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Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
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Pediatric Obesity
Pediatric Obesity
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Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
Pediatric Obesity
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Pediatric Obesity
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Pediatric Obesity

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  • Weight is typically the goal that most patients and parents focus on the most. This is not necessarily the goal that should be focused on. As you all know young children have the potential for growth so that their BMI will improve with weight maintenance as they continue to grow. Most children who are overweight have an accelerated rate of weight gain. Therefore the first weight goal for everyone should be weight maintenance.
  • Weight is typically the goal that most patients and parents focus on the most. This is not necessarily the goal that should be focused on. As you all know young children have the potential for growth so that their BMI will improve with weight maintenance as they continue to grow. Most children who are overweight have an accelerated rate of weight gain. Therefore the first weight goal for everyone should be weight maintenance.
  • Transcript

    • 1. Childhood and Adolescent Obesity Kathryn Camp, MS, RD, CSP
    • 2. WHY WORRY ABOUT PEDIATRIC OBESITY? <ul><li>Pediatric obesity is of epidemic proportion. </li></ul><ul><li>Pediatric obesity is the most common chronic disease of childhood. </li></ul><ul><li>The epidemic is worldwide </li></ul>
    • 3. Some Scary Stats <ul><li>300,000 Americans died from obesity-related causes in 2000 (Surgeon General Report) </li></ul><ul><ul><li>$117 billion in obesity-related economic costs </li></ul></ul><ul><li>Cost of caring for obese patients is 35% greater than normal weight </li></ul>
    • 4. <ul><li>Anthony </li></ul><ul><li>15 yr old </li></ul><ul><li>Referred by his new PMC </li></ul>
    • 5. <ul><li>Anthropometrics </li></ul><ul><ul><li>Weight: 121 kg </li></ul></ul><ul><ul><li>Height: 175 cm </li></ul></ul>
    • 6. BMI: 39
    • 7. How Do We Define Overweight in Children and Adolescents?
    • 8. Definition of Overweight in Children and Adolescents <ul><li>Overweight = </li></ul><ul><li>BMI  95th %ile </li></ul><ul><li>At risk for overweight = </li></ul><ul><li>BMI between 85th-95th %ile </li></ul><ul><li>Expert Committee Recommendations from the Maternal and Child Health Bureau, 1997 </li></ul>
    • 9. Calculate Your BMI <ul><li>kg  m 2 </li></ul><ul><li>Height in inches x 2.54  100 = meters </li></ul><ul><li>Meters x meters = m 2 </li></ul><ul><li>Weight in pounds  2.2 = kg </li></ul><ul><li>Divide your weight in kg by m 2 = BMI </li></ul>
    • 10. Classification of Overweight and Obesity in Adults Using BMI
    • 11. University of Miami Blocking Machine 35 36 37 39 38 43
    • 12. Height: 6-6 Weight: 98 kg 25 Height: 7-1 Weight: 154 kg 33
    • 13. BMI is Age Specific in Children and Adolescents
    • 14. 17 21 24
    • 15. Increasing Incidence of Overweight in Children and Adolescents
    • 16.  95 th %ile for age and gender These #s double when including &gt;85%ile
    • 17. PERCENT OF OBESE CHILDREN WHO BECOME OBESE ADULTS
    • 18. Etiology of Obesity <ul><li>Genetic/heritablility </li></ul><ul><li>Molecular </li></ul><ul><li>Syndromes </li></ul><ul><li>Environmental </li></ul>Multifactorial Condition
