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Fit Kids: Why "Exercise More, Eat Less" is Not Enough
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Fit Kids: Why "Exercise More, Eat Less" is Not Enough

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Explore a range of factors that influence energy metabolism and weight management in children

Explore a range of factors that influence energy metabolism and weight management in children

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  • Should BMI be used diagnostically?Mostly it is a screening tool
  • Plausible reporters58.4 % (Savage, 2008)45.3% (Fulton, 2009)Implausible reporters 16.4% under reporters 25.1% over-reportersLooking at food….
  • Land of immigrantsPeople come to America looking for opportunityHow many of us are predisposed genetically and epigenetically to survive abundance?
  • How does farm policy play out in the grocery store? Fresh fruits and vegetables cost more
  • How significantly does cost of foods impact incidence of obesity?
  • Average supermarket items in 1970-- 12,000Average supermarket items today – 48,000
  • There is extraordinary attention paid to where we purchase and eat our foodWe buy a lot more food from big box stores
  • I say be careful what you wish forOnly 2/10 are fast food entrees: pizza, chicken strips and fries
  • This is only one of many studies with similar findingsOnly 50 calories difference; the leaner kids are eating more
  • Fattest kids: 4 grams less carbohydrate; 2 grams more fat
  • Mean anthropometric measures in children 2-18 years of ageNHANES Data 1999-2004 –24 hour recall 32% children; 30% of adolescents reported candy consumption day of recallCandy consumers have lower weight lower BMI lower waist circumference than non consumers
  • Candy consumers (w/ lower weight, BMI, waist circ) eat more calories
  • Tufts UniversityStudy of high insulin secretors vs. low insulin secretors [hi secretors >66 mU/l< low secretors]N= 32 (24-42 years old)BMI 25-29.9FBG <100 mg/dl24 week trial – 30% calorie restriction compared to individual baseline energy needs (2017 vs. 1972 calories)60:20:20 15 g fiber/1000 kcal GL116g/1000kcal mean GI 8640:30:30 15 g fiber/1000 kcal GL 45g/1000 kcal meanGI 53
  • Appetitive traits
  • Taken off the internet at a highly reputable site for medical advice
  • DDT. PCB. Bisphenyl A, Pthalates. PBDE, Perfluorocatonic acid (PFOA)Some other examples of putative EDCs are polychlorinated dibenzo-dioxins (PCDDs) and -furans (PCDFs), polycyclic aromatic hydrocarbons (PAHs), phenol derivatives and a number of pesticides (most prominent being organochlorine insecticides like endosulfan and DDT and its derivatives, the herbicide atrazine, and the fungicide vinclozolin), the contraceptive 17-alpha ethinylestradiol, as well as naturally occurring phytoestrogens such as genistein and mycoestrogens such as zearalenone.
  • Atrazine – most common herbicide used in America functions as an ED
  • Is your hunger gone?
  • Avoid the issues with shame, guilt, increased risk of disordered eating behaviorThe changes in true biomarkers will follow; maybe weight

