Prevention of childhood obesity

Содержание

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Introduction Obesity is a major public health problem across the world.

Introduction

Obesity is a major public health problem across the world.

Obesity results from excessive caloric intake, decreased energy expenditure and/or from a combination of the two.
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World Health Organization (WHO) definitions for obesity BMI = Weight kg/Height

World Health Organization (WHO) definitions for obesity

BMI = Weight kg/Height m²
Underweight:

<18.5 BMI
Healthy weight: 18.5-24.9 BMI
Overweight (Grade I obesity): 25.0-29.9 BMI
Obese (Grade II): 30.0-39.9 BMI
Morbidly obese (Grade III): 40 or above BMI
Super obese (Grade IV): BMI >50
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Environment & Physiology of gaining wt Older environments: an unreliable food

Environment & Physiology of gaining wt

Older environments: an unreliable food supply

& high need for physical activity to procure food to survive.
No logical reason for humans to develop a strong physiological defense against weight gain.
The weak physiological regulation of energy balance was effective.
Today’s environment provides a constant supply of high energy food with reduced needs for physical activity.
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Remarkably Short History for Caloric Beverages: Might the Absence of Compensation

Remarkably Short History for Caloric Beverages: Might the Absence of Compensation

Relate to This Historical Evolution?

AD

BCE

10000 BCE

200000 BCE

Beginning of Time

100000 BCE

200000 BCE Homo Sapiens

Pre-Homo Sapiens

200,000BCE - 10,000 BCE Origin of Humans

Modern Beverage Era
10,000 BCE - present

0

Earliest possible date
Definite date
Water, Breast Milk

2000 BCE

Milk (9000 BCE)

Beer (4000 BCE)

Wine (5400 BCE)

Wine, Beer, Juice

(8000 BCE)

(206 AD)

Tea (500 BCE)

Brandy Distilled (1000-1500)

Coffee (1300-1500)

Lemonade (1500-1600)

Liquor (1700-1800)

Carbonation (1760-70)

Pasteurization (1860-64)

Coca Cola (1886)

US Milk Intake 45 gal/capita
(1945)

Juice Concentrates (1945)

US Coffee Intake 46 gal/capita
(1946)

US Soda Intake 52/gal/capita
(2004)

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How has the obesity epidemic arisen? Most of the Affluent population

How has the obesity epidemic arisen?

Most of the Affluent population has

been in slight positive energy balance over the past 10-15 years.
Gradual weight gain of up to 1 kg/month, can be produced by a very small degree of positive energy balance of 50 kcal/day.
Decreased physical activity as technology & urbanization promotes sedentary life style
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Obesity: Environmental Influence Current environment Past environment Genetic susceptibility BMI %

Obesity: Environmental Influence

Current environment

Past environment

Genetic susceptibility

BMI %

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Built environment Includes transportation systems, architectural design, use of land, parks,

Built environment

Includes transportation systems, architectural design, use of land,

parks, and public spaces.
Life style discourages physical activity & encourage automobile use
Neighborhoods without sidewalks - discourage walking.
Tall buildings discourage stair case & encourage elevator and escalator use
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Commercial environment Low cost junk food available everywhere heavily advertised especially

Commercial environment

Low cost junk food available everywhere heavily advertised especially to

children.
Many schools have vending machines & fast food outlets.
Heavy promotion of activities and products that discourage physical activity.
Sedentary forms of entertainment e.g. Home entertainment systems …etc
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Environment factors that promote overeating Availability of fast food & snacks

Environment factors that promote overeating

Availability of fast food & snacks

Easy accessibility
Low Cost
Good taste
Big Portion Size
High Fat Content
Energy Dense soft Drinks
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Environmental factors that reduce physical activity Technological advances reduce need for

Environmental factors that reduce physical activity

Technological advances reduce need for physical

activity
In most occupations
In most jobs
For daily living and household activities
In schools
Competition from attractive sedentary activities:
television, video/DVD, video/computer games, internet
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In 1980, about 50 percent of high school seniors reported eating

In 1980, about 50 percent of high school seniors reported eating

green vegetables “nearly every day or more.” By 2003, that figure had dropped to about 30 percent.
(YES Occasional Papers. Paper 3. Ann Arbor, Mich.: Institute for Social Research, May 2003)

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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Between 1977-78 and 2000-01, milk consumption decreased by 39 percent in

Between 1977-78 and 2000-01, milk consumption decreased by 39 percent in

children ages 6-11, while consumption of fruit juice rose 54 percent, fruit drink consumption rose 69 percent and consumption of carbonated soda rose 137 percent.

