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Youth Obesity Causes, Consequences, and Solutions

Youth Obesity Causes, Consequences, and Solutions. Stephen Cook, MD, MPH Assistant Professor, Pediatrics Golisano Children’s Hospital at Strong. Winter is almost over in Rochester; we can see the deer wandering around now. Consequences. The Metabolic Syndrome: Historical Perspective.

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Youth Obesity Causes, Consequences, and Solutions

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  1. Youth Obesity Causes, Consequences, and Solutions Stephen Cook, MD, MPH Assistant Professor, Pediatrics Golisano Children’s Hospital at Strong

  2. Winter is almost over in Rochester; we can see the deer wandering around now

  3. Consequences

  4. The Metabolic Syndrome:Historical Perspective 1988: Syndrome X InsulinResistance GlucoseIntolerance Hyperinsulinemia  TG  HDL-C Hypertension CORONARY HEART DISEASE Reaven G. Diabetes. 1988;37:1565-1607.

  5. Criteria for Metabolic Syndrome inAdults and Adolescents

  6. Rates of Metabolic Syndrome by Increased Smoke Exposure in US teens

  7. Genetics, Peri-natal, Puberty, Diet, Physical Activity Potential Precursors: Adiponectin Other inflammatory cytokines • Dyslipidemia • Elevated BP • Abnormal glucose-insulin metabolism • Pro-inflammatory factors • Pro-thrombotic factors Tobacco use/exposure Bold = factors included in this study Diabetes Obesity Abdominal Obesity Cardiovascular Disease Proposed Metabolic Syndrome Factors in the Life Course from Obesity to Cardiovascular Disease

  8. Co-morbidities with Cardio-metabolic Risk among youth • Non Alcoholic Fatty Liver Disease • Polycystic Ovarian Syndrome • Obstructive Sleep Apnea

  9. Polycystic Ovarian Syndrome • Menstrual Irregularities / Infertility • Small Cysts on Ovaries • Hyper-Androgenism • Insulin Resistance • +/- obesity • Increased CVD risk

  10. Prevalence of Metabolic Syndrome and Components among Obese Teen Girls Rossi, et al. Journ of Clin Endo & Met 2008; 93:4780

  11. A schematic representation of how components of the metabolic syndrome relate to fat accumulation in the liver Kotronen, A. et al. Arterioscler Thromb Vasc Biol 2008;28:27-38

  12. Cardiovascular Risk Factor Values by Liver Status in Obese Children & Adolescents Schwimmer, J. B. et al. Circulation 2008;118:277-283

  13. Distribution of features of metabolic syndrome in obese youth with and without NAFLD Schwimmer, J. B. et al. Circulation 2008;118:277-283

  14. Solutions?

  15. Greater Rochester Health Foundation Strategic Areas of Focus Neighborhood Health Status Improvement Health system improvement Prevention

  16. GRHF Childhood Strategy GOAL: Reduce the prevalence of overweight and obesity from 15% to 5% of Monroe County children ages 2-10 by 2017 [from 12,144 kids to 4,081 kids] Execute a community communications campaign Increase physical activity and improve nutrition Advance policy and practice solutions Engage the clinical community

  17. Change is hard Most difficult steps: Increasing my own physical activity is difficult (68% moderate to very difficult) Reducing TV time for my children is a challenge (63%) Getting my kids to eat healthier won’t be easy (61%)

  18. Opportunities Getting my kids to be physically active is doable (70% Easy) I want my child’s school to offer more physical activity (84% Very Important) I trust health and nutrition information from my doctor (63% Trust a Lot), and pharmacist (37%), more than my family (20%) and the Internet (12%) I am willing to engage in physical activity to lead my children to be more active (56% Easy)

  19. BMI categories for children living in Rochester, by Race/Ethnicity

  20. Funded activities fornext 3 years Early childhood - $1.8 million Clinical outreach - $750,000 Advocacy - $467,000 Suburban School projects - $820,000 Community Champions - $500-1000/ea Media/Social Marketing Campaign ~ $5 million over 3 years

  21. Greater Rochester Healthy Child Care 2010:An early childhood overweight and obesity prevention program The Children’s Institute Eat Well / Play Hard Enhanced Child Care Council & Centers Hip Hop to Health Jr Rochester Childfirst Network & Home care providers 9 sites in each arm, 3 arms per year 3 years

  22. Clinical Strategy: Greater Rochester Obesity Collaborative Interactive, group training that promotes collaborative learning, implementing small cycles of changes, with practice feedback and sharing lessons learned from other teams

  23. Institute for Healthcare Improvement Break Through Series (BTS) Model

  24. G-ROC Use a Learning Collaborative approach to train pediatric primary care providers Collaborate with Expert Consultants from NICHQ and AAP Recruit motivated practice teams: physician, nurse, off mgr & PARENT Adapt AMA/CDC Expert Recommendations for local community Conduct 4 training workshops with follow-up conference calls and individual practice visits over ~ 12 months, conduct 3 cycles over 3 years Provide on-line/free access simple practice tools and link to local resources Create a Community-wide toolkit and Region-specific resource guide

  25. G-ROC Practice and Overall results For October 2008

  26. Policy Project

  27. HEALTHI Kids:Healthy Eating and Active Living THrough policy and practice Initiatives for Kids Finger Lakes Health Systems Agency Wade S. Norwood Director of Community Engagement (585) 461-3520 ext.110 wadenorwood@flhsa.org 45

  28. Convening HEALTHi Kids • Texas Obesity Policy Portfolio 2006, Texas Department of State Health Services, Center for Policy & Innovation • Convene 27-member HEALTHi Kids Policy Team • Examine public policy/practices that promote youth’s healthy eating and active living.

  29. Eliminate the availability of food in schools that compete with the national school breakfast and lunch program. Mandate the development and execution of nutritional standards so all food available on school campuses is consistent with a set of community standards.

  30. Mandate the development and execution of nutritional standards for preschools, childcare centers, and school-age childcare programs, so that food and drinks available comply with Dietary Guidelines for Americans or equivalent community standards.

  31. Create policies that are supportive of breastfeeding throughout the community and all hospitals in Monroe County meet the WHO Baby Friendly Hospital Criteria (Ten Steps to Successful Breastfeeding for Hospitals).

  32. Improve the safety of, the perception of safety of, and access to recreational facilities, bike trails, parks, and green spaces, while expanding after-hour access to schools and promoting safe play.

  33. Require that K-12 grade students are provided with 45-minutes of moderate to intense physical activity daily.

  34. QuestionsMy Drive Home

  35. Monroe County Obesity Rate by Geography, 11 – 14 yr olds, 1999 16%

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