OBESITY FOR THE STATE

CHILDHOOD OBESITY AN EPIDEMIC: 

CHILDHOOD OBESITY AN EPIDEMIC

INCIDENCE OF CHILDHOOD OBESITY IS INCREASING: 

INCIDENCE OF CHILDHOOD OBESITY IS INCREASING

DEFINING OBESITY IN CHILDREN- THE PEDIATRIC BMI CHART: 

DEFINING OBESITY IN CHILDREN- THE PEDIATRIC BMI CHART Obese (andgt;95TH %) At Risk ?

CAUSATIVE FACTORS-EXCLUDING SYNDROMES: 

CAUSATIVE FACTORS-EXCLUDING SYNDROMES PRIMARY Poor food choices Inactivity SECONDARY Psychological Environmental Genetics Fetal environment

CONSEQUENCES: 

CONSEQUENCES The epidemic of obesity is affecting children as young as 2 More overweight children are developing, insulin resistance or metabolic syndrome and type 2 diabetes Sleep apnea, asthma, hypertension, orthopedic problems and others If we do not reverse the trend health costs will be astronomical

EXCESS SUBSTRATE WITHOUT EXCESS EXPENDITURE=LIPOGENESIS : 

EXCESS SUBSTRATE WITHOUT EXCESS EXPENDITURE=LIPOGENESIS

OBESITY A FATAL DISEASE: 

OBESITY A FATAL DISEASE

TREATMENT OF PEDIATRIC OBESITY: 

TREATMENT OF PEDIATRIC OBESITY Nutrition management Physical activity Behavior modification / Counselling Family support

OUR PRACTICE: 

OUR PRACTICE Faculty of the UNSOM Full service cardiology program: Echo Cath Surgery Intervention EP Full-time M.D., MPH research director, extensive data base system Pediatric Risk Factor Reduction Program

CHILDREN’S HEART CENTER - NEVADA: 

CHILDREN’S HEART CENTER - NEVADA 15,000 OUT-PATIENT VISITS/YR 6,000 IN-PATIENT VISITS/YR MORE PATIENT VISITS THAN* -UCLA -UCSF -STANFORD -CHILDREN’S HOSPITAL OF LOS ANGELES -LOMA LINDA -CEDARS SINAI *FROM PUBLISHED DATA AND PERSONAL CONVERSATIONS

OUTLINE OF OUR PROGRAM: 

OUTLINE OF OUR PROGRAM PATIENTS REFERRED BY PRIMARY CARE PROVIDERS Primary care providers without time or staff to treat effectively BMI andgt; 95%ile for age Hypertension with BMI andgt;95%ile Dyslipoproteinemias

OUTLINE OF OUR PROGRAM: 

OUTLINE OF OUR PROGRAM Initial evaluation Laboratory testing Intensive initial nutritional evaluation andamp; recommendations If appropriate exercise program enrollment If indicated family counselling Follow up

LAB TESTS RESULTS IN 410 PATIENTS BMI >95th %tile: 

LAB TESTS RESULTS IN 410 PATIENTS BMI andgt;95th %tile Average age 11.4 years 44% Females 56% males Average BMI 32.5 Total cholesterol 179 ± 45 HDL 42 ± 10 Triglycerides 149 ± 97 Insulin 22 ± 25

CHILD/ADOLESCENT NORMALS: 

CHILD/ADOLESCENT NORMALS Total cholesterol andlt; 170 mg/dl HDL andgt; 45 mg/dl- Probably andgt;50 desirable Triglycerides andlt;125- Probably andlt;100 desirable Insulin level andlt;10 (Dr. Sears andlt;5)

OUTLINE OF OUR PROGRAM: 

OUTLINE OF OUR PROGRAM 12 WEEK INTEGRATED PROGRAM Nutrition counselling Simple psychological evaluation Exercise RX Motivational intervention and family counselling referral if indicated

INTAKE DATA FROM OUR PROGRAM: 

INTAKE DATA FROM OUR PROGRAM 25% Carbs HFCS

MOST IMPORTANT NUTRTION-RECOMMENDED INTAKE: 

MOST IMPORTANT NUTRTION-RECOMMENDED INTAKE

WHO WILL WIN THE BATTLE?: 

WHO WILL WIN THE BATTLE? Soft Drink!? USDA food pyramid

BRIEF PSYCHOLOGIC EVALUATION: 

BRIEF PSYCHOLOGIC EVALUATION Perera self esteem test 16 true or false questions Scored number of 'true answers' Initial and repeated at end of 12 week program

EXERCISE : 

