Childhood Obesity
Vicki Cunningham
March 2015
Overview
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Epidemiology
Health impact
Identification
Management
Case studies
Child obesity statistics
2012/13 New Zealand Health Survey
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11% of children aged 2–14 years obese (1 in 9 children)
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Additional 22% overweight
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19% of Māori children obese
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27% of Pacific children obese
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Rate has increased from 8% in 2006/07 to 11% in
2012/13.
Childhood Obesity
•Global increase in childhood obesity
•USA 30% of children and adolescents obese
•Sociodemographic gradients
– Overweight more prevalent among socio-economically
disadvantaged children in developed countries and
children of higher socio-economic status in developing
countries
– NZ children living in the most deprived areas were 3
times as likely to be obese as children living in the least
deprived areas (independent of sex, age or ethnic
composition)
•Ethnic disparities
Genetics of childhood
obesity
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Genetic
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higher concordance between monozygotic than dizygotic twins
high concordance in body fat in monozygotic twins raised apart
Genetics do not explain rapid increase in obesity rates
High rates of parental obesity - probably due to genetics
and shared environment
Obesogenic environment
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Cooking skills being lost
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Cheap calorie rich food and drink
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Takeaways
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Outside and physical play less
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Fewer natural occurrences for activity, now needs
planning
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Food advertising/marketing
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Screen time
Health Impact
Complications of
childhood obesity
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“Puppy fat myth”, overweight is not harmless in
children
Childhood obesity effects both physical and
psychosocial health
Obese children and adolescents become obese
adults
Risks associated with adolescent obesity persist
into adulthood (independent of adult BMI)
Complications
Metabolic
•Hyperlipidaemia
•Hypertension
•Insulin resistance and abnormal
glucose tolerance
•Poor pulmonary function
•Asthma
•Advanced growth and early maturity
•Hepatic steatosis and cholelithiasis,
•Low grade systemic inflammation,
•Sleep apnoea,
•Polycystic ovary disease
•Orthopaedic complications eg SUFE,
flat feet
Psychosocial
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isolation,
stigmatisation,
bullying
psychological problems eg
depression
Tracking
•Overweight children become overweight
adolescents who become overweight adults
•1/3 obese preschoolers become obese adults
•½ obese school-age children become obese adults
•1996 US cohort of adolescents
– 37% of obese (BMI>95th percentile) male and 51% of
obese female were severely obese (BMI>40kg/m2) by 30
years of age, compared with <5% of normal-weight
teenagers.
Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of
the literature. Prev Med. 1993;22(2):167-77.
The NS, Suchindran C, North KE, Popkin BM, Gordon-Larsen P. Association of adolescent obesity with risk of severe obesity
in adulthood. JAMA. 2010;304(18):2042-7.
Georgia add campaign
Identification
Recognition of
overweight and obese
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Under recognition of overweight and
obese by parents and health
professionals
Shifted "norms"
Normal children
identified as
underweight
Diagnosis of obesity in
children
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Obesity in adults defined by BMI level associated with
short and long term disease and mortality risk
Childhood obesity acute complications are uncommon
and longer term risks are harder to track
No uniformly accepted diagnosis but most refer to BMI
>95th centile (overweight is >85th), using age and sex
specific centiles
BMI 95th centile approximates BMI of 30 by age 19
BMI centile charts in med tech or online (CDC)
www.cdc.gov/growthcharts
Other measure of
obesity or adiposity
•BMI SDS
– Is the number of standard deviations from the mean
– BMI SDS of 2 is equivalent to the 95th centile
– Good to track over time
•Waist circumference
•Waist to hip ratio
•Percentage body fat
– Bioelectrical impedance
– Skin fold thickness
Societal view of obesity
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Stigma “Obesity is the result of weakness and
poor self control”
Need to get away from blame, guilt and shame
Recognise that it’s NOT easy
Lots of factors and outside influences involved
(influence of friends and family, school,
supermarkets, shops, TV and advertising,
marketing, governmental policy, cost of food,
technology use, sedentary lifestyles)
Message – Some things you can control and some
things you cant
Having the conversation
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Choose your language; healthy weight or
size
Don’t be apologetic about bringing it up
Conversation with kids about healthy
weight
Don't be overly afraid of triggering body
image problems
Having the conversation
•“I’ve plotted weight adjusted for height
here on the growth chart…. You can see
that it’s above the healthy range for age….
