Renée R. Jenkins MD FAAP Professor of Pediatrics Howard University

1. What Caring Adults Can DoTo Support Healthy Self-Esteem, Body Image and Well-BeingOctober 17, 2007 Renée R. Jenkins MD FAAP Professor of Pediatrics Howard University President-Elect American Academy of Pediatrics

2. Points of Emphasis • American Academy of Pediatrics-AAP • Weight Issue Priorities for AAP • Obesity Prevention in Childhood • Obesity Risks and Management • Disordered Eating Risks and Management • Supporting Child and Adolescent Well-Being

3. AAP Mission Attain optimal physical, mental, and social health and well-being for all infants, children, adole-scents, and young adults. To accomplish this mission, the Academy shall support the professional needs of its members.

4. AAP Vision Children have optimal health and well-being and are valued by society. Academy members practice the highest quality health care and experience professional satisfaction and personal well-being.

6. Percentage of children ages 6–17 who are overweight by gender, selected years 1976–2004

7. Resources for Patients & Families • AAP overweight and obesity web site (average 55K hits; 4K unique visitors PER MONTH) • Books • Brochures

8. For More Info: www.aap.org/obesity

9. BMI BMI Boys: 2 to 20 years BMI BMI BMI Charts:Definitions • At risk of overweight: • 85-95th BMI % for age • Overweight: • > 95th BMI % for age Referral

10. BMI Charts: Why BMI? • BMI  body fatness • BMI = screening tool • Allows tracking of weight relative to height • Age-specific BMI values • Identify high risk patterns: • Rapid changes in BMI • Risk of complications • Childhood BMI tracks into adulthood Girls: 2 to 20 years Referral

11. Plotted BMI-for-Age Measurements: Age=4 y Height=99.2 cm (39.2 in) Weight=17.55 kg (38.6 lb) Girls: 2 to 20 years BMI BMI=17.8 = 85-95th percentile “At risk for overweight”

12. BMI BMI Girls: 2 to 20 years BMI BMI GG: School Aged Child BMI = 33.7 (190% of ideal, c/w severe o.w.)

13. Health Effects of Obesity Obesity increases the burden of disease for children and adolescents • Cardiovascular disease • Type 2 diabetes, DKA • Polycystic ovarian syndrome • Respiratory disease • Slipped capital femoral epiphysis, Blount’s disease • Nonalcoholic steatohepatitis • Pseudotumor cerebri • Depression, low self-esteem, decreased quality of life

16. 4 Components of Behavioral Strategies • Clean up /Control the environment • E.g. Eliminate sugar sweetened beverages from home; serve fruits & veg • Teach self-monitoring behavior • Set achievable, specific goals “If you can’t count it you can’t change it” • Rewarding successful behavioral change E.g. Praise, privileges, time w/ parents;  food, $$$ Dietz & Robinson, NEJM, 2005

17. ACTION Plan: Healthy People 2010 Objectives for Prevention and Control of Childhood Obesity • 5 general goals • Goal #1: Increase daily physical activity among children and adolescents. • Goal #2: Reduce the amount of time kids spend watching television, video games, and the Internet. • Goal #3: Decrease the consumption of energy-dense, high-sugar/high-fat foods like soda, ice cream, junk food, and fast food. • Goal #4: Increase the consumption of nutritious foods like fruits, vegetables, whole grains, and skim milk. • Goal #5:Create social, monetary, and policy-driven incentives that reinforce long-term environmental and behavioral change.

18. How common are eating disorders? • Estimates!! • Anorexia – 1% of population • Bulimia – 4% • Binge eating - 2% • Outcomes for those affected • 60% get treated and recover • 20% get treated and partially recover • 20% of severely affected people not treated die

19. Disordered Eating Patterns Start Early • 46% of 9-11 year olds are "sometimes" or "very often" on diets, and 82% of their families are "sometimes" or "very often" on diets (Gustafson-Larson & Terry, 1992). • 35% of "normal dieters" progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders. (Shisslak & Crago, 1995) • 95% of all dieters will regain their lost weight in 1-5 years

20. How do we define eating disorders? • EATING DISORDERS include extreme emotions, attitude, and behavior surrounding weight and food issues experienced by both women and men. They include anorexia nervosa, bulimia nervosa, and binge eating disorder. All are serious emotional and physical problems that can have life-threatening consequences. • ANOREXIA NERVOSA is characterized by self-starvation and excessive weight loss. • BULIMIA NERVOSA is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food-more than most people would eat in one meal- in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising.

21. Less Common Disordered Eating Syndromes • Binge eating disorder is characterized by consuming large quantities of food in a very short period of time until the individual is uncomfortably full.  Binge eating disorder is much like bulimia except the individuals do not use any form of purging (i.e. vomiting, laxatives, fasting, etc.) following a binge. • Anorexia Athletica – compulsive exercising • Night Eating Syndrome- type of sleep disorder in which people eat while seeming to be sound asleep.

22. Complications of Anorexia Nervosa • Medical • Emaciation including muscle wasting • Lowered pulse rate • Loss of menstrual cycle • Joint swelling • Behavioral • Clinical depression • Anxiety and personality disorders

23. Complications of Bulimia Nervosa • Medical • Electrolyte imbalance risking cardiac arrest • Esophagitis • Tooth Enamel Erosion • Swelling of Salivary Glands • Behavioral • Poor Coping Skills • Problems with Anxiety

24. Treating Eating Disorders • Requires the help of health professionals with expertise in managing these disorders • Pediatrician • Mental health professional • Nutritionist • Nurse • Requires hospitalization when physical signs suggest medical risks

25. America’s Promise Five Promises: • Caring adults in their lives • Safe places to live and learn • A healthy start • Effective education • Opportunities to help others

26. Bright Futures: Optimal Preventive Care • Building Effective Partnerships with child, family, health professional and community to promote health and prevent illiness • Supporting open communication • Identifying strengths of child and family • Identifying shared goals • Developing an action plan based on those goals

27. Thank You