Nutrition BS911

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NutritionBS911

• The Childhood Obesity Epidemic
• Nutrition for special populations
• Weight regulation, diets and dieting and appetite
• Week 10

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The Female Population - Pregnancy

• Folic acid
• Reduces risk of neural tube defects (NTD)
• 400µg daily supplement plus 200µg from diet
• Fortification of flour

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The Male Population

• Similar micronutrient requirements as women
• Amount differs according to age and gender
• Often found to have low Vitamin B6 and E intake
• CVD - saturated fat

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The Male Population cont

• Men and osteoporosis
• 2 million US males have osteoporosis (National
  Osteoporosis Foundation)
• Risk factors in males
• prolonged use of certain medications
• chronic disease of the kidneys, lungs, stomach
  and intestines
• low levels of testosterone
• lifestyle habits

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Children and Young People

• Diet and academic performance
• The percentage of children and adolescents who
  are overweight has more than doubled in the past
  30 years
• Eating behaviours
• too much fat
• too little fruit and vegetables
• low calcium intake

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The Vegetarian Population

• Approximately 5 of the population do not eat
  meat or fish (British Nutrition Foundation)
• Consideration needs to be given to
• the health implications of vegetarian diets
• the nutritional adequacy of vegetarian diets,
  particularly protein, vitamin B12 and iron
  requirements

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Types of Vegetarian Diet

• Semi/demi vegetarian
• Lacto-ovo-vegetarian
• Lacto-vegetarian
• Vegan
• Fruitarian
• (Zen) Macrobiotic diet

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The Diabetic Athlete

• Diabetes mellitus is a disease of abnormal
  regulation of glucose metabolism, resulting in an
  elevated blood glucose concentration
• Type I (IDDM)
• develops at young age
• risk of hypoglycaemia with high insulin dose
• risk of ketoacidosis with a too low concentration
  of insulin
• insulin dose must be adjusted to exercise
  intensity
• Dietary considerations
• insulin matched to dietary glucose uptake of meal
• exercise duration gt30mins extra glucose required

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Thursday 30th January 2003

• Fast food 'as addictive as heroin'
• Hamburgers and French fries could be as addictive
  as heroin, scientists have claimed.
• Researchers in the United States have found
  evidence to suggest people can become overly
  dependent on the sugar and fat in fast food.

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Weight control strategies

• Dietary treatment
• Exercise and physical activity
• Surgical intervention
• Behavioural management
• Drug therapy

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Exercise in Weight Control

• Exercise
• expends energy
• may suppress appetite
• can counteract the ill effects of obesity
• can improve psychological functioning
• may minimise the loss of LBM
• may counter the metabolic decline produced by
  dieting

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Body Weight and Caloric Intake as a Function of
Physical Activity
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Weight Loss by Diet Alone or Diet With Exercise
INTERVENTION
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Weight Loss and Weight Regain With and Without
Exercise
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Surgical Intervention

• Vertical banded gastroplasty
• Stomach stapling
• Aim is to reduce the size of the stomach
• Gastric bypass
• Aim is to reduce the size of the stomach and
  bypass some of the small intestine to reduce the
  absorption of food

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Behavioural Management
CONTEMPLATION
PREPARATION
ACTION
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New anti-fat drug 'cuts side-effects'

• In clinical trials the drug, known as ATL-962,
  was reported to have 90 less side-effects than
  other anti-obesity drugs.

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Range of Benefits from Weight Loss

• Lower Blood Pressure
• Lowered risk of developing diabetes
• Improve blood glucose and insulin levels in those
  who are already diabetic
• Lower total cholesterol, LDLs, and triglycerides
• Raise blood level of HDLs
• Lessen (or eliminate) the need for
  anti-hypertensive, oral hypoglycemic (or
  insulin), or lipid lowering medications
• Reduce symptoms of arthritis by reducing stress
  on joints

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Nutritional Strategies

• Research
• Agricultural subsidies
• Taxation
• Regulation of food production
• Controls on labelling
• Surveillance of educational material
• Health promotion activities

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The Eating-Right PyramidThe Essentials of Good
Nutrition
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Foods that play a role in diseaseKhaw, K-T, MRC
News, Autumn 1997.
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Regional differences in food consumption 1960(
deviation from average)
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Regional differences in food consumption 1990(
deviation from average)
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Socio-economic differences in food consumption
( deviation from average)
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Energy Intake in the UK 1950-1990
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Secular Trends in Diet and Activity in Relation
to Obesity in Britain
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NHANES III BMI and fatness in relation TV viewing
girls
boys
girls
boys
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32
30
21
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BMI kg/m2
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sum trunk skinfolds, mm
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24
22
20
19
lt2
2-3
gt4
lt2
2-3
gt4
hours of TV watched per day
hours of TV watched per day
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TV Viewing and Obesity
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TV and overweight (adults)
Salmon et al, IJO, 2000
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Nutritional Strategies

• Research
• Agricultural subsidies
• Taxation
• Regulation of food production
• Controls on labelling
• Surveillance of educational material
• Health promotion activities

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We do not eat for today but for the day before
yesterday Edholm, 1977
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Obesity in childrenDenial of weight related
issues

• My girls will never get fat they are like
  beanpoles and can eat anything
• We are all big boned
• He is a bit tubby but he runs around a lot and
  is very healthy
• It is hereditary and there is nothing you can
  do
• I cant stop them eating a pack of chocolate
  biscuits I like them too

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Prevalence of overweight and obesity in children
by sex and age, 2002, England
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Key influences on diet behaviour in children

• Breast feeding
• The foods available
• Childs age, activity and growth rate
• Individual taste preferences
• Parents time constraints
• Where children eat
• Advice from family and friends
• Peer group pressure
• Advertising

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Current issues Obesity27 September 2004

• King size chocolate bars face axe
• The larger Mars and Snickers bars will be among
  those that disappear during the campaign.
• Reducing portion sizes is one of seven pledges in
  the first Manifesto for Food and Health.

