in 16% of cases – mostly in families of low parental education.

22. Television cont’d • Significant associations of the time spent watching television and the prevalence of obesity have been observed. • In 12-17 year-old adolescents the prevalence of obesity increased by 2% for each additional hour of television viewed. Dietz, Gortmaker Pediatrics 1985

23. Kids and Media Kaiser Foundation Report • American children spend the equivalent of a full-time work week using media. • The average child spends about five and a half hours a day using media – more that 38 hours a week. This includes electronic (TV, videos, music, computers and video games) as well as books, magazines and newspapers. It does not include any media used in schools or for homework. • Kids today grow up literally surrounded by media. Kaiser Foundation Report 1999

24. Kids and Media cont’dKaiser Foundation Report • Even the youngest children are widely exposed to media. • Many parents do not appear to exercise much oversight of their children’s media use. • Young people’s media use hits its zenith just as children are making the transition to their teen years. • Despite widespread access, children spend a relatively small amount of time each day using computers. Kaiser Foundation Report 1999

25. Kids and Media cont’dKaiser Foundation Report • Traditional media – especially TV – continue to dominate children’s media use time. • Most kids still read for fun. • Kids use new media to supplement rather that replace other forms of media. • In a possible indication of things to come, most kids say they prefer computers to TV if they’re forced to choose. • Children who spend most time with media are the least contented. Kaiser Foundation Report 1999

26. Kids and Media cont’dKaiser Foundation Report • Children who live in or go to school in lower income communities spend more time with most types of media than kids in wealthier neighborhoods, but are significantly less likely to use computers. • Black and Hispanic children spend significantly more time using media – especially television – than White children. Kaiser Foundation Report 1999

27. Kids and Media cont’dKaiser Foundation Report • Black and Hispanic children have significantly less access to computers than White children, but find a way to spend about as much time on computers as White kids anyway. • Boys and girls spend roughly the same amount of time each day using media, but girls listen to more music and boys watch more TV and play more video games. Kaiser Foundation Report 1999

28. Kids and Media cont’dKaiser Foundation Report • Boys spend a little more time than girls do with computers, mostly playing games. • Whether kids live in rural or urban areas makes very little difference in how much or what kinds of media they use. • Kids in single parent homes watch more TV than those in two-parent homes. Kaiser Foundation Report 1999

29. Food Guide Pyramid Recommended Daily Food Intake

30. 12% Meat 12% Milk 20%Vegetable 13% Fruit 41%Grains Food Guide Pyramid Percent Recommended Food Intake by Food Groups

31. 50.3 % Other 4.5% Milk 1.8% Meat 0% Fruit 0% Veg. 43.4% Grains Percent Food Group Representation During Saturday Morning Commercials

40. Reasons for Concern • Obesity increases the risk of death from hypertension, type II diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems and endometrial, breast, prostate and colon cancers. • Long-term health-related problems for children.

41. Consequences

42. Consequences • Current evidence suggests that overweight children become overweight adults. • Approximately 60% of overweight 5-10 year olds already have one obesity-associated risk factor, like elevated blood pressure or increased insulin levels. • Almost 80% of obese adults have diabetes, high cholesterol, high blood pressure, heart disease, gall bladder disease, or osteoarthritis.

43. Consequences cont’d Because overweight is associated with various risk factors even among young children, it is possible that the successful prevention and treatment of obesity in childhood could reduce the adult incidence of cardiovascular disease. Freedman, DS, Diertz WH, Srinivansan SR, Berenson GS Pediatrics June 1999

44. Consequences of Childhood and Adolescent Obesity • Social burden • Lower self esteem • Poor body image • Cardiovascular risks and other disease risks • Premature death • Economic mobility

45. Parent and Family Influences • Family obesity is a predictor of childhood obesity. • A mothers’ child-feeding practices influence daughters’ eating as early a pre-school. • Mothers may believe it desirable to have heavy babies. • Adults may use food to calm or reward children. • Relationships may affect weight of children. • Intervention recommendation: Treat the parent in order to treat the child.

46. Parental Influences cont’d • Parental obesity and inactivity is associated with lower levels of physical activity in children. • More child activity outdoors is associated with higher levels of physical activity of the parent. • Parents may not follow health professionals recommendations.

47. Parental Influences cont’d • Research supports concept that high soft drink consumption is related to low milk and fruit juice consumption. • Nutrition messages to children and parents should encourage limited consumption of soft drinks. • Policies that limit children’s access to soft drinks at day care centers and schools should be promoted. Harnack L, Stang J, Story M Journal of American Dietetic Association

48. Intervention • Research documents a positive relationship between overweight children and adolescents becoming overweight adults. • Population-based intervention approaches are likely more effective than approaches that target fat children. Power C, Lake JK, Cole TJ International Journal of Obesity Related Metabolism Disorders

49. InterventionA Committee of pediatric obesity experts representing Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Resources and Services recommend: 1. Children of specific high body mass index undergo evaluation and possible treatment. • Certain rare causes and complications of obesity should be ruled out. Barlow SE, Dietz WH Pediatrics 1998

50. Intervention cont’d 3. Recommendations for treatment should include assessment of patient and family readiness to engage in a weight-management program and an assessment of diet and physical activity habits. 4. The primary goal of obesity therapy should be healthy eating and activity. Barlow SE, Dietz WH Pediatrics 1998