Monkey see, Monkey do. A presentation about Childhood obesity and a Parent’s preventative Role

1. Monkey see, Monkey do.A presentation about Childhood obesity and a Parent’s preventative Role By: Brenna Smith & Kelsey Buckley

2. Objectives • Introduce and discuss the problem of childhood obesity. • Discuss the emotional effects on children. • Describe short & long term health effects of childhood obesity. • Explain the parents or guardians role in the prevention of childhood obesity.

3. “ Food habits, preferences, and behaviors established during the toddler and preschool ages logically influence dietary habits later in life and subsequent health status.” -Nutrition Through the Life Cycle 1

4. Overweight and Obese Definitions 1 • Overweight is defined as the BMI-for-age between the 85th and 94th percentiles. • Obesity is defined as the BMI-for-age >95th percentile. • Children under 2 a weight-for-length >95th percentile is overweight.

5. The Epidemic and the Statistics 1 • NHANES 2007-8 data, 10.4% of children (2-5 y.o.a) had BMI > 95th percentile. • Differences in ethnicity. • Hispanic M/F more likely to have higher BMI than non-Hispanic white

6. The Epidemic and the Statistics • Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese. 2 • 70-80% chance of staying overweight or obese in adult life. 3

7. http://www.cdc.gov/obesity/data/childhood.html

8. Percentage of high school student’s who were obese in state in 2003 2

9. Percentage of high school student’s who were obese in state in 2011 2

10. The Factors Contributing to Obesity • High energy diets 1, 2 • Sugary beverages, less healthy food choices, excess snacking. • Limited accesses to healthy foods. Higher availability of high-energy-dense foods. • Increased portion sizes. • Lack of breastfeeding support.

11. The Factors Contributing to Obesity • Sedentary life styles 1, 2 • Lack of physical activity in schools. • Unsafe places to play in the community. • Increased screen time.

12. Adiposity Rebound 1 • Normal for children to have a decrease in BMI. • Lowest around 4-6 y.o.a • Then there is a gradual increase in weight • Early adiposity rebound could increase the risk of adult obesity.

13. Screen time • TV viewing time can have negative effects to both eating and decreasing physical activity • associated with increased energy intake 4 • A study of ~4000 children between 8-16 found that obesity was highest in those who watched 4+ hours a day and lowest in those who watched 1 or less hours.5

14. Food Advertisements • Study done during Saturday morning TV found that 56% of the advertisements were for food. 6 • The four most advertised foods are: Breakfast cereals, snacks, candy, and soda. 7 • Advertising increase children’s knowledge of these foods and consumption as well as children influencing purchasing for these foods. 7, 8

15. Short Term Effects on Children 9 • Body Dissatisfaction and Low Self Esteem • Obese children tend to be more dissatisfied with their bodies than overweight and normal weight children. • These children also had lower self esteem.

16. Short Term Effects on Children 9 • Depression • Obese children with body dissatisfaction and low self esteem also had higher rates of depression.

17. Body Dissatisfaction Long Term Effects 10 • Disordered Eating • Causes • Low self-esteem • Feelings of inadequacy or lack of control in life • Depression, anxiety, anger, stress or loneliness • History of being teased or ridiculed based on size or weight

18. Body Dissatisfaction Long Term Effects 11 • Higher risk of suicide • “Obese and overweight teenagers in Liverpool have more suicidal thoughts than those with a normal weight.”

19. Weighing the Evidence for an Association Between Obesity and Suicide Risk Article 12 • “Considering the evidence to date, it appears that a positive association between obesity and suicide has been observed more frequently than a negative or no association, implying that obese individuals are indeed at an increased risk of suicide.”

20. Other Short Term Effect on Children 2 • Hypertension • High cholesterol • Abnormal glucose tolerance, Insulin resistance, and Type II Diabetes. • Breathing problems, sleep apnea, and asthma. • Early puberty • Joint problems- Reduces desire to exercise. • Fatty liver disease, gallstones, and GERD

21. Long Term Chronic Health Effects1, 2 • When older were more likely to have: • CVD- Prevention of CVD begins in childhood. • Digestive disease • Infertility • Some cancers • Death from any cause as compared with those who were lean.

