Childhood Obesity from the Womb and Beyond

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1 Childhood Obesity from the Womb and Beyond Dr. Theresa Loomis, RD Assistant Professor, SUNY Oneonta Director; MS- Nutrition and Dietetics Program Pediatric Private Practice Dietitian

2 Objectives Who is at risk for childhood obesity? Why is childhood obesity on the rise? How can we prevent the development of childhood obesity What are the risks associated with childhood obesity? What counseling strategies can be employed?

3 Who is at Risk for Obesity?

4 Not All Weight Gain Created Equal used with permission

5 Lean body Mass is Important used with permission

6 Protein is the Limiting Nutrient

7 Childhood Obesity: A Worldwide Issue Childhood Obesity has increased in every country worldwide where data is available

8 Obesity Trends 8

9 2017; Purple indicates > 35%

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11 Definition of Childhood Obesity Overweight: BMI between 85 and 94 th percentile Obesity: BMI greater than 95 th percentile

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13 Childhood overweight and obesity described as epidemic; no longer an adulthood problem Boys between the ages of 6 and 19 are at the heaviest weight levels

14 Risk Factors for Childhood Obesity Genetic Factors Environmental Factors Decreased Physical Activity Increased screen time Lack of Income Lack of Education

15 Dietary factors associated with Obesity Low intake of fruits and vegetables High intake of energy dense foods Low intake of calcium and vitamin D

16 Vitamin D Obese adults and children have been shown to have low serum 25(OH)D levels and elevated PTH levels Hypovitaminosis D hypothesized to be due to enhanced sequestration of vitamin D in fat Increased parathyroid hormone levels are believed to increase intracellular calcium in adipocytes which leads to increased lipogenesis and weight gain Subjects with hypovitaminosis D are believed to be at higher risk for insulin resistance and metabolic syndrome

17 The earlier overweight or obesity develops, the greater the likelihood that it will persist into adulthood and the greater the chances of developing consequences associated with it

18 Overweight children are at risk for being overweight adults It is estimated that 80% of overweight children go on to be overweight adults (Serdula et al)

19 Consequences Associated with Childhood Obesity Type II Diabetes Mellitus Cardiovascular disease Metabolic Syndrome Asthma Sleep Apnea Orthopedic Problems Psychosocial disorders

20 Consequences Associated with Childhood Obesity Type II Diabetes Mellitus Cardiovascular disease Metabolic Syndrome Asthma Sleep Apnea Orthopedic Problems Psychosocial disorders

21 PREVENTION!!! The earlier the prevention of childhood obesity begins, the more likely it is to be effective

22 Right From the Start Healthy diet during pregnancy Breastfeed Delayed introduction of solid foods Structured meal and snack times Family Meals Involve children in cooking Grocery shop with children Role model healthy behaviors

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24 Expert Committee Recommendations

25 Expert Committee Recommendations Limit consumption of sweetened beverages Encourage 5-9 fruits and vegetables per day Eat a healthy breakfast daily Prepare more meals at home as a family Encourage family meals Involve the whole family in lifestyle changes Limit portion sizes Limit television and other screen time to less than 2 hours per day Emphasize 60 minutes of physical activity per day (American Heart Association Reccommendations)

26 Limit Consumption of Sweetened Beverages Limit juice to 4 oz per day Limit milk to oz per day Soda an occasional treat Encourage 8 glasses of water per day Bring water bottle to sip on throughout the day Avoid artificial sweeteners to decrease preference for sweet

27 Encourage 5-9 Fruits and Vegetables Per day Have them choose Multiple exposures necessary Yogurt dips and hummus One at each meal Mix them into foods Smoothies

28 Healthy Breakfast Daily Choose at home or at school Balanced with protein and fruit or vegetable Improved energy throughout the day Get a start on fruits and vegetables Pack the night before for grab and go

29 Role Modeling Prepare more meals as a family Eat out less often Involve the whole family in lifestyle changes Provide appropriate serving sizes

30 Encourage appropriate CHILD size portion sizes ¼-1/3 of appropriate adult serving sizes

31 Limit screen time to less than 2 hours per day

32 Emphasize Exercise Encourage at least 60 minutes per day Make activity part of the lifestyle Stairs instead of the elevator Park far away Family walks or trips to the park Dancing during commercials What does the child like to do?

33 Other Tips Avoid good vs. bad foods Promote increase in desired foods to push-out foods lower in nutrient density Make half plate fruit and/or vegetable Encourage adequate sleep to decrease cortisol and improve energy

34 Counseling Strategies Group vs. individual counseling Employ motivational interviewing Focus on healthy behavior change Follow-up frequently for accountability Set a few goals each time Don t focus on weight

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36 Prevention Programs Let s Move Fuel Up To Play 60 Let s Go School Breakfast Program

37 Summary The prevalence of childhood obesity is on the rise The earlier childhood obesity develops, the greater the chances of developing long term consequences Encourage activity and appropriate serving sizes Family meals and role modeling important Encourage fruits and vegetables Focus on healthy behavior change