Childhood Obesity. Jay A. Perman, M.D. Vice President for Clinical Affairs University of Kentucky

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1 Childhood Obesity Jay A. Perman, M.D. Dean, College of Medicine Vice President for Clinical Affairs University of Kentucky

2 Epidemic of Overweight & Obesity in Children

3 Prevalence of Overweight by Race/Ethnicity (Aged years) [ CDC gov] Adolescent Boys Adolescent Girls

4 Definition & Scope of Problem Obesity is BMI-for-age & gender 95 th percentile At risk for Obesity is BMI-for-age & gender from 85 th to 95 th percentiles 30% of U.S. children and adolescents are at risk or obese [NHANES, USDHHS 2004]

5 Contributing Factors to Obesity Genetics Low-energy Expenditure Diet Psychological oogca Factors acos Family/social factors

6 Genetics

7 Heredity/Environment Heredity may influence fatness and regional fat distribution Rare genetic syndromes may co exist with obesity (see handout) Heredity may co exist with environmental factors Parental modeling dli of both eating and exercising ii behaviors Both parents obese

8 J Pediatr Gastroenterol Nutr., Vol. 48, No.3 March 2009

9 Influences on gut microbial composition during early infancy Prematurity Mode of delivery Infant feeding Hospitalization Antibiotic Use

10 Altered Microbiome and Obesity Is gut microbiome altered in obese individuals? Population-based studies; twins discordant for obesity? Does gut microbiome influence visceral obesity or obesity in general? Do gut bacteria directly influence appetite? Satiety? t How does antibiotic treatment in childhood influence obesity in later life?

11 Other Contributing Factors Low-energy Expenditure Watching TV or playing video games High-calorie snacks when watching TV Diet Regular consumption of high calorie foods, vending machine snacks, soft drinks Psychological Factors Overeating to cope with problems or to deal with emotions Family/social factors Parental purchasing: Unhealthy foods

12 Medical Complications

13 Comprehensive Treatment DIET ACTIVITY FAMILY PARTICIPATION BEHAVIORAL INTERVENTION REWARD

14 Dietary Strategies for Families Balance calories with activity to maintain growth 60 mins of play or physical activity daily Fruits and veggies daily Limit juice and sugar sweetened beverages Change to skim milk Eat whole grain breads and cereals

15 Dietary Strategies for Families Reduce salt intake,including including processed foods Eat lean meats Eat more fish Substitute tofu and beans for meat Use vegetable oil or soft margarines in cooking Limit high calorie sauces e.g Alfredo

17 Resources Mypyramid.gov We Can cdc.gov website Fruitsandveggiesmatter.gov es atte go

18 Activity Emphasize activity, not exercise-60 minutes daily Vary the activity Find activity child likes Encourage organized sports or structured sports Encourage activities done as a family

19 Walking school bus

20 What can healthcare providers do? Walking school buses Demand all food in school meet US Dept. of Agriculture nutrition guidelines Daily physical education in school Campaign for sidewalks, play grounds, bike paths and recreational facilities particularly in underserved areas Eliminate unhealthy advertisement

21 Prevention Early recognition Teach healthy behaviors at young age Create a healthy eating environment Create an active environment Make physical fitness fun One change at a time Families and schools are the two critical links

22 Activate Johnson

23 1. 53 million students Why Schools? 2. Continuous and intensive contact with children 3. Children eat 1-2 meals 5 days a week (30% of calorie intake) 4. Schools have resources, gyms, playgrounds, fitness equipment 5. Health and nutrition t education part of school mission 6. Potential to influence attitudes and behavior change

24 Building a Coalition Lexington-Fayette County Health Department Fayette County Public Schools YMCA UK Colleges of Agriculture, Education, Medicine, Nursing and Public Health Community Trust Bank God s Pantry

25 Why Johnson Elementary? Risk factors for Obesity Johnson Risk Factors Low income Minority both African American and Hispanic Communities with poor access to parks and safe areas to play Poor access to grocery stores with fresh fruit and vegetables 93% children on free or reduced lunch 80% minority (67%AA, 13% H) Few parks No full service grocery stores 53% children over the 85%ile 30% overweight (national average 16%)

26 Building a Program Teacher Involvement Faculty meeting Focus group Naming of after-school program Non-food reward choices Parental Involvement WE CAN curriculum How to cook on a budget Educate regarding WIC vouchers for vegetables and fruits PTA involvement

27 Jumpin Jaguars Obesity Prevention

28 Jumpin Jaguars Obesity Model Universal Targeted Intensive Universal (All Kids) Nutrition Education In Class physical activity Removing food as rewards Healthy B-fast and Lunch School Health Advisory Council Targeted (kids > 85%) Parent education We Can After School fun activity-2 days a week for 90 minutes Healthy snacks Mentors Behavioral support Intensive (kids >95%) To be developed

29 Lessons Learned Obesity Prevention programs have to be comprehensive involving students, families, and school staff Community partners are necessary for success and bring unique strengths and resources Multi year interventions are needed to have lasting impact Children have fun and feel positive about the experience

30 An Ounce of Prevention is Better than a Pound of Cure

Module Let s Eat Well & Keep Moving: An Introduction to the Program

Module Let s Eat Well & Keep Moving: An Introduction to the Program Module 1 Let s Eat Well & Keep Moving: An Introduction to the Program From L.W.Y Cheung, H. Dart, S. Kalin, B. Otis, and S.L. Gortmaker, 2016, Eat Well & Keep Moving, 3rd ed. (Champaign, IL: Human Kinetics).