Laura Bellows, MPH, RD

1
Child OverweightTodays Public Health Epidemic

• Laura Bellows, MPH, RD
• Dept Food Science Human Nutrition
• Colorado State University
• September 26, 2007

2

• For the first time in this countrys history,
  health experts question if this generation of
  children will be first to lead shorter lives.
• Kelly Brownell, Yale Center for Eating and
  Weight Disorders

3
Prevalence and Trends

• Poor diet and inadequate physical activity are
  the 2nd leading cause of death in the U.S. and
  together account for 300,000 deaths annually.
• 9 million U.S. children are overweight
• Triple the number in 1980
• Overweight in preschoolers has increased 35 in
  last 10 years
• Minority populations are at greatest risk
• No indication that the incidence of overweight in
  children is decreasing.

www.ActionforHealthyKids.org
4
Setting the Stage

• Definition Overweight vs. At Risk for
  Overweight
• Based on CDC gender- and age- specific growth
  charts
• Overweight gt 95
• At risk for overweight gt85 and lt95th
• Healthy People 2010 Goal
• Reduce the proportion of children and adolescents
  who are overweight or obese.
• Target 5

5
Incidence

• Nationally
• School-aged children (6 to 19 years of age)
• 11 of children were overweight in 1990
• 15 in 2000
• Preschool-aged children (2 to 5 years of age)
• 14.8 in 2004
• Colorado
• School-aged 14.8 in 2004
• Preschoolers 9.7 in 2004

CDPHE The Health Status of Colorados Maternal
and Child Health Population WIC data
6
Percent of Overweight Children
Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
7
Percent of Children at risk for Overweight
Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
8
Trends in Childhood Obesity
Trends in Infant and Child Obesity, Boys and
Girls Aged 6 Months Through 5 Years
Institute of Medicine. Preventing Childhood
Obesity Health in the Balance, 2004.
9
Consequences

• Overweight adolescents have a 70 chance of
  becoming overweight adults
• Overweight Preschoolers are 5 times more likely
  to overweight as an adult
• Children born in US in 2000 are more likely to
  develop diabetes
• 31 white girls, 27 white boys
• 49 AA girls, 40 AA boys
• 53 Hispanic girls, 45 Hispanic boys

Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
10
Health Consequences

• Childhood Overweight can lead to
• Blood Pressure
• Cholesterol
• Joint problems
• Type II diabetes
• Gallbladder disease
• Asthma
• Risk for social and emotional difficulties
• Of overweight 5 to 10 year-olds, 61 have at
  least one risk factor for heart disease

www.ActionforHealthyKids.org
11
Psychosocial Consequences

• Childhood overweight is associated with
• lowered self-esteem,
• diminished body image,
• Decreased quality of life,
• Increased symptoms of depression
• Children, as young as 6, describe overweight
  individuals as lazy, lying, cheating, sloppy,
  dirty, ugly, and stupid.
• Overweight children have increased peer
  difficulties teasing and marginalization.

Must et al., Strauss et al., Krishnamoorthy et al.
12
Economic Consequences

• Severely overweight children miss 4x as much
  school as normal-weight kids.
• Cost to avg. size school district 95,000 -
  160,000 annually
• Obesity associated annual hospital costs for
  children increased more than 3-fold over 20
  years.
• From 35 million (1979-80) to 127 million
  (1997-99)
• National health expenditures related to adult
  obesity range from 98-129 billion

www.ActionforHealthyKids.org
13

• School-Aged Children

14

• What are the factors that are influencing
  School-Aged Childrens Eating Habits, Weight
  Status, and Health?