22. Childhood Intelligence and Adult Obesity 13 • Objective: to study if there is a connection between childhood intelligence and their BMI when they are adults. • Design and Methods: • Longitudinal study of 17,419 started in 1958. • Childhood intelligence is measured at 7, 11, and 16. • When they turn 51, their BMI is measured.

23. Childhood Intelligence and Adult Obesity13 • Conclusion: • There is a connection between childhood intelligence and their adult BMI. • General intelligence reduces BMI when the individuals have complete control over what they eat.

24. Some good news! 2 • Rates of obesity in low-income preschool aged children decreased in recent years CDC. • Prevalence of obesity decreased 15.21% to 14.94%. • Extreme obesity decreased 2.22% to 2.07%.

25. Parents role

26. Parents role in obesity • Targeting parents only in weight loss of children ages 6-11 shows greater weight loss then when both parents and children were targeted. 14 • One study showed a relationship in weight loss in the parent that passed onto the child. Proving that when the parents demonstrate healthy behavior it can be passed on to their children. 15

27. Preventing Childhood Obesity • Maternal obesity during the first trimester doubled the risk of a child being obese at ages 2-4. 16 • Women of childbearing years should seek a healthy lifestyle. 17

28. Feeding methods during infancy • Breastfeeding has been show to help prevent obesity in children. 17 • Cohort study done in 2003 of children at age 6 found that bottle fed infants had higher prevalence of obesity compared to those who were breastfed. 18 • Meal size is learned during breastfeeding. 19 • Bottle feeding may encourage overfeeding. 17

29. Feeding methods during infancy • Breastfeeding provides the infant with metabolic and hormonal cues within the breast milk. 20 • Breast milk flavors change due to what the mother is eating. This may contribute to the infants acceptance of foods during transition from milk to solid foods. 20, 21 • Early interdiction to sweetened beverages and high fat foods my contribute to preferences for theses foods as the child ages. 20, 22

30. Toddlers and young children • Biggest determent for intake is food flavor. 17 • Foods with flavors that aren’t sweet or salty are often rejected and the new tastes will need to be learned. 17 • Let children try new foods without being forced to eating them. 24, 25

31. Toddlers and young children • Exposure to food also determines liking of various foods. 17 • Parent led exposure to fruits and vegetables can increase acceptance. Also increasing availability of these foods in schools and day care centers. 26 • On the other hand increased exposure to high-fat and energy-dense foods will increase their liking for them.17

32. Toddlers and young children 15 • As in infants, toddlers have physiological sense of fullness. During development children respond to environmental cues to larger portion sizes. • In preschool introduce children to: • many flavors and textures of foods, • have nutrition education, • encourage daily physical activity.

33. Older children and Adolescence • During this age children are more in charge of their food choices inside and outside of the home. 17 • Parents should help healthful eating by promoting healthful foods. 17 • During adolescence continue with nutrition education and physical activity. 15

34. Older children and Adolescence • Eating as a family without the TV on has been shown to increase children's intake of nutritious foods.17, 27, 28 • Sugar sweetened drinks are a big concern for this age group. 17 • Portion control is also a major concern. • Let children serve themselves. • Consumed 25% less when served themselves 29

35. Family-Focused Treatment 30 • Objective: Evaluate a healthy lifestyle intervention by adding parenting skills training. • Methods: children aged 5-9, 6-month program, targeted parents as the agents of change, only parents attended training, BMI and waist z scores were used. Measurements were taken at 6, 12, 18, and 24 months. • Results: There was a reduction in BMI and waist scores at 6 months and was maintained at 24 months.

36. Modeling • Children’s behavior is modeled after the parents behavior. 15 • Preschooled children are more likely to eat foods they seen adults eat. 31 • Steps to help with Modeling 30: • Start early • Keep mostly healthy foods in the house • Make it easy to eat healthy • Eat healthy yourself • Eat as a family

37. Modeling • Modeling can also be negative. If the parents are engaging in a unhealthy lifestyle so will the children 17 • Mothers dieting habits can be learned from daughters as soon as 5 years old 32

38. Providing • Parents provide variety of healthful foods. • Let children choose type (from what was offered) and portion size. 31 • Reduce the availability of sugar sweetened beverages. 33 • Take children shopping. • Have them help prepare meals and snacks.