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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In 1970, about 25 percent of total food spending occurred in

In 1970, about 25 percent of total food spending occurred in

restaurants. By 1995, 40 percent of food dollars were spent away from home.

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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Between 1970 and 1980, the number of fast-food outlets in the

Between 1970 and 1980, the number of fast-food outlets in the

United States increased from about 30,000 to 140,000, and sales increased by about 300 percent. In 2001, there were about 222,000 fast-food outlets.

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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Lack of public information Some people can not judge which products

Lack of public information
Some people can not judge which products

are high in fat and by how much.
Food manufacturers display macronutrients in grams, when the correct way would be to express their contribution in energy.
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Children eat nearly twice as many calories (770) at restaurants as

Children eat nearly twice as many calories (770) at restaurants as

they do during a meal at home (420).

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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According to a national study, 92 percent of elementary schools do

According to a national study, 92 percent of elementary schools do

not provide daily physical education classes for all students throughout the entire school year.

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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Statistics from the Centers for Disease Control and Prevention (CDC) are

Statistics from the Centers for Disease Control and Prevention (CDC) are

alarming. Today, about 16 percent of all children and teens in the United States are overweight.

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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Why people physically inactive? Lack of awareness regarding the of physical

Why people physically inactive?

Lack of awareness regarding the of physical activity

for health fitness and prevention of diseases
Social values and traditions regarding physical exercise (women, restriction).
Non-availability public places suitable for physical activity (walking and cycling path, gymnasium).
Modernization of life that reduce physical activity (sedentary life, TV, Computers, tel, cars).
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Six out of 10 children ages 9-13 don’t participate in any

Six out of 10 children ages 9-13 don’t participate in any

kind of organized sports/physical activity program outside of school, and children whose parents have lower incomes and education levels are even less likely to participate. Nearly 23 percent don’t engage in any free-time physical activity.

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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Studies have shown that, between 1977 and 1996, portion sizes for

Studies have shown that, between 1977 and 1996, portion sizes for

key food groups grew markedly in the United States, not only at fast-food outlets but also in homes and at conventional restaurants.

One study of portion sizes for typical items showed that:
Salty snacks increased from 132 calories to 225 calories.
Soft drinks increased from 144 calories to 193 calories.
French fries increased from 188 calories to 256 calories.
Hamburgers increased from 389 calories to 486 calories.

(Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA 2003;289:450-3)

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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Lack of public information Advertising gives children confused messages about nutrition,

Lack of public information
Advertising gives children confused messages about nutrition, and

can change their food preferences and buying behaviour.
Subsidies on food products play an important part, as children as well as adults, are influenced by cheap prices.
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The typical American child spends about 45 hours per week using

The typical American child spends about 45 hours per week using

media outside of school.

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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In 1977-78, children ages 6-11 drank about four times as much

In 1977-78, children ages 6-11 drank about four times as much

milk as soda. In 2001-02, they drank about the same amounts of milk and soda.

From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org

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Tackling Obesity The WHO’s 1997 interim report argues that it is

Tackling Obesity

The WHO’s 1997 interim report argues that it is

not enough to tackle obesity at individual level and that a society-wide public health approach needs to be employed.
Medical profession should work with the food industry to promote a healthier diet for everyone from childhood to adult life.
Management of obesity in Primary Care by a motivated well-informed multi-disciplinary team could achieve and maintain weight loss by promoting sustainable changes in lifestyle.
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GOALS OF PROGRAM Policy components: choosing a strategy to change the

GOALS OF PROGRAM

Policy components:
choosing a strategy to change the environment
Behavior

changes
Best to Begin with small changes
Outcome Objectives:
primary prevention of weight gain
Prevention of further weight gain
Weight loss
prevention of weight regain
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National policy Controlling food inports & food labelling Improving facilities for

