Revitalize Our Children:
Revitalize Our Children:
 How health care providers can
understand and help our overweight
children
Revitalize Our Children:
 Objectives:
 Review prevalence of pediatric obesity
 Identify co morbidities of overweight
conditions in children
 Identify risk factors for pediatric obesity
 Suggest prevention and treatment strategies
 David B. Jack, M.D.
Corpulence
 Obesity now affects 17% of all children
and adolescents in the United States triple the rate from just one generation
ago
 Since 1980, obesity prevalence among
children and adolescents has almost
tripled
Background Differences
 There are significant racial and ethnic
disparities in obesity prevalence among
U.S. children and adolescents. In 2007—
2008, Hispanic boys, aged 2 to 19 years,
were significantly more likely to be obese
than non-Hispanic white boys, and nonHispanic black girls were significantly
more likely to be obese than nonHispanic white girls.
2009—2011 County Obesity
Prevalence Among Low-Income Children
Aged 2 to 4 Years

Washington ranks 18 in overall
prevalence with 29.5% of children
considered either overweight or obese.
Washington State:
% Children Ages 6- 17 with TV in Bedroom:
 32.0%
% Children Ages 12-17 Not Eating Family Meals Most
Days of Week:
 25.8%
From: Prevalence of Obesity and Trends in Body Mass Index Among US Children and Adolescents, 1999-2010
JAMA. 2012;307(5):483-490. doi:10.1001/jama.2012.40
Copyright © 2012 American Medical
Association. All rights reserved.
What Causes Childhood Obesity?
Sugar drinks and less healthy foods
on school campuses.
 About 55 million school-aged children are enrolled in
schools across the United States, and many eat and
drink meals and snacks there
 More than half of U.S. middle and high schools still
offer sugar drinks and less healthy foods for purchase
 Students have access to sugar drinks and less healthy
foods at school throughout the day from vending
machines and school canteens and at fundraising
events, school parties, and sporting events
Advertising of less healthy foods.
 Nearly half of U.S. middle and high schools
allow advertising of less healthy foods, which
impacts students' ability to make healthy food
choices
 Foods high in total calories, sugars, salt, and
fat, and low in nutrients are highly advertised
and marketed through media targeted to
children and adolescents, while advertising for
healthier foods is almost nonexistent in
comparison
Lack of daily, quality physical activity
 Most adolescents fall short of the 2008
Physical Activity Guidelines for Americans
recommendation of at least 60 minutes of
aerobic physical activity each day, as only 18%
of students in grades 9—12 met this
recommendation in 2007
 Daily, quality physical education in school can
help students meet the Guidelines. However, in
2009 only 33% attended daily physical
education classes
No safe and appealing place, in many
communities, to play or be active.
 Many communities are built in ways that make
it difficult or unsafe to be physically active. For
some families, getting to parks and recreation
centers may be difficult, and public
transportation may not be available. For many
children, safe routes for walking or biking to
school or play may not exist. Half of the
children in the United States do not have a
park, community center, and sidewalk in their
neighborhood. Only 27 states have policies
directing community-scale design.
Limited access to healthy affordable foods
 Some people have less access to stores and
supermarkets that sell healthy, affordable food such as
fruits and vegetables, especially in rural, minority, and
lower-income neighborhoods
 Supermarket access is associated with a reduced risk
for obesity
 Choosing healthy foods is difficult for parents who live
in areas with an overabundance of food retailers that
tend to sell less healthy food, such as convenience
stores and fast food restaurants
Greater availability of high-energy-dense foods
and sugar drinks.
 High-energy-dense foods are ones that have a lot of
calories in each bite
 A high-energy-dense diet is associated with a higher
risk for excess body fat during childhood
 Sugar drinks are the largest source of added sugar and
an important contributor of calories in the diets of
children in the United States
 High consumption of sugar drinks, which have few, if
any, nutrients, has been associated with obesity
 On a typical day, 80% of youth drink sugar drinks
Increasing portion sizes
 Portion sizes of less healthy foods and
beverages have increased over time in
restaurants, grocery stores, and vending
machines
 Children eat more without realizing it if
they are served larger portions
Lack of breastfeeding support.