39. Kids in the Kitchen • Have children get involved. • Preschool aged children can help with: • Washing • Adding ingredients to mixtures • School aged children can help with: • Mixing • Peeling and cutting • Measuring

40. Healthy snacking • Making healthy snakes available instead of sugary and convenience foods will improve nutrition intake. • Ways to have health snacks available: • Have a fruit plate. • Prepackaged low fat cheese snacks. • Pre-make snacks with children once a week for grab and go. • Snacks are not meals, keep around 100- 150 kcals.

41. Move more • Do activities as a family. • Think outside of the box • Doing chores together around the house. • Going for a walk as a family after dinner, if possible walk children to and from school or to the store. • Family outings centered around physical activity. • Give gifts such as balls and sports equipment. 17

42. Move More • Parents shouldn’t be discouraged to do physical activities with their children because of their own health. 34 • Parents should encourage children to be active and play outdoors. 17 • This increases opening for social contact, bonding, and maturational guidance. 17

43. Campaigns to help with childhood obesity and prevention • We can! Created by Michael Obama • Healthier school meals • Kids Can’t Wait created by the Children's Health Fund • Kids Eat Right created by The Academy of Nutrition and Dietetics • Appetite for a Change created by Organic Consumers Association

44. Mother May I?

45. References • Brown JE Nutrition through the life cycle. 4th ed. Belmont: Wadsworth, Cengage Learning; 2011. • Childhood Obesity Facts. [homepage on the Internet]. 2013 [cited 2013 Nov 7]. Available from: Centers for Disease Control and Prevention, Web site: http://www.cdc.gov/healthyyouth/obesity/facts.htm • American Heart Association Understanding childhood obesity; 2010. • Robinson TN. Population-based obesity prevention for children and adolescents. In: Johnston FE, Foster GD, editors. Obesity, Growth and Development. London: Smith-Gordon; 2001. pp. 129–141. • Crespo CJ, Smit E, Troiano RP, Bartlett SJ, Macera CA, Andersen RE. Television watching, energy intake, and obesity in US children: Results from the third National Health and Nutrition Examination Survey, 1988-1994. Arch PediatrAdolesc Med. 2001;155(3):360–365. • Kotz K, Story M. Food advertisements during children's Saturday morning television programming: Are they consistent with dietary recommendations? J Am Diet Assoc. 1994;94(11):1296–1300. • Hastings G, Stead M, McDermott L, Forsyth A, MacKintosh A, Rayner M, Godfrey C, Caraher M, Angus K. Review of Research on the Effects of Food Promotion to Children. Glasgow, UK: Center for Social Marketing, University of Strathclyde; 2003. • Gorn GJ, Goldberg ME. Behavioral evidence for the effects of televised food messages on children. J Consumer Res. 1982;9:200–205. • Shin NY, Shin MS. Body dissatisfaction, self-esteem, and depression in obese korean children. J of Pediatrics 2008; 152(4):502-506. • Contributing Factors & Prevention. 2011 [cited 2013 Dec 1]. Available from: http://www.nationaleatingdisorders.org/contributing-factors-prevention • Obesity suicide warning. (2008, Sep 19). Liverpool Echo. Retrieved from http://search.proquest.com/docview/340601308?accountid=26417 • Heneghan H.M., Heinberg L.,Windover A., Rogula T., & Schauer P.R., (2012) Weighing the evidence for an association between obesity and suicide risk. Surgery for Obesity and Related Diseases 8 (2012) 98 –107. • Kanazawa S, Childhood intelligence and adult obesity. J Obesity 2013; 21:434 - 440. • Golan M, Weizman A, Apter A, Fainaru M. Parents as the exclusive agents of change in the treatment of childhood obesity. Am J ClinNutr 1998; 67:1130-1135. • Wrotniak BH, Epstein LH, Paluch RA, Roemmich Jn. Parent Weight Change as a Predictor of Child Weight Change in Family-Based Behavioral Obesity Treatment, Arch PediatrAdolesc 2004; 158:342-347. • Whitaker RC. Predicting preschooler obesity at birth: The role of maternal obesity in early pregnancy. Pediatrics. 2004;114(1):e29–36 • Koplan JP, Liverman CT & Kraak VI Preventing Childhood Obesity: Health in the Balance. Washington DC: The National Academies Press; 2005.