National policy

Controlling food inports & food labelling
Improving facilities for sports and

making the streets safe for walking or cyclin
Education programmes for all, directed towards promoting healthy lifestyles and explaining the risks associated with obesity.
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Management Prevention is the Key Team work Individualized goal of wt

Management

Prevention is the Key
Team work
Individualized goal of wt loss
Components:
Education &

motivation
Diet modification
Increased activity
Parents are role models
Medicines & surgery
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Educate & Motivate Children Public support for healthier lifestyles needs to

Educate & Motivate Children

Public support for healthier lifestyles needs to begin

with our children.
Teach early - why physical activity and healthy eating are so important.
Provide them with the knowledge and the cognitive skills to manage energy balance in the modern environment.
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Education points to address Resist temptation to always clean your plate

Education points to address

Resist temptation to always clean your plate
Do not

eat while talking on the phone or watching TV
Avoid appetizer and dessert in restaurants
Eat a healthy snack before going to a holiday party so you will feel full
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Your Eating Habits Small, frequent meals at regularly scheduled times Regularly

Your Eating Habits

Small, frequent meals at regularly scheduled times
Regularly scheduled snacks

of fruit or vegetables
Do not skip meals
No foods are off limits however in order to encourage success moderation is the key
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Portion Sizes Most of us underestimate the amount of food we

Portion Sizes

Most of us underestimate the amount of food we eat
Limiting

portion sizes is critical for good health
Check serving sizes listed on packages & learn to judge sizes more accurately.
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Cutting Back On Calories But Feeling Full Add vegetables to as

Cutting Back On Calories But Feeling Full

Add vegetables to as many

things as possible
Eat several servings of fruits daily
Avoid processed & fried foods, red meat, ghee butter, cream & chocolates
Some fat is needed to provide essential nutrients to the body; use veg. oils like olive & sunflower, but avoid saturated fats.
Watch foods labeled “fat-free” or “low-fat”; you may consume more calories overall.
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Cutting Back On Calories But Feeling Full Traditionally, dieters cut cereals,

Cutting Back On Calories But Feeling Full

Traditionally, dieters cut cereals, pasta

and potatoes to control weight
These are sources for complex carbohydrates that help you feel full and maintain a healthy weight
Avoid high-fat toppings on carbohydrates and try plain or low-fat yogurt.
Foods high in protein are often high in fat, so limit protein to 10-15% of total daily calorie intake
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Food Diaries Most people do not realize the amount of food

Food Diaries

Most people do not realize the amount of food they

eat per day and what they are doing at the exact time they are eating that food
Suggest taking notebook and taking a one week diary
Note in diary all intake of food, snacks, drinks and activities while eating
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Management For overweight children small reduction in calories allows gradual decline

Management

For overweight children small reduction in calories allows gradual decline in

BMI
For obese children & adolescents weight loss of 0.5-1 kg/week is the goal.
Rapid wt loss can lead to electrolyte disturbances (↓ K+, ↑uric acid)
Special diets like protein rich diet not recommended
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Atkin’s diet High-protein low-CHO diet Induces ketosis. Caloric intake as protein

Atkin’s diet

High-protein low-CHO diet
Induces ketosis.
Caloric intake as protein is

less prone to fat storage than the equivalent caloric intake as carbohydrate,
Has no supporting physiologic basis.
No long-term data to evaluate safety.
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Dieting and Eating Habits Maximum recommended daily calorie intake: 1600 calories:

Dieting and Eating Habits

Maximum recommended daily calorie intake:
1600 calories: house

wives & older adults
2200 calories: most children, teen girls, active
women, and sedentary men
2800 calories: teen boys & active men
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Diet: Bottom Line Follow the food pyramid Low calorie, low fat,

Diet: Bottom Line

Follow the food pyramid
Low calorie, low fat, low

saturated fat diet
Avoid junk food & extra salt
Practice moderation, not avoidance
Parents are the role models
Permanent changes to family eating habits
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* ©M.Miqdady, M.D.

*

©M.Miqdady, M.D.