 Breastfeeding protects against childhood overweight
and obesity
 However, in the United States, while 75% of mothers
start out breastfeeding, only 13% of babies are
exclusively breastfed at the end of 6 months
 The success rate among mothers who want to
breastfeed can be improved through active support
from their families, friends, communities, clinicians,
health care leaders, employers, and policymakers.
 Children who are breastfed for six months are less
likely to become obese
Television and Media
 Children 8—18 years of age spend an
average of 7.5 hours a day using
entertainment media, including TV,
computers, video games, cell phones,
and movies. Of those 7.5 hours, about
4.5 hours is dedicated to viewing TV
Television and Media
 Eighty-three percent of children from 6
months to less than 6 years of age view
TV or videos about 1 hour and 57
minutes a day
Television and Media
 TV viewing is a contributing factor to
childhood obesity because it may take
away from the time children spend in
physical activities; lead to increased
energy intake through snacking and
eating meals in front of the TV; and,
influence children to make unhealthy
food choices through exposure to food
advertisements
Health Risks Now
 Childhood obesity can have a harmful effect on
the body in a variety of ways. Obese children
are more likely to have–
 High blood pressure and high cholesterol, which are
risk factors for cardiovascular disease (CVD). In one
study, 70% of obese children had at least one CVD
risk factor, and 39% had two or more
 Increased risk of impaired glucose tolerance, insulin
resistance and type 2 diabetes
Health Risks Now
 Childhood obesity can have a harmful
effect on the body in a variety of ways.
Obese children are more likely to have–
 Breathing problems, such as sleep apnea,
and asthma
 Joint problems and musculoskeletal
discomfort
Health Risks Now
 Childhood obesity can have a harmful effect on
the body in a variety of ways. Obese children
are more likely to have–
 Fatty liver disease, gallstones, and gastroesophageal reflux (i.e., heartburn)
 Obese children and adolescents have a greater risk
of social and psychological problems, such as
discrimination and poor self-esteem, which can
continue into adulthood
Health Risks Later In Life
 Obese children are more likely to become
obese adults
 Adult obesity is associated with a number of serious
health conditions including heart disease, diabetes,
and some cancers
 If children are overweight, obesity in adulthood
is likely to be more severe
Young children ages 2 to 5 have a lower prevalence of
overweight and obesity than older youth.
Among young people ages 2 to 19:
 About 31.8 percent are considered to be either
overweight or obese, and 16.9 percent are
considered to be obese
 About 1 in 3 boys (33 percent) are considered
to be overweight or obese, compared with 30.4
percent of girls
 About 18.6 percent of boys and 15 percent of
girls are considered to be obese
Children and Adolescents Ages 6 to 19:
 Almost 1 in 3 (33.2 percent) are considered to be
overweight or obese, and 18.2 percent are
considered to be obese
 More than 2 in 5 black and Hispanic youth (more
than 41 percent) are considered to be overweight or
obese*
 About 25.7 percent of black, 22.9 percent of
Hispanic, and 15.2 percent of white youth are
considered to be obese*

Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass
index among US children and adolescents, 1999–2010. Journal of the American Medical
Association. 2012; 307(5):483–90.
Childhood Obesity
 Obesity now affects 17% of all children
and adolescents in the United States triple the rate from just one generation
ago
 Since 1980, obesity prevalence among
children and adolescents has almost
tripled
How Do We Diminish the Problem?