Does that surprise you? …. Would you like
to discuss it?
•Be aware of your own
experiences/feelings regarding the subject
Management
Clinical Guidelines for Weight Management in
New Zealand Children and Young People
FAB
•Food
•Activity
•Behaviour
FIGURE 2 Meta-analysis of studies comparing
lifestyle intervention with no-treatment or waitlist controls.
• Significant metabolic improvements up to 1 year from
baseline
• low-density lipoprotein cholesterol (-0.30mmol/L, 95% CI
-0.45 to -0.15)
• triglycerides (-0.15 mmol/L, 95% CI -0.24 to -0.07),
• fasting insulin (-55.1 pmol/L, 95% CI -71.2 to -39.1)
• blood pressure
• No difference
• high-density lipoprotein cholesterol
Diet
“Diet” approach
•Focus on weight
•Expectation of personal
self control
•Negative interaction
around food
•Short term gain
Lifestyle approach
•Focus on health
•Whole family/whanau
change
•Healthy food environment
•Long term gains
Medication or surgery
•Metformin
•Orlistat
•Bariatric surgery
NDHB Healthy Lifestyle
Programme
HLP principals & structure
• Family based
• Committed families
(contract)
• Group sessions
• Small Sustainable
Steps
• Goal setting (SMART)
• Mentoring
• Peer support
• Initial assessment
• 8 weekly group session
– Afternoon tea
– Presentations
– Group work
– Active games
• Follow up
– 3,6,9,12 mths
• Optional
– Active Families
– Health camp
HLP Content
• Food
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Eat breakfast
Drink water (or milk)
5+ a day, colours
Portion sizes
Reduce takeaways
NIP reading
School lunch from
home
– Eat as a family
– Modelling of a
healthy snack
• Activity
– Increase activity
– Decrease screen
time
– Pedometers
• Behaviour
– What influences our
eating
– Food advertising
– Parental modelling
– Barriers to change
Our ‘Super 7’
1. Choose water as your main drink
2. Eat breakfast each day
3. Eat together once a day as a family (TV OFF)
4. Be active/play outside for 1 hour every day
5. Limit screen time to less than 2 hours a day
6. Develop a sleep routine
7. Monitor progress
Other common topics
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Food availability - shopping and pantry
Manage "sometimes foods"
Mindful eating
Portion size
Parenting support
Parental role modelling
Treatment goals
•Family wide sustained lifestyle
changes
•Improvement in BMI SDS
•Avoidance or reversal of metabolic
complications
•Improved self esteem
The fact that a multi-disciplinary intervention programme did
not outperform medical follow-up may be explained by two
factors. Firstly the multi-disciplinary cohort were older, and
increasing age was found to lead to a smaller BMI SDS
reduction overall. The BMI SDS was greater at entry, which
may have also impacted on the degree of BMI SDS reduction.
Almost half of the multi-disciplinary cohort was either Maori or
Pacific peoples, which may have contributed to outcomes given
the known differences in BMI between Maori and NZ
European cohorts with increasing age.
It is important to note that the multi-disciplinary intervention
programme included in this study was as successful as those
seen in recent meta-analyses of intervention programmes.
Case Study
•12 year old boy with Rheumatic fever and obesity
•Lifestyle changes – mostly food
– No raro, only water
– Increased water at school
– Reduced purchase of packets of biscuits from 5/week to 2/week
– Light blue milk
– Regular breakfast (avoid bread and cheese)
– Composition of dinner plate – portion size, less carbs, more veges
•Already active,
enjoys sports
•Reduce
screentime
Summary
•Childhood obesity common, underrecognised and important health
issue
•Lifestyle (FAB) approach to
management