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Pediatric Obesity

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Title: Pediatric Obesity


1
Pediatric Obesity
  • Elizabeth H. Kwon MD, MPH

2
(No Transcript)
3
OBESITY DEFINED
  • According to the AMAs Expert Committee on the
    Prevention, Assessment, and Treatment of Child
    and Adolescent Overweight and Obesity in 2005
    (Co-funded by Health Resources and Services
    Administration (HRSA) and the Centers for Disease
    Control and Prevention (CDC))
  • Overweight
  • BMI for age 85ile to 94ile
  • Obese
  • BMI for age gt95ile

4
Causes of Pediatric Obesity
  • Caloric Intake has Increased
  • Less supervised family meals
  • More eating out/ Fast food/ Restaurants
  • Portions sizes are much larger
  • Fried foods/ Trans fats
  • High Calorie Beverages
  • Increased availability of calorically dense,
    ready-to-eat food
  • More chips, cakes, cookies, donuts, crackers,
    candy
  • Pop tarts, Easy Mac, Canned Ravioli, frozen
    pizzas
  • (From Cochran, W., Pediatric Obesity A Huge
    Problem in the USA)

5
Causes of Pediatric Obesity
  • Less Physical Activity
  • More sedentary activities like video games, TV
    and computer? less time to run around
  • TV/Computer --Average 2.5 hours/day with 20 gt5
    hours day
  • Studies show higher BMIs, obesity and
    cholesterol with more TV
  • 40 of low-income children 1-5y.o had a TV in
    their room
  • Schools have less or no gym time in order to
    achieve No Child Left Behind goals
  • More kids in after school programs without much
    physical activities
  • More dangerous worldkeeps children inside more
    than previous decades
  • (From Cochran, W., Pediatric Obesity A Huge
    Problem in the USA)

6
Causes of Pediatric Obesity
  • Genetics
  • One parent obese?3x risk
  • Two parents obese?10x risk
  • ( Hassink, A Parents Guide to Childhood Obesity
    2006)
  • Environmental
  • Energy imbalance
  • (Energy IngtEnergy Used ?Energy Stored at Fat)
  • (From Cochran, W., Pediatric Obesity A Huge
    Problem in the USA)

7
Increasing Percent of Obese Children and
Adolescents
  • From Comorbidities of Pediatric ObesityWilliam
    Cochran, MD

8
  • 12. 5 Million US Children are Overweight today

9
Racial Disparities in Overweight/Obesity
Prevalence
  • The NHANES in 1988-1994 versus the NHANES in
    2002 showed overweight prevalence in non-Hispanic
    Black (20.5) and Mexican-American (22.2)
    increased at a faster rate than in Whites.

10
Childhood Obesity has Medical Consequences
  • Diabetes Mellitus type II
  • Psychosocial
  • Hypertension
  • Hyperlipidemia
  • Asthma
  • Sleep Apnea
  • Arthritis
  • SCFE
  • Blounts Disease
  • Steatohepatitis
  • Gallstones
  • Pancreatitis
  • Metabolic Syndrome
  • Polycystic Ovarian Syndrome
  • Skin Infections
  • Back Pain
  • Pseudotumor Cerebri

11
Prevalence of Diabetes in US 1990 versus 2001
  • From Narayan et al. 2003, Sinha et. Al 2002,
    Weiss et al, 2003

12
Life years lost from Diabetes in the US from
Narayan et al., 2003
  • If diagnosed at age 10 years
  • White
  • male 16.5 yrs
  • female 18.0 yrs
  • Hispanic
  • male 19.0 yrs
  • female 16.0 yrs
  • Black
  • male 22.0 yrs
  • female 23.0 yrs
  • If diagnosed at age 40 years
  • White
  • male 1.01 yrs
  • female 13.5 yrs
  • Hispanic
  • male 11.5 yrs
  • female 12.4 yrs
  • Black
  • male 13.0 yrs
  • female 17.0 yrs

13
Hypertension
  • 60 of Children with persistently elevated blood
    pressure had weight gt120 Ideal Body Weight
    (Lauer J Pediatrics 197586697-706.)
  • Overweight adolescents have 8.5 x increased risk
    of hypertension as adults (Srinivasan Metab
    199645235-240)

