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Pediatric Obesity and the Early Childhood Obesity Prevention Collaborative

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Title: Pediatric Obesity and the Early Childhood Obesity Prevention Collaborative


1
Pediatric Obesity and theEarly Childhood
Obesity Prevention Collaborative
  • Presenters
  • Jolene Smith, Executive Director, FIRST 5 Santa
  • Clara County
  • Daniel Delgado, MD, FAAP
  • Pediatric Healthy Lifestyle Center,
  • Santa Clara County Health and Hospital System
  • Jo Seavey-Hultquist, FIRST 5 Santa Clara County,
  • Performance Management Liaison
  • Michelle Wexler, FIRST 5 Santa Clara County,
  • Performance Management Liaison

2
Why Should We Care About Pediatric Obesity?
  • Daniels, SR. Future Child. 2006
    Spring16(1)47-67.
  • the possibility has even been raised that the
    increasing prevalence and severity of childhood
    obesity may reverse the modern era's steady
    increase in life expectancy, with today's youth
    on average living less healthy and ultimately
    shorter lives than their parents-the first such
    reversal in lifespan in modern history. Such a
    possibility, he concludes, makes obesity in
    children an issue of utmost public health
    concern.

3
Goals of Todays Talk
  • Clarify the extent of the obesity epidemic on a
    national state level
  • Educate on the health problems that pediatric
    obesity causes
  • Clarify what the epidemic means on the front
    lines at the patient level
  • Not to scare you but call you to legislative
    action

4
Clarify the terms a word about BMI tracking an
epidemic
  • Body Mass Index weight (kg) height (cm)
    height (cm) x 10,000
  • BMI is a proxy for weight for height and
    overweight/obesity
  • In 1990, NO STATES had obesity prevalence rates
    above 20 percent

5
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 6
Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data
7
Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 20
8
Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 20
9
Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 2024 25
10
Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data 2024 25 29 30
11
What about California children?
  • Data from Childrens Health and Disability
    Prevention (CHDP) - Pediatric Nutrition
    Surveillance System (PedNSS)

12
Prevalence of Obesityfrom PedNSS
2006California, Children ethnicity, with BMI-for-age 95
95th percentile weight-for-length or
BMI-for-age, CDC Growth Charts, 2000.
Pediatric Nutrition Surveillance System 2006
Centers for Disease Control Report, Table 8C,
provided by the Child Health and Disability
Prevention Program (CHDP), Public Health
Department, Santa Clara County
13
So do kids grow out of it?
  • The NIH Institute of Child Health and Human
    Development Study of Early Child Care and Youth
    Development looked at 1042 healthy children in 10
    locations
  • Born in 1991, their growth reflects the secular
    trend of increasing overweight/obesity in the US
    population

14
So do kids grow out of it? NO!
  • BMI 85 once between 24-54 months old were 5
    times more likely to be overweight at age 12
  • 60 of overweight preschoolers were overweight at
    age 12
  • 80 of overweight elementary school kids were
    overweight at age 12
  • Pervasive message prevention starts EARLY
  • Nader, PR, et al. Identifying Risk for Obesity
    in Early Childhood. Pediatrics 2006 118
    e594-e601

15
What does obesity mean for kids?
  • Kids now present with adult disease states that
    were unheard of 10 years ago
  • Seeing not only earlier progression to disease
    but also more severe disease
  • Pediatric obesity effects current quality of life

16
Diseases seen in obese children
  • Neurologic
  • Headaches
  • Increased incidence
  • Obstructive Sleep Apnea (OSA)
  • 90 of obese kids that snore have some component
    of OSA
  • 50 of OSA children also have ADHD symptoms
  • Many need tonsillectomies/adenoidectomies

17
Diseases seen in obese children
  • Cardiovascular
  • Obese kids (BMI 95) have risk of hypertension
    (BPs 95 or above)
  • 8 of 2-5 year olds
  • 11 of 6-10 year olds
  • 20 of 11-15 year olds
  • 20 of 16-19 year olds
  • J. Pediatr. 2006 148 195-200.

18
Diseases seen in obese children
  • Gastroenterologic
  • Non-alcoholic Fatty Liver Disease (NAFLD)
  • Excess fat storage in liver (think foie gras)
  • Is related to insulin resistance (certain
    ethnicities at risk)
  • 38 of PHLC kids that had labs had elevated liver
    enzymes
  • Non-alcoholic steatohepatitis (NASH)
  • Inflammation/scarring due to fatty liver
  • Up to 20 of NASH may progress to cirrhosis

19
Diseases seen in obese children
  • Endocrine Disorders
  • Precocious Puberty
  • Treated as older by peers and family
  • Polycystic Ovarian Syndrome
  • Infertility
  • Insulin Resistance/Pre-diabetes
  • Irregular menses, liver dysfunction

20
Diseases seen in obese children
  • Orthopedic
  • Slipped Capital Femoral Epiphysis (SCFE)
  • Growth plate shears at the femur leads to
    pinning
  • Blounts disease
  • Crushing of growth plate at knees

21
Diseases seen in obese children
  • Psychologic/Psychiatric
  • Depression
  • Diminished self-esteem
  • Eating disorders
  • Up to 50 of adults in self-help weight loss
    program had findings of Binge Eating Disorder

