Childhood Obesity

1. Childhood Obesity Health Outcomes of Breastfeeding Dennette Fend, NP William Beaumont Hospital Nutrition and Preventive Medicine Outpatient Breastfeeding Clinic March 28, 2014

2. Outline • Obesity Epidemics • Etiology of Obesity • Medical and Psychosocial Consequences • Efforts to Reverse the Epidemic – Health Outcomes of Breast feeding

4. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

6. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

7. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

8. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

9. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

10. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

11. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

12. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

13. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

14. Obesity Trends* Among U.S. AdultsBRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

15. Obesity Trends* Among U.S. AdultsBRFSS,1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2000 1990 Obesity: 35% Overweight and Obesity: 68% 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

16. Childhood Obesity (ages 10-17) • Childhood obesity has more than tripled over the past 3 decades. • Obesity: 17% • Overweight & obesity: 35%

17. Race/Ethnicity and Childhood Obesity

18. Body Mass Index (BMI) Weight (kg) Height (m2) BMI = Adapted from the World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO; 2000.

19. Defining Childhood/Adolescent Overweight and Obesity Child Obesity BMI > 95th % Child Overwt BMI > 85th % and < 95th %

20. Outline • Obesity Epidemics • Etiology of Obesity • Medical and Psychosocial Consequences • Efforts to Reverse the Epidemic

21. Positive Energy Balance Leads to Weight Gain FatStores Basal metabolic rate, Physical activity Food, Drinks

22. Saving and OverconsumingEnergy

24. 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

25. Portion Distortion 30 Years Ago Today 320 calories How many calories today?

26. Portion Distortion 30 Years Ago Today 320 calories 820 calories 500 Calorie Difference

27. Portion Distortion 30 Years Ago Today 85 Calories 6.5 ounces How many calories today?

28. Portion Distortion 30 Years Ago Today 170 Calorie Difference 85 Calories 6.5 ounces 250 Calories 20 ounces

29. BAGEL Portion Distortion 30 Years Ago Today 140 calories 3-inch diameter How many calories today?

30. BAGEL Portion Distortion 30 Years Ago Today 140 calories 3-inch diameter 350 calories 6-inch diameter Calorie Difference: 210 calories

31. Portion Sizes for Americans Aged 2 years and Older JAMA, 2003; 289: 450-453 et al., JAMA 2003; 289:450-453.

32. 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. VartanianLR, Am J Public Health 2007;97(4):667—675. Wang YC, Pediatrics 2008;121(6):e1604—1614.

33. 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.

34. 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

35. 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

36. 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 RideoutVJ, A Kaiser Family Foundation Study; 2010. Rideout V, The Henry J. Kaiser Family Foundation; 2006.

37. 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. PediatrClin North Am 2001;48(4):1017—25. .

38. 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

39. 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

40. Outline • Obesity Epidemics • Etiology of Obesity • Medical and Psychosocial Consequences • Efforts to Reverse the Epidemic

41. 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.

42. 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

43. 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

44. 1 out of 3 children born in the year 2000 will be diabetic during their lifetime.

45. 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.

46. 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.

47. Perceptions

48. Perceptions

49. Perceptions

50. 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)