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Obesity and Children

Obesity and Children. “Overweight” = BMI > 95 th percentile “At risk for Overweight” = BMI > 85 th percentile but < 95 th percentile. What Causes Obesity?. Genetics Familial Factors Socio-demographic Factors Dietary Factors Physical Activity and Sedentary Activity

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Obesity and Children

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  1. Obesity and Children .

  2. “Overweight” = BMI > 95th percentile “At risk for Overweight” = BMI > 85th percentile but < 95th percentile

  3. What Causes Obesity? • Genetics • Familial Factors • Socio-demographic Factors • Dietary Factors • Physical Activity and Sedentary Activity • Psychological Factors

  4. Pathological obesity • genetics... • Prader-Willi syndrome (15q11) • Bardet-Biedl syndrome • (11q13,, 16q21, 3p13, 15q22.3, 2q31 20p12) • isolated GH deficiency • Thyroid hormone resistance • ... others • Turner sydrome • Klinefelter sydrome • Down syndrome

  5. Pathological obesity • Endocrinological disorders • Cushing syndrome • hypothyroidismus • GH deficiency • PCOS • hypoparathyroidismus • hiperinsulinisus

  6. Hereditary? Somewhere between 30 – 75% of the variance in adiposity within a population can be explained by genetics.

  7. Prevalence of Overweight in 9-10 Year Old Girls by Parental Education and Race Black Girls White Girls n=1213 n=1166 Parental Education < High School 31% 29% Some College 31% 25% >4 Years College 32% 16% Patterson, Crawford, et al1997

  8. Health Risks • Increased blood pressure • Increased total cholesterol • Abnormal lipoproteins • Hyperinsulineamia

  9. Psycho Social • Depression • Low self-esteem • Work difficulties • Social difficulties

  10. Thursday 30th January 2003 • Fast food 'as addictive as heroin' • Hamburgers and French fries could be as addictive as heroin, scientists have claimed. • Researchers in the United States have found evidence to suggest people can become overly dependent on the sugar and fat in fast food.

  11. Classification of Overweight and Obesity in Adults BMI (kg/m2) Underweight <18.5 Normal Weight 18.5-24.9 Overweight 25-29.9 Obesity >30 WHO, U.S. NIH and Health Canada recommendations.

  12. Classification of Overweight and Obesity in Children and Adolescents Boys Cole et al. BMJ 320:1-6, 2000.

  13. Classification of Overweight and Obesity in Children and Adolescents Girls Cole et al. BMJ 320:1-6, 2000.

  14. Temporal Trends In Overweight, Canada, 1981-1996 Tremblay, Katzmarzyk & Willms. Int J Obes 2002; 26:538-543.

  15. Temporal Trends In Obesity, Canada, 1981-1996 Tremblay, Katzmarzyk & Willms. Int J Obes 2002; 26:538-543.

  16. Comparison of Overweight and Obesity Prevalences in School-Aged Children From 34 Countries and Their Relationships with Physical Activity and Dietary Patterns Janssen et al. Obes Rev: In Press. Prevalence (%)

  17. Relationship between the prevalence of overweight (BMI > 85th percentile) and reported TV watching time TV Viewing Prevalence Adjusted (hrs/day) n % Odds Ratio 0-2 69 11.6 1.00 2-3 114 22.6 1.72 3-4 129 27.7 2.84 4-5 134 29.5 3.01 >5 300 32.8 5.26 Gortmaker et al, 1996

  18. Health and Social Consequences of Childhood Obesity

  19. Relation Between Obesity and Beinga Victim of Relational Bullying in Canadian Youth Girls Boys Odds Ratio for Relational Bullying Normal Weight Normal Weight Pre-Obese Obese Pre-Obese Obese Janssen et al., Pediatrics, 2004

  20. Relation Between Obesity and Beinga Perpetrator of Physical Bullying in Canadian Youth Girls Boys Odds Ratio for Physical Bullying Normal Weight Normal Weight Pre-Obese Obese Pre-Obese Obese Janssen et al., Pediatrics, 2004

  21. Pediatric Obesity and Cancer have Devastating Effects A UCSD study+ compared 106 children in the top 3% for obesity (mean BMI 35 kg/m2) with a control group and a group of pediatric cancer patients. Both the severely obese children and cancer patients report the same degree of feelings of social isolation (67% and 69% respectively). Both miss 4 times as much school as the control group. Schwimmer, JAMA, 289, 2003

  22. Obesity in Childhood & Adolescence and Future Health

  23. Predicting Obesity in Young Adulthood from Childhood and Parental Obesity. Whitaker et al. NEJM: 1997;337: 869-73. Odds (95% CI) of being obese in young adulthood based on childhood and parental obesity. Obese as a Child No. of Obese Parents Age yes vs no 1 vs 0 2 vs 0 1-2 1.3 (0.6-3.0) 3.2 (1.8-5.7) 13.6 (3.7-50.4) 3-5 4.7 (3.5-8.8) 3.0 (1.7-5.3) 15.3 (5.7-41.3) 6-9 8.8 (4.7-16.5) 2.6 (1.4-4.6) 5.0 (2.1-12.1) 10-14 22.3 (10.5-47.1) 2.2(1.2-3.8) 2.0 (0.8-5.2) 15-17 17.5 (7.7-39.5) 2.2 (1.1-4.3) 5.6 (2.5-12.4)

  24. Predicting Obesity in Young Adulthood from Childhood and Parental Obesity. Whitaker et al. NEJM: 1997;337: 869-73. Odds (95% CI) of being obese in young adulthood based on childhood and parental obesity. Obese as a Child No. of Obese Parents Age yes vs no 1 vs 0 2 vs 0 1-2 1.3 (0.6-3.0) 3.2 (1.8-5.7) 13.6 (3.7-50.4) 3-5 4.7 (3.5-8.8) 3.0 (1.7-5.3) 15.3 (5.7-41.3) 6-9 8.8 (4.7-16.5) 2.6 (1.4-4.6) 5.0 (2.1-12.1) 10-14 22.3 (10.5-47.1) 2.2 (1.2-3.8) 2.0 (0.8-5.2) 15-17 17.5 (7.7-39.5) 2.2 (1.1-4.3) 5.6 (2.5-12.4)

  25. Adolescent Overweight is Associated with Adult Overweight and Related Multiple Cardiovascular Risk Factors: The Bogalusa Heart Study Srinivasan et al. Metabolism 45;1996:235-40.

  26. Long-term Morbidity and Mortality of Overweight Adolescents. A Follow-up of the Harvard Growth Study of 1922 to 1935 Must et al. N Engl J Med 327;1992:1350-5. Men Women *p<0.05

  27. BMI and Mortality Under- weight Normal Weight Overweight Obese Calle et al. New Eng J Med 1999;341:1097-105.

  28. BMI and Mortality Calle et al. New Eng J Med 1999;341:1097-105.

  29. Body Mass Index in Adolescence in Relation to Total Mortality: 32-year follow-up of 227,000 Norwegian Boys and Girls Engeland et al. Am JEpidemiol 157;2003;517-523.

  30. Economic Burden of Obesity in Youths Aged 6 to 17 Years: 1979-1999 Wang & Dietz. Pediatrics 109;2002:e81. • Between 1979 and 1999, hospital discharges related to obesity • and gallbladder disease tripled in youth • Between 1979 and 1999, obesity-related annual hospital costs • increased more than three-fold ($35 million to $127 million)

  31. Summary RR Estimates and PAR% for Adulthood Obesity in Canada Disease Summary RR PAR% CHD 2.24 15.4 Stroke 1.50 6.8 Hypertension 4.50 34.0 Colon Cancer 1.45 6.2 Postmenopausal BC 1.47 6.5 T2DM 3.73 28.6 Gall Bladder Disease 3.33 25.5 Osteoarthritis 1.99 12.7 Katzmarzyk & Janssen. Can J Appl Physiol 2004;29:90-115.

  32. Economic Cost of Adult Obesity Total: $4.3 billion $1.6 billion $2.7 billion Direct costs include medical costs to treat coronary heart disease, hypertension, stroke, breast cancer, colon cancer, type 2 diabetes, gall bladder disease, and osteoarthritis. Katzmarzyk & Janssen. Can J Appl Physiol 2004;29:90-115.

  33. Weight control strategies • Dietary treatment • Exercise and physical activity • Surgical intervention • Behavioural management • Drug therapy

  34. Exercise in Weight Control • Exercise: • expends energy • may suppress appetite • can counteract the ill effects of obesity • can improve psychological functioning • may minimise the loss of LBM • may counter the metabolic decline produced by dieting

  35. Energy intake (kcal/day) Body weight (lbs) Sedentary light medium heavy v. heavy (Mayer et al, 1956) Occupational activity Body Weight and Caloric Intake as a Function of Physical Activity

  36. INTERVENTION Weight Loss by Diet Alone or Diet With Exercise

  37. Weight Loss and Weight Regain With and Without Exercise

  38. Surgical Intervention • Vertical banded gastroplasty • Stomach stapling • Aim is to reduce the size of the stomach • Gastric bypass • Aim is to reduce the size of the stomach and bypass some of the small intestine to reduce the absorption of food

  39. Behavioural Management PRECONTEMPLATION CONTEMPLATION TERMINATION MAINTENANCE PREPARATION ACTION RELAPSE CONTEMPLATION PREPARATION ACTION

  40. New anti-fat drug 'cuts side-effects' • In clinical trials the drug, known as ATL-962, was reported to have 90% less side-effects than other anti-obesity drugs.

  41. Range of Benefits from Weight Loss • Lower Blood Pressure • Lowered risk of developing diabetes • Improve blood glucose and insulin levels in those who are already diabetic • Lower total cholesterol, LDL’s, and triglycerides • Raise blood level of HDL’s • Lessen (or eliminate) the need for anti-hypertensive, oral hypoglycemic (or insulin), or lipid lowering medications • Reduce symptoms of arthritis by reducing stress on joints

  42. Nutritional Strategies • Research • Agricultural subsidies • Taxation • Regulation of food production • Controls on labelling • Surveillance of educational material • Health promotion activities

  43. The Eating-Right PyramidThe Essentials of Good Nutrition

  44. Foods that play a role in diseaseKhaw, K-T, MRC News, Autumn 1997.

  45. TV Viewing and Obesity

  46. TV and overweight (adults) Salmon et al, IJO, 2000

  47. “We do not eat for today but for the day before yesterday”Edholm, 1977

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