14
Hyperlipidemia
  • Obesity in adolescence is associated with
  • 2.4 times more likely to have cholesterol
    gt240mg/dl
  • 3 times more likely to have LDLgt160mg/dl
  • 8 times more likely to have HDLlt35 mg/dl by the
    time they are adults aged 27-31 y.o.
  • (From Srinivasan Metab 199645235-240)

15
Steatohepatitis
  • Affects 20-25 of Obese Children (Tazewa Acta
    Paeditr-1997 86238-241) while 83 of Children
    with Steatohepatitis are Obese (Comorbidities of
    Pediatric Obesity, William Cochran MD)
  • Can progress to fibrosis or frank cirrhosis.
  • Obesity and type 2 diabetes are the strongest
    predictors for fibrosis progression (Angulo P.
    Keach JC, Batts KP, Lindor KD, Hepatology 1999
    30(6) 1356-62.)

16
Cholelithiasis
  • Is caused by obesity in 8-33 of childhood
    cases(Friesen Clin Pediatr 1989 7294)
  • Is associated with obesity in 50 of adolescent
    cases (Crichlow Dig Dis. 1972 1768-72)
  • May be associated with weight loss (Crichlow Dig
    Dis. 1972, 1768-72).

17
SCFE and Blounts
  • 50-75 of SCFE patients are obese
  • (Wilcox , J Pediatric Orthopedics 19888 196-200)
  • 2/3 of Blounts Disease patients are obese
  • (Dietz, J Pediatrics 1982 101 735-737)

18
Obstructive Sleep Apnea
  • 40 of severely obese children had central
    hypoventilation (Silvesti, Pediatric Pulmonology
    1993 16124-139)
  • Abnormal sleep patterns were found in 94 of
    obese children in one study
  • OSA leads to decreases in learning, attention
    span and memory
  • (Rhodes, J Pediatrics 1995127741-744
    Greengerg GD, Watson RK, Deptula D., Sleep 1987
    10(3)254-62.)
  • And increases in pulmonary hypertension, systemic
    hypertension and right heart failure
  • (Tal A, Lieberman A, Margulis G, Sofer S.,
    Pediatric Pulmonology 19884(3)139-43 Marcus
    CL, Greene MG, Carroll JL., American J
    Respiratory Critical Care Medicine 1998 157 (4
    PT1) 1098-103 Massumi RA, Sarin RK, Pooya M,
    Reichelderfer, Dis Chest 1969 55(2) 110-4.)

19
Pseudotumor Cerebri
  • 30-80 of children with pseudotumor cerebri have
    obesity
  • (Scott, American J Ophthalmology 1997 124
    253-255)
  • Increased Intracranial Pressure can lead to
    visual impairment or blindness
  • (Comorbidities of Pediatric Obesity, William
    Cochran)

20
Physical Exam
  • Hypertension
  • Acanthosis Nigricans
  • Papilledema
  • Thyroid
  • Hepatomegaly
  • Bowed legs/Osgood Sclatters
  • Depression
  • Short Stature

21
Laboratory Tests
  • BMI 85-94ile with no other risk--gtFasting lipid
    profile
  • BMI 85-94ile with risk factors (family history
    of obesity, family history of obesity-related
    diseases, elevated lipid levels, elevated blood
    pressure, smoking) ? Fasting lipid profile,
    LFTs, fasting glucose
  • BMI gt95ile? Fasting lipid profile, LFTs,
    fasting glucose
  • Repeat tests every 2 years after age 10.
  • Other possible suggested tests by
    endocrinologists
  • Fasting Insulin
  • HbA1C
  • Thyroid function tests

22
Obese Children are Likely to Become Obese Adults
  • From Pediatric Obesity A Huge Problem in the
    USAWilliam Cochran MD

23
Obesity Increases Mortality
  • Because of the increasing rates of obesity,
  • unhealthy eating habits, and physical
    inactivity,
  • we may see the first generation that will be
    less healthy and have a shorter life expectancy
    than their parents
  • --Richard H. Carmona, MD, MPH, FACS, Surgeon
    General
  • U.S. Dept of Health and Human Services, 2004

