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Overweight Children Prevalence, Problems, and Solutions (?)

Overweight Children Prevalence, Problems, and Solutions (?). David L. Gee, PhD FCSN 547 – Nutrition Update Summer 2004. Assessment of Overweight in Children. 1997 Expert Panel

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Overweight Children Prevalence, Problems, and Solutions (?)

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  1. Overweight ChildrenPrevalence, Problems, and Solutions (?) David L. Gee, PhD FCSN 547 – Nutrition Update Summer 2004

  2. 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

  3. Is a child’s BMI useful in predicting adult obesity?

  4. Prevalence of Overweight Children in the US

  5. Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-2002 A. Hedley et al. JAMA 2004; 291: 2847-2850 (June 16)

  6. Prevalence of OverweightandObesity Among US Children, Adolescents, and Adults, 1999-2002 • NHANES • 1999-2000 • N=4115 adults • N=4018 children • 2001-2002 • N=4390 adults • N=4258 children • Adult prevalence • 65.1% overweight or obese • 30.4% obese • 5.1% extreme obese (BMI>40)

  7. Prevalence of OverweightandObesity Among US Children, Adolescents, and Adults, 1999-2002 • Children 6-19 yrs • 31% at risk for overweight or overweight • 16% overweight • At risk for overweight or overweight • by age • 2-5 = 22.6% • 6-11 = 31.2% • 12-19 = 30.9%

  8. Prevalence of OverweightandObesity Among US Children, Adolescents, and Adults, 1999-2002 • At risk for overweight or overweight • by gender • Boys = 31.8% • Girls = 30.3% • At risk for overweight or overweight • By ethnicity • White = 28.2% (29.2%b, 27%g) • Black = 35.4% (31%b, 40%g) • Mexican-American = 39.9% (42.8%b, 36.6%g)

  9. Type 2 Diabetes in the YoungThe evolving epidemic(review article) Z. Bloomgarden Diabetes Care 2004 (Apr); 27:998-1010

  10. Type 2 Diabetes in the YoungThe evolving epidemicPrevalence • NHANES III (1988-1994) • ~3000 subjects, 12-19 yo • IFG: 17.6 per 1000 • HbA1c>6%: 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?

  11. Type 2 Diabetes in the YoungThe evolving epidemicPrevalence • Sinha et al., NEJM 346:802-810, 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)

  12. Prevalence of T2 diabetes has increased significantly (2-3X) among Indian children in the past 30 years.

  13. Type 2 Diabetes in the YoungThe evolving epidemicPrevalence Trends • 10 fold increase from 1982-1994 in Cincinnati • J. Ped. 128:608-615, 1996 • % of diabetic children w/ T2 increased from 9.4% (1994) to 20% (1998) (Florida) • Pub. Health Rep. 117:373-379, 2002 • ~1/3rd of children w/ diabetes have T2 in OH, AR, CA(Hispanics) • Diabetes Care 22:345-354, 1999

  14. Type 2 Diabetes in the YoungThe evolving epidemicPrevalence • Other factors: • Gender • Girls 1.7 times more likely than boys • Diabetes Care 22:345-354, 1999 • Family History • 2/3rd of children w/ T2DM with at least one parent with T2DM • Diabetes Care 23:381-389, 2000

  15. Type 2 Diabetes in the YoungThe evolving epidemicPrevalence • Other factors (1998 study from India) • Low birthweight • High prepubertal weight

  16. 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)

  17. Obesity and the Metabolic Syndrome in Children and Adolescents R. Weiss et al. NEJM 350:2362-74,2004

  18. 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 < 40 mg/dl • women < 50 mg/dl • Pre-hypertension (>130/>85 mmHg) • Pre-diabetes (> 110 mg/dl)

  19. 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

  20. 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: < 5th pct • Glucose intolerance following OGTT • Insulin resistance = [fasting glu]x[fasting plasma insulin]/22.5

  21. Obesity and the Metabolic Syndrome in Children and AdolescentsAnthropometric & Metabolic Characteristics

  22. Obesity and the Metabolic Syndrome in Children and AdolescentsAnthropometric & Metabolic Characteristics

  23. 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 reported…prevalence increases directly with the degree of obesity.”

  24. Prevalence of metabolic syndrome increases with degree of insulin resistance

  25. Health-Related Quality of Life of Severely Obese Children and Adolescents J. Schwimmer et al JAMA 289:1813-1819 (Apr 9, 2003)

  26. 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-score=2.6) • Compared with 401 healthy and 106 cancer pediatric patients

  27. Obese children and adolescents reported significantly lower health-related QOL in all domains compared with healthy controls.

  28. Obese children were more likely to have impaired health-related QOL than healthy controls and were similar to children and adolescents with cancer.

  29. 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.

  30. Children’s Food Consumption Patterns Have Changed over Two Decades (1973-1994): The Bogalusa Heart Study T. Nicklas et al., JADA 104:1127-1140 (2004)

  31. Children’s 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

  32. Amount of food consumed at schools and restaurants Increased, while the amount consumed in ‘other’ decreased.

  33. The amount of dessert and candy consumed decreased,While the amount of salty snacks increased.

  34. Egg and pork consumption decreased, while consumption of cheese, beef and poultry increased.

  35. Consumption of fats/oils and breads/cereals decreased,while consumption of fruits/juices and mixed meats increased.

  36. Milk consumption decreased while consumption of sweetened beverages increased.

  37. Total consumption and consumption at lunch and dinnerIncreased, while consumption of snacks decreased.

  38. Children’s 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

  39. Children’s 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)

  40. 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)

  41. 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

  42. 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

  43. 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

  44. 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.

  45. 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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