15
Factors that Influence Behavior
Social Ecological Model
16
Individual Factors

• Decrease in ability to self regulate
• Daily caloric intake has increased by 300 kcal
  since 1980
• Todays overweight teenagers consume 700-1000
  additional kcal than what is needed for growth
  and body function
• Increase in Nutritionally Inadequate Foods
• Dietary changes
• Less Dietary Variety
• Decrease in Fruit, Vegetable and
• Whole Grains
• Increase in Sugar
• Increase in Fat
• Decrease In Breakfast

www.HealthyEatingResearch.org
17
Americans Diet
www.USDA.gov
18
Childrens Diets
www.USDA.gov
19
Poor Eating Habits

• Only 2 of school-aged children consume the
  recommended daily number of servings from all 5
  major food groups.
• More than 80 of children and adolescents eat too
  much fat More than 90 eat too much saturated
  fat.
• 98 of 6-18 y.o. report eating at least 3 snacks
  per day, and more than 50 report 5 or more
  snacks daily.

www.ActionforHealthyKids.org
20
The Real Food Guide Pyramid
21
Fruit and Vegetables

• Nationally
• Only 23.6 and 20.3 of females eat 5 or more
  servings
• Between 1978-2001, 50 of HS seniors reported
  eating green vegetables nearly every day or
  more. By 2003, down to 30
• In Colorado
• 37 of children eat 2 or more servings of fruit
  (not including juice)
• 5 eat 3 or more servings of vegetables

Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States CDPHE The Health
Status of Colorados Maternal and Child Health
Population
22
Milk

• Only 30 consume the suggested amount of milk
• 1978 to 2001 consumption decreased by 39 in 6-11
  y.o.
• Fruit juice rose 54
• Carbonated Soda rose 137
• Today Milk and Soda are equally consumed

Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
23
Top 10 Items Consumed (6-19yo)
Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
24
Breakfast

• On the decline in recent decades
• May prevent overeating later in life
• Skipping breakfast consistently associated with
  overweight
• School Performance
• Better attendance
• Better test scores
• Better attention and memory

25
Interpersonal

• Shift in Division of Responsibilities
• Independence
• Traditional Home-Cooked meal a thing of the past
• Busy schedules
• More convenience
• 43 of children eat dinner daily with their
  family
• Family meals Inc. FV consumption, Dec.
  snacking, Improved school-readiness, Dec. risky
  health behaviors

26
Institutional/Organizational (School)

• School Meals / Competition
• Vending
• Classroom
• Physical Education
• After School Programs (or not)

27
Vending

• 43 of elementary schools
• 74 of middle/junior high schools
• 98 of senior high

Wooton, M. SNE 2005 conference
28
Vending Pyramid
Wooton, M. SNE 2005 conference
29
Community (Environment)

• Portion Distortion (1977-1994)
• Caloric Consumption has increased by
• 9 in adolescent boys
• 7 in adolescent girls
• Portion Sizes Increased Calories
• Salty Snacks 132 to 225
• Soft Drinks 144 to 193
• French Fries 188 to 256
• Hamburgers 389 to 486

Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
30
Community/Environment (cont)

• Eating Out
• Spending on fast food increased from 6 billion
  to 110 billion over the last 30 years
• Children (11-18yo) eat at fast food restaurants
  2x per week on average
• Number of fast food outlets
• 1970 30,000
• 1980 140,000
• 2001 222,000

Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
31
Community/Environment (cont)

• Fast Food
• Consume more calories, fat, carbohydrates,
  added sugars and sugar sweetened beverages
• Consume less fiber, milk, fruits, and
  non-starchy vegetable
• On days when kids eat fast food consume 187 more
  calories
• Children eat twice as many
• calories (770) at restaurant
• than at home (420)

Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
32
More FatAnd Sugar

• Burger King
• Whopper w/ Cheese 47 g
• Lg Fry 25 g
• Total Fat 72 g
• Sugar 4g / 1 tsp
• Lg Coke 116 g sugar 29 tsp
• Sm Coke 41 g sugar 10 tsp

33
Sugar for Breakfast

• Dunkin Donut Glazed Coke Donut
• 33g 8 tsp sugar (and 15 g fat 3 tsp)
• Strawberry Passion Awareness Fruitopia (20 oz)
• 71g 18 tsp sugar
• Starbucks Frapacinno
• 51 g 13 tsp sugar (16 g fat 3 tsp)

