The Burden of Overweight Children and Adolescents in Utah: The Burden of Overweight Children and Adolescents in Utah Do we have the medical, social, and political resolve to control this issue?


The Medical Model: The Medical Model Definitions Pathogenesis Clinical Assessment Management


Definitions: Definitions Overweight – BMI>95% At Risk – 85%30


Pathogenesis: Pathogenesis Genetic Environment Behavioral


Clinical Assessment : 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.


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


Respiratory: Respiratory Sleep apnea Snoring Asthma


Orthopedic: Orthopedic Blount disease Slipped capital femoral epiphysis


Gastrointestinal: Gastrointestinal Gallbladder disease Steatohepatits


Cardiovascular: Cardiovascular Dyslipidemias Hypertension


Endocrine System: Endocrine System Insulin resistance Hyperinsulinism Impaired glucose tolerance Type 2 diabetes Polycystic ovarian syndrome Menstrual irregularity


Psychological: Psychological Depression Eating disorders Social isolation


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


Dietary Modification: 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 specialist’s care


Exercise Regimens: 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


US Expert Committee Barlow & Dietz. Peds 1998: 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


Parenting skills: 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


School-based Approaches: 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?


Medications? : 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


Bariatric Surgery - Last Resort: 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.


Action: 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.


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


Pediatric medicine has had an exemplary history in advocating for children.: Pediatric medicine has had an exemplary history in advocating for children. Immunizations Injury Prevention Fluoridation


Nutrition and Exercisein the educational system: Nutrition and Exercise in 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


Advertising: 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.


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


Recreation: 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


Decrease sedentary behaviors: 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


Slide29: “We live in a world in which we need to share responsibility. It’s easy to say ‘It’s not my child, it’s 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


Slide30: 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.actionforhealthykids.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


Slide31: 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?id=FL00058 National Association of County and City Health 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 through School-Based Efforts www.nga.org/cda/files/022603Preventing.pdf United States Department of Agriculture (USDA) Healthy School Meals Resource System http://schoolmeals.nal.usda.gov