Childhood Obesity: Causes, Consequences, and Solutions

1
Childhood Obesity Causes, Consequences, and
Solutions

• Relatives As Parents Program Grantees
• The Brookdale Foundation
• Jana R. Kicklighter, PhD,RD
• Associate Professor
• Division of Nutrition
• Georgia State University
• Atlanta, Georgia
• June 17, 2009

2
Objectives Participants will

• Describe how to determine a childs weight status
  
• Identify trends in childhood obesity
• Explain the causes and consequences of childhood
  obesity
• Interpret results of a healthy habits quiz
• Describe potential solutions to the childhood
  obesity problem
• Identify goals for change to address weight
  issues in childhood

3
Determination of Healthy Weights for Children

• Use Body Mass Index (BMI) as screening tool
• Calculated from childs weight and height
• Indicator of body fatness
• Use for children 2 years of age and older

4
CDC Growth Chart Example
5
CDC Weight Definitions for Children based on BMI

• gt5th percentile,
• lt 85th percentile
• gt85th percentile,
• lt 94th percentile
• gt95th percentile

• Healthy weight
• Overweight
• Obese

6
Prevalence of Childhood Overweight National
Health and Nutrition Examination Surveys (NHANES)
NHANES 1976-1980 NHANES 2003-2004
2-5 year olds 5.0 13.9
6-11 year olds 6.5 18.8
12-19 year olds 5.0 17.4
7
Consequences of Childhood Overweight

• Cancer
• Heart disease
• Stroke
• Type 2 diabetes
• High blood pressure
• High blood cholesterol

• Asthma
• Bone and joint problems
• Fatty liver
• Emotional pain
• Obese adult

8
Cause of Childhood ObesityEnergy
ImbalanceFood/Beverages Activity

• Energy Imbalance

9
Socioecological Model

• To promote healthy weight incorporate strategies
  at four levels
• Individual increase individuals knowledge and
  skills
• Relationships use family, friends and social
  networks as positive influences
• Community work for positive changes in schools
  and neighborhoods
• Societal level advocate for educational and
  social policies to support positive changes

10
Factors Contributing to Energy Imbalance and
Weight Problems (Last 2-3 Decades)

• Heredity Plays a small role
• Way we live, eat and play has changed
  dramatically
• Greater variety of readily available, low cost
  energy dense foods
• Larger portion sizes
• Increase in eating out fast food
• More exposure to food and beverage advertisements
  
• Increased screen time
• Decreased physical activity

11
Healthy Habits Quiz
Do you and your family Yes (2 pts) No (0 pt) Some-times (1 pt)
Have regularly scheduled meals when you are at home?
Eat meals together at least once a day?
Plan snacks?
Tailor portion sizes to each persons needs?
Plan and prepare meals together once a day?
Eat three meals every day?
Try to make mealtimes enjoyable?
12
Healthy Habits Quiz (cont)
Do you and your family Yes (2 pts) No (0 pt) Some-times (1 pt)
Avoid making everyone eat everything on their plate?
Make meals last more than fifteen minutes?
Eat only in designated areas of the house?
Avoid using food to punish or reward?
Enjoy physical activities together once or twice a week?
Source Kosharek SM. If Your Child is Overweight
A Guide for Parents. 3rd ed. Chicago, IL
American Dietetic Association 2006.
13
Healthy Habits Quiz Scores

• Add up total points and interpret as follows
• 20-24 Your family is on the right track.
• 13-19 Your family is doing well but could work
  on areas where you answered no or sometimes.
• lt12 The next section on solutions should be
  very helpful as you help your grandchild(ren)
  toward healthier habits.

14
Solutions Eat regular meals and increase family
meals

• Eat meals 3 times/day and only in designated
  areas
• Eat together as a family one time/day
• Keep meals simple, easy and nutritious
• Get everyone involved in planning, shopping and
  preparing meals
• Make mealtimes relaxed, pleasurable, enjoyable
  and engaging
• Get creative and be flexible a family meal could
  be a picnic prior to a sports event

15
Benefits of Family Meals

• More healthful diets
• Better school performance
• Grandparents serve as role models for healthful
  attitudes toward food and eating
• Grandparents can model healthy food habits
• Promotes psychological wellness Lower rates of
  smoking, drinking and drug use, getting in
  fights, later initiation of sexual activity

16
Grandparent/Grandchildren Responsibilities

• Grandparents are responsible for the what, when
  and where of feeding
• Nutritionally and developmentally appropriate
  foods
• Opportunity to eat every 2 1/2 3 hours
• Provide support
• Grandchildren are responsible for whether, what
  and how much to eat from those provided
• Source Satter E. Secrets of Feeding a Healthy
  Family. Madison, WI Kelcy Press 1999.