24
Psychosocial Impact of Childhood Obesity
  • Increased rates of Depression
  • Poorer Self-Esteemmay last til adulthood
  • 10-11 year olds prefer friends with handicaps
    than obese (Richardson, 1961)
  • 6-10 year olds associate obesity with laziness
    (Staffieri,1967)
  • Obese Females have lower college acceptance rates
    than non-obese females (Canning, 1966)
  • Obese Adolescent Females as young adults had less
    education, less income, higher poverty rates and
    decreased rate of marriage versus non-obese
    females (National Longitudinal Survey of Youth,
    1993)

25
Economic Consequences of Obesity
  • In 2002, the estimated cost of obesity in the US
    was 117 billion dollars.
  • Hospital Costs associated with pediatric obesity
    are rising
  • In 1979 35 million
  • In 1999 127 million
  • From Pediattric Obesity A Huge Problem in the
    USAWilliam Cochran, MD

26
What can we do about Childhood Obesity?
  • PREVENTION
  • IS KEY SINCE TREATMENT IS SO MUCH MORE DIFFICULT

27
Prevention of Childhood Obesity
  • Advise Pregnant Women to gain the recommended
    amount of weight during pregnancy
  • LGA, SGA and infants of diabetic mothers have
    increased rates of obesity (Hediger M.. ,
    Pediatrics 104, p. 33, 1999)
  • Encourage Breastfeeding
  • 8 out of 11 studies noted a lower rate of obesity
    in children if breastfed vs. formula fed (Dewey
    2003)
  • Longitudinal study of breastfed vs. formula fed
    infants (Bergmann 2003)
  • BMI the same at birth
  • BMI at 3 6 months gt in formula fed vs.
    breastfed infants
  • Rate of obesity at 6 years was tripled in formula
    fed vs. breastfed
  • (From Cochran, W., Pediatric Obesity A Huge
    Problem in the USA)

28
Prevention of Childhood Obesity
  • CALCULATE AND PLOT BMI on ALL CHILDREN OVER 2
    YEARS OLD at all WELL CHILD EXAMS.
  • PLOT WEIGHT-FOR-LENGTHS ON ALL CHILDREN UNDER 2
    YEARS OLD!
  • If there was an infectious disease that had
  • double - tripled in prevalence,
  • was afflicting 25-30 of children of all ages,
  • had life life-long, potentially life threatening
    impact
  • Would we be acting?
  • Would we take 10 sec to plot a point?
  • (From Krebs, N., Hassink S., Obeesity Basics 101
    Role of the Pediatrician)

29
Prevention of Childhood Obesity
  • Are MDs Using the BMI Charts?
  • 31 of pediatricians Never
  • 11 Always
  • According to a 2006 AAP Periodic Survey, only a
    little more than half the pediatricians assessed
    a BMI.
  • Use of BMI by MDs was associated with
  • Greater assessment of fatness
  • Greater concern about co-morbidities
  • Visual diagnosis subject to under-diagnosis of
    obesity
  • (Perrin et al, J Peds 2004, and Krebs,
    N., Hassink S., Obeesity Basics 101 Role of the
    Pediatrician)

30
Can you see risk?
  • 4 year old girl
  • Is her BMI-for-age
  • 5th to lt85th percentile normal?
  • gt85th to lt95th percentile overweight?
  • gt95th percentile obese ?
  • (Photo from UC Berkeley Longitudinal Study, 1973)
  • (Slide Courtesy Krebs, N., Hassink S., Obeesity
    Basics 101 Role of the Pediatrician)

