Overweight Children Prevalence, Problems, and Solutions

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Overweight ChildrenPrevalence, Problems, and
Solutions (?)

• David L. Gee, PhD
• FCSN 547 Nutrition Update
• Summer 2004

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Assessment of Overweight in Children

• 1997 Expert Panel
• The Maternal and Child Health Bureau, Health
  Resources and Services Administration, the
  Department of Health and Human Services
• PEDIATRICS Vol. 102 No. 3 September 1998, p. e29
• Recommends that BMI be routinely used to screen
  children for overweight
• Defined
• Overweight as a BMI for age over the 95th
  percentile
• Risk for overweight as a BMI for age between the
  85th and 95th percentile

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Is a childs BMI useful in predicting adult
obesity?
Note in 1999-2000, 26 of 20-39 yo were obese.
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Prevalence of Overweight Children in the US
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Prevalence of Overweight and Obesity Among US
Children, Adolescents, and Adults,
1999-20021999-2004

• A. Hedley et al.
• JAMA 2004 291 2847-2850
• C. Ogden et al.
• JAMA 2006 295 1549-1555

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Prevalence of Overweight and Obesity Among US
Children, Adolescents, and Adults,
1999-2002(2003-2004)

• NHANES
• 1999-2000
• N4115 adults
• N4018 children
• 2001-2002
• N4390 adults
• N4258 children
• Adult prevalence
• 65.1 overweight or obese (66.3)
• 30.4 obese (32.2)
• 5.1 extreme obese (BMI40) (4.8)

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Prevalence of Overweight and Obesity Among US
Children, Adolescents, and Adults,
1999-20022003-2004

• Children 6-19 yrs
• 31 at risk for overweight or overweight
• 6-11 37.2 12-19 34.3
• 16 overweight
• At risk for overweight or overweight
• by age
• 2-5 22.6 (26.2)
• 6-11 31.2 (37.2)
• 12-19 30.9 (34.3)

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Prevalence of Overweight and Obesity Among US
Children, Adolescents, and Adults,
1999-20022003-2004

• At risk for overweight or overweight
• by gender
• Boys 31.8 (34.8)
• Girls 30.3 (32.4)
• At risk for overweight or overweight
• By ethnicity
• White 28.2 (29.2b, 27g)
• 33.5, 35.4b, 31.5g
• Black 35.4 (31b, 40g)
• 35.1, 30.4b, 40.0g
• Mexican-American 39.9 (42.8b, 36.6g)
• 37.0, 41.4b, 32.2g

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Type 2 Diabetes in the YoungThe evolving
epidemic(review article)

• Z. Bloomgarden
• Diabetes Care 2004 (Apr) 27998-1010

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Type 2 Diabetes in the YoungThe evolving
epidemicPrevalence

• NHANES III (1988-1994)
• 3000 subjects, 12-19 yo
• IFG 17.6 per 1000
• HbA1c6 3.9 per 1000
• Diabetes (all types) 4.1 per 1000
• Extrapolate 600,000 US adolescents with some
  degree of glycemic abnormality
• How many with Type 2 diabetes?

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Type 2 Diabetes in the YoungThe evolving
epidemicPrevalence

• Sinha et al., NEJM 346802-810, 2002
• 167 obese adolescents and children
• 4 prevalence of Type 2 DM
• All in Hispanic and black adolescents
• IGT
• 16 obese white
• 27 obese black
• 26 obese Hispanic
• (UK study found risk of Type 2 DM 13.5 times
  greater in Asian than white children)

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Prevalence of T2 diabetes has increased
significantly (2-3X) among Indian children in the
past 30 years.
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Type 2 Diabetes in the YoungThe evolving
epidemicPrevalence Trends

• 10 fold increase from 1982-1994 in Cincinnati
• J. Ped. 128608-615, 1996
• of diabetic children w/ T2 increased from 9.4
  (1994) to 20 (1998) (Florida)
• Pub. Health Rep. 117373-379, 2002
• 1/3rd of children w/ diabetes have T2 in OH, AR,
  CA(Hispanics)
• Diabetes Care 22345-354, 1999

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Type 2 Diabetes in the YoungThe evolving
epidemicPrevalence

• Other factors
• Gender
• Girls 1.7 times more likely than boys
• Diabetes Care 22345-354, 1999
• Family History
• 2/3rd of children w/ T2DM with at least one
  parent with T2DM
• Diabetes Care 23381-389, 2000

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Type 2 Diabetes in the YoungThe evolving
epidemicPrevalence