17
(No Transcript)
18
MyPyramid for Kids Key Messages

• Be physically active every day
• Every color every day5 different food groups
• Eat more from some food groups than others
• Choose healthier foods from each group
• Take one step at a time and start with small
  changes

19
Solution Tips for Healthier Foods

• Make half your grains whole
• Vary your veggies
• Focus on fruits
• Get your calcium-rich foods
• Go lean with protein
• Change your oil
• Dont sugarcoat it
• Know your portions

20
Recommended Number of ServingsBy Age and Sex
2-3 years 4-8 years 9-13 years
Milk/dairy (c) 2 2 3
Lean meat beans (oz) 2 5
Female 3
Male 4
Fruits (c) 1 1.5 1.5
Vegetables (c) 1
Female 1 2
Male 1.5 2.5
Grains (oz) 3
Female 4 5
Male 5 6
21
3 Star Meal and Snack Guidelines

• Include more than one food group
• Limit fat and sugar
• Include fruits, vegetables, and foods made with
  whole grains

22
Solution Appropriate Portion Sizes
Serving What it Looks Like
Grains (oz) 1 slice bread
1 c dry cereal
½ c rice, pasta or cereal
Vegetables (cup) ½ c chopped
1 c lettuce
Fruits (cup) 3/4 c juice
1/2 c chopped
1 medium fruit
1/4 c raisins
23
Solution Appropriate Portion Sizes
Serving What it Looks Like
Milk and Dairy (cup) 1 c milk or yogurt
1 1/2 oz cheese
Lean Meat and Beans (oz) 3 oz cooked meat, fish and poultry
2 eggs
1 c cooked dried beans
2 tablespoons peanut butter
1/2 c nuts
24
Solution Be Aware of Portion Distortion

• Portion sizes have increased over past 20 years
• Larger portions add up
• 100 extra calories/day can lead to weight gain of
  10 pounds/year
• Examples that follow are from the National Heart,
  Lung and Blood Institute website

25
Portion Distortion 257 More Calories

• 20 years ago
• 333 calories

• Today
• 590 calories

26
Portion Distortion 350 More Calories

• 20 years ago
• 500 calories

• Today
• 850 calories

27
Portion Distortion 525 More Calories

• 20 years ago
• 1 cup spaghetti with sauce 3 small meatballs500
  calories

• Today
• 2 cups spaghetti with sauce 3 large
  meatballs1,025 calories

28
Portion Distortion 165 More Calories

• 20 years ago
• 6.5 oz 85 calories

• Today
• 20 oz250 calories

29
Portion Distortion 290 More Calories

• 20 years ago
• 1.5 oz 210 calories

• Today
• 4 oz 500 calories

30
Portion Distortion 400 More Calories

• 20 years ago
• 2.4 oz210 calories

• Today
• 6.9 oz610 calories

31
Effect of Eating Out on Children

• Consume more
• Calories
• Fat
• Added sugar
• Sugar sweetened beverages
• Consume fewer
• Fruits
• Non-starchy vegetables
• Consume less
• Fiber
• Milk

32
Characteristics of Childrens Meals at Chain
Restaurants

• Dominated by burgers, chicken nuggets, macaroni
  cheese, French fries and soft drinks
• Most common entrée fried chicken
• Most common side order fries
• Most popular beverage soft drinks
• Source Wootan MG, Batada A, Marchlewicz E.
  Kids Meals Obesity on the Menu. Center for
  Science in the Public Interest. Available at
  www.cspinet.org/kidsmeals.

33
Childrens Menu Hall of Shame

• Chilis
• Country-fried chicken crispers, cinnamon apples
  chocolate milk
• Chilis
• Cheese pizza, homestyle fries lemonade
• KFC
• Popcorn chicken, baked beans, biscuit, fruit
  punch Teddy Grahams
• Burger King
• Double cheeseburger, fries chocolate milk
• Sonic
• Grilled cheese, fries slushie

• 1020 calories
• 1000 calories
• 940 calories
• 910 calories
• 830 calories

34
Healthier Restaurant Choices

• Subway
• Chilis
• Arbys

• Ham mini-sub with juice box apple slices or
  raisins
• Grilled chicken sandwich with apple juice, corn
  kernels or mandarin oranges or pineapple
• Popcorn chicken or Jr. roast beef sandwich with
  fruit cup and fruit juice