31
Plotted BMI-for-Age
Measurements Age4 y Height99.2 cm (39.2
in) Weight17.55 kg (38.6 lb)
Girls 2 to 20 years
BMI
BMI17.8 85-95th percentile Answer
b)overweight (Slide Courtesy Krebs, N.,
Hassink S., Obeesity Basics 101 Role of the
Pediatrician)
32
Can you see risk?
3 year old boy Is his BMI-for-age a) 5th to
lt85th percentile normal b) gt85th to lt95th
percentile overweight? c) gt95th percentile
obese? (Slide Courtesy Krebs, N., Hassink S.,
Obeesity Basics 101 Role of the Pediatrician)
CDC
Photo from UC Berkeley Longitudinal Study, 1973
33
Plotted BMI-for-Age
Measurements Age 3 y 3 wks Height 100.8 cm
(39.7 in) Weight 18.6 kg (41 lb)
BMI18.3 Answer BMI-for-age 95th
percentileobese (Slide Courtesy Krebs, N.,
Hassink S., Obeesity Basics 101 Role of the
Pediatrician)
34
BMIgt95 strongly correlates with body fat Slide
Courtesy Krebs, N., Hassink S., Obeesity Basics
101 Role of the Pediatrician)
Slide Courtesy Krebs, N., Hassink S., Obeesity
Basics 101 Role of the Pediatrician)
Referral
3 yr old boy
35
Early Identification BMI vs Visual
Diagnosis (Slide Courtesy Krebs, N., Hassink S.,
Obeesity Basics 101 Role of the Pediatrician)
? 95th
gtgt 95th
85-95th
36
Nutrition Advice
  • ALL children should be counseled (not just those
    with BMIsgt85ile)
  • Beverages Guidelines
  • Lowfat Milk (3 dairy servings/day)
  • Juice/juice drinks (120calories/8oz.)
  • Ages 1-6 ? 4-6 oz/day
  • Ages 7-18?8-12 oz/day
  • Dont buy it for the housegtjust drink it when
    out/school/afterschool
  • No Soda/Iced Tea/ Lemonade/Gatorade unless its
    diet
  • Lots of Water
  • Make it inviting and convenient -gt put bottles in
    the fridge, fun sippy cups with iced water,
    pitchers of water with lemon wedges etc.

37
Nutrition Advice
  • 5 Fruits and Vegetables per day
  • Draw out a plate with 2/3 plate with fruit
    vegetables, and 1/3 carbs and meat
  • Whole Grains and High Fiber foods (FiberAge5)
  • Use Canola/Vegetable oils not butter
  • Limit Fried Foods
  • No Trans Fats
  • Keep track of what child eats at school,
    afterschool, daycare etc.
  • Do not use food as a reward
  • Do not skip meals

38
f NUTRITION ADVICE Pediatric Annals March 2010
39
Nutrition Advice
  • Give appropriate portions for age Allow child
    to decide on how much he/she wants (within
    reason)
  • Studies showed children consumed 25 less of an
    entrée when allowed to serve themselves rather
    than being served a large portion (Fisher et al.,
    AJCN, 2003)
  • Dont force a child to clean the plate
  • Try to eat at home rather than out
  • Eat food at the table (not in front of the TV)
  • Eating in front of the TV is associated with
  • higher intake of fat and salt
  • Lower intake of fruits/ vegetables
  • Eating without awareness?encourages overeating
  • 60-80 of commercials during childrens shows
    relate to food
  • Eat slowly/Stop when full
  • Read Labels

40
Nutrition Guidelines
41
(No Transcript)
42
frrom Pediatric Annals March 2010
43
Encourage Physical Activity
  • COUNSEL ALL CHILDREN at WELL CHILD CHECKS (not
    just those with BMIgt85ile)
  • Limit screen time with TV and video games to less
    than 2 hrs/day
  • Make it active by running/dancing during
    commercials or requiring running/ dancing for the
    first 30 minutes to be able to watch the next
    1-1/2 hours.
  • Dont use the remote control
  • Encourage 60 minutes/day of activity
  • Encourage organized sports
  • Encourage outdoor time
  • Parents have to support the childs
    activity--Otherwise it will not likely happen.
  • Plan family field trips on weekends

44
  • (Slide Courtesy of Krebs, N., Hassink S.,
    Obeesity Basics 101 Role of the Pediatrician)

45
  • (Slide Courtesy Krebs, N., Hassink S., Obeesity
    Basics 101 Role of the Pediatrician)

46
Treatment of Obesity
  • The new recommendations detail treatment
    strategies organized in a stepwise protocol
    format. By facilitating a more aggressive
    approach to weight management in the primary care
    setting (eg. More frequent follow-up visits, more
    timely and appropriate referrals to nutritionists
    and exercise specialists), the greater the
    likelihood of success.
  • --Contemporary Pediatrics Volume 25, no. 4

