PREVENTION OF CHILDHOOD OBESITY: It Takes a Nation Cardiovascular Health Summit Missoula, MT April 4

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PREVENTION OF CHILDHOOD OBESITY It Takes a
NationCardiovascular Health SummitMissoula,
MTApril 4, 2008

• Barbara J. Moore, Ph.D.

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TOPICS

• Defining obesity
• Prevalence of obesity in U.S. and in Montana
• Prevalence in youth
• What can be done?
• The Emmaus PA Experience
• The Cuban Experience
• The United Kingdom Ambition

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Adult Obesity is typically defined by BMI

• BMI is Body Mass Index
• BMI weight (kg)/height (m)2
• BMI weight (lbs)/height (in)2 X 703
• Overweight ? BMI 25.0 29.9
• Obesity ? BMI 30.0 or higher

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U.S. Overweight Obesity of Adult Population
(20-74 yr)(NCHS, NHANES 2003-2004)
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Childhood Obesity Assessment is more complex

• Requires measured height and weight
• BMI weight (kg)/height (m)2
• Plot age-specific and sex-specific BMI Percentile
  on CDC growth chart
• 95th percentile overweight CDC term or
  obese AMA or IOM term
• 85th -

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Reference Population Standard Normal Curve
50th Percentile
5th
95th
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For Children, BMI Differs by Age
BMI
BMI
Example 95th Percentile Tracking Age
BMI 2 yrs 19.3 4 yrs 17.8 9 yrs
21.0 13 yrs 25.1
Boys 2 to 20 years
BMI
BMI
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(No Transcript)
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An Epidemic of Childhood Obesity 17 or 9
million U.S. children older than 6 years
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Obesity in Adulthood is Predicted by Weight
Status in AdolescenceSource Whitaker et al.
NEJM 1997337869-873
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The word epidemic doesnt even do this
justice. It is one of the most profound medical
crises we have had in generations

• Eric Topol, MD
• Chief of Cardiology
• Cleveland Clinic

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Montana Prevalence Self-Reported Data of
Adult Population (BRFSS Data)
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Montana Prevalence Trends Increasing Obesity
Declining Healthy Weight (BRFSS)
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Increasing OverweightMontana Teens (14 to yrs)(2007 Youth Risk Behavior Survey, Trend
Report)
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Pediatric Diabetes -- Growing of Cases is now
Type 2
1990
2000
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Obesity and Mortality

• Earlier estimates of 400,000 deaths per year were
  for poor diet and inactivity
• Flegal et al. estimated obesity mortality at
  112,000 deaths annually
• The majority of these deaths are due to CVD
  (Manson et al. NEJM, 1995)

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Shortened Lifespan Due to Obesity in Native
Americans
Obesity and glucose intolerance during childhood
shorten lifespan Paul W Franks, Robert L Hanson,
William C Knowler, Helen C Looker
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Kaplan Meier Survival plots for risk of death by
quartile of BMI during childhood The risk of
early death is lowest in Q1 and highest in Q4.
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Summary

• Obesity is a severe and growing public health
  issue
• The great majority of US adults and Montana
  adults are overweight or obese and the trend is
  worsening
• Assessment of children requires accurate
  measurement of height and weight, calculation
  and plotting of BMI
• Data in children show increasing overweight and
  obesity and disease consequences similar to those
  in adults

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What can be done?

• The Emmaus PA Experience
• The UK New Ambition
• The Cuban Special Period
• Building the science on obesity prevention ?
  Preventing Childhood Obesity Health in the
  Balance www.nap.edu

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The Emmaus PA Experience

• Initiated by the School Nurse in 1999
• District-wide (7000 children, K-12)
• Height, weight, BMI for every child
• Letters to parents
• Referrals to HCPs
• Inclusive Wellness Committees
• No increase in obesity after year 3

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The Cuban Experience

• Franco M, Ordunez P, Caballero B, Granados JAT,
  Lazo M, Bernal JL, Guallar E, Cooper RS. Impact
  of energy intake, physical activity, and
  population-wide weight loss on cardiovascular
  disease and diabetes mortality in Cuba,
  1980-2005. Am J Epidemiol. 2007 166(12)1374-80

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The Cuban Experience

• 1960 -- economic embargo by the United States
• 1989 -- the Soviet Union (primary trade partner)
  collapsed
• 1990 -- prolonged crisis -- Special Period
  lasting a decade (until 2000)
• Economic output in 1995 reached only half the
  level in 1990 reduced imports, limited fuel
  availability, scarce food (very limited fat and
  protein available)
• 1993 - 27 of Cubans lost 10 or more of their
  body weight over the previous 12 months and 43
  experienced severe caloric restriction
• Special Period continued for 7 more years

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The Cuban Experience

• Prevalence of obesity decreased from 11.9 to
  5.4
• Physical activity walking and cycling
  increased, with 30 considered physically active
  before the crisis to a high of 70 during and
  immediately after
• Substantial declines in mortality from coronary
  heart disease (-35), type 2 diabetes (-51) and
  all-cause (-18) mortality were documented
  between the years 1995 and 2002

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The Cuban Experience Many Negative Consequences

• More elderly persons died, primarily of
  infections
• Decline in infant mortality was interrupted for 3
  years
• Incidence of low birth weight babies increased
  from 7.3 to 9.0
• Epidemic of optical and peripheral neuropathy
  attributed to vitamin and protein deficiencies
  affecting at least 50,000 people

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The Cuban Experience

• The Special Period in Cuba suggests the potential
  public health impact that could be achieved with
  a population intervention designed to maintain
  nutritional sufficiency while boosting physical
  activity and moderating fat and calorie intake.

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The UK New Ambition

• the first major country to reverse the
  rising tide of obesity and overweight in the
  population by ensuring that all individuals are
  able to maintain a healthy weight.
• By 2020 we will have reduced the proportion of
  overweight and obese children to 2000 levels

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The UK New Ambition

• Pregnancy Screening and Counseling
• Exclusive Breastfeeding Optimal Choice
• WHO growth charts for 0-2 y olds
• Preschool environment
• Monitoring of BMI in selected grades
• Mandatory cooking courses (middle)
• Media Messages/Media Campaigns

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Conclusion

• Strategies focusing on one component wont hurt
  and should be encouraged
• But comprehensive strategies are needed to
  reverse the obesity epidemic
• Primary focus on children should be guided by
  science, and evaluated
• Beneficial impact on diseases and on mortality
  can be expected

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Contact Information

• Barbara.moore_at_att.net
• www.shapeup.org
• www.montananapa.org