    • 19. Heritability <ul><li>Survival advantage to conserve energy as fat through human evolution </li></ul><ul><li>Humans enriched for genes that promote energy intake and storage and minimize expenditure. </li></ul><ul><li>Enhance female fertility and ability to breastfeed offspring </li></ul>
    • 20. <ul><li>In modern industrial environment </li></ul><ul><ul><li>easy access to calorically dense foods </li></ul></ul><ul><ul><li>encourages sedentary lifestyle </li></ul></ul><ul><li>Metabolic consequences of these genes are maladaptive </li></ul>
    • 21. <ul><li>173 human obesity cases due to single gene mutations in 10 different genes were reported by 2004 (Perusse, 2005) </li></ul><ul><li>&gt; 600 genes, markers, and chromosomal regions have been linked with human obesity phenotypes </li></ul>Genetic Factors account for 20-40% of heritability of BMI Buchard 97 Rankinen 02 Familial Risk: 2-3 fold for moderate obesity 5-8 fold for severe obesity Bouchard 01
    • 22. More than 50 Obesity Associated Genetic Syndromes Bardet-Biedl Prader Willi Spina bifida Down Syndrome
    • 23. Hormones, Neurotransmitters, Enzyme defects??? <ul><li>Obesity is not well understood at the molecular level. </li></ul><ul><li>Discovery of leptin was hoped to revolutionize the field but its role has remained obscure </li></ul><ul><li>Role of other hormones, neurotransmitters, etc remains unknown </li></ul>
    • 24. <ul><li>But doctor, my child must have a low metabolism…. </li></ul><ul><ul><li>Little evidence that metabolic rate is different (Baker, 05) </li></ul></ul><ul><ul><li>Obese adolescents have a higher total daily energy expenditure and REE (Bandini, 90) </li></ul></ul><ul><ul><li>There may be small differences in metabolic efficiency but these are hard to measure </li></ul></ul>
    • 25. What is Causing this Marked Increase in Overweight??
    • 26. <ul><li>Obesity is not a genetic shift, rather it is an environmental shift </li></ul>
    • 27. Causes of Marked Increase in Overweight <ul><li>Reflects a shift towards positive energy balance </li></ul><ul><li>energy intake = energy expenditure </li></ul>McDowell 94; Kann 99; Troiano 00, NHANES II to III calories PE sed act
    • 28. Increased Energy Intake <ul><li>Kids are </li></ul><ul><ul><li>Eating more away from home </li></ul></ul><ul><ul><li>Eating more fast food and snack foods </li></ul></ul><ul><ul><li>Drinking more sodas </li></ul></ul><ul><li>100 kcal/day above needs = 10 pound weight gain per year </li></ul>
    • 29. &nbsp;
    • 30. Physical Activity <ul><li>Daily participation in PE declined from 42% to 29% between 1991 and 1999 ( www.cdc.gov/HealthyYouth ) </li></ul><ul><li>Walking and bicycling dropped 40% in kids aged 5-15 between 1977 and 1995 </li></ul><ul><li>What constitutes “active” these days? </li></ul>
    • 31. Increase in Sedentary Activity <ul><li>Excessive TV watching– </li></ul><ul><ul><li>The average child spent 6 hr/day watching TV or playing on computers. </li></ul></ul><ul><ul><li>Encourages overeating while viewing </li></ul></ul><ul><ul><ul><li>Influences food choices </li></ul></ul></ul><ul><ul><ul><ul><li>80% of commercials on children’s programs are for food </li></ul></ul></ul></ul><ul><ul><ul><li>Lower resting metabolic rate compared to at rest (Klesges 1993) </li></ul></ul></ul><ul><ul><ul><li>Reduces time available for more active pursuits </li></ul></ul></ul>
    • 32. <ul><li>Video and computer games </li></ul><ul><li>Parental work schedules </li></ul><ul><li>Unsafe neighborhoods </li></ul><ul><ul><li>discourage parents from allowing children to play outdoors </li></ul></ul><ul><ul><li>force parents to drive children to school </li></ul></ul><ul><li>Lack of recreational facilities in low-income neighborhoods </li></ul>Other Contributors to Sedentary Lifestyles