22
Diseases seen in obese children
  • Pulmonary
  • Pulmonary hypertension
  • End result of untreated OSA, leads to right-sided
    heart failure
  • Increased allergen sensitivity
  • Asthma
  • Worse in both in incidence and severity

23
Could one disease lead to another?
  • Overweight kids in Harlem twice as likely to
    suffer from asthma J of Urban Health
  • Chicken or egg?
  • Overweight exposed to more allergens since they
    spend more time indoors
  • Asthma kids less active to avoid flares and thus
    gain weight

24
Could one disease lead to another?
  • Sedentary lifestyle - more allergen sensitivity
  • enlarged adenoids and tonsils
  • increased OSA/apnea - morning sleepiness
  • less time to eat b-fast increase in
    weight
  • ADHD symptoms - more homework time
  • less play - increase in weight -
    worse asthma/allergies - worse apnea
  • The downward spiral

25
The Pervasive Message?
  • All organ systems are related!
  • Obese children are complicated patients
  • Pediatricians are ill-prepared to deal with these
    medical problems

26
Why Should We Care About Pediatric Obesity?
  • Indeterminable cost to society in the future
  • Already needing to start kids on diabetes meds
  • Generic Metformin 600-1,200 per year
  • Echocardiograms, liver biopsies, sleep studies
  • It is all on the tax dollar
  • Future issues of rationing care
  • Which diabetics should we dialyze?
  • Which NASH kids should get a liver transplant?

27
Typical day at the PLMC
  • 8 y.o. (163 lb) 10 y.o. (220 lb) Latina
    sisters, both insulin resistant (IR) and abnormal
    lipid panels
  • 8 y.o. (105 lb) Latina, IR, no weight gain x 2
    months, active now, says shes happy
  • 15 y.o (237 lb) Latina, IR, on metformin, 6 lb wt
    loss in 2 months

28
Typical day at the PLMC
  • 6 y.o. (70 lb) Latina, acanthosis, labs pending
  • 12 y.o. (143 lb) Latina, IR, gained 10 lbs in 2
    months, not ready to change lifestyle, started
    metformin at visit for borderline sugar
  • 11 y.o. (180 lb) Latino, at charter school
    7am-5pm everyday. 4 hours of PE a week. IR,
    fatty liver, metformin candidate
  • 4 y.o. (55 lb) Latina, mom now concerned
  • 11 y.o. (121 lb) Filipina, Fam Hx diabetes, labs
    pending, likely IR

29
Typical day at the PLMC
  • 10 y.o. (150 lb) Latina, IR, mom diabetic,
    recently cut back soda
  • 13 y.o. (181 lb) Latina, nl labs, wt loss but
    frustrated not faster, poor body image
  • 10 y.o. (155 lb) Latina, IR, OSA, likely NAFLD,
    liver US pending, metformin candidate
  • 9 y.o. (121 lb) Latino, likely IR, labs pending,
    4 hours of videogames every afternoon

30
Early Childhood Obesity Prevention Collaborative
  • Co-Chaired by Dr. Daniel Delgado, and FIRST 5
  • Charged with developing a strategic plan that
    incorporates interventions which will address the
    issue of early childhood obesity
  • Sub-group Policy Workgroup Chaired by Santa
    Clara County Supervisor Ken Yeager
  • Generated ideas for policy approaches to early
    childhood obesity

31
Call to Action
Early Childhood Obesity Prevention
CollaborativePotential Legislative Strategies
  • Provide subsidies to small stores so that they
    can price healthier foods cheaper than unhealthy
    foods
  • Tax or fee on fast food sales and have the fee
    monies be used for obesity prevention programs
  • Advocate for health insurance plans to cover
    obesity prevention in clinical practice and
    breastfeeding/lactation services
  • Have preschool and child care licensing/
    certification contingent upon meeting and
    implementing nutritional and physical activity
    guidelines
  • Create policies that regulate advertising/marketin
    g of unhealthy foods to young children

32
Call to Action
Other School-Age Potential Legislative Strategies
  • Continued changes needed in school lunch
    offerings re-do current nutritional guidelines
  • Junk Food Tax or even better Diabetes Prevention
    Tax on unhealthy foods (high fructose corn
    syrup)
  • Junk food-free school campuses
  • Mandatory everyday PE in schools
  • Mandatory play before homework in after-school
    programs
  • Legislation so that insurance companies will pay
    for obesity treatment/lifestyle modification
    visits currently not a reimbursed visit
  • Examine legislation to mandate changes in medical
    education

33
Call to Action
Strategies for Change on a Personal Level
  • Stop serving soda/high fructose corn syrup drinks
    at family functions
  • Soda beer/tequila. Its a drink for adults
    only.
  • Have your kids play as soon as they get home
    before doing their homework, especially in winter
  • Buy a kid a bike, not videogames
  • Eat dinner as a family

34
Contact Information
  • Jolene Smith, FIRST 5 (408) 260-3701
  • Dr. Dan Delgado,
  • Pediatric Healthy Lifestyle Center (408)
    817-1406
  • Jo Seavey-Hultquist, FIRST 5 (408) 260-3720
  • Michelle Wexler, FIRST 5 (408)
    260-3730
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