34
Community/Environment (cont)

• Physical Inactivity
• 92 of elementary schools dont provide daily PA
• 6 out of 10 children 9-13 dont participate in
  any kind of organized sport outside of school
• 25 of high school students participate in at
  least 30 minutes of moderate PA on 5 or more days
  a week.
• Colorado (2004)
• 60 of children aged 5-14 participated in sports
• 17 of children walked to school on regular
  basis 3 biked

Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
35
Community/Environment (cont)

• Screen Time
• Survey of 8-18 year olds showed daily activities
  as
• Watching TV 3hrs 51 min
• Computer 1hr 2 min
• Video Games 49 min
• Reading 43 min
• Typical American child spends 44.5 hrs/wk using
  media outside of school
• 68 of kids have TV in room and 31 have computer
• Kids who have TV and computer in room watch 90
  min and 45 more, respectively, than those who
  dont

Robert Wood Johnson Foundation. A Nation at Risk
Obesity in the United States
36
Policy

• Healthy foods cost more than less healthy,
  high-calorie foods
• School Wellness Policies
• Vending Policies
• Advertising to children
• 97.8 and 89.4 of all food advertisements viewed
  by children 2-11 and adolescents 12-17,
  respectively, were for products high in sugar,
  fat or sodium

Robert Wood Johnson Foundation, News Release
(Powell, L. Pediatrics)
37
Child Nutrition Promotion and School Lunch
Protection Act

• Calls on USDA to update its nutrition standards
  for school foods sold outside of meals to ensure
  that they conform with current nutrition science
  and address pressing threats to child health and
  nutrition at school.
• Applies the new definition to all foods sold
  outside of federally reimbursed school meals
  throughout the school grounds and the school day.

38
What we are up against?
Wooton, M. SNE 2005 conference
39

• Preschoolers

40
Boulder Daily Camera, 12/31/04
41
Food Friends Get Movin with Mighty Moves

• Experimental, Urban Head Start Centers
• RM SER Pueblo Head Start RM SER Western Slope
  Head Start
• Experimental, Rural Head Start Centers
• The Center (Leadville) CDI Head Start (Alamosa)
• Control, Urban Head Start Centers
• Poudre Early Childhood Program (fort Collins) RM
  SER Denver Head Start
• Control, Rural Head Start Centers
• Iliff Head Start Otero Jr. College Child
  Development
• USDA CSREES NRI
• grant 2005-35215-15386

42

• In Conclusion

43
The Numbers

• 20 Minutes
• 75 of children get less than 20 minutes of
  vigorous activity every day.
• 9 Million
• More than 9 million children between the ages of
  6 and 19 are considered overweight
• Tripled
• In the past 20 years the incidence of overweight
  has doubled among children and tripled among
  adolescents

www.ActionforHealthyKids.org
44
The Consequences

• Isolation
• Overweight children are prone to depression and
  isolation from their peers.
• Complications
• Overweight children tend to have at least one
  medical complication like asthma or elevated
  blood pressure.
• Obese Adults
• Nearly 80 of children who are overweight will
  become obese adults.

www.ActionforHealthyKids.org
45
Healthy People 2010

• Goal 1 Increase daily physical activity among
  children and adolescents.
• Goal 2 Reduce the amount of time kids spend
  watching television, video games, and the
  Internet.
• Goal 3 Decrease the consumption of
  energy-dense, high-sugar/high-fat foods like
  soda, ice cream, junk food, and fast food.
• Goal 4 Increase the consumption of nutritious
  foods like fruits, vegetables, whole grains, and
  skim milk.
• Goal 5 Create social, monetary, and
  policy-driven incentives that reinforce long-term
  environmental and behavioral change.

46

• How do we influence childrens eating habits,
  physical activity and health?

47

• One step at a time
• Together as a team
• Education
• Policy
• Child-driven

48

• Questions?
• Comments?

49
Resources

• Action for Healthy Kids
• www.ActionforHealthyKids.org
• Institute of Medicine
• Preventing Childhood Obesity Health in the
  Balance
• www.iom.edu
• Robert Wood Johnson Foundation
• A Nation at Risk Obesity in the United States
• www.rwjf.org
• Healthy Eating Research
• www.healthyeatingresearch.org
• USDA
• www.USDA.gov