The Habits of the Family. American Childhood: Overweight, Undernourished, & Unfit. Nine Evidence-Based Messages 4/4/2011. Childhood Obesity Now

Transcription

1 American Childhood: Overweight, Undernourished, & Unfit Childhood Obesity Now Robert Murray MD The Ohio State University Columbus, OH Nine Evidence-Based Messages The Habits of the Family 1. Support exclusive breastfeeding 4-6 months 2. Limit sweetened beverages 3. Eat 5 servings per day of fruits & vegetables 4. Participate in moderate to vigorous physical activity for 60 mins/ day 5. Limit screen time to a maximum of 2hrs/ day 6. Do not allow your child to have a television in his or her bedroom 7. Eat a nutritious breakfast every day 8. Engage in regular family meals 5-6 times/ week 9. Limit portion sizes Prevention & Counseling Genes TV Habits Snack Habits attitude Exercise Habits Meal Habits 1

2 Cereals Infants & Toddlers The Feeding Infants & Toddlers Study JADA December 2010 Any Grain Infant Cereal Non- Sweet Sweet Cereal Cereal Bars 4-6 mo 65.8 % 64.8 % 0.5 % 0.0 % 0.0 % Fox et al JADA, Jan 2004 What Infants & Toddlers Drink All milks 100% juice Fruit drinks Soft drinks Water 4-6 mo 100 % 21.3 % 1.6 % 0.1 % 33.7 % Skinner et al 2004, 104:s45 Desserts and Sweets Any Dessert Baby Desserts Cakes, pastries, cookies 4-6 mos 10.4 % 4.2 % 4.3 % 0.0 Candy % Fox et al JADA, Jan

3 We Don t Promote Vegetables Dark Green Vegetables are consumed by fewer than 10% of toddlers Deep yellow vegetables decrease from 39% at 9 mos to 14% at 18 mos Potatoes on any day 4-6 mos 3.6% 7-8 mos 12.4% 9-11 mos 24.1% mos 33.2% mos 42.0% mos 40.6% By 24 mos 25% of toddlers consume fried potatoes on any day Actual Fruit & Vegetable Intake 1/3 Did Not Eat Any Source: Fox et al Briefel, FITS 2010 Age (mos) The TV Habit Starts Early, Too >5 hours/ d Children watching > 2 hrs/ day at age 2 yrs were more likely to watch > 2 hrs/ day at 6 yrs Media Use: 8-18 yo Screen time > 7 hours/ per day TV 4.5 hrs/ day Music 2.3 hrs/ day Computer 1.5 hrs/day Print media only 30 minutes / day Strasburger, Pediatrics 2010; 125:756 3

4 know the number! BMI %-ile At every well-child visit, discuss weight nutrition, activity and health risk Dietary Guidelines for Americans, 2010 WHAT IS QUALITY NUTRITION? Targeted Dietary Behaviors for Normal Weight Energy in = Energy Out Lower total energy Lower energy density Lower total fat Less fast food Less television? Dairy? Fiber Lower sweetened beverages Lower fruit juice Smaller portions More fruits & veggies Breakfast daily Dietary Guidelines Advisory Committee,