Transcript

  • 1. Fit KidsWhy “Exercise More, Eat Less”Is Not EnoughBonnie Y. Modugno, MS, RDwww.muchmorethanfood.com
  • 2. State of the Nation • Change in 70 incidence of 60 obesity between 50 1970 and 2000 40 1970s 30 2000 20 10 0 Adult CH ADUS Dept of Health and Human Services, NCHS, Prevalence of overweight and obesity among adults andadolescents, 1999-2000.
  • 3. Treating Obesity• Eat less• Exercise more Calories in < Calories out = Weight Loss
  • 4. Interventions for preventing obesity in children • 22 RCT or CCT published after 1990 • Results of 12 short term trials – Two of four short-term studies aimed to increase physical activity levels resulted in minor reductions in overweight – The other eight studies included advice on diet and physical activity, but none had a significant impact.Summerbell CD, Waters E, Edmunds L, Kelly SAM, Brown T, Campbell KJ.Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD001871.
  • 5. Treatment of Pediatric Obesity:A Systematic Reviewand Meta-Analysis of 61 Randomized Trials• Results – Limited evidence supports the short-term efficacy of medications and lifestyle interventions – The long-term efficacy and safety of pediatric obesity treatments remain unclearMcGovern, et al. J Clin Endocrinol Metab 93: 4600–4605, 2008)
  • 6. How good are the studies?Methodological challenges1. BMI2. Dietary assessment – Food frequency surveys – 1-3 day food recalls3. Dietary approach
  • 7. Point: BMI• BMI is an important indicator of overweight and obesity in childhood and adolescence.• When measurements are taken carefully and compared with appropriate growth charts and recommended cutoffs, BMI provides an excellent indicator of overweight and obesity sufficient for most clinical, screening, and surveillance purposes.Himes. Pediatrics Vol. 124 No. Supplement 1 September 1, 2009 pp. S3 -S22
  • 8. Counterpoint: BMI • BMI is a poor surrogate measure of adiposity • Compared w/ dual energy x-ray absorptiometry, excessive body fat was found in • 77% of children w/ BMI > 95th % • 20% of children w/ BMI between 85-94th % – 50% of children have “moderate” adiposity – 30% of children have “normal” body fat storesFreedman, et al. Classification of Body Fatness by Body Mass Index–for-AgeCategories Among Children Arch Pediatr Adolesc Med. 2009;163(9):805-811.
  • 9. BMI BMI32.5 30.6
  • 10. What are we measuring?
  • 11. What is the purpose of measuring?• Body size ? – Height/weight – BMI – Body composition• Health ?
  • 12. Reliability of Dietary Intake• Review of 4 prospective cohort studies The Degree of Misreporting of Dietary Intake McCrory, et al. Public Health Nutrition: 5(6A), 873–882 , 2002.
  • 13. What are we eating?• Weekly food costs• N. Carolina, USA• $341.98 Menzel and DiAluisio. Hungry Planet: What the World Eats. C 2005.
  • 14. What are we eating?• Weekly food costs• California, USA• $159.18 Menzel and DiAluisio. Hungry Planet: What the World Eats. C 2005
  • 15. What are we eating?• Weekly food costs• Mexico• $189.09
  • 16. What are we eating?• Weekly food costs• Guatemala• $76.70
  • 17. USDA Food Disappearance Data
  • 18. Cost of food 1985-2000 Soft Drinks Fats/Oils Eggs Sugar/Sweets Poultry% Increase Red Meat Dairy Cereal/Bakery Fish Fr and Veg Fr. Fruit and Veg 0 50 100 150USDA Data 2002
  • 19. How Much Does 100 Calories Cost? 90 Soda 80• Cost in cents Bread 70 60 Potato• Vegetables and fruits cost chips more per calorie 50 Cookies 40 Licorice• Food costs surveyed 30 Orange Sept/2011 20 10 Apple 0 Carrots 100 Calories
  • 20. Childhood Obesity by State Assembly Districthttp://healthyamericans.org/reports/obesity2005/CaliforniaEndowmentReport.pdf
  • 21. Antidote to a Food Desert/Food Swamp:More Full Service Supermarkets
  • 22. Are Supermarkets the Answer?
  • 23. Where are we purchasing our food?70605040302010 1972 0 2008www.usda.ers.usda.gov/Briefing/CPIFoodandExpenditures/Data
  • 24. Calories on the Menu Crispy Calimari w/… Pork Milanese Personal Meat Lovers… Chicken Strips w/ fries… Large Tuna Melt Sunrise Quesadilla… Fat KcalSmokin Q 3 Pack Burger… CaloriesGrannys Country Omelet Jalapeno Smokehouse… Ribs and More Ribs 0 500 1000 1500 2000 2500 http://www.nowpublic.com/health/forbes-top-10-most-fattening-chain-restaurant-meals-calorie-menu
  • 25. What about calories? • N = 253 9-10 y/o 2500 **living in/near Provo, Utah 2000 Leanest 1500 1000 Moderate 500 Fattest 0 KcalTucker, et al. ADAJ, 1997; (97) 9
  • 26. What about the source of calories? 300 80 250 70 60 200 Leanest Leanest 50 150 40 Moderate Moderate 100 30 50 Fattest 20 Fattest 10 0 CHO (gm) 0 Fat (gm)Tucker, et al. ADAJ, 1997; (97) 9
  • 27. Candy Consumers (n = 3,458)vs. Non-Consumers (n=7,724)807060 T. Candy -Cons50 T. Candy- NC40 Choc-Cons.30 Choc-NC20 Sugar-Cons10 Sugar-NC 0 Weight (kg) BMI Waist Circ. (cm)http://www.eurekalert.org/pub_releases/2011-06/fl-nss062811.phphttp://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675
