-Impuls- Übergewicht und Adipositas bei Kindern: Entwicklung, Folgen & Präventionsstrategien

Transcription

1 -Impuls- Übergewicht und Adipositas bei Kindern: Entwicklung, Folgen & Präventionsstrategien Prof. Dr. med Dr. (h.c.) Arya M Sharma, Chair in Obesity Research & Management University of Alberta Edmonton, AB, Canada

2 Obesity Trends* Among Canadian Adults CCHS, 2003 Data from: Statistics Canada. Health Indicators, June, ALBERTA No Data <10% 10%-14% 15-19% 20%

3 Alberta Edmonton Calgary Canadian Rockies

4 Global Obesity Map 2014 The Lancet, 2016

5 Obesity 2016;24:

6 Obesity Class 1 95 th percentile Obesity Class 2 120% of the 95 th percentile Obesity Class 3 140% of the 95 th percentile

7 CMAJ 2016 May 9 (Epub ahead of print) >14,000 children (3 19 years old) from Data from the Canadian Community Health Survey and Canadian Health Measures Survey Over this period Obesity remained stable (13%) Overweight decreased (31% 27%) Abdominal fatness decreased

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9 Societal influences Individual psychology Food Production Food Consumption Individual activity Activity environment Biology

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11 % weight regain Recovery of Lost Weight After Diet-Induced Weight Loss (16 studies) Duration of Follow-Up Safer, So. Med. J. 84:1470, 1991

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13 Summary (Whitlock et al., 2010) Objective: To examine the benefits and harms of behavioural and pharmacologic weight-management interventions for overweight and obese children and adolescents (effectiveness). Inclusion Criteria: RCTs or case-control trials Outcomes available >6 months post-baseline Behavioural (including lifestyle) and/or drug interventions Feasible to implement in primary care Reported all potential harms / adverse events Results: n = 13 lifestyle or behavioural interventions (n = 1,258 children and youth) n = 7 drug + behavioural interventions (n = 1,294 youth) Conclusions: - Behavioural Interventions: Medium- to high-intensity interventions (26 75 hrs of contact) lead to modest short-term weight reductions; limited evidence supports long-term weight maintenance. - Drug + Behaviour Interventions: Benefits are superior to behaviour tx alone; limited evidence of adverse events related to medication. - Many intervention models are feasible in primary care setting.

14 Successful Weight-Loss Maintainers National Weight Control Registry Limit their intake of certain foods Consume an average of 1400 Cal/day 24% of cal from fat 19% of cal from protein 56% of cal from carbohydrates. Eat five times a day Burn an average of 2,800 Cal a week through exercise 400 Cal/day or 60 min of walking at 15 min/mile

15 Isn t Obesity Simple? Genetics Diet Energy In +/- +/- Exercise Energy Out Energy Regulation is Complex! Sharma AM 2007

16 Central Control of Energy Metabolism

17 Adaptations To Weight Loss Hormonal changes (e.g. decrease in leptin, increase in ghrelin, etc.) Increase in appetite Decrease in metabolic rate Decrease in activity thermogenesis

18 Biggest Losers Fight a Slower Metabolism New York Times 2016

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20 Morphological Microglial Reactivity in Diet-Induced Obesity in Mice (AIF-1-ir) Stefanie Kälin et al., Nature Reviews Endocrinology 2015 Chow-fed High-fat diet

21 Horvath TL, et al. PNAS 2010;107:14875

22 These data suggest that consumption of an HFD has a major impact on the cytoarchitecture of the arcuate nucleus in vulnerable subjects, with changes that might be irreversible due to reactive gliosis. Horvath TL, et al. PNAS 2010;107:14875

23 Stunkard: Twin Studies Monozygous Share genes and environment

24 Stunkard: Twin Studies Monozygous Share genes and environment Heterozygous Share environment

25 Gene Map of Common Obesity El-Sayed Moustafa et al. Nature Reviews Endocrinology, 2013

26 Epigenetics nihroadmap.nih.gov

27 Increased Melanocortin Expression in Fetal Offspring of Nonhuman Primates Fed a High-Fat Diet Grayson BE, et al. Endocrinology 2010;151:1622 Maternal Control Diet Maternal High Fat Diet

28 J Clin Endocrinol Metab. 2009;94: mothers with bariatric surgery; 54 children before and 57 after surgery yrs old Children born after surgery: 3-fold lower prevalence of severe obesity (11 vs. 35%) greater insulin sensitivity improved lipid profile lower C-reactive protein

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30 N Engl J Med 2015;373:

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32 BMC Pediatr 2014;14:154

33 Table 4 Nutrition- and physical activity-related habits of children and youth categorized as overweight/obese (OW/OB) and severely obese (SO) OW/OB SO p-value Energy intake (kcal/d) 1955 ± ± 857 <0.001 (n = 166) (n = 139) Carbohydrate intake (g/d) 261 ± ± (n = 166) (n = 139) Protein intake (g/d) 77 ± ± 43 <0.001 (n = 166) (n = 139) Fat intake (g/d) 68 ± ± 42 <0.001 (n = 166) (n = 139) Vegetables and Fruit (servings/d) 3.6 ± ± (n = 156) (n = 132) Grain Products (servings/d) 7.7 ± ± (n = 156) (n = 132) Milk and Alternatives (servings/d) 2.0 ± ± (n = 156) (n = 132) Meat and Alternatives (servings/d) 1.9 ± ± (n = 155) (n = 132) Steps/d 8012 ± ± (n = 154) (n = 120) MVPA (min/d) 69.1 ± ± (n = 159) (n = 119) Active video game time (min/d) 2.9 ± ± (n = 158) (n = 117) Leisure time screen time (min/d) ± ± (n = 159) (n = 120) Sleep duration (hr/night) 9.6 ± ± (n = 163) (n = 125)

34 Paediatr Child Health Vol 21 No 1 January/February 2016

35 Edmonton Obesity Staging System Pediatrics (EOSS-P) Pediatric Staging Tool Hadjiyannakis S et al. Paediatr Child Health 2016

36 >50% of referred children do not initiate treatment 30 50% of children dropout of treatment prematurely

37 Why don t families enroll in care after referral? Why do families discontinue care prematurely? Why do families continue care for an extended period of time? Multi-site, qualitative study at multidisciplinary pediatric weight management clinics (Vancouver, Edmonton, Hamilton, Montreal); data collection: on-1 interviews with families: n=20 Non-Initiators n=40 Initiators n=40 Continuers

38 Referral Declined

39 Adult Obesity Drives Childhood Obesity

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