Obesity and Type 2 Diabetes in Children

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Obesity and Type 2 Diabetesin Children

• A presentation to initiate awareness and advocacy
  for an international health epidemic
• Developed by
• Jeanne Fenn, RN, BC, MEd, CDE
• Cecilia Rosales, MD, MS
• Claire Logue

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The purpose of this presentation is to

• Explain the obesity and type 2 diabetes crisis
• Discuss methods of curbing this
  epidemic
• Encourage participation within your family,
  school, and/or community in developing a
  healthier lifestyle

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What is Obesity?

• A condition resulting from excessive storage of
  fat in the body. (Best measured by BMI)

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What is BMI?

• BMI (Body Mass Index) is the ratio of weight in
  kilograms to square of height in meters. BMI
  correlates with more accurate measures of body
  fatness.
• Pediatrics
• At risk BMI between 85th 95th percentile for
  age and sex
• Overweight/Obese BMI at or above the 95th
  percentile for age and sex
• American Academy of Pediatrics Prevention of
  Pediatric Overweight and Obesity, 2003

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Example Calculation

• Weight (lb) Height (in) Height (in) x 703
  BMI
• Ex13 year old boy, wt146 pounds, ht 64 in
• 146 64 64 x 703 25
• BMI of 25 per growth chart 95
• This young man is overweight/obese
• http//www.cdc.gov/growth charts

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Examples of Children At Risk
By Mayo Clinic Staff
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The prevalence of childhood overweight and
obesity has doubled in the past 20
years.American children are less physically
active as a group than were previous
generations.American Academy of Pediatrics
Policy Statement Prevention of Pediatric
Overweight and Obesity, 2003
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What are common medical problems in obese
children?

• Type 2 diabetes
• Heart disease
• Mental health depression, low self-esteem
• Pulmonary or Respiratory problems

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How Does Arizona Fare?

• The number of overweight/obese adults has
  increased from 44.7 (1994) to 56 (2001)
• Currently it is estimated that 58 of Arizonans
  are overweight/obese
• 34 of children enrolled in Headstart programs
  are overweight.

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Trends in Prevalence of Overweight in US Boys
12-17 Years Old
Prevalence ()
BMI at or above sex- and age-specific 95th
percentile CDC, National Center for Health
Statistics. 1998.
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Trends in Prevalence of Overweight in US Girls
12-17 Years Old
Prevalence ()
BMI at or above sex- and age-specific 95th
percentile CDC, National Center for Health
Statistics. 1998.
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U. S. Obesity Rates Past 20 Years

• Todays obese children could be the 1st
  generation of Americans with a life expectancy
  less than their parents!
• Richard Carmona MD, US Surgeon General

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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4 woman)
No Data 1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
No Data 1519 2024 25
Source Behavioral Risk Factor Surveillance
System, CDC
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Obesity Trends Among U.S. AdultsBRFSS, 1991-2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
2002
No Data 1519 2024 25
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Children Then.
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Children Now.
From Childhood Adolescent Obesity and Type 2
Diabetes by Francine Kaufman MD
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Factors Related to the Onset of Obesity

• Altered dietary intake
• Decreased physical activity
• Increased inactivity

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Altered dietary intake

• Nutritional content
• Portion size

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Decreased physical activity

• Not as much participation in physical activities
  walking, active play, recess
  

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Increased inactivity
Look at time spent watching TV, playing
electronic games
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Enrollment in daily physical education classes
From the Surgeon General's Report on Physical
Activity and Health, 1996
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Percentage of High School Students Who Reported
Not Being Enrolled in Physical Education Class,
1999                                            
                                                  
                    

CDC, Youth Risk Behavior
Surveillance System
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The Burden of Obesity (Adapted from American
Obesity Association source, 2002)
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Prevention is the Key!

• Tommy Thompson,
  Secretary of Health Human Services
• Dr. Richard Carmona,
  U.S. Surgeon General
• Center for Disease Control (CDC)
• American Academy of Pediatrics (AAP)
• American Diabetes Association (ADA)

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Why Target Children?

• Prevention is more cost effective
  than cure
• Children can be reached through
  schools
• Effects of chronic disease accumulate over time
  so need long-term changes
• We need to begin awareness at an early age
• E. Sanchez, MD, MPH

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Why Should Schools Care About Health?

• As a society, we value good health.
• Good health is necessary for effective learning
• Healthy students become healthy, productive
  citizens
• Schools are the one place where the majority of
  our nations youth can be found
• E. Sanchez, MD, MPH

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How Do You Initiate Change?

• Environmental/Policy
• Obtain baseline assessments
• Make physical activity and
  nutrition a priority in schools
• Fund preventative programs
  and services in community
• Develop a comprehensive approach

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How Do You Initiate Change?

• Community Action
• Utilize local data/community input to assess your
  needs
• Increase awareness of obesity problem in
  culturally appropriate ways
• Develop partnerships for community-wide healthy
  lifestyle actions

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How Do You Initiate Change?

• Schools can provide
• Quality daily P.E. classes
• Nutrition awareness campaign
• Parent education/awareness campaign
• Psychosocial education/intervention
• School nutrition policy

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What Can We Do In Our School?

• Ask for support from the school board and
  superintendent
• Incorporate students, parents, teachers in
  providing strategies and ideas
• Look at your school practices
• Focus on health and activity, not
  weight
• HAVE FUN!!!

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Governor Napolitanos Call to Action Reports
January 30, 2004

• SELECTED REQUESTS
• Keep recess sacred, not used as a punishment
• Daily P. E. classes
• Provide healthy vending machine choices
• Educate students about marketing ploys for
  unhealthy snacks
• Age appropriate nutrition education
• Omit unhealthy fundraisers/limit candy rewards
  for good behavior

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Behavior Change Strategies

• Increase physical activity
• Provide exercise choices to children
• Encourage age appropriate and creative exercises
• Start with 30 minutes of moderate activity per
  day
• Make it fun!

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Behavior Change Strategies

• Increase awareness of food choices
• Moderate food portions
• 5 a day Vegetables and Fruits
• Limit inactivity
• American Academy of Pediatrics recommends
  limiting TV viewing to 1-2 hrs/day

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CDCs Guidelines for Promoting Lifelong Physical
Activity

• Physical activity of moderate intensity for 5
  days of the week
• Walking 2 mi X30
• Running 11/2 mi X 15
• Bicycling 5 mi X30 / 4 mi X 15
• Basketball X 15-20

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A Pound of Prevention.

• Life-long healthful eating
• Daily physical activity throughout life
• All things in moderation
• TIP Everyone needs to do these things,
  whether they are obese, overweight, or normal
  weight.

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What are
your views?