Post on 23-Dec-2015
Childhood Obesity
Dennette Fend, NP
William Beaumont Hospital
Nutrition and Preventive Medicine
Outpatient Breastfeeding Clinic
March 28, 2014
Health Outcomes of Breastfeeding
Outline
• Obesity Epidemics• Etiology of Obesity• Medical and Psychosocial Consequences• Efforts to Reverse the Epidemic –
Health Outcomes of Breast feeding
Obesity Trends* Among U.S. Adults
BRFSS, 1989
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults
BRFSS, 1991
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults
BRFSS, 1993
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults
BRFSS, 1995
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults
BRFSS, 1997
No Data <10% 10%–14% 15%–19% ≥20%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults
BRFSS, 1999
No Data <10% 10%–14% 15%–19% ≥20%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults
BRFSS, 2001(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2003(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2005(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2007(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2009(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
2000
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2010
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity: 35%
Overweight and Obesity: 68%
Childhood Obesity (ages 10-17)
• Childhood obesity has more than tripled over the past 3 decades.
• Obesity: 17%
• Overweight & obesity: 35%
Race/Ethnicity and Childhood Obesity
Body Mass Index (BMI)
BMI (kg/m2)Risk of
Comorbidities
Healthy Weight 18.5 – 24.9 Normal
Overweight 25.0 – 29.9 Increased
Obese Class I 30.0 – 34.9 High
Obese Class II 35.0 – 39.9 Very High
Obese Class III > 40.0 Extremely High
Adapted from the World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO; 2000.
Weight (kg)
Height (m2)BMI =
Child ObesityBMI > 95th %
Child OverwtBMI > 85th % and < 95th %
Defining Childhood/Adolescent
Overweight and Obesity
Outline
• Obesity Epidemics• Etiology of Obesity• Medical and Psychosocial Consequences• Efforts to Reverse the Epidemic
Positive Energy Balance Leads to Weight Gain
FatStores
Basal metabolic rate,
Physical
activityFood,
Drinks
Saving and Overconsuming Energy
Contributing Factors to Childhood Obesity
Nutrition and Eating Habits:• Eating less fruits and vegetables than recommended• Increases in snacking, especially on less healthy food• Larger portion sizes of food and beverages• Increases in consumption of sugar sweetened drinks• More food eaten away from home• Lack of access to healthy foods at neighborhood stores
Centers for Disease Control
How many calories today?
320 calories
Portion Distortion
30 Years Ago Today
500 Calorie Difference
820 calories 320 calories
Portion Distortion
30 Years Ago Today
How many calories today?
85 Calories 6.5 ounces
Portion Distortion
30 Years Ago Today
250 Calories 20 ounces
85 Calories 6.5 ounces
Portion Distortion
30 Years Ago Today
170 Calorie Difference
140 calories 3-inch diameter
How many calories today?
BAGEL 30 Years Ago Today
Portion Distortion
140 calories 3-inch diameter
Calorie Difference: 210 calories
350 calories 6-inch diameter
BAGEL 30 Years Ago Today
Portion Distortion
Portion Sizes for Americans Aged 2 years and Older
0
5
10
15
20
Fo
od
Inta
ke p
er E
atin
g O
ccas
ion
, oz
1977-1978
1989-1991
1994-1998
et al., JAMA 2003; 289:450-453.JAMA, 2003; 289: 450-453
Soft Drinks: “Liquid Candy”
• Sugar drinks are the largest source of added sugar and an important contributor of calories in the diets of children in the United States.
• High consumption of sugar drinks, which have few, if any, nutrients, has been associated with obesity.
• On a typical day, 80% of youth drink sugar drinks.
Reedy J, J Am Diet Assoc 2010;110(10):1477—84. Vartanian LR, Am J Public Health 2007;97(4):667—675.
Wang YC, Pediatrics 2008;121(6):e1604—1614.
The School Environment
• ~55 million children are enrolled in schools across the United States
• > 50% of U.S. middle and high schools still offer sugar drinks and less healthy foods for purchase
• Children have access to sugar drinks and less healthy foods at school throughout the day from vending machines and school stores, as well as fundraising events, school parties, and sporting events.
Snyder TD, National Center for Education Statistics; 2009. CDC. Children's Food Environment State Indicator Report, 2011.
Michigan Youth Health Risk Behavior Survey:
High School Students, 2011• During the 7 days before the survey
– 5% did not eat fruit or drink 100% fruit juices – 6% did not eat vegetables – 9% drank a can, bottle, or glass of soda or pop three or
more times per day
www.cdc.gov/yrbss
Contributing Factors to Childhood Obesity
Physical Inactivity:• Spending more time in front of a screen (television, video
games, computers)• Less physical activity in schools and at home• Less walking/biking to school and in the community• Communities designed for driving, not walking or biking
Centers for Disease Control
Television and Media
• 8 to18 year-olds spend an average of 7.5 hours a day using entertainment media (TV, computers, video games, cell phones, and movies)
• 83% of children 6 months to <6 years old view TV or videos about 1 hour and 57 minutes a day
Rideout VJ, A Kaiser Family Foundation Study; 2010.Rideout V, The Henry J. Kaiser Family Foundation; 2006.
TV and Childhood Obesity
• Takes away from the time children spend in physical activities
• Leads to increased energy intake through snacking and eating meals in front of the TV
• Influences children to make unhealthy food choices through exposure to food advertisements
Zimmerman FJ, Am J Public Health 2010;100(2):334—40.
Robinson TN. Pediatr Clin North Am 2001;48(4):1017—25.
.
Physical Activity in Schools
• At least 60 minutes of aerobic physical activity each day is recommended
• Only 18% of students in grades 9 -12 met this recommendation in 2007.
• Daily, quality physical education in school could help students meet the guidelines.
• However, in 2009 only 33% attended daily physical education classes.
U.S. Department of Health and Human Services. 2008. Youth Risk Behavior Surveillance System.
http://www.cdc.gov/HealthyYouth/yrbs/pdf/us_physical_trend_yrbs.pdf
Michigan Youth Health Risk Behavior Survey:
High School Students, 2011
• Physical Inactivity– 66% did not attend physical education (PE) classes in an
average week when they were in school.– 29% watched television 3 or more hours per day on an
average school day.– 27% used computers 3 or more hours per day on an
average school day.
www.cdc.gov/yrbss
Outline
• Obesity Epidemics• Etiology of Obesity• Medical and Psychosocial Consequences• Efforts to Reverse the Epidemic
Health Risks of Childhood Obesity
• The current generation of young people could be the first in U.S. history to live sicker and die younger than their parents’ generation.
• Nearly one-third of children and teens are currently obese or overweight, which is putting them at higher risks for developing a range of diseases and developing them earlier in life.
Health Risks of Childhood Obesity
• Children who are obese are more than twice as likely to die before the age of 55 as children with normal BMI
• Around 70% of obese youths have at least one additional risk factor for cardiovascular disease, such as:– Elevated total cholesterol– Elevated triglycerides– Elevated insulin– Elevated blood pressure
Health Risks of Childhood Obesity
• Sleep apnea• Asthma• Gallstones• Type 2 diabetes• Hypertension• Orthopedic/joint problems• Fatty liver• Cancer• Poor self esteem/depression• Victims of bullying and social stigma• Eating Disorders
1 out of 3 children born in the year 2000 will be diabetic during their lifetime.
Risk of Adult Obesity
• Children who are obese after the age of 6 are 50% more likely to be obese as adults.
• For overweight tweens and teens (10 – 15 years old), 80% will be obese as adults.
Psychosocial Consequences
• Overweight and obese children and teens face a higher risk for:– more severe and frequent bullying– are rejected by their peers more often– are chosen less as friends – generally not as well-liked as healthy-weight children
• Weight-based teasing is related to increased susceptibility to depression.
Perceptions
Perceptions
Perceptions
Financial Costs of Obesity
• >25% of all U.S. health care costs are related to obesity and inactivity. (Anderson, et al 2005)
• 1979 and 1999: Obesity-associated hospital costs for children tripled from $35 million to $127 million. (Wang and Dietz, 2002)
• Physical inactivity costs $128 per person. (Garrett, 2004)
• Adult obesity costs $2.9 billion in Michigan. (BRFS 2008)
Outline
• Obesity Epidemics• Etiology of Obesity• Medical and Psychosocial Consequences• Efforts to Reverse the Epidemic
Reducing Childhood Obesity
• Reducing and preventing childhood obesity is critical to improving the future health of the country, and consequently would help to lower health care costs and improve productivity.
• Research supports the concept that focusing on children and getting them on a healthy path early in life is one of the areas where the greatest successes can be achieved.
Breastfeeding & Obesity
• Breast feeding during infancy has been shown to reduce the risk of infants developing overweight and/or obesity in childhood.
• The risk of overweight in children decreases by 30% with 9 months or more of breastfeeding and each month of breastfeeding was associated with a 4% decrease in the risk of overweight into childhood.
Tawia, S. Breastfeeding Review. 2013
Long term health benefits
Dose response gradient- better with prolonged, exclusive breastfeeding!
Gunderson, EP. 2008. Curr Diab Rep.
Why does BF protect against obesity?
• Feeding from the breast prevents over feeding (feeding beyond satiety)– babies do not take in more than they need.
• BREAST FEEDING rather than BREAST MILK protects against obesity in later life.
• SELF-REGULATION!• Baby led weaning: babies continue to self-regulate
their intake.
» Li, R. Arch Pediatric Adolesc Med. 2012
How?• Baby led weaning provides infants, from about 6
months, the opportunity to continue to self-regulate their food intake – very successfully!
• Babies who are breastfed less likely to over consume calories compared to formula fed infants = less likely to become overweight/obese as they grow older.
• BF babies are not encouraged to “finish the bottle”. They learn self-regulation of caloric intake more closely suited to their needs.
• Substances pass from mom to baby - such as the appetite-regulating hormone leptin.
AICR. August 2012. Issue 73.
Definition of LEPTIN
• : a peptide hormone that is produced by fat cells and plays a role in body weight regulation by acting on the hypothalamus to suppress appetite and burn fat stored in adipose tissue
http://www.merriam-webster.com/medical/leptin
Babies drink more frombottle than breast
Why?• 1. Working moms: pumped milk is costly – finish
bottle. • 2. Sharing in responsibility of feeding.• 3. Empty bottle/clean plate satisfying to
parents/caregivers.• 4. Infants with slow initial weight gain more likely to
receive formula for risk of under nutrition • 5. Want to know how much child is eating.
» Li, R. Arch Pediatric Adolesc Med. 2012
Appetite regulation
• STUDY: Does feeding human milk from breast or bottle lead to better appetite regulation in childhood?
• Children aged 3-6 y/o categorized into directly, exclusively BF, bottle fed human milk, or bottle fed formula in first 3 months
• Direct BF associated with greater appetite regulation
• Children bottle fed human milk 67% less likely to have high satiety response compared to those directly BF
» DeSantis, K. (2011). Int’l Journal of Behavioral Nutrition and Physical Activity.
Childhood obesity
• October 13 - Japanese study showed exclusive breastfeeding at 6-7 months was associated with decreased risk of being overweight and obesity compared to formula feeding.
• Results effective through 7-8 years of age among Japanese schoolchildren.
Yamakawa, M. JAMA. 2013.
BF reduces obesity
• BF reduces body size, visceral fat, subcutaneous fat, and protects against central fat patterning of youths at higher fat levels.
» Crume et al. (2012). Int’l Journal of Obesity
Delaying Solid Food
• Analyses of breastfeeding practice combinations revealed that when children were not breastfed, obesity odds decreased when solid foods postponed until 4 months of age.
• Obesity odds were further decreased when solid food delay was combined with breastfeeding.
• Consistent increases in delaying complementary foods = consistently and substantially lower likelihood of obesity.
Prevention of Type 1 Diabetes
Most studies indicate that BF: Offers a protective effect against development T1DM
Shorter duration of BF could be a modifiable risk factor in development of T1DM.
Duration of BF and age at intro to bottle feeding are inversely associated with T1DM (>5 months compared to <2 weeks).
» J Pediatr (Rio J). 2013 Oct 16. pii: S0021-7557(13)00178-2
Breast vs formula
Why do breast-fed babies have a decreased risk of developing T1DM?– Due to a cell mediated response to a specific cow’s milk
protein (beta-casein) which may be involved in the pathogenesis of type 1 diabetes mellitus
Prevention of T1DM
Pooled data 43 studies:
Overall risk reduction of DM after exclusive BF for >2 weeks
Association for >3 months a bit weaker, but results vary
No association after non-exclusive BF for >2 weeks or >3 months
Author cites marked variation in effect and possible biases
» Cardwell, CR et al. Diabetes Care. 2012 Nov;35(11):2215-25.
Early nutrition matters!
Risk of T1DM increased if:
Starting solids <4 months of age or >6 months
Safest age to introduce solids 4-5 months
BF while introducing new foods may decrease risk T1DM
Frederiksen, B. JAMA Pediatr. 2013 Sep;167(9):808-15.
Thank you