Obesity in Hispanic Children: Reversing the Tide

Donna Spruijt-Metz, MFA PhDAssociate Professor, USC Keck School of Medicine

Director, Responsible Conduct of Researchdmetz@usc.edu

www.metzlab.net

Persists into adulthood (Whitaker et al. NEJM: 1997;337:869-873)

Data from the National Longitudinal Survey of Youth 1986-1998, NHANES 1998-2008

Overweight has doubled in 30 years, and

Obesity has TRIPLED

Overweight has doubled in 30 years, and

Obesity has TRIPLED

Childhood Obesity: Childhood Obesity: Metabolic ConsequencesMetabolic Consequences

Childhood Obesity: Childhood Obesity: Psychosocial ConsequencesPsychosocial Consequences

• Proximal consequences: – Negative stereotyping– Teasing– Fewer friends– Poor body image

• Distal consequences:– Lower educational

attainment– Discrimination

(apartment rentals, college admissions)

– Higher poverty

Overweight Hispanic youth in Los Angeles from our studies:

• 32% have pre-diabetes

• 30% have metabolic syndrome- 90% have > 1 metabolic syndrome feature

• 38% have Non Alcoholic Fatty Liver Disease (NAFLD)

Complex Etiology of Childhood ObesityComplex Etiology of Childhood Obesity

IOM 2011 Report: Early Childhood Obesity Prevention Policies

• Role of mother’s diet, obesity & smoking during pregnancy

• Early development: – Not yet necessary to change poor dietary and

activity patterns, – Great time to promote the development of

healthy patterns.– Exclusive breast feeding for 6 months, continued

with complimentary foods for AT LEAST one year

http://www.nap.edu/catalog.php?record_id=13124

Breast feeding & Sugar Sweetened Beverage consumption

in 1483 Hispanic Children in Los Angeles WIC Clinics

Davis et al in press AJCN

Physical Activity in Hispanic Youth

Physical activityPhysical activity• Improves

– Body Composition

– Insulin sensitivity

– Cholesterol

– Sleep

– Self Esteem

– Academic Performance

• Protects against – Breast, colon and other cancers

– Obesity

Pubertal Decline in Physical Activity by Age Pubertal Decline in Physical Activity by Age (Males + Females)(Males + Females)

Troiano, Berrigan, et al. MSSE 2008;40(1):181-8.

Mea

n M

inut

es o

f MVP

A pe

r day

One Year Decline in Physical ActivityOne Year Decline in Physical Activity

Covariates: age, baseline Tanner stage, baseline SAT, baseline VAT, SISpruijt-Metz et al under review

Sugar Intake in Hispanic Youth

Sugar Intake is Related to Decreased Insulin Sensitivity

r=-0.29, p= 0.01

Davis et al, AJCN 2007

120 Hispanic children ages 10-17 years

Sugar Intake is Related to Increased Body Fat

Davis, Ventura, et al. AJCN 2007.

Ejemplo de la dieta de una niña del proyecto SOLAR(Sample diet of a 11-year-old girl from the SOLAR project)

Desayuno(Breakfast)

Lucky Charms --2 tazas/cupsLeche 2%/ 2% milk --1 taza/cupJugo Tampico/Tampico juice -- 2 tazas/cups

Resumen de esta Dieta(Summary of Diet):3100 calorias/calories7 g fibra/fiber 220 g azucar/sugarAlmuerzo

(Lunch)Pizza – 1 rebanada/slice Papas fritas (Fries) – 1 taza/cupGatorade – 1 botella de 20 onzas/FO

Merienda(Snack)

Hot Cheetos – bolsa/bag de $0.99Coca-Cola – 1 lata/can

Goal:~1800 calorias/calories25-30 g fibra/fiber<50 g azucar/sugar

Cena(Dinner)

Tortilla de Harina (Flour Tortilla) - 2Carne Asada (Grilled beef) – 1 taza/cupArroz Mexicano (Mexican Rice) – 1 taza/cup Agua de Jamaica (Sweetened hibiscus drink) – 2 tazas/cups

Summary: TARGETS to Prevent and Treat Obesity

• INCREASE & PROLONG Breastfeeding • INCREASE Physical Activity • INCREASE Fiber Intake • DECREASE Total and added sugar intake

At home, child care, schools, parks, hospitals – and GARDENS!!!

TWO NEW USC PROJECTS

to Prevent and Treat Obesity in Hispanic

Youth & Families

• 12-week after-school gardening / nutrition / cooking intervention for 4th & 5th graders:– 80 controls– 45 LA Sprouts students

• Gardening/nutrition classes (1x/wk) at Milagro Allegro Community Garden & Farmer’s market trips (4 times)

• Pre/Post Testing: BMI, Body Fat, BP, waist, dietary intake, motivation/preference/self-efficacy to eat F&V, engagement

Funded by: Kaiser and Childhood Obesity Research Center (PI: Davis)

Changes in Diet

• Increased preference for fruit and veggies

• Improved cooking and gardening self-efficacyDavis et al; in press JADAGatto and Davis; in review at JADA

A virtual gardening game for the prevention of obesity in minority youth

Virtual Sprouts Web-based Gardening Games

What is Virtual Sprouts?• A web-based gardening game designed to use gardening as a teaching tool• In the virtual garden children learn to select what crops to plant, plant their

own garden, watch it grow, tend the crops, and harvest them

Goal• To positively influence dietary intake and prevent/treat obesity in Hispanic

youth and families through meaningful play

Proposal • Bring a novel combination of technology and teaching to bear on pediatric

obesity in urban Los Angeles• Use interactive, web-based game techniques, rich narrative, a pedagogical

agent, and experiential learning to achieve the aims of the program

Using Mobile and Internet Technologies: The mHealth advantage

• Any time, anywhere, children and their families can play• Enormous reach: 84% of US Hispanics own a cell phone;

78% of US Hispanic adults and 95% of youth use the internet

• Immersive games are FUN! And engaging.• Immediate access to data for health professionals,

children, families, teachers• Real-time, personalized & tailored interventions • Strong Participatory Approach

AcknowledgementsAcknowledgements• Michael Goran• Britni Belcher• David Berrigan• Marc Weigensberg• Ana Romero• Ya Wen Janice Hsu• Arianna McClain • Javier Diaz• LeRoy Downs• Luz Castillo• Gisele Ragusa• Ting Li

• Selena Rodriguez• Adar Emken• Jaimie Davis• Nicole Gatto• Emily Ventura• Tom Wright• Adriana Padilla• Chih-Ping Chou• Courtney B.William• Christianne J. Lane• Chad Lane• Marientina Gotsis• Gillian O’Reilly

AcknowledgementsAcknowledgements

• NCI USC Center for Transdisciplinary Research on Energetics and Cancer (U54 CA 116848)

• NCCR (R25RR032159)

• NCMHD P60 002564

• Kaiser Permanente

• USC Childhood Obesity Research Center

• Study Participants

AcknowledgementsAcknowledgements