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Mal-Nutrition : Our N ational Pandemic

Mal-Nutrition : Our N ational Pandemic. Mark B. Stephens, MD MS FAAFP Associate Professor of Family Medicine. FOUR PRIMARY RISK FACTORS*. Formula feeding during infancy Consumption of sugar-sweetened drinks Excessive television/video viewing Low physical activity. Whitaker (2003).

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Mal-Nutrition : Our N ational Pandemic

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  1. Mal-Nutrition: Our National Pandemic Mark B. Stephens, MD MS FAAFP Associate Professor of Family Medicine

  2. FOUR PRIMARY RISK FACTORS* • Formula feeding during infancy • Consumption of sugar-sweetened drinks • Excessive television/video viewing • Low physical activity Whitaker (2003)

  3. THEMES • Life on a J-shaped curve • Applying Newton’s Laws of Thermodynamics • Common Sense vs Evidence

  4. Is BMI the best measure of obesity? • Yes • No

  5. What do you think the best measure of obesity is? • BMI • Waist Circumference • Skinfold thickness • Bioelectrical Impedance • CT • Underwater Weighing

  6. Are you comfortable helping patients lose weight? • Yes • No

  7. Which do you find most helpful in assisting patients with weight loss? • Diet • Exercise • Medication • Surgery • Motivational Counseling • Combination of factors

  8. Since entering Medical or Professional school, has your weight: • Increased • Decreased • Stayed the same

  9. When in your life was it easiest to exercise? • Preschool • Elementary School • High School • Graduate/prof school • Residency • Fellowship • Staff life

  10. What is the worst handicap for a child? • Obesity • Cleft lip • Cystic Fibrosis • Muscular Dystorphy • Asthma • ADHD • Cerebral Palsy • Diabetes

  11. Now for the Data!

  12. Is it OK to use the term “obese” to describe heavy children? • Yes • No

  13. How many US children are overweight or obese? • 1 in 2 • 1 in 3 • 1 in 4 • 1 in 5 • 1 in 6

  14. How many Adults are overweight or at-risk? • 2 of 3 • 1 of 2 • 1 of 3 • 1 of 4 • 1 of 5

  15. OBJECTIVES • Define terms • Describe epidemiology • Discuss risk factors and implications • Decide what to do about it • Take home messages • Central role for Family Physicians

  16. DEFINITIONS • Underweight • BMI <5% for age • Normal • BMI 6%-84% for age • At risk for overweight • BMI 85%-95% for age • Overweight* • BMI >95% for age *Overwt = Obese (IOM, 2005) http://www.cdc.gov/growthcharts/

  17. WHY BMI? • Can be used from childhood into adolescence and adulthood • Correlates with laboratory measures of fat Best we have for now

  18. DIAGNOSIS • Based on CDC BMI-for-Age curves • Children (and adults) should be screened for obesity (SORT C) CSBM VS

  19. So What? OVERWEIGHT CHILDREN BECOME OVERWEIGHT ADULTS Guo, 2002

  20. So What, Part 2 OVERWEIGHT ADULTS HAVE MUCH HIGHER RISK* *For just about everything!!!!

  21. Background Data* • Overweight has tripled in US kids since 1980 • 31% of 6-19 year-olds are overweight or at-risk-to-become overweight • 10% of 2-5 year-olds are overweight or at-risk-to-become overweight *www.cdc.gov

  22. COLLATERAL DAMAGE Trifiletti, 2006

  23. Country Boys > 85%ile Girls > 85%ile Austria 12% 11% Belgium 13% 15% France 10% 13% Ireland 19% 14% Portugal 14% 21% Sweden 12% 12% USA 28% 31% Not Just an “American” Problem

  24. URBANIZATION AND GLOBALIZATION • “NUTRITION TRANSITION” • Agro-food systems (global corporations) • Cheap, calorie-dense foods, fats and oils • Reduction in local subsistence farming • Congregation in urban areas • Consumer culture • Less physical activity • More oils/fats/calories