47
Stage 1Prevention Plus Protocol
  • The Committee recommends a staged approach based
    on age and progress on decreasing BMI as follows
  • The MD should recommend
  • gt5 servings of fruits and vegetables /day
  • lt2 hours of screen time/day and no tv or
    computers in the childs sleeping area
  • gt1 hours of physical activity/day
  • No sugar-sweetened beverages
  • Eat breakfast every day
  • Limit fast food
  • GOAL? weight maintenance ?decrease BMI
  • Follow patients as often as monthly for 3-6
    months
  • If there is no progress? GO TO STAGE 2

48
Stage 2 Structured weight management protocol
  • Physicians should
  • Develop a plan for an organized diet with
    structured daily meals and snacks with
    nutritionist advice
  • Recommend that the child have active play for at
    least 1 hour a day and further restrict screen
    time to one hour or less per day
  • Suggest improved monitoring of exercise, screen
    time or diet by patient and/or family
  • GOAL? maintain weight or lose weight
  • (no more than 1 lb./month in children aged 2 to
    11 OR 2 lbs./week in those aged 12 and older)
  • Follow patients as often as monthly for 3-6
    months
  • If there is no progress? GO TO STAGE 3

49
Stage 3 Comprehensive multidisciplinary protocol
  • REFER to a multidisciplinary team for more
    aggressive and coordinated management including
    evaluation by a psychologist with consideration
    given to behavior modification and motivational
    counseling
  • Stage 3 interventions include the same eating and
    activity goals as stage 2 plus psychological
    counseling that may involve the entire family
  • GOAL? weight maintenance or loss (no more than 1
    lb./month ages 2-5, or 2 lbs./week ages 6 and up
    )til BMIlt85ile
  • Follow up may be provided weekly

50
Stage 4 Tertiary Care Protocol
  • For patients with BMIgt95ile with comorbidities
    or who have not responded to Stage 1-3
    strategies
  • OR
  • For patients with BMIgt99ile with no improvement
    after 6-12 months of a Stage 3 regimen
  • MUST be referred to a tertiary weight management
    center that usually include dietary and activity
    counseling, low-calorie diets and sometimes even
    medications and surgery.

51

From Contemporary Pediatrics Volume 25, No. 4 April 2008

52
From Contemporary pediatrics Volume 25, no. 4 April 2008
  • An obesity action plan for children

53
Treatment of Obesity
  • Important to communicate effectively with patient
    and family
  • Try to assess a typical dayto better identify
    ways to change diet and activity
  • Try to be sensitive and not use words that may
    offend (obese, fat). Try to avoid being
    judgmental and stigmatizing.
  • Are you concerned about your childs weight?
  • Im concerned that your childs weight is
    getting ahead of his height
  • (older child) Is your weight ever a problem for
    you?

54
Motivational Interviewing
  • Recent studies have demonstrated the efficacy of
    motivational interviewing in helping patients
    change their health behaviors.
  • MI is a patient-centered method for enhancing
    intrinsic motivation to change by exploring and
    resolving ambivilance.
  • MI is patient centered, not doctor centered.
  • The physician listens to the patients
    perspective on how the problem affects daily life
    and seeks to understand the patients point of
    view without judging or criticizing the behavior.

from Pediatric Annals March 2010
55
3 Communcation Styles of Motivational Interviewing
  • Following (history taking)
  • Open-ended questions
  • Reflective listening
  • Agenda setting
  • Asking permission
  • Directing
  • Commonly used by physiciansclinicians tells
    patients what to do and how to do it
  • Guiding
  • The physician helps the patient find his/her way
    and acts more like a tutor.
  • The patient is encouraged to explore his/her own
    motivation and goals. The patient makes the case
    for change

56
Four Guiding Principles of Motivational
Interviewing
  • Resist arguing and trying to persuade your
    patient to change behavior
  • Otherwise patient will become defensive
  • Understand your patients motivation
  • Ask them why they might want to change and might
    do it
  • Listen to your patient
  • For example? Your patient may have the answers as
    to how to defeat the barriers to exercise in his
    daily life.
  • Empower your patient
  • A physicians belief in the patients ability to
    change can be all a patient needs to succeed.
  • frrom Pediatric Annals March 2010

57
frrom Pediatric Annals March 2010
58
Motivational Counseling Script (contd)
59
Treatment of Obesity
  • Negotiate for family changeotherwise, it will be
    almost impossible for the patient to change.
  • Try to get all family members to come to at least
    one visit so everyone is on the same page.
  • The familys kitchen and habits have to change.
  • Food diaries
  • Activity logs
  • Pedometers.
  • Handouts
  • on food nutritional content/ portion sizes
  • on healthy recipes snacks
  • on exercise ideas
  • reviewing eating habits, activity goals

60
Treatment of Obesity
  • BUT TREATMENT IS VERY DIFFICULT
  • Thus, PREVENTION OF PEDIATRIC OBESITY IS THE MOST
    EFFECTIVE WAY TO COMBAT CHILDHOOD OBESITY.
  • IT IS VITAL that pediatricians help develop,
    encourage healthy eating and activity habits.