35
Solution Emphasize Healthy Eating Out

• Plan ahead where to go
• Look beyond the childs menu Consider
  appetizers, soups, salads and side dishes
• Be a good role model
• Make portion control a priority split a
  sandwich, share an entrée, or take home a doggy
  bag
• Build a healthier food choose whole wheat bread
  and lean ham for a sandwich load up the pizza
  with veggies and lean meats

36
Solution Limit Exposure to Advertisements Geared
to Children

• Typical child watches gt 40,000 TV commercials
  each year
• gt 12 billion per year is spent on marketing to
  children
• Most heavily advertised
• Fast foods
• Snack foods
• Highly sugared foods
• Source Ritchie LD, Welk G, Styne D, Gerstein
  DE, Crawford PB. Family environment and pediatric
  overweight What is a parent to do? J Am Diet
  Assoc. 2005 105 S70-S79.

37
Solution Decrease Screen Time

• Negative effects of TV
• Snacking on sweets, chips, pizza, fast foods
• Advertisements encourage unhealthy foods
• Lower intake of fruits and vegetables
• Increased inactivity
• Limit screen time
• lt 2 hours/day
• No TV for child lt 2 years old
• Remove TV and computers from bedroom
• Establish family rules
• Source American Academy of Pediatrics

38
Solution Increase Family Physical Activity

• Benefits of physical activity
• Strengthens bones
• Decreases blood pressure
• Relieves stress
• Increases self-esteem
• Helps with weight management

39
Physical Activity Recommendations for Children

• One hour or more of moderate or vigorous physical
  activity per day
• Examples of moderate activities
• Hiking skateboarding bicycle riding brisk
  walking
• Examples of vigorous activities
• Jumping rope running soccer basketball
• Sources American Academy of Pediatrics
  American Heart Association Centers for Disease
  Control and Prevention

40
Tips for Getting the Family more Active

• Build into family routines
• Focus on fun activities and use them as rewards
  for good behavior
• Encourage children to play outside with other
  children
• Include in daily routines

41
Solution Identify What to ChangeHow many of
these describe your family?

• Little physical activity (lt 15 minutes/day)?
• Snacks frequently on high fat, high calorie foods
  (chips, cookies, candy, ice cream)?
• Does not eat at regular mealtimes?
• Skips meals and snacks throughout the day?

42
Solution Identify What to Change (Cont) How
many of these describe your family?

• Watches gt 2 hours TV/day?
• Spends several hours each day playing videogames
  or using computer?
• Snacks while watching TV or playing videogames?
• Eats a lot of sugary or fried foods?
• Eats fast food more than 1 time/week?
• Drinks sweetened beverages daily (soda, juice
  drinks, fruit juice, sweetened milk drinks)?

43
Identify Specific Behaviors to Change

• Examine the behavioral statements answered with
  a yes
• Identify 2-3 behaviors you would like your family
  to change
• Start with those

44
Solution Identify Barriers to Change and
Brainstorm Ways to Overcome

• Do barriers include
• Lack of skills?
• Lack of time?
• Lack of money?
• Or a combination of these?

45
Solution How to Change

• Make it a family affair
• Start with small changes
• Write down realistic and measurable goals (2-3)
• Make weekly goals and track progress
• Dont expect perfection
• Reward with nonfood prizes

46
Solution Become an Advocate for Community and
Societal Change

• More sidewalks in neighborhoods
• Community gardens and farmers markets
• Walking school bus program
• Changes in schools
• Ban soft drinks and candy sales
• Teach nutrition
• Incorporate physical education
• Teach healthy cooking
• Regulate advertising to children
• Healthier menu options for kids
• Post nutrition information in restaurants

47
In Summary

• G - Grandparents can
• R role model good eating habits/attitudes
• A arrange for family physical activities
• N note the 3 star meal and snack guidelines
• D decrease screen time
• P plan and prepare regular family meals
• A avoid using food to punish or reward
• R restrict eating out
• E encourage fruits, vegetables whole grains
• N note food label nutrition information
• T tailor portion sizes to individual needs
• S set realistic and measurable goals

48
Quote

• Grandparents are a family's greatest treasure,
  the founders of a loving legacy, The greatest
  storytellers, the keepers of traditions that
  linger on in cherished memory. Grandparents are
  the family's strong foundation. Their very
  special love sets them apart. Through happiness
  and sorrow, through their special love and
  caring, grandparents keep a family close at
  heart.
• author unknown