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C5, D5 - Obesity Prevention and Treatment Laura Brey, MS, Training Director lbrey@nasbhc.org 919-866-0920

C5, D5 - Obesity Prevention and Treatment Laura Brey, MS, Training Director lbrey@nasbhc.org 919-866-0920. Ice Breaker. Objectives. Describe the magnitude of the child and adolescent obesity epidemic in the US

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C5, D5 - Obesity Prevention and Treatment Laura Brey, MS, Training Director lbrey@nasbhc.org 919-866-0920

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  1. C5, D5 - Obesity Prevention and Treatment Laura Brey, MS, Training Director lbrey@nasbhc.org 919-866-0920

  2. Ice Breaker

  3. Objectives Describe the magnitude of the child and adolescent obesity epidemic in the US Summarize the national recommendations for child and adolescent prevention, assessment, and intervention Utilize the national resources available to providers for assisting in implementation of the national recommendations and guidelines List the 4 stages of pediatric overweight treatment List for the 4 stages of pediatric blood pressure/ hypertension management Utilize motivational interviewing in the treatment of overweight children and adolescents

  4. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% www.cdc.gov

  5. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) www.cdc.gov No Data <10% 10%–14%

  6. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% www.cdc.gov

  7. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% www.cdc.gov

  8. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% www.cdc.gov

  9. Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% www.cdc.gov

  10. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% www.cdc.gov

  11. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% www.cdc.gov

  12. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov

  13. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov

  14. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov

  15. Obesity Trends* Among U.S. AdultsBRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov

  16. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% www.cdc.gov

  17. Prevalence of At-Risk & Overweight Among Children and Adolescents ≥ 95% ≥ 85% Ogden, et al. (2006). JAMA, 295(13), 1549-1555.

  18. Suicide Risk Actual and perceived overweight is an important risk factor for suicidal behaviors in youth Risk factor for suicidality even after controlling for alcohol and illicit drug use More studies needed to better understand association between perceived and actual overweight and risk for suicide attempts (Swahn, M., Reynolds, M., Tice, M., et. al, Journal of Adolescent Health, 2009.)

  19. Health Risks: Psychosocial Obese children and their parents rate the quality of life as similar to pediatric cancer patients. Schimmer, Burwinkle, & Varni, 2003

  20. Ethnic Disparity: At Risk for Overweight or Overweight 2003-2004 ≥ 85% ≥ 95% Ogden, C et al. (2006). JAMA, 295(13), 1549-1555.

  21. Health Risks of Obesity • Pulmonary • Sleep disorders • Asthma • Obesity-linked hypoventilations • Neurologic • Pseudotumorcerebri

  22. Health Risks of Obesity • Orthopedic • Slipped capital epiphysis • Tibia vara (Blount’s disease) • Tibial torsion • Flat feet • Ankle sprain • Fractures

  23. Health Risks of Obesity • Cardiovascular • Hypertension • Dyslidemia • Fatty deposits • Left ventricular hypertrophy • Other • Systemic inflammation

  24. Health Risks of Obesity • Gastrointestinal • Cholelithiasis • Non-alcoholic fatty liver disease • Gastro-esophageal reflux • Endocrine • Insulin resistance/Type II Diabetes • Acanthosisnigricans • Menstrual abnormalities • Polycystic ovary syndrome • Hypercoricism

  25. Significance of Problem • 80% of obese adolescents will become obese adults

  26. Significance: What about their future? Minino, Arias, Kochanek, Murphy, & Smith 2002 Leading Causes of Death in the US Cause of Death Death rate/100,000 Heart disease 258.2 Cancer 200.9 Cerebrovascular disease 60.9

  27. Economic Consequences • Obesity increased 30% in last 20 years • Medical expenses for obesity = 9.1% of US medical expenditure • Direct and indirect costs in US • $78.5 billion in 1998 • $92.6 billion in 2002 Finkelstein, Fiebelkorn, & Wang(2003). Health Affairs (Millwood).

  28. Etiology: Family Cohort of 854 mostly white subjects followed up to age 21-29 years Odds Ratio Maternal obesity 3.6 (2.1-5.9) Paternal obesity 2.9 (1.7-4.9) Two obese parents 13.6 ( 3.7-50.4) Whitaker, et al.(1997). NEJM, 337(13).

  29. Etiology: Decreased Activity • 29% of US children have daily PE • 50% of 12-21 year olds have no regular physical activity Foster, et al., 2003; Ogden, et al., 2002

  30. Etiology: Portion Size Comparisons Young and Nestle (2002) Am J Public Health. 2(2):246-249.

  31. Etiology Portion Sizes: Paris vs. Philadelphia On average, American portions were 25% larger! Rozin et al., (2003).Physiological Science. 14(5):450-4.

  32. Etiology: Inactivity TV Viewing Predicts Childhood Overweight Gortmaker et al. (1996) Arch PediatrAdolesc Med. 150(4):356-62.

  33. What’s happening in primary care? Goldstein, Dworkin, & Bernstein, 1999 Time for Anticipatory Guidance during WCC Average visit length 17.8 minutes Average time in advisement 2.4 minutes • Nutrition 31.7 seconds • Growth 6.4 seconds • Exercise 1.6 seconds

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