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Fit not Fat -- Childhood Obesity and the Environment

Fit not Fat -- Childhood Obesity and the Environment. Helen J. Binns, MD, MPH Ann & Robert H. Lurie Children ’ s Hospital of Chicago Feinberg School of Medicine, Northwestern University Sponsored by Region 5, Pediatric Environmental Health Specialty Unit. Disclosure Information.

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Fit not Fat -- Childhood Obesity and the Environment

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  1. Fit not Fat --Childhood Obesity and the Environment Helen J. Binns, MD, MPH Ann & Robert H. Lurie Children’s Hospital of Chicago Feinberg School of Medicine, Northwestern University Sponsored by Region 5, Pediatric Environmental Health Specialty Unit

  2. Disclosure Information This material was supported by the Association of Occupational and Environmental Clinics (AOEC) and funded under the cooperative agreement award number 1U61TS000118-03 from the Agency for Toxic Substances and Disease Registry (ATSDR). Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing funds to ATSDR under Inter-Agency Agreement number DW-75-92301301-0. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications. Dr. Binns has no conflicts of interest to disclose.

  3. Growing Up Healthy

  4. Parent Behaviors Home Environment • Health Habits • Dietary Choices • Exercise • Verbal prompts to child • Parenting Skills • Parental leadership • Parent-child communication • Problem-solving skills • Support for Eating Choices • Support for Activity & Inactivity Child Weight Status Parental Modeling Modeling Child Health Behaviors Adapted from Golan & Weizman JNE 2001

  5. Parents Create a Healthy Home Environment! Be Active Limit Screens Have Routines Healthy Foods Safe Products

  6. Physical Activity Fun • Recommended activity for children is 1 hour daily • Study of children surveyed twice (1 year apart) • For those who increased their activity by 7 hours per week: • Healthy weight children achieved BMI maintenance • OBESE children had BMI fall of -0.2 kg/m2 (gained about 1 less lb than expected) Berkey CS, et al. Pediatrics 2003;111:836-843

  7. Physical Activity Fun •  screen time   physical activity • Screen time contingent upon physical activity • 8 weeks intervention • Reward for activity: 1 hr activity = 1 token =1 hr TV • Follow-up at 16 weeks • Intervention group compared to controls •  activity by 30 minutes/day •  sedentary behaviors by 2 hrs/day •  snacking while watching TV • BMI -0.6 kg/m2 vs.  +0.3 kg/m2 controls Goldfield GS, et al. Pediatrics 2006;118;e157-e166

  8. COUNSELING TIPS:Family Activity • Incorporate activity into your family events • Young children need play partners – that is the parent! • Support your child’s activities • Plan to be active yourself • (30 minutes of jogging = 1 soda)

  9. Home Exercise Program www.chicagochildrensresearch.org/pprg/resources/obesity/ Lisón JF Acad Pediatr 2012; 12:319-325.

  10. Cognitive factors: Conscious rational control Beliefs about the food Advertising Family & Social Influences Satiety/hunger signals: Adipose tissue signals Gut hormones Gastric distension Weight Status Food Content Regulation of Eating Sensory factors: Taste Smell Texture Sight Effects of: Variety Sensory-specific satiety Palatability Food concentration Ready availability Brain mechanisms: Modulate sensory factors by satiety signals to produce reward value and appetite Eating from Rolls ET. Obes Rev 2007;8(suppl 1):67-72

  11. Increase Intake of Fruits and Vegetables

  12. Fruits and Vegetables Low in calories High in fiber – fill you up! Sensory appeal Taste, texture, color Rich in vitamins and minerals, which are needed to fight oxidative stress

  13. Fight Oxidative Stress • 20% of oxygen breaks down to Free Radicals & Reactive Oxygen Species • Stressors can increase that to 80% • UV light • Poor nutrition • Inflammation • Air Pollution • Tobacco • Radiation http://www.smokersrx.com/images/why2.jpg

  14. Fruits and Vegetables • 1/2 cup = 1 serving • Needs for children: • <15% of US children get 5 daily servings! • Adult on a 2000 calorie /day diet • NEED 9 servings/day

  15. The million dollar question… • How do you get kids to eat more vegetables?

  16. First thing: • How are the parents interacting with vegetables? • Are the parents buying vegetables? • Are the parents serving vegetables? • Are the parents eating vegetables? • Children pattern their behavior after their parents

  17. Parental Modeling and Pressure to Eat • 191 families; Girls age 5 yrs • Measures: • F&V servings/day • Girls: 3/day • Parents 2/day • Parental pressure to eat scale • Parents with high F&V intake • had girls with higher levels of F&V intake (about 1 more/day) • Parents with lower F&V intake • had higher levels of pressure to eat • High pressure decreased F&V intake • about 1 less/day, after controlling for parental intake Fisher J et al. J Am Dietetic Assoc 2002;102:58-64

  18. Changing Food Preferences • Intervention study • Children 2-6 yrs • “Tasting” method: • Taste vegetable for 14 consecutive days • Parent taste & provide positive verbal cues • No forcing • Significant increase in liking and consumption after using the method (compared to controls) • Repeated “tasting” can transform dislike into like Wardle J et al. Appetite 2003;40:155-62 Birch LL. Annu Rev Nutr 1999;19:41–62

  19. Positive Messages: Increasing Healthy Eating vs. Reducing High Energy-Dense Foods • Family-based obesity intervention • 13 groups sessions over 5 months • 2 groups • Healthy Eating = more fruit, vegetables, and low-fat dairy • Reducing High Energy-Dense Foods = less high-fat, high-sugar foods • BMI reduction sustained only in Healthy Eating group • BMI of parents in Healthy Eating group improved more, too! Epstein LH, et al. Obesity 2008;16:318-26

  20. Parents set an example! • Buy, cook, serve, and eat more vegetables • To start, double what you’re currently doing • Put vegetables in everything you’re cooking • Bring fruit and vegetable snacks with you • Eat a fruit at every meal and two vegetables at dinner • Learn to like new vegetables

  21. Increase Intake of Whole Grains and Fiber

  22. What are Whole Grains? Whole grain foods contain all the grain layers, including: Bran (outer layer, contains seed fiber) Endosperm or Kernel (contains vitamins and minerals) Germ (concentrated source of nutrients)

  23. What is Fiber? A group of compounds including lignin (plant cell walls) and complex carbohydrates that cannot be digested by human enzymes in the small intestine

  24. Fiber: Health benefits Increases satiety (the feeling of fullness) Helps prevent constipation (increases fecal bulk) Lower cholesterol absorption and LDL synthesis  5-10 g/day reduces LDL cholesterol by about 5% ↓ serum triglycerides ↓ cholesterol synthesis May decrease insulin resistance Additional 5 g fiber/day→ 10% ↓ in belly fat deposition* May help reduce weight gain Higher fiber inversely associated with BMI in major observational studies Role of fiber in weight control is not yet clear *Ventura E, et al. Arch Pediatr Adolesc Med 2009;163:320–7

  25. Dietary Fiber: HOW MUCH? • How many grams of fiber do children need? • US adults typically get 14-15 g fiber/day • Children: Note: 14 g fiber / 1000 calories Saldanha et al, Pediatrics 1995;96:994-7

  26. Dietary Fiber: Contrasting Foods

  27. Read It Before You Eat It! • Read the food label • Look for High Fiber and Whole Grain •  5 g fiber/serving is HIGH for cereal and bread • Find the LOW SUGAR food • 4 g sugar = 1 teaspoon sugar • Sugary circles: 12 g sugars; 3 g fiber • Sugary flakes: 11 g sugars; 1 g fiber • Look for those with < 8 g sugar per serving • Mix brands of cereals to increase fiber and lower sugar content

  28. Reduce/Avoid Sugar-Sweetened Beverages and Foods

  29. Sugar-Sweetened Beverages (SSB) • What are SSBs? • Soda, fruit drinks, juice blends, lemonade, sweetened tea • Other carbonated or uncarbonated drinks (ie, sports and energy drinks) • Most consumption happens at home (55-75%) • Daily calories from juice and other SSB (among those consuming): • 2-5 yrs, 190 calories • 6-11 yrs, 220 calories • 12-19 yrs, 345 calories Vartanian, et al. Am J Pub Health. 2007;97:667-75 NHANES 1999-2004

  30. Juices & Sugar-Sweetened Beverages • Theoretically, if added to the typical US diet: • 1 soda/day =  15 lb/year • Studies show switch to calorie free saves 1-3 kg/yr gain in children & lowers fat deposition

  31. Sugar-Sweetened Beverages • Sugar types • Sucrose (cane/beet sugar = 50% glucose + 50% fructose) • High fructose corn syrup (55% fructose + 45% glucose) • Fructose has more negative health effects (compared to glucose) • An increase in visceral fat (in organs) • Less sensitivity to insulin • Increased fat production in the liver • Higher LDL cholesterol • Higher triglycerides • Effects on energy intake • ↑ hunger & ↓ satiety • Displace appetite for nutrient-balanced foods Stanhope et al, J Clin Invest 2009;119:1322-34 Wang et al, Pediatrics 2008;121:e1604-14

  32. Diet Beverages(Non-nutritive sweetened beverages) • Typically sugar-free, artificially sweetened, non-alcoholic, carbonated beverages • Marketed towards: • health-conscious people, diabetics, athletes • people who want to lose weight or stay fit • Replacing sugar-sweetened beverages with water and diet beverages can lower total calories consumed. Raben et al. Am J Clin Nutr 2002;76:721-9

  33. However… • Sweet goes with fatty and salty! • When consumed alone, diet beverages may increase hunger EVEN BETTER WITH A DIET COKE AND FRESH LIME The food item alone has 710 cals (40 grams fat, 13 grams saturated fat) and that is without the 300-600 calories from French fries! http://www.foodfacts.info/blog/uploaded_images/sonic-bacon-cheddar-sheeses.jpg Mattes et al. Am J Clin Nutr 2009;89:1-14

  34. Diet Beverages Oh yeah… a diet soda too. • No benefits for weight loss or slowing weight gain, UNLESS accompanied by total energy restriction and improved energy balance http://www.cartoonstock.com/directory/d/diet_drinks.asp

  35. Counseling Tips: Beverages • Plain water is best! Drink plenty of it. • Flavor water with lemon or lime. Keep it cold in the refrigerator. • While diet drinks are preferred over regular soda, the sweet taste can increase your intake of high calorie foods.

  36. Less & Safer Chemical Exposures • Effects • Fat cell regulation -- PPAR – peroxisome proliferator-activated receptors • Endocrine disruptors • Products w/ potential for harm • BPA -- 7 • Phthalates – 3 • Organotins – PVC - 3 • PBDE (polybrominated diphenyl ethers)

  37. Less & Safer Chemical Exposures • Choose safer plastics • Avoid heating plastics • Wash produce • Buy organic if you can, but Eating Fruits and Veggies is more important than eating only organic F & V • Peel – but think about fiber

  38. Summary • Be a role model for healthy habits! • Be positive about healthy foods. • Make changes to the home environment to promote healthy habits. • A few changes can have a big impact.

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