5 2010 Dietary Guidelines Meals and snacks from 5 food groups Fruits Vegetables Whole grains Low-fat milk and dairy Lean meats, quality protein Control excess weight Balance food with daily activity Nutrition from every calorie nutrient rich foods Activity = Calories Gender Age (years) Sedentary Moderately Active Female Male Active 2-3 1,000 1,000-1,400 1,000-1,400 1,200 1,600 1,800 2,000 1,800 1,600 1,400 1,800 2,200 2,400 2,200 2,000 1,400-1,600 1,600-2,000 2,000 2,000-2,200 2,000 1,800 1,400-1,600 1,800-2,200 2,400-2,800 2,600-2,800 2,400-2,600 2,200-2,400 1,400-1,800 1,800-2,200 2,400 2,400 2,200 2,000-2,200 1,600-2,000 2,000-2,600 2,800-3,200 3,000 2,800-3,000 2,400-2,800 Nutrient Rich Foods Consume a variety of nutrientdense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt and alcohol. TEN Power Foods! Sweet Potatoes/ Squash Carotenoids, Vit C, potassium, fiber Spinich Vit A,C,K, folate, potassium, mag., iron, phytochemicals Tomatoes Vit A,C, fiber, phytochem Salmon Omega-3 fatty acids Blueberries Vit C, fiber, folate, potassium Broccoli Vit C, folate, carotenoids Rye crackers Whole grain, fiber Brown rice Whole grain, fiber, vit E, B-6, zinc, magnesium Citrus fruits Vit C, fiber, folate Nuts Fiber, protein, MUFA/ PUFA, omega-3 FA (walnuts), vit E (almonds), folate (peanuts) Dietary Guidelines for Americans,

6 Veggies & Kids Vegetable Intake 1-8 yrs age cup servings/ day 9-18 yrs age cup servings/ day % Children Consuming Daily Recommended Intake Overfed But Undernourished Critical Age Sources Veggies in complex foods 51% Starchy vegetables 36% Legumes 7% Yellow vegetables 3% Green vegetables 3% Iron Phosphorus Zinc Vitamin C Vitamin A Magnesium Folate Calcium 6-11 Mo. 1 Yr. 1-4 Yrs. 5-8 Yrs Yrs Yrs. National Cancer Institute, 2010 Data compiled by Dr. John Lasekan, Ross Labs from NHANES and the Continuing Food Survey , 1998 Women, Infants & Children Program ½ of all U.S. infants are on WIC 8.7 million participants/ month 25% infants 50% children to age 5 years 25% pregnant and lactating females At-risk women between pregnancies A more nutrient rich diet than non-wic peers and equal to higher income infants WIC has adjusted to Childhood Obesity Nutrient Inadequacy High School Students Males Vit A, Vit C, Vit E Magnesium, potassium Fiber Calcium Clark, Fox, JADA 2009; s44 Females Vit A, Vit C, Vit E, Vit D Magnesium, potassium Vit B-6 Folate Thiamin Iron Phosphorous Zinc Fiber Calcium 6

7 Women in Child-bearing Years years of age Fetal Experience Programs Future Disease Deficiency common: iron, vitamin D Intake high: saturated fat and sodium Intake low: fiber, vitamin E, calcium, magnesium and potassium Intake moderately low: vitamins A, C, B-6 and Folate IOM Dietary Reference Intakes, 2006; USDA, HHS: Dietary Guidelines for Americans, 2005 Growth Obesity Hypertension Abnormal Lipids Cardiovascular Disease Diabetes Metabolic Syndrome Behavioral Health Gillman, NEJM 2009 Snack Foods and Drinks are Sabotaging Child Nutrition NOT DIETS 7

8 Kids & Energy-Dense, Nutrient-Poor Foods Snacking = 30-40% of daily energy Daily calories Carbohydrates Fats increased increased increased Displace: Protein, fiber, vitamins, folate, calcium, magnesium, iron, zinc Kant Arch Ped Adol Med 2003; 157:789 Dietary Guidelines for Americans, 2010 Trends in Snacking U.S. Children 31,337 ages 2-18 yrs Nationwide Food Consumption Survey Continuing Food Survey of Individuals National healthy & Nutr Examination Survey 24-hr dietary recall interviews on 2 days Snacks defined conservatively Snacks consumed in 15 min periods Health Aff 2010; 29: Snacking has Increased Markedly yr olds 76% 99% 7-12 yr olds 74% 99% yr olds 73% 98% All subjects 74% 98% Snack Facts: 2-6 year olds Past 3 decades Added 1.4 snacks (1.34 to 2.75/ day) Added 29 grams/ snack Added 182 more kcal/ day Health Aff 2010; 29:

9 Snack Calorie Sources Desserts 21.4% Salty Snacks 15.7% * Sweetened drinks 14.5% Juice and fruit 9.4% Candy 8.5% * Milk and dairy 8.4% Snack s Contribution FOOD GROUP SERVINGS CONSUMED AS SNACKS Grains 22% chips, puffs, breads, cookies Vegetables 15% potato chips, pizza, french fries Fruits 39% OJ, apples, non-citrus juices Milk 24% white, flavored, frozen dairy Meat/beans 12% hot dogs, lunch meats Oils 37% corn chips, puffs, potato chips Solid fats 24% frozen dairy, cookies, milk Added sugars 43% soft drinks, fruit drinks, candies Discretionary 35% soft drinks, frozen dairy, candies Health Aff 2010; 29: Sebastian, J Adol Health 2008; 42:503 Empty Calories Key Target: SoFAS 6 Foods = ½ of all empty calories Grain desserts * 138 kcal/d Pizza * 136 kcal/d Soft drinks * 118 kcal/d Fruit drinks Dairy desserts Whole milk = empty fat Solid Fats Pizza Grain desserts Whole milk Regular cheese Fatty meats Added Sugars Soda Fruit drinks Grain desserts Dairy desserts Candy Nearly 40% of total calories in 2-18 year olds Children s Dietary Intakes, DGA, 2010 National Cancer Institute,

10 Teen Snacking a steady rise over 25 years FREQUENCY MALES FEMALES 0 Snacks 11% 2156 kcal 1501 kcal 1 Snack 25% 2391 kcal 1812 kcal 2 Snacks 26% 2505 kcal 1944 kcal 3 Snacks 19% 2916 kcal 2136 kcal 4 Snacks 18% 3249 kcal 2437 kcal GRAZING is the new norm Sebastian, J Adol Health 2008; 42:503 The Urban Corner Store 833 intercept surveys 4-6th graders 10 urban schools, > 50% free/ reduced Most purchased: snacks Chips, candy, sweet beverages Foods > beverages Fruit drinks doubled soda Spent Calories per trip $1.07 on 2.1 items/ trip 356 kcal Pediatrics 2009; 124: % of Daily Calories School may be the Only Place a Child Learns are consumed at school Portion & Proportion 10

11 How School Lunch is Balanced Must meet Dietary Guidelines for Americans No more than 30% fat / 10% saturated fat Provide 1/3 RDA for: Protein Iron Calories Calcium Vits A &C Local school decides the menu and how to prepare, they purchase foods, then balance the meals over the week HEALTHY FOOD ZONE Competitive Foods A la Carte Sales School Parties Fundraisers School Stores Vending Boosters Athletics Student Clubs Versus The Federally Regulated School Meal Program Avoidance Messaging We have created a dangerous misperception: That fewer bad nutrients = quality nutrition 11

12 Less fat, fewer calories but not more nutrients The Baby with the Bathwater? Does it merit this? BUT Kids Don t Get Enough Calcium Age Male Female 6-11 y 44% 58% y 64% 87% >20 y 55% 78% Naturally Nutrient Rich the basics of nutrition 12

13 A Crossroads Reformulate Processed Foods? 100 Years of Fortification Fortification Iodine (salt) Vit D (milk) Calcium (OJ) Folate (cereal) B vitamins (flour) Flouride (toothpaste) Vit A ( golden rice ) Niacin (bread) Nutraceuticals Omega-3 FA Antioxidants B-carotene/ lycopene Transgenic oils Remove sugarsweetened beverages Remove high-calorie snacks from all sites Zone fast food Set policy on marketing foods Lower sedentary time Recommendations for Children Improve food sold in school Educate on nutrition, PE, health Track BMI Safe routes to school Affordable summer programs DGA,

14 Summary Societal problem Habits start early in life Prevent excess weight gain Optimize nutrition Processed snacks #1 target We need industry! 14