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Television advertisementsAverage child in USA
sees over 20000 adverts a year
1 hours TV viewing has more calories, fat, salt
and CHO than a child needs in a whole day!
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Changes in childrens food choices
consuming poor food choices
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Pester power

• 73 of children demand advertised products
• 80 persist with demands when parents say no
• Source CWS Ltd 2000 Blackmail the first in a
  series of inquiries into consumer concerns about
  the ethics of modern food production and
  advertising, CWS Ltd Manchester, Sustain 2000
  Reaching the parts. Community mapping working
  together to tackle social exclusion and food
  poverty. Sustain London.

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Children and advertising
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Children and advertising

• If advertising is not a major influence (as some
  claim), why do food and advertising industries
  get so upset at international suggestions to ban
  it?

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McDonald's denies 'causing children's obesity'

• McDonald's has rejected accusations that its
  cooking fattens America's children.
• The company has told a judge that a lawsuit
  relied on incomplete information and outdated
  material to allege that children were misled by
  advertising.

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Food advertiser's perspective
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Changes needed

• The home
• Set aside time for healthy meals
• Limit television viewing

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Changes needed

• Marketing and media
• Consider a tax on fast food and soft drinks
• Subsidise nutritious foods fruit and vegetables
• Require nutrition labels on fast-food packaging
• Prohibit food advertisement and marketing
  directed at children
• Increase funding for public health campaigns

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Physical activity is

• Sports and organised games
• Playing with the dog
• Climbing trees
• Mowing the lawn
• Housework
• Not using the remote control

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The (possible) causes

• Increased (and increasing) opportunities for
  sedentary recreation
• A television and radio
• Internet use and chat rooms
• Computer games

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The (possible) causes

• Increased and increasing demands for better
  academic performance
• Coaching
• Homework
• Reading
• Computer work (not games)

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The (possible) causes

• Increased car travel and less person powered
  transport
• Increased concerns over child safety stranger
  danger and traffic
• Fewer walkable destinations - shops

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The (possible) causes

• Changes to the urban environment more car and
  less pedestrian friendly
• Higher density living are the needs of young
  people really considered
• Changes in architecture

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The (possible) causes

• Personal injury litigation and reduced
  opportunities for physical activity
• More families with two working parents Go inside
  and lock the door until we get home
• Parents working longer hours too tired or too
  busy to play

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The (possible) causes

• Poor fundamental movement skills as children
  participate less, they fail to develop these
  fundamental skills so want to participate less
• The sedentary cycle

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Changes needed

• Physical activity
• Urban design
• Open spaces
• Pavements
• Bike paths
• Parks
• Playgrounds
• Pedestrian zones

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Changes needed

• Schools
• Fund mandatory PE
• Establish stricter standards for school lunch
  programmes
• Eliminate unhealthy foods such as soft drinks
• Provide concessions on healthy snacks

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Key influences where we can change
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Extra Reading

• ACSM Position Stand. Appropriate Intervention
  Strategies for Weight Loss and Prevention of
  Weight Regain for Adults
• http//www.acsm-msse.org/pt/pt-core/template-jour
  nal/msse/media/1201.pdf
• Andersen, R.E., Exercise, an Active Lifestyle,
  and Obesity. The physician and Sportsmedicine.
  27 (10), October, 1999.(online)

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Extra reading

• Ebbeling. C.B., D.B. Pawlak and D.S. Ludwig.
  Childhood obesity public-health crisis, common
  sense cure. Lancet 360 473-82, 2002.
• Bar-Or, O. Juvenile obesity, physical activity
  and lifestyle changes. The Physician and
  Sportsmedicine. 28 (11), 1999 (online)

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Extra reading

• News briefs. Can school PE make kids fitter?.
  The Physician and Sportsmedicine. 27 (13), 1999
  (online)
• ACSM roundtable discussion
• Bar-Or, O., J. Foreyt and C. Bouchard et al.
  Physical activity, genetic and nutritional
  considerations in childhood weight management.
  Med.Sci. Sports Exerc. 30 (1) 2-10, 1998

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Extra Reading

• New White Paper on public health
• Choosing health making health choices easier
• http//www.dh.gov.uk/PublicationsAndStatistics/Pub
  lications/PublicationsPolicyAndGuidance/Publicatio
  nsPolicyAndGuidanceArticle/fs/en?CONTENT_ID409455
  0chkaN5Cor
• Tackling Obesity
• http//www.nao.gov.uk/publications/nao_reports/00
  -01/0001220.pdf
• Saving Lives Our Healthier Nation, 1999
• http//www.archive.official-documents.co.uk/docum
  ent/cm43/4386/4386.htm