46. References • Bergmann KE, Bergmann RL, von Kries R, Bohm O, Richter R, Dudenhausen JW, Wahn U. Early determinants of childhood overweight and adiposity in a birth cohort study: Role of breast-feeding. Int J ObesRelatMetabDisord. 2003;27(2):162–172. • Fisher JO, Birch LL, Smiciklas-Wright H, Picciano MF. Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes. J Am Diet Assoc. 2000;100(6):641–646. • Lederman SA, Akabas S, Moore BJ, Bentley ME, Devaney B, Gillman MW, Kramer MS, Mennella JA, Ness A, Wardle J. Summary of the presentations at the Conference on Preventing Childhood Obesity, December 8, 2003. Pediatrics. 2004;114:1146–1173. • Sullivan SA, Birch LL. Infant dietary experience and acceptance of solid foods. Pediatrics. 1994;93(2):271–277 • Mennella JA, Jagnow CP, Beauchamp GK. Prenatal and postnatal flavor learning by human infants. Pediatrics. 2001;107:E88. • Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers study: What foods are infants and toddlers eating? J Am Diet Assoc. 2004;104(1 Suppl 1):S22–S30. • Birch LL, Marlin DW. I don't like it; I never tried it: Effects of exposure on two-year-old children's food preferences. Appetite. 1982;3(4):353–360. • Loewen R, Pliner P. Effects of prior exposure to palatable and unpalatable novel foods on children's willingness to taste other novel foods. Appetite. 1999;32(3):351–366. • Nicklas TA, Baranowski T, Baranowski JC, Cullen K, Rittenberry L, Olvera N. Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption. Nutr Rev. 2001;59(7):224–235. • Gillman MW, Rifas-Shiman SL, Frazier AL, Rockett HR, Camargo CA Jr, Field AE, Berkey CS, Colditz GA. Family dinner and diet quality among older children and adolescents. Arch Fam Med. 2000;9(3):235–240. • Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: Associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc. 2003;103(3):317–322. • Orlet-Fisher J, Rolls BJ, Birch LL. Children's bite size and intake of an entree are greater with large portions than with age-appropriate or self-selected portions. Am J ClinNutr. 2003;77(5):1164–1170. • Magarey AM, Perry RA, Baur LA, Steinbeck Ks, Sawyer M, Hills Ap et al. A Parent-Led Family-Focused Treatment Program for Overweight Children Aged 5 to 9 years: The PEACH RCT. Pediatrics 2011; 127:214-222. • Golan M, Crow S. Targeting Parents Exclusively in the Treatment of Childhood Obesity: Long-Term Results. Obesity Research 2004; 12(2):357-361. • Abramovitz BA, Birch LL. Five-year-old girls' ideas about dieting are predicted by their mothers' dieting. J Am Diet Assoc. 2000;100(10):1157–1163. • Lindsay AC, Sussner KM, Kim J, Gortmaker Sl. The Role of Parents in Preventing Childhood Obesity. The Future of Children 2006; 16(1):169-186. • Koivisto UK, Fellenius J, Sjoden PO. Relations between parental mealtime practices and children's food intake. Appetite. 1994;22(3):245–257.

47. Picture resources • http://cakeandcarrots.files.wordpress.com/2010/07/child_eating_sandwich.jpg • http://4.bp.blogspot.com/-PuN_IQNutU4/Tp8wWvjszQI/AAAAAAAAAcI/G2DpPAqDQZc/s1600/obese+family_1105039.jpg • http://www.telegraph.co.uk/health/children_shealth/4839016/Children-who-watch-TV-are-fatter.html • http://topnews.in/healthcare/sites/default/files/Obese-children.jpg • http://www.telegraph.co.uk/health/healthnews/9632588/Thousands-of-pregnant-women-at-risk-from-antidepressants-doctors-warn.html • http://www.todaysparent.com/toddler/picky-eaters/how-to-deal-with-a-toddler-who-is-fussy-about-food/ • http://www.openideo.com/open/how-might-we-give-children-the-knowledge-to-eat-better/winner-announced/role-model-chefs-teens-teaching-younger-kids-how-to-cook-and-eat-healthier/ • http://www.bewellconsulting.com/nutrition-tips/feel-happy-rested-and-relaxed