  25. How many servings of fruits or vegetables are recommended per day? • 1 • 2 • 3 • 4 • 5 or more

  26. How many glasses of milk should adolescents consume per day? • 1 • 2 • 3 or more • No data

  27. How many HS students watch more than 3 hours of TV/day? • 1 in 2 • 1 in 3 • 1 in 4 • 1 in 5 • 1 in 10

  28. How many HS students meet recommended activity levels? • 1 in 2 • 1 in 3 • 1 in 4 • 1 in 5 • 1 in 10

  29. SO WHAT? Jot down diseases you think obesity increases risk for

  30. Hypertension Diabetes Hyperlipidemia Coronary Artery Disease Gallbladder disease Steatohepatitis Obstructive sleep apnea Pseutotumor cerebri Orthopedic complaints PCOS Metabolic Syndrome Depression All-cause mortality Childhood/Adolescent Overweight Increases Risk for

  31. Psychosocial Effects of Obesity • Decreased self-esteem • Bullying • Stigmatization • Sadness • Loneliness • Isolation • Increased SI/SA

  32. STIGMATIZATION • Children shown pictures of obese kids and kids with various disabilities said they would be least likely to befriend the obese child Latner, Obes Res 2003

  33. STIGMATIZATION • Overweight adolescent women • Lower education • Decreased earning potential • The ‘worst’ handicap for young adolescents?* *PARENTS OVERLOOK!!

  34. ‘Causes’ of Obesity INTAKE  OUTPUT • Energy is neither created nor destroyed • The disorder of an isolated system can never decrease (Entropy) • A body at rest tends to stay at rest (Inertia)

  35. CAUSALITY? : GENETICS? *Genetics explains 30-50% of tendency to adiposity • Genetics* • Leptin • Melanocortin • Adiponectin • 1 parent obese (50%); 2 parents (80%) *At least 430 genes linked with obesity phenotypes at present (Spieser, 2005)

  36. CAUSALITY? : GENETICS? • Secondary obesity • Prader-Willi • Bardet-Biedl • Beckwith-Wiedeman Secondary causes should particularly be considered when the child is obese AND short OR ‘dysmorphic’

  37. DIET, EXERCISE and the MODERN ENVIRONMENT

  38. MAL-NUTRITION FOOD IS: • Increasingly available • Calorie-rich • Nutrient-poor • CHEAP

  39. FAT • 4% decrease in overall fat intake in US since 1970 • ADDED fat (butter, oil shortening) has doubled since 1909 (annual average of 64lb/person) *Recent WHI data!

  40. CALORIES • Increased ‘availability’ (3300 to 3800 kcal/d from ’70 to ’98) • Increased “density”

  41. CARBS • Added sugars 20% of adolescent Kcal • Avg of 20 tsp/day • Glycemic Index has increased.

  42. CALCIUM • Inverse relationship between calcium intake and adipose levels • 85% of adolescents do not meet RDI for calcium

  43. FRUITS AND VEGETABLES • Overall US intake has increased 24% since 1970 • 80% of children and adolescents do not meet USDA recommendations (5-a-day) Eat a Rainbow

  44. FAST FOOD • On any given day, 20-30% of US households patronize a restaurant. • 25%-50%* of all meals are away-from-home (35% of overall energy intake) • Fast food = 10% of school food! *Washington Post, 2007

  45. FAST FOOD Children and Adults who consume fast food: • More total energy • More total fat • More total carbohydrate • More added sugars • Less fiber • Less calcium • Fewer fruits and vegetables

  46. SUGARED BEVERAGES Sugar-Sweetened Beverages (SSB) • Beverage of choice • Intake has doubled over past 20 years • Average 19 oz/day for boys; 11 oz/day for girls

  47. PHYSICAL INACTIVITY • 25% of adolescents do not engage in ‘sufficient’ physical activity; 14% do not exercise at all. • Only 28% of 9th-12th graders have daily PE • Many in PE aren’t active! • Play is the traditional, spontaneous form of physical activity • Organized sports activities

  48. PHYSICAL INACTIVITY • Free time is increasing • 2-3 hours/wk used for physical activity • 28 hours/wk used for television/videos • >40,000 targeted ads for candy, cereal and fast food

  49. I’d rather Die than Exercise • 6 of 10 British adults would rather die than exercise or eat properly • UK Guardian September 23, 2007

  50. TV/VIDEO… • 38% of children watch at least 3 hours of TV on most, if not all, school days. • 98% of households have 1 TV; 75% have 2+ • Hours of TV viewing correlate directly with BMI

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