The Burden of Overweight Children and Adolescents in Utah

1
The Burden of Overweight Children and Adolescents
in Utah

• Do we have the medical, social, and political
  resolve to control this issue?

2
The Medical Model

• Definitions
• Pathogenesis
• Clinical Assessment
• Management

3
Definitions

• Overweight BMI95
• At Risk 85
• Adult obesity is a BMIor30

4
Pathogenesis

• Genetic
• Environment
• Behavioral

5
Clinical Assessment

• Family History obesity, hypertension, thyroid
  disease, atherosclerosis, hyperlipidemia, T2DM,
  and cancers.
  
• Social History composition of the family,
  school attendance, location of meals, organized
  sports, TV/screen time, peer group, depression,
  eating disorder.

6
Physical Examination

• Height/weight/BMI
• Blood pressure
• Sexual Maturity Rating
• Special attention for possible complications
  Respiratory Ortho GI Cardiovascular Endocrine
  Psychological

7
Respiratory

• Sleep apnea
• Snoring
• Asthma

8
Orthopedic

• Blount disease
• Slipped capital femoral epiphysis

9
Gastrointestinal

• Gallbladder disease
• Steatohepatits

10
Cardiovascular

• Dyslipidemias
• Hypertension

11
Endocrine System

• Insulin resistance
• Hyperinsulinism
• Impaired glucose tolerance
• Type 2 diabetes
• Polycystic ovarian syndrome
• Menstrual irregularity

12
Psychological

• Depression
• Eating disorders
• Social isolation

13
Management

• Dietary Modification
• Increase physical activity
• Behavioral modification for the patient and the
  family
  
• Medications?
• Surgery?

14
Dietary Modification

• Options No weight gain as height increases
  Weight
  gain slower than height gain
  
• Rapid weight loss and strict dieting are not
  appropriate for growing children unless under a
  specialists care

15
Exercise Regimens

• Increase calorie expenditure and muscle mass
• Assist in weight control
• One mile (1500 m) walk as a benchmark, gradually
  increasing the distance and speed
  
• A less structured approach may be easier to
  sustain long term and must take into account age
  and development of the child

16
US Expert Committee Barlow Dietz. Peds 1998

• Intervention should begin early
• The family must be ready for change
• The family should learn to monitor eating and
  activity and make small, gradual changes

17
Parenting skills

• Find reasons to praise
• Never use food as a reward
• Establish daily family meal and snack times
• Offer only healthy options
• Be a role model
• Be consistent

18
School-based Approaches

• The school is an appropriate setting for
  prevention!
  
• Healthy diet in school
• Daily physical activity
• Foster emotional and social competence
• Gold medal schools/Presidents Council on Physical
  Fitness
  
• ?BMI report card?

19
Medications?

• Metformin (Glucophage) Inhibits hepatic
  glucose production and is used for the treatment
  of T2DM
  
• Sibutramine Inhibits of the synaptic reuptake of
  norepinephrine, serotonin, and dopamine in order
  to reduce energy intake

20
Bariatric Surgery - Last Resort

• Considered only after other intensive therapies
  have failed and only in the most extreme cases of
  obesity.
  
• Pediatric age patients who undergo bariatric
  procedures trade the disorders associated with
  obesity for life-long medical care for
  nutritional deficiencies but do have large,
  sustained weight reductions.

21
Action

• Negotiate realistic goals and monitoring plans.
  Parents should be involved as much as possible,
  but adolescents may prefer to take responsibility
  for themselves.
• Make small, progressive, sustainable changes in
  eating habits, physical activity and inactivity.

22
Advocacy

• The Big Picture
• What can be done in the community to reduce
  childhood obesity.

23
Pediatric medicine has had an exemplary history
in advocating for children.

• Immunizations
• Injury Prevention
• Fluoridation

24
Nutrition and Exercisein the educational system

• Improve the school lunch (and breakfast)
• Eliminate junk machines from all schools K-12
• Eliminate corporate sponsorship of school events,
  activities, and programs as advertising and a
  form of product branding.
  
• Daily physical activity

25
Advertising

• The AAP considers advertising directly to young
  children to be inherently wrong and exploits
  children under the age of 8 years.
  
• Advertising and promotion of energy-dense,
  nutrient-poor products to children may need to be
  restricted or curtailed.
  
• Prohibition on interactive advertising to
  children in the digital age.

26
Sports

• Encourage aerobic lifestyles
• Encourage the participation of all children
• More unstructured free time (less standing
  around)
  
• Healthy rewards for active kids.

27
Recreation

• Improve sidewalks
• Bike paths clearly marked
• Walk-able cities
• Breathable cities
• Turn golf courses into parks fitness circuits,
  playing fields.
  
• Make sure parks are safe

28
Decrease sedentary behaviors

• Set limits on screen time
• Turn off the TV during dinner
• No TV in the bedroom
• Place the TV out of the way, not center stage
• Keep books, magazines, and games in the TV room
• Unplug the TV for a while

29
We live in a world in which we need to
share responsibility. Its easy to say Its
not my child, its not my community, not
my world, not my problem. Then there
are those who see the need and respond.
I consider those people my heroes.
Mr. Rogers
30
NIHCM The National Institute for Health Care
Management
Childhood Obesity Advancing Effective
Prevention And Treatment An Overview for Health
Professionals
www.nihcm.org
Action for Healthy Kids www.actionforhealth
ykids.org

American Academy of Pediatrics
www.aap.org

American School Food Service Association
www.asfsa.org

Bright Futures in Practice Nutrition and
Physical Activity
www.brightfutures.org
Center for Health and Health Care in Schools
Childhood Obesity What the Research Tells
Us Keeping Kids Healthy Obesity, Nutrition
, and P.E. www.healthinschools.org
31
CDC BAM! Body and Mind www.bam.gov
Maternal and Child Health Library
www.mchlibrary.info/KnowledgePaths
Mayo Clinic Childhood Obesity Parenting
Advice www.mayoclinic.com/invoke.cfm?idF
L00058 National Association of County and City He
alth Officials www.naccho.org/prod148.cfm
National Conference of State Legislatures
www.ncsl.org/programs/health
National Governors Association, Center for Best
Practices The Obesity Epidemic www.nga
.org/cda/files Preventing Obesity in Youth throug
h School-Based Efforts www.nga.org/cda/fil
es/022603Preventing.pdf United States Department
of Agriculture (USDA) Healthy School Meals
Resource System http//schoolmeals.nal.us
da.gov