• Other factors (1998 study from India)
• Low birthweight
• High prepubertal weight

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Type 2 Diabetes in the YoungThe evolving
epidemicScreening

• Prevalence of T2DM in young low but growing
• Prevalence of overweight growing rapidly
• Screening of all children not cost effective
• 10,000 per case found (Japan/Taiwan study)
• ADA/AAP Consensus Position
• Diabetes Care 2000
• Testing 10yr if BMI 85th pct with 1o or 2o
  relative with DM, at risk ethnic group, or signs
  of insulin resistance (metabolic syndrome)

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Obesity and the Metabolic Syndrome in Children
and Adolescents

• R. Weiss et al.
• NEJM 3502362-74,2004

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Obesity and the Metabolic Syndrome in Children
and Adolescents

• Metabolic Syndrome
• Cluster of metabolic abnormalities associated
  with insulin resistance
• Diagnosis of Metabolic Syndrome in Adults
• Three or more of the following
• Abdominal Obesity
• men 40 waist circumference
• women 35 waist circumference
• Hypertriglyceridemia (150 mg/dl)
• Low HDL
• men
• women
• Pre-hypertension (130/85 mmHg)
• Pre-diabetes ( 110 mg/dl)

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Obesity and the Metabolic Syndrome in Children
and AdolescentsMethods

• 439 obese children/adolescents
• 31 overweight siblings
• 20 non-obese siblings
• 41 white, 31 black, 27 Hispanic
• Administered oral GTT
• Measured BP, plasma lipids, C-reactive protein

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Obesity and the Metabolic Syndrome in Children
and AdolescentsCriteria for Metabolic Syndrome
in Children

• Obesity (instead of waist circumference)
• Obese z-score 2.0 for BMI
• Moderate Obese z-score 2.0-2.5
• Severe Obese z-score 2.5
• Metabolic values
• TG 95th pct
• HDL-C
• Glucose intolerance following OGTT
• Insulin resistance fasting gluxfasting
  plasma insulin/22.5

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Obesity and the Metabolic Syndrome in Children
and AdolescentsAnthropometric Metabolic
Characteristics
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Obesity and the Metabolic Syndrome in Children
and AdolescentsAnthropometric Metabolic
Characteristics
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Obesity and the Metabolic Syndrome in Children
and AdolescentsPrevalence

• Overall
• 38.7 in moderately obese
• 49.7 in severely obese
• 39 in severely obese blacks
• metabolic syndrome is far more common among
  children and adolescents than previously
  reportedprevalence increases directly with the
  degree of obesity.

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• Prevalence of metabolic syndrome increases with
  degree of insulin resistance

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Health-Related Quality of Life of Severely Obese
Children and Adolescents

• J. Schwimmer et al
• JAMA 2891813-1819 (Apr 9, 2003)

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Health-Related Quality of Life of Severely Obese
Children and Adolescents

• Health-related QOL
• Physical functioning
• Emotional functioning
• Social functioning
• School functioning
• 106 children adolescents
• mean age 12 yrs (3)
• Mean BMI 34.9 (9.3) (z-score2.6)
• Compared with 401 healthy and 106 cancer
  pediatric patients

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Obese children and adolescents reported
significantly lower health-related QOL in all
domains compared with healthy controls.
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Obese children were more likely to have impaired
health-related QOL than healthy controls and were
similar to children and adolescents with cancer.
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Health-Related Quality of Life of Severely Obese
Children and AdolescentsConclusions

• Obese children and adolescents reported
  impairment of total and all domains of QOL
• Likelihood of impaired QOL was 5.5 times greater
  in obese than healthy
• Obese children and adolescents reported similar
  impairment of QOL as in cancer patients
  undergoing chemotherapy
• Lower than children with rheumatoid arthritis,
  type 1 diabetes, congenital heart disease.

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Childrens Food Consumption Patterns Have Changed
over Two Decades (1973-1994) The Bogalusa Heart
Study
T. Nicklas et al., JADA 1041127-1140 (2004)
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Childrens Food Consumption Patterns Have Changed
over Two Decades (1973-1994) The Bogalusa Heart
Study

• One 24-hr dietary recall
• Seven surveys of 10 yr-olds
• 1584 children surveyed

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Amount of food consumed at schools and
restaurants Increased, while the amount consumed
in other decreased.
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The amount of dessert and candy consumed
decreased,While the amount of salty snacks
increased.
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Egg and pork consumption decreased, while
consumption of cheese, beef and poultry increased.
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Consumption of fats/oils and breads/cereals
decreased,while consumption of fruits/juices and
mixed meats increased.
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Milk consumption decreased while consumption of
sweetened beverages increased.
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Total consumption and consumption at lunch and
dinnerIncreased, while consumption of snacks
decreased.
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Childrens Food Consumption Patterns Have Changed
over Two Decades (1973-1994) The Bogalusa Heart
Study

• Findings that may contribute to childhood obesity
• More food consumed at restaurants
• More fruits and fruit juices
• More cheese, mixed meat, beef, and poultry
• More salty snacks
• More sweetened beverages and less milk
• More food consumed at lunch and dinner
• More total food consumed

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Childrens Food Consumption Patterns Have Changed
over Two Decades (1973-1994) The Bogalusa Heart
Study

• Surprising findings
• Less food consumed at places other than home,
  school, restaurants
• Less fats and oils
• Less dessert and candy
• Less food consumed outside of meals (snacks)

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Parent Weight Change as a Predictor of Child
Weight Change in Family-Based Behavioral Obesity
Treatment

• B. Wrotniak et al.
• Arch. Pediatr. Adolesc. Med.
• 158 342-347 (Apr. 2004)

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Parent Weight Change as a Predictor of Child
Weight Change in Family-Based Behavioral Obesity
Treatment

• Family-based behavioral treatment
• Parenting techniques
• Reinforcement
• Stimulus control
• Environmental restructuring
• Obese parents make similar behavioral changes

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Parent Weight Change as a Predictor of Child
Weight Change in Family-Based Behavioral Obesity
Treatment

• Participants
• 142 obese children (8-12yo) and at least one
  parent attended family-based weight control
  program
• 2-year study with measurements at 6, 12, and 24
  months

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Parent Weight Change as a Predictor of Child
Weight Change in Family-Based Behavioral Obesity
Treatment

• Both child and parents lost significant amounts
  of weight over 6 and 24 months

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Parent Weight Change as a Predictor of Child
Weight Change in Family-Based Behavioral Obesity
Treatment

• Parents who lost the most weight had children who
  lost the most weight.

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Parent Weight Change as a Predictor of Child
Weight Change in Family-Based Behavioral Obesity
Treatment

• Conclusions
• Parent z-BMI change was a significant predictor
  of child z-BMI change over 6 and 24 months.
• youth benefit the most from parents who lose
  the most weight in family-based behavioral
  programs.
• support the inclusion of parents into
  family-based programs for their children.

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Reducing childrens television viewing to prevent
obesity A randomized controlled trial.

• T. Robinson
• JAMA 2821561-1567 (1999)

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Reducing childrens television viewing to prevent
obesity A randomized controlled trial.

• Many observational studies have found
  associations between television viewing and
  child/adolescent adiposity.
• Reviewed in AAPs Policy Statement
• Pediatrics 112424-430 (2003)
• 25 children watch 4hrs TV/day
• BMI of children who watch 4hrs per day
  significantly greater than those watching
  per day
• TV in childs bedroom significant predictor of
  overweight

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Reducing childrens television viewing to prevent
obesity A randomized controlled trial.

• 192 3rd 4th grade children in two matched
  public elementary school
• Intervention group
• 18-lesson, 6-month classroom curriculum to reduce
  TV, videotape, and videogame use
• Measures at 0 and 8 months

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Reducing childrens television viewing to prevent
obesity A randomized controlled trial.

• Compared to controls, children in intervention
  group had statistically significant relative
  decreases in BMI, TSF, waist circumference, and
  W/H ratio.

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Reducing childrens television viewing to prevent
obesity A randomized controlled trial.

• The intervention significantly decrease
  childrens television viewing and video game use.

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Reducing childrens television viewing to prevent
obesity A randomized controlled trial.

• However, reducing television viewing did not
  significantly reduce
• Frequency of snacking in front of TV
• Daily servings of high-fat foods
• Or increase
• Overall physical activity
• Fitness
• Reducing television may be a promising,
  population-based approach to help prevent
  childhood obesity.

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Useful references

• American Academy of Pediatrics Policy Statement
• Pediatrics 112424-430(2003)
• Society for Nutrition Education
• Guidelines for Childhood Obesity Prevention
  Programs Promoting Healthy Weight in Children
• J. Nutr. Ed. Behav. 351-3 (2003)
• Childhood and Adolescent Overweight The Health
  Professionals Guide to Identification,
  Treatment, and Prevention.
• M Mullen J Shield
• ADA 2004