EXERCISE INITIAL EVALUATION Rockport walk test Timed 1 mile walk Score based on time and heart rate Gender and weight Max VO2 estimate andlt;25 Poor, 25-30 Fair, 30-40 Average, 40-50 good, andgt;50 excellent

EXERCISE RX: 

EXERCISE RX AEROBIC Treadmill, bike or walking At home we recommend 30-45 min 3-5x/week Supervised in program 2x per week Our exercise staff tries to achieve 40-70% of VO2 max(estimated)

EXERCISE RX: 

EXERCISE RX ADDITIONAL PROGRAM ACTIVITIES Weights Calisthenics Stretching

PROGRAM MATERIALS: 

PROGRAM MATERIALS Hand outs Homework Off site exercise Behavior modification Positive rewards

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OUR ON SITE EXERCISE FACILITY: 

OUR ON SITE EXERCISE FACILITY

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INITIAL BIOMETRIC & SELF ESTEEM RESULTS FROM THE 12 WEEK PROGRAM: 

INITIAL BIOMETRIC andamp; SELF ESTEEM RESULTS FROM THE 12 WEEK PROGRAM

RESULTS FROM 12 WEEK PROGRAM: 

RESULTS FROM 12 WEEK PROGRAM N=76 Average age 12.5 (7-18) Male 56% Female 44% Reported at Society of Pediatric Research in San Francisco May 2004

RESULTS FROM 12 WEEK PROGRAM N=76: 

RESULTS FROM 12 WEEK PROGRAM N=76 RESTING HR Pre=111 Post=98NS SYSTOLIC BP Pre=123 Post=113* * P andlt;.05

RESULTS FROM 12 WEEK PROGRAM N=76: 

RESULTS FROM 12 WEEK PROGRAM N=76 BMI Pre=33 Post=32* % BODY FAT Pre=40 Post=38* * P andlt;.05

RESULTS FROM 12 WEEK PROGRAM N=76: 

RESULTS FROM 12 WEEK PROGRAM N=76 SELF ESTEEM Pre=10.6 Post=12.4* WALK TEST SCORE Pre=10 Post=27* * P andlt;.05

PARENTAL SURVEYED PHYSICAL ACTIVITY AND NUTRITIONAL CHANGES RESULTS FROM 12 WEEK PROGRAM: 

PARENTAL SURVEYED PHYSICAL ACTIVITY AND NUTRITIONAL CHANGES RESULTS FROM 12 WEEK PROGRAM

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* * * * * P-value andlt; 0.05 TV watching on weekends TV watching on school days Gross Activity Daily Activity

Slide34: 

Breakfast freq. Fruits consump. Vegetables consump. Sodas / Juices * * * * * P-value andlt; 0.05

INSULIN RESISTANCE IN OUR PATIENTS: 

INSULIN RESISTANCE IN OUR PATIENTS

INSULIN RESISTANCE IN OUR PATIENTS: 

INSULIN RESISTANCE IN OUR PATIENTS Quicki (1/log insulin +log glucose)* Glucose/Insulin ratio** Increasing IR with age and with BMI in euglycemic patients with BMIs andgt;95th%ile. Presented at the AHA LJ Filer San Francisco in March *J Clin Endocrinol Metab. 2000 Jul;85(7):2402-10 ** J Clin Endocrinol Metab. 1998;83:2694-2698

INSULIN RESISTANCE: 

INSULIN RESISTANCE N=334 *J Clin Endocrinol Metab. 2002 Jan;87(1):144-7.

QUICKI VS AGE: 

QUICKI VS AGE

GLUCOSE/INSULIN VS AGE: 

GLUCOSE/INSULIN VS AGE

QUICKI VS BMI: 

QUICKI VS BMI

GLUCOSE/INSULIN VS BMI: 

GLUCOSE/INSULIN VS BMI

CURRENT RESEARCH: 

CURRENT RESEARCH Analysis of metabolic abnormalities in our population Biometric, psychological and metabolic abnormalities pre and post treatment intervention Effects of Omega 3 fish oil supplementation effect on eicosanoids and inflammation Vascular reactivity Urinary / salivary inflammatory markers

CURRENT RESEARCH: 

CURRENT RESEARCH Maternal factors on fetal environment Infants born SGA/LGA and relationship to obesity in our population Cardiac function/ LV Hypertrophy/ BNP Measured VO2 studies Possible animal studies

CURRENT RESEARCH: 

CURRENT RESEARCH Long term follow up and longitudinal studies Possible pharmacologic intervention ? Cannabinoid receptor inhibitors ? Surgical intervention