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Physical Activity and Exercise Physical Activity Exercise Household Chores Occupational Activity Gardening/Yardwork

Physical Activity and Exercise

Physical Activity

Exercise

Household Chores

Occupational Activity

Gardening/Yardwork

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Physical Activity Burns calories and keeps metabolism geared towards using food

Physical Activity

Burns calories and keeps metabolism geared towards using food for

energy instead of storing it for fat.
Increase house & daily activities
Sports & structured exercise
Begin slow and gradually increase exercise time to 30-60 minutes per day
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Exercise: Bottom Line Use “life activity” not formal exercise programs whenever

Exercise: Bottom Line

Use “life activity” not formal exercise programs whenever possible
Find

partners :friends, family
Home activities 3 kcal/min
Walking 4 kcal/min
Jogging 6 kcal/min
Running 8 kcal/min
Running up the stairs 10 kcal/min
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Exercise vs. Lifestyle Physical Activity Exercise Lifestyle Physical Activity

Exercise vs. Lifestyle Physical Activity

Exercise

Lifestyle Physical Activity

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Behavior Most people resist change Patterns are learned over a lifetime

Behavior
Most people resist change
Patterns are learned over a lifetime
Limit T.V., internet,

games <2hr/day
Family therapy not just the child
Psychological dimension
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Medications Only two medicines & one fat substitute are approved by

Medications

Only two medicines & one fat substitute are approved by FDA

for long-term use.
Central acting : impair dietary intake, e.g. Sibutramine (Meridia®)
Impair lipid absorption, e.g. Orlistat (Xenical®)
Olestra (Olean®) fat substitute
No drug has been approved for use in children below 15 years of age
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Sibutramine (Meridia®) Enhances satiety Raises the basal metabolic rate by inhibiting

Sibutramine (Meridia®)

Enhances satiety
Raises the basal metabolic rate by inhibiting

norepinephrine reuptake
CNS side effects
Several drug interactions
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Orlistat (Xenical®) Gastrointestinal lipase inhibitor Reduces absorption of some fat-soluble vitamins

Orlistat (Xenical®)
Gastrointestinal lipase inhibitor
Reduces absorption of some fat-soluble vitamins (A, D,

E, K)
Causes flatulence & leakage of oily stools
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Fat substitutes Olestra (Olean®) Sucrose polyester plus fatty-acids Fast food Zero

Fat substitutes

Olestra (Olean®)
Sucrose polyester plus fatty-acids
Fast food
Zero kcal
Less tasty
Flatulence

and diarrhea
FDA approved with fat soluble vitamins
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Surgery Bariatric surgery Morbid obesity (BMI >40) Most common procedures are:

Surgery

Bariatric surgery
Morbid obesity (BMI >40)
Most common procedures are:
Roux-en-y gastric

bypass
Gastric banding
Ballon
Omentumectomy
Fat liposuction
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Fasting for wt loss? Fasting is popular because it can provide

Fasting for wt loss?

Fasting is popular because it can provide dramatic

weight-loss but it is primarily water rather than fat
Lost water is regained quickly when eating is resumed.
Prolonged fasting is not recommended and may lead to nutritional imbalances
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Conclusions Obesity is not a disease, it is a public health

Conclusions

Obesity is not a disease, it is a public health problem

and it is a risk factor for several chronic diseases.
Understanding the role of environmental factors on development of obesity help in control & prevention.
Healthy eating combined with increased physical activity is the answer
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Summary No miracle “cures” or products No “revolutionary” diets No pill

Summary

No miracle “cures” or products
No “revolutionary” diets
No pill or potion
No magic
Your

will and your lifestyle are in control of weight management.
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Weight-Control Organizations TOPS (Take-Off Pounds Sensibly) started in 1948 and has

Weight-Control Organizations

TOPS (Take-Off Pounds Sensibly) started in 1948 and has over

300,000 members in 20 countries.
WW (weight watchers) started in the 1969 and has branches in 60 countries.
Overeaters Anonymous is founded in 1960 for compulsive overeaters. It has about 8500 groups in 50 countries. It operates on the premise that overeating is a progressive illness that cannot be cured but can be arrested.
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