    • 33. Medical Consequences of Overweight
    • 34. <ul><li>60% of OW children have 1 or more CVD risk factors </li></ul><ul><li>Hyperlipidemia--  LDL and TG,  HDL </li></ul><ul><ul><li>90% of children with elevated TGs are overweight </li></ul></ul><ul><li>Hypertension </li></ul><ul><ul><li>Low frequency in children </li></ul></ul><ul><ul><ul><li>60% with  BP were &gt;120% of IBW </li></ul></ul></ul><ul><li>Obtain fasting lipid profile and blood pressure on all overweight children. </li></ul>Cardiovascular
    • 35. Type 2 Diabetes <ul><li>95% of teens with Type 2 diabetes have a BMI &gt;85%ile </li></ul><ul><li>Tremendous public health implications </li></ul><ul><ul><li>Longer duration of disease, &gt; risks of complications </li></ul></ul><ul><li>Obtain fasting glucose and insulin on all overweight children, especially those with.. </li></ul>Dabelea 99; Vinicor 00; Richards 85
    • 36. <ul><li>Acanthosis Nigricans </li></ul><ul><li>Hyperpigmented, velvety plaques in body folds </li></ul><ul><li>Caused by hyperinsulinemia which stimulates formation </li></ul><ul><li>Associated with obesity </li></ul>
    • 37. <ul><li>Growth </li></ul><ul><ul><li>Taller, advanced bone age, mature earlier </li></ul></ul><ul><ul><li>Early maturation is associated with </li></ul></ul><ul><ul><ul><li>increased fatness and truncal fat distribution in adulthood </li></ul></ul></ul><ul><ul><li>Short, obese children should be evaluated for hypothyroidism, Cushing syndrome or Turner syndrome </li></ul></ul>Other Endocrinological Issues
    • 38. More Complications <ul><li>Hepatic Steatosis with elevated LFTs </li></ul><ul><li>Cholelithiasis </li></ul><ul><ul><li>50% of kids with cholecystitis are overweight </li></ul></ul><ul><li>Orthopedic Problems </li></ul>
    • 39. Acute Complications that Require Immediate Medical Attention <ul><li>Sleep Apnea </li></ul><ul><ul><li>Occurs in 17% of obese children and teens (Marcus 1996) </li></ul></ul><ul><ul><li>Deficits in learning, memory, and vocabulary (Rhodes 1995) </li></ul></ul><ul><li>Obesity hypoventilation syndrome </li></ul><ul><ul><li>rare, potentially fatal disorder </li></ul></ul>
    • 40. Psychological and Economic Consequences of Pediatric and Adolescent Obesity <ul><li>Discrimination, rejection and low self-esteem (Gortmaker 93), particularly for females </li></ul><ul><li>Less participation in PE and sports activities </li></ul><ul><li>Lower college acceptance rates (Canning 1966) </li></ul>
    • 41. Who Needs to be Evaluated?
    • 42. Evaluating For Overweight in a Primary Care Setting BMI Overweight BMI  95 th % Not at risk BMI  85 th % At risk for Overweight BMI 85-95 th % <ul><li>Family history </li></ul><ul><li>Blood pressure </li></ul><ul><li>Lipids </li></ul><ul><li>Lg  in BMI </li></ul><ul><li>Concern re wt </li></ul><ul><li>Note in chart </li></ul><ul><li>No therapy </li></ul><ul><li>Return next yr </li></ul>Return next yr for screen In depth medical assessment + 
    • 43. Medical Assessment <ul><li>r/o genetic syndromes, esp if associated with mental retardation </li></ul><ul><li>Blood pressure </li></ul><ul><li>Labs to include </li></ul><ul><ul><li>Fasting lipid panel </li></ul></ul><ul><ul><li>Fasting glucose and insulin </li></ul></ul><ul><ul><ul><li>OGTT </li></ul></ul></ul><ul><ul><li>LFTs </li></ul></ul><ul><ul><li>Thyroid fx tests </li></ul></ul>
    • 44. Back to Anthony—Medical <ul><li>PMHx </li></ul><ul><ul><li>chronic otitis media and allergies </li></ul></ul><ul><ul><li>overweight since 7 yrs of age </li></ul></ul><ul><li>Currently c/o headache </li></ul><ul><li>On no chronic meds </li></ul><ul><li>Blood Pressure </li></ul><ul><ul><li>136/73 </li></ul></ul><ul><ul><li>&gt;95 th %ile </li></ul></ul>
