Obesity in Hispanic Children:
Reversing the Tide
Donna Spruijt-Metz, MFA PhD
Associate Professor, USC Keck School of Medicine
Director, Responsible Conduct of Research
dmetz@usc.edu
www.metzlab.net
 Persists into adulthood (Whitaker et al. NEJM: 1997;337:869-873)
Data from the National Longitudinal Survey of Youth 1986-1998, NHANES 1998-2008
Childhood Obesity:
Metabolic Consequences
Visceral
Fat
CVD
Insulin
Sensitivity
NAFLD
Leptin
Resistance
Some
Cancers
Inflammation
Diabetes
Childhood Obesity:
Psychosocial Consequences
• Proximal consequences:
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Negative stereotyping
Teasing
Fewer friends
Poor body image
• Distal consequences:
– Lower educational
attainment
– Discrimination
(apartment rentals,
college admissions)
– Higher poverty
Overweight Hispanic youth in Los Angeles
from our studies:
• 32% have pre-diabetes
• 30% have metabolic syndrome
- 90% have > 1 metabolic syndrome feature
• 38% have Non Alcoholic Fatty Liver Disease
(NAFLD)
Complex Etiology of Childhood Obesity
IOM 2011 Report:
Early Childhood Obesity Prevention Policies
• Role of mother’s diet, obesity & smoking
during pregnancy
• Early development:
– Not yet necessary to change poor dietary and
activity patterns,
– Great time to promote the development of
healthy patterns.
– Exclusive breast feeding for 6 months, continued
with complimentary foods for AT LEAST one year
http://www.nap.edu/catalog.php?record_id=13124
Breast feeding & Sugar Sweetened
Beverage consumption
in 1483 Hispanic Children
in Los Angeles WIC Clinics
Davis et al in press AJCN
Physical Activity
in Hispanic Youth
Physical activity
• Improves
– Body Composition
– Insulin sensitivity
– Cholesterol
– Sleep
– Self Esteem
– Academic Performance
• Protects against
– Breast, colon and other cancers
– Obesity
Mean Minutes of MVPA per day
Pubertal Decline in Physical Activity by Age
(Males + Females)
Troiano, Berrigan, et al. MSSE 2008;40(1):181-8.
One Year Decline in Physical Activity
Covariates: age, baseline Tanner stage, baseline SAT, baseline VAT, SI
Spruijt-Metz et al under review
Sugar Intake in Hispanic Youth
Sugar Intake is Related to
Decreased Insulin Sensitivity
120 Hispanic
children ages 10-17
years
r=-0.29, p= 0.01
Davis et al, AJCN 2007
Sugar Intake is Related to
Increased Body Fat
Davis, Ventura, et al. AJCN 2007.
Ejemplo de la dieta de una niña del proyecto SOLAR
(Sample diet of a 11-year-old girl from the SOLAR project)
Desayuno
(Breakfast)
Lucky Charms --2 tazas/cups
Leche 2%/ 2% milk --1 taza/cup
Jugo Tampico/Tampico juice -- 2
tazas/cups
Almuerzo
(Lunch)
Pizza – 1 rebanada/slice
Papas fritas (Fries) – 1 taza/cup
Gatorade – 1 botella de 20 onzas/FO
Merienda
(Snack)
Hot Cheetos – bolsa/bag de $0.99
Coca-Cola – 1 lata/can
Cena
(Dinner)
Tortilla de Harina (Flour Tortilla) - 2
Carne Asada (Grilled beef) – 1 taza/cup
Arroz Mexicano (Mexican Rice) – 1
taza/cup
Agua de Jamaica (Sweetened hibiscus
drink) – 2 tazas/cups
Resumen de esta Dieta
(Summary of Diet):
3100 calorias/calories
7 g fibra/fiber
220 g azucar/sugar
Goal:
~1800 calorias/calories
25-30 g fibra/fiber
<50 g azucar/sugar
Summary: TARGETS
to Prevent and Treat Obesity
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INCREASE & PROLONG Breastfeeding
INCREASE Physical Activity
INCREASE Fiber Intake
DECREASE Total and added sugar intake
At home, child care, schools, parks, hospitals –
and GARDENS!!!
TWO NEW USC
PROJECTS
to Prevent and Treat
Obesity in Hispanic
Youth & Families
• 12-week after-school gardening / nutrition / cooking
intervention for 4th & 5th graders:
– 80 controls
– 45 LA Sprouts students
• Gardening/nutrition classes (1x/wk) at Milagro Allegro
Community Garden & Farmer’s market trips (4 times)
• Pre/Post Testing: BMI, Body Fat, BP, waist, dietary
intake, motivation/preference/self-efficacy to eat F&V,
engagement
Funded by: Kaiser and Childhood Obesity Research Center (PI: Davis)
Changes in Diet
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Increased preference for fruit and veggies
Improved cooking and gardening self-efficacy
Davis et al; in press JADA
Gatto and Davis; in review at JADA
A virtual gardening game for the
prevention of obesity in minority youth
Virtual Sprouts Web-based Gardening Games
What is Virtual Sprouts?
• A web-based gardening game designed to use gardening as a teaching tool
• In the virtual garden children learn to select what crops to plant, plant their
own garden, watch it grow, tend the crops, and harvest them
Goal
• To positively influence dietary intake and prevent/treat obesity in Hispanic
youth and families through meaningful play
Proposal
• Bring a novel combination of technology and teaching to bear on pediatric
obesity in urban Los Angeles
• Use interactive, web-based game techniques, rich narrative, a pedagogical
agent, and experiential learning to achieve the aims of the program
Using Mobile and Internet Technologies:
The mHealth advantage
• Any time, anywhere, children and their families can play
• Enormous reach: 84% of US Hispanics own a cell phone;
78% of US Hispanic adults and 95% of youth use the
internet
• Immersive games are FUN! And engaging.
• Immediate access to data for health professionals,
children, families, teachers
• Real-time, personalized & tailored interventions
• Strong Participatory Approach
Acknowledgements
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Michael Goran
Britni Belcher
David Berrigan
Marc Weigensberg
Ana Romero
Ya Wen Janice Hsu
Arianna McClain
Javier Diaz
LeRoy Downs
Luz Castillo
Gisele Ragusa
Ting Li
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Selena Rodriguez
Adar Emken
Jaimie Davis
Nicole Gatto
Emily Ventura
Tom Wright
Adriana Padilla
Chih-Ping Chou
Courtney B.William
Christianne J. Lane
Chad Lane
Marientina Gotsis
Gillian O’Reilly
Acknowledgements
• NCI USC Center for Transdisciplinary
Research on Energetics and Cancer (U54
CA 116848)
• NCCR (R25RR032159)
• NCMHD P60 002564
• Kaiser Permanente
• USC Childhood Obesity Research Center
Acknowledgements
• Study Participants