  • 28. Candy Consumers (n = 3,458)vs. Non-Consumers (n=7,724)24002300 T. Candy -Cons2200 T. Candy- NC2100 Choc-Cons. Choc-NC2000 Sugar-Cons1900 Sugar-NC1800 Calorieshttp://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675
  • 29. Food Composition and Insulin * * 0 -1 -2 Weight change (kg) -3 -4 -5 High CHO -6 Low CHO -7 -8 -9 -10 Low Insulin High Insulin Secretor SecretorPittas, A. et al. Diabetes Care 28 (12): December 2005
  • 30. Changesover timefor studyoutcomes Ebbeling, C. B. et al. Arch Pediatr Adolesc Med 2003;157:773-779.Copyright restrictions may apply.
  • 31. Effects of Meal High in Carbohydrate on Satiety in Pre-pubertal Children NW Obese Lomenick J P et al. JCEM 2009;94:4463-4471©2009 by Endocrine Society
  • 32. Effects of Meal High in Protein on Satiety in Pre-pubertal Children NW Obese NW Pre-adol. Obese Pre-adol. Lomenick J P et al. JCEM 2009;94:4463-4471©2009 by Endocrine Society
  • 33. What starts the day?
  • 34. Ten Putative Contributorsto the Obesity Epidemic• Food marketing • Maternal age practices • Assortative mating• Physical activity • Sleep debt• Infections • Endocrine disruptors• Perinatal epigenetic • Pharmaceutical factors iatrogenesis – maternal obesity • Ambient temperature – over/undernutrition – hyperinsulinemiaCritical Reviews in Food Science and Nutrition 49(10) 868-913 (2009)
  • 35. Ten Putative Contributorsto the Obesity Epidemic• Food marketing • Maternal age practices • Assortative mating• Physical activity • Sleep debt• Infections • Endocrine disruptors• Perinatal epigenetic • Pharmaceutical factors iatrogenesis – maternal obesity • Ambient temperature – over/undernutrition – hyperinsulinemiaCritical Reviews in Food Science and Nutrition 49(10) 868-913 (2009)
  • 36. Perinatal Epigenetic Factors• Before pregnancy health status – Nutrient intake, calorie intake – Relative insulin sensitivity – Activity level, stress management• Perinatal nutrition status – Diet & activity – Glucose tolerance – Total and rate of weight gain• Nutrition status infant – Birth weight, rate of weight gain – Breast v. Bottle feeding
  • 37. Genetic Traits Impact Food Intake • Up to 69% of eating behaviors may be genetically determined – Response to internal satiety cues – Response to taste or smell of food – Sensitivity to rewards/reinforcement for eating preferred foods – Food preferences • Parental monitoring of food intake – is more result of child obesity, not an antecedentStang and Loth. ADAJ:111(9) 1301-1305
  • 38. Iatrogenic Medications for Kids• Weight gain is possible with many medications – Psychoactive meds • Anti-psychotics • Mood stabilizers • Antidepressants – Diabetes Meds • Insulin, Sulfonureas – Steroids • Allergies, asthma, • Oral birth control
  • 39. PSYCHOACTIVE DRUGS:Dietary Guidance• Use portion control for all food at meals and snacks• Use more healthy food choices (example - fresh fruits and vegetables for snacks)• Limit snacks and junk food• Substitute high calorie for lower calorie snacks (example – pretzels instead of chips/nuts)• Drink several large glasses (or bottles) of water throughout the day• Limit sugar sweetened beverages
  • 40. Endocrine Disruptors (POPs): Sources & Pathways to Human Exposures SOURCES TRANSPORT DEPOSITION FOOD SUPPLY Industrial ProcessesCombustion Runoff Erosion Direct DischargeCourtesy of Dr. Linda Birnbaum, PhD, Director of Toxicology, EPA (adapt)
  • 41. Food System–Related Environmental Chemicals Detectable In Pregnant Women In The United States, 2003–04. Sutton P et al. Health Aff 2011;30:888-897©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
  • 42. Endocrine Disruptors, POP’s Impaired neurological growth and function  Learning disabilities  Autism Impaired glucose tolerance  Obesity, Diabetes  Cardio -Metabolic Syndrome  Cancer Impaired thyroid function  Obesity  Cancer Impaired fertility; reproduction  PCOS  Low Testosterone (males)
  • 43. Pesticides: Atrazine• Obesity epidemic is most rampant in Mississippi valley watershedKwak, S. H., Park, K. S., Lee, K.-U. and Lee, H. K. (2010),Mitochondrial metabolism and diabetes. Journal of DiabetesInvestigation, 1: 161–169.
  • 44. State of the Californiahttp://healthyamericans.org/reports/obesity2005/CaliforniaEndowmentReport.pdf
  • 45. Dietary Guidelines for Fit Kids• Eat balanced meals and snacks – Enough protein – Carbohydrates preferentially from whole foods, mostly produce – Enough healthy fats CHO PRO + PRO +CHO CHO w/ FAT 0 1 2 3 4 5 6 SATIETY --TIME AFTER EATING (hours)
  • 46. Dietary Guidelines for Fit Kids• Eat regular meals, snacks through the day• Avoid getting over hungryStarving Just Enough Full Stuffed Still Hungry Satisfied Overfull
  • 47. Dietary Guidelines for Fit Kids• Eat when your are hungry; stop when your hunger is gone • Self regulation • Resilience
  • 48. Dietary Guidelines for Fit Kids• Health at Every Size – Focus on behavior, not weight or BMI – Body size should not a litmus for what someone gets to eat – We need to teach all of our children how to survive abundance
  • 49. Fit KidsQ&A Thank You Bonnie Y. Modugno, MS, RD www.muchmorethanfood.com