Pediatric Obesity Prevention The Basics

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Pediatric Obesity PreventionThe Basics

• William H. Dietz, M.D., Ph.D.
• Director, Division of Nutrition, Physical
  Activity and Obesity
• Centers for Disease Control and Prevention

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Prevalence () of Obesity in 6-11 yo Children
2003-2006
Ogden CL et al. JAMA 20082992401
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BMI for age gt 95th percentile by race/ethnicity,
boys 2-19 years
SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Health and Nutrition
Examination Survey Ogden et al. 2008
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Odds Ratio of Overweight and Obesity in Children
with Developmental Disorders

• Overweight Obese
• Limitations in PA 2.4 (1.7, 3.4) 2.3 (1.5,
  3.6)
• Special education 1.1 (0.9, 1.4) 1.1 (0.8,
  1.5)
• ADD males 0.8 (0.5, 1.3) 0.7 (0.5, 1.1)
• ADD females 1.4 (0.9, 2.3) 1.5 (0.8, 2.6)
• Learning disability M 1.0 (0.7, 1.4) 1.4
  (0.9, 2.2)
• Learning disability F 1.7 (1.2, 2.4) 1.7
  (1.1, 2.7)
• Bandini LG et al. J Pediatr 2005146738

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Critical Periods in Childhood for the Development
of Persistent Adult Obesity

• Prenatal
• Adiposity rebound?
• Adolescence

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Logistic Regression Model for AdultObesity
Parental Obesity and Age

• Variable Odds Ratio
• Paternal obesity 4.1 (1.5 - 10.8)
• Maternal obesity 3.2 (1.0 - 10.6)
• Rebound
• Middle vs late 3.8 (0.9 - 15.4)
• Early vs late 5.9 (1.5 - 24.3)

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Average Daily Energy Gap (kcal/day)
Behavioral implications of 150 kcal Replacing 1
can of soda (12 oz) with water (140
kcal) Reducing TV watching by an hour (167
kcal/day)1 Walking 1.9 hours instead of sitting
(for a 30-kg boy) Increasing PE from 1 to 3
times/week (240 kcal)
Wang YC et al. Pediatrics 2006118e1721 Wiecha
et al. 2006 Arch Pediatr Adolesc Med 160436
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Principal Targets

• Reduce energy intake
• Decrease high and increase low ED foods
• Increase fruit and vegetable intake
• Reduce sugar-sweetened beverages
• Decrease television time
• Breastfeeding
• Increase energy expenditure
• Increase daily physical activity

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Effects of Fruit and Vegetable Intake on the Odds
Ratios for Development of Obesity or Weight Gain
gt 25 kg over 12 Years

• Quintile 3 Quintile 5
• Fruits 0.22 increase 1.86
  increase
• obesity 0.86 0.75
• wt gain 0.78 0.76
• Vegetables 0.36 increase 2.80 increase
• obesity 0.99 0.84
• wt gain 0.86 0.76
• He et al. Int J Obesity 2004281569 data
  adjusted for age, pa, smoking, and other
  lifestyle variables

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Intake of Vegetables by Breast and Formula Fed
Infants
Sullivan and Birch Pediatrics, 1994 93271
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Number of Vegetable Servings Consumed by PROP
and non-PROP Tasters
Vegetable Intake ( servings)
Black olives, cucumber, red pepper, carrots, and
broccoli Bell KI and Tepper BJ. Am J Clin Nutr
200684245
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Sweetness Preferences (g/100 ml) of
Propylthiouracil (PROP) Tasters

• Sucrose SSB sugar content
• AA (31) 15.5a 9.3a
• AP (48) 21.8b 10.3
• PP (21) 22.0b 11.0b
• Tasters (AP, PP) less likely to include milk or
  water as favorite beverages
• Mennella JA et al. Pediatrics 2005115e216

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Prevalence of Obesity by Hours of TV per Day
NHES Youth Aged 12-17 in 1967-70 and NLSY Youth
Aged 10-15 in 1990
0-1 1-2 2-3 3-4 4-5 gt5
TV Hours Per Day (Youth Report)
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Effect of Reduced Inactivity or Exercise on
Obesity

• Percent
• Overweight
• Change

• Time (months)

• Epstein et al, Health Psychol 1995 14109

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Physical Activity Guidelines for Children and
Adolescents

• 1 hour physical activity daily, preferable
  activities appropriate for age, enjoyable, and
  offer variety
• Moderate- or vigorous-intensity
• Vigorous-intensity, muscle-strengthening, and
  bone-strengthening physical activity 3d/w

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Relationship of Motor Proficiency to PA
Time in Moderate to Vigorous PA
Quartile of Motor Proficiency Score
Wrotniak et al. Pediatrics118e1758, 2006
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Odds Ratios for Obesity at Age 33 Years Based on
Teachers Assessment at age 7
Odds Ratio
Adjusted for social class, maternal age, birth
weight, ethnicity, and BMI Osika W and Montgomery
AM. BMJ 2008337a699
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Additional Targets for Obesity Prevention and
Control in Childhood

• Prenatal tobacco use (Oken et al. Int J Obesity
  200832201)
• Sleep (Chen et al. Obesity 200816265)

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Parenting Styles
Expectations for self control High Low
High Sensitivity
Low Sensitivity
Rhee et al. Pediatrics 20061172047
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Relative Odds of Overweight by Parenting Style

• Parenting style OR (95 CI)
• Authoritarian 4.9 (2.1-11.0)
• Permissive 2.8 (1.1-7.3)
• Neglectful 2.7 (1.1-6.4)
• Rhee et al. Pediatrics 20061172047

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NYCDHMH, Amend Article 47, NYC Health Code
Applies to Group Day Care in NYC

• Television, video and other visual viewing
• Cannot be used for children lt2 yo
• Limited 60 minutes per day of educational
  programs or programs that actively engage child
  movement for children 2 yo
• 60 physical activity required
• Eliminate sugar-sweetened beverages
• Provide 1 or no-fat milk