    • 45. Social hx <ul><li>Only child </li></ul><ul><li>High school sophomore, gets good grades </li></ul><ul><li>No exercise or organized sports activities </li></ul><ul><li>Spends 6 hrs/day watching TV and playing video games </li></ul>
    • 46. Dietary Information <ul><li>Picky eater </li></ul><ul><li>Consumes NO fruits or vegetables </li></ul><ul><li>Mom prepares separate meals for him </li></ul>
    • 47. 24-Hour Recall <ul><li>Breakfast--none </li></ul><ul><li>Mid morning--16 oz ginger ale </li></ul><ul><li>Lunch--none </li></ul><ul><ul><li>generally has lunch at school of chocolate milk, pizza, and french fries </li></ul></ul><ul><li>Dinner--10 beef tacos, 2 cans of soda </li></ul>
    • 48. What to Do with Anthony? <ul><li>Weight goals </li></ul><ul><ul><li>First step is to achieve weight maintenance </li></ul></ul><ul><ul><li>2-7 years of age </li></ul></ul><ul><ul><ul><li>BMI 85-95% </li></ul></ul></ul><ul><ul><ul><ul><li>Weight maintenance </li></ul></ul></ul></ul><ul><ul><ul><li>BMI &gt;95% </li></ul></ul></ul><ul><ul><ul><ul><li>No complications: weight maintenance </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Complications: weight loss </li></ul></ul></ul></ul><ul><ul><li>7 and above </li></ul></ul><ul><ul><ul><li>BMI 85-95 th % </li></ul></ul></ul><ul><ul><ul><ul><li>No complications--weight maintenance </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Complications—weight loss </li></ul></ul></ul></ul><ul><ul><ul><li>BMI &gt;95 th weight loss </li></ul></ul></ul>
    • 49. What to Do with Anthony? <ul><li>Weight goals </li></ul><ul><ul><li>First step is to achieve weight maintenance </li></ul></ul><ul><ul><li>2-7 years of age </li></ul></ul><ul><ul><ul><li>BMI 85-95% </li></ul></ul></ul><ul><ul><ul><ul><li>Weight maintenance </li></ul></ul></ul></ul><ul><ul><ul><li>BMI &gt;95% </li></ul></ul></ul><ul><ul><ul><ul><li>No complications: weight maintenance </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Complications: weight loss </li></ul></ul></ul></ul><ul><ul><li>7 and above </li></ul></ul><ul><ul><ul><li>BMI 85-95 th % </li></ul></ul></ul><ul><ul><ul><ul><li>No complications--weight maintenance </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Complications—weight loss </li></ul></ul></ul></ul><ul><ul><ul><li>BMI &gt;95 th weight loss </li></ul></ul></ul>
    • 50. General Treatment Goals <ul><li>Behavioral goals </li></ul><ul><ul><li>Promote life long healthy eating and activity behaviors </li></ul></ul><ul><li>Medical goals </li></ul><ul><ul><li>Prevent complications of obesity in childhood and potentially adulthood </li></ul></ul><ul><ul><li>Improve or resolve existing complications of obesity </li></ul></ul>
    • 51. Refer? <ul><li>Formal obesity clinic--Team approach </li></ul><ul><ul><li>Physician, therapist, dietitian, exercise therapist </li></ul></ul><ul><ul><li>Intensive multi-session programs </li></ul></ul><ul><ul><ul><li>Parent and child/teen participate </li></ul></ul></ul><ul><ul><li>Advantages </li></ul></ul><ul><ul><ul><li>Multidisciplinary approach, frequent visits </li></ul></ul></ul><ul><ul><li>Disadvantages </li></ul></ul><ul><ul><ul><li>Expensive, time consuming, require parent participation </li></ul></ul></ul>
    • 52. If Going It Alone… Where Do You Start? <ul><li>Assess child’s and family’s willingness to change </li></ul><ul><li>Negotiate with child/family on specific, targeted changes </li></ul><ul><li>Develop realistic, achievable goals </li></ul><ul><li>