61
BARRIERS TO THERAPY OF PEDIATRIC OBESITY
  • Lack of commitment of primary care physicians
  • Many physicians do not address obesity
  • Price 1989
  • 17 of pediatricians felt physicians did not need
    to counsel parents of obese children
  • 33 did not feel that normal weight is important
    to child health
  • 22 felt competent in treating obesity
  • 11 felt treatment of obesity was gratifying
  • (Slide Courttesy of Cochran, W., Pediatric
    Obesity A Huge Problem in the USA)

62
BARRIERS TO THERAPY OF PEDIATRIC OBESITY
  • Time commitment
  • Lack of reimbursement
  • Tershakovec 1999
  • Median reimbursement rate 11
  • Lack of standard treatment protocol
  • Social / environmental barriers
  • Slide Courtesy of Cochran, W., Pediatric
    Obesity A Huge Problem in the USA)

63
PREVENTION SCHOOL
  • Promote physical activity
  • Provide nutritious meals
  • Control vending machines
  • Have nutrition education incorporated into
    regular school curriculum.
  • Encourage children to walk or bike to school
    safely.
  • Slide Courtesy of Cochran, W., Pediatric
    Obesity A Huge Problem in the USA)

64
PREVENTION COMMUNITY
  • Have safe playgrounds
  • Provide safe places for bike riding and walking
  • Promote physical activity outside of school
  • Slide Courtesy of Cochran, W., Pediatric
    Obesity A Huge Problem in the USA)

65
PREVENTION INSURANCE AND GOVERNMENT
  • Acknowledge obesity as a medical condition for
    which one can be reimbursed.
  • Provide reimbursement for anticipatory guidance
    for nutrition and physical activity
  • Slide Courtesy of Cochran, W., Pediatric
    Obesity A Huge Problem in the USA)

66
LETS MOVE Campaign
  • The White House Obesity Initiative and Your
    Family
  • What is the White House Obesity Initiative?
  • The First Ladys national campaign against
    childhood obesity called Lets Move is a
    comprehensive and coordinated initiative with
    many partners. The focus is to prevent childhood
    obesity.
  • The campaign has four pillars
  • healthy schools,
  • access to affordable and healthy food,
  • raising childrens physical activity levels,
  • and empowering families to make healthy choices.
  • The American Academy of Pediatrics (AAP) is proud
    to join the White House in this initiative

67
White House Obesity Initiative FAQ for Families
  • Why do parents need to know their childs BMI?
  • Parents need to know their childs BMI because
    prevention is the best medicine.
  • By plotting BMI and monitoring physical activity
    and nutrition throughout childhood, parents and
    pediatricians can keep an eye out for children
    at-risk of becoming overweight and take action
    early to prevent future obesity.
  • By catching at-risk children early, families in
    partnership with their pediatrician can explore
    ways to make changes to live healthier active
    lives.

68
From the House Obesity Initiative FAQ for Families
  • How do I talk with my children about making
    healthy active changes?
  • Talk with your children about the importance of
    the whole family being healthy. Get together with
    your family and decide ways your family can make
    healthier choices.
  • Talk with the whole family and decide what
    changes to make together. Remember to make it fun
    to try new things together.

69
What can families do to lead healthier lives?
  • Healthy active living can be fun and
    family-oriented. Make healthy choices together
    grow a garden, play outdoor games, cook as a
    family. Have fun! As parents, its important to
    set a good example.
  • There are a lot of things families can do to be
    healthier and it can be overwhelming trying to
    decide where to start. From the House Obesity
    Initiative FAQ for Families

70
5-2-1-0- RX
  • But it is important to remember that small
    changes can make a big difference.
  • The AAP recommends starting with one of these
    behaviors
  • 5 Eat 5 fruits and vegetables a day.
  • 2 Limit screen time (TV, computer, video
    games) to 2 hours each day.
  • Children younger than 2 should have no screen
    time at all.
  • 1 Strive for 1 hour of physical activity a
    day.
  • 0 Limit sugar-sweetened drinks.
  • From the House Obesity Initiative FAQ for
    Families

71
5-2-1-0 Rx. For Healthy Active Living
72
5-2-1-0 Rx. Contd
  • To start, families can pick one of these
    behaviors and set specific goals to improve their
    health.
  • In addition to 5, 2, 1, 0, goals, families can
    make small changes in their family routines to
    help everyone lead healthier active lives.
    Science suggests these activities can help
    prevent obesity
  • Eating breakfast every day
  • Eating low-fat dairy products like yogurt,
    milk, and cheese
  • Regularly eating meals together as a family
  • Limiting fast food, take-out food, and eating
    out at restaurants
  • Preparing foods at home as a family
  • Eating a diet rich in calcium and
  • Eating a high fiber diet.
  • From the House Obesity Initiative FAQ for Families

73
How do we start to make changes to our familys
routine?
  • You can start in small steps. Small changes can
    make a big difference in your childs health.
  • First Lady Michelle Obama gives a few concrete
    examples of doing just that putting water in
    your childs lunch box, providing a fruit serving
    at breakfast, and curbing fast food consumption.
  • TheAAPs healthy active living prescription
    available at www.aap.org/obesity/whitehouse is
    designed to help you and your pediatrician
    identify some areas where you might want to
    begin. Small changes you make every day can make
    a big difference in your familys health in the
    long run!
  • From the House Obesity Initiative FAQ for
    Families

74
How can our communities support healthy active
children?
  • The environments our children live in have a
    profound impact on the foods they eat and the
    amount of activity they get.
  • Some communities lack full-service grocery
    stores, but have an abundance of fast food
    restaurants. In turn, families may fall back on
    these fast food options because healthy, fresh
    foods are not available nearby.
  • Working with community leaders to encourage the
    creation of healthy, fresh food options can make
    a difference in the choices available for
    families.
  • From the House Obesity Initiative FAQ for Families

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How can our communities support healthy active
children? (contd)
  • Communities can also ensure that children have a
    safe place to play.
  • Community centers, green space, parks these all
    provide an opportunity for kids to be active.
  • Encourage your community to have fun and safe
    places for children to play inside and outside
    so they have options for fun and safe
    activities.
  • From the House Obesity Initiative FAQ for Families

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How can pediatricians and parents partner on
healthy active living?
  • Your pediatrician can partner with you on a
    prescription for healthy active living that is
    right for your family.
  • He or she knows your family and understands the
    nutritional and physical activity needs for your
    child.
  • Your pediatrician is also familiar with your
    community and may be able to help you find needed
    resources to support your healthy active
    lifestyle goals.
  • Together, you and your pediatrician can help your
    family get started on the path to leading
    healthier lives.
  • From the House Obesity Initiative FAQ for Families

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EAT WELL PLAY HARD or else
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Relevant WEBSITES
  • www.aap.org/obesity/whitehouse/index.html
  • Lets move campaign by First Lady Michele Obama
    endorsed by the AAP
  • www.nichq.org/NICHQ/Programs/ConferencesAndTrainin
    g/ ChildhoodObesity/ActionNetwork/htm
  • Pediatrician can join the Childhood Obesity
    Action Network
  • http//www.verbnow.com
  • CDC site for 9-13 year olds to promote physical
    activity
  • www.aap.org/obesity/index.html
  • American Academy of Pediatrics web site regarding
    obesity
  • http//www.bam.gov
  • Site to answer kids questions

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Relevant WEBSITES
  • http//147.208.9.133/
  • A free dietary assessment tool to keep up to a
    20-day food log
  • http//www.kidnetic.com/
  • An interacitve website for 9-13 year olds and
    families re healthy eating and activity
  • http//www.trowbridge-associates.com
  • Pediatric BMI wheels
  • http//www.usda.gov/cnpp/kidspyra
  • Pediatric food pyramid
  • (From Cochran, W., Pediatric Obesity A Huge
    Problem in the USA)
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