Build a Healthy Plate With Fruits
• Build a Healthy Plate With Vegetables
• Build a Healthy Plate With Dry Beans and Peas
• Meat and Meat Alternates
• Build a Healthy Plate With Whole Grains
• Build a Healthy Plate With Less Salt and Sodium
• Fats and Oils: Build a Healthy Plate With Options Low in
Solid Fats
• Build a Healthy Plate With Less Added Sugars
• Make Water Available Throughout the Day
• Provide Opportunities for Active Play Every Day
• Encourage Active Play and Participate With Children
• Promote Active Play Through Written Policies and Practices
• Limit Screen Time
• Appendix B: Care for Children With Food Allergies (updated
1/17/13)
•
Fat Prevention Begins At Home
Fat Prevention Begins At Home
Make Meal Times a Family Affair
Be a Good Role Model -----
Not a Poor Example
Beans and Peas
 Help children feel full longer and maintain a healthy
weight
 Promote proper digestion and make children’s
“potty time” easier by providing dietary fiber
 Add shape, texture, and flavor to children’s plates
Fruits, Vegetables
 Add color, texture, and flavor to children’s plates
 Give children the vitamins and minerals they need
to grow and play
 Add color, crunch, and flavor to children’s plates
 Promote proper digestion, help children feel full,
and provide fiber for fullness
Decreasing Solid Fats
 Make food fun
 “Kangaroo Pockets” (stuff half a whole-grain pita pocket with
sliced chicken, romaine lettuce, shredded carrots, and a little
salad dressing)
 Try “Crunchy Baked Chicken” (oven-baked chicken tenders
coated in crushed whole-grain cereal or breadcrumbs)
Have children help with cooking and
let them choose healthy foods
Decreasing Solid Fats
 Have children help cook
 Make a “fruit and yogurt parfait” by topping nonfat plain yogurt
with whole-grain cereal and fresh or frozen berries, banana
slices, fruit canned in 100% juice, a favorite fruit
Encourage Active Play
 Display posters and pictures of children
and adults being physically active.
Encourage Active Play
 Make a chart for tracking physical activity
with children’s and child care providers’
names
 Have children place a sticker or a stamp by
their name every time they participate in
active play
Intermountainlive.org
Limit Screen Time
 Play music
Limit Screen Time
 Organize puzzle time
 Have easy puzzles children can do alone or
in pairs
Limit Screen Time
 Draw, color, create a sculpture, or use
play dough
Limit Screen Time
 Read with or to children; Provide books
Limit Screen Time
Limit Screen Time
 Having the TV on can disturb children’s
sleep and play, even if it is on in the
background
Limit Screen Time
 TV and some DVDs include
advertisements for unhealthy foods
Limit Screen Time
 The more time children spend playing
video games, the more likely they are to
have difficulty concentrating in school
Limit Screen Time
 Many video games contain violence
 Computer games can impair children’s
sleep at night, possibly causing them to
spend less time in deep sleep. Sleep is
important for children’s health and
development
Limit Screen Time
 We know from research that, at least for
boys, the more time they spend playing
video games and watching TV, the less
active they are
Mistreatment
 Almost 100% of obese teenage girls
have been at least verbally abused about
their weight
 Studies show discrimination in school
and work settings and in dating and
relationships
Body Image
 “Skinny” is the only good body type
 One quarter of all girls age 6 and 7 have
dieted
 Dieting numbers nearly identical for average
and overweight girls
Body Image
 “No one at school eats
lunch because they
don’t want to get fat.”
Food Discussions
 Emphasize health, not weight
 Discuss food in terms of its capacity to provide
energy, and to improve thinking and strength
 Do not allow “fat talk”
 Love children and ourselves
 Support children in hobbies and passions that have
nothing to do with weight
 Value their accomplishments
Change the Model
 Do not make parties about cupcakes, ice
cream, brownies and Cheetos
 Try different kinds of foods as a treat
 Do not associate parties with sugar and
fat food indulgences---fun does not just
come with lots of sugar!
Personal Experience
 David Gourley Elementary School
 Disadvantaged neighborhood
 Half of students do not speak English
 Attended by speaker 50 years ago when it
first opened
 Little community support
 Became a “Health Mentor”
Congratulations To
___
___
for Outstanding Achievements and Participation in the
Gold Medal Schools Program for the
2007-2008 School Year
_______________________
GMS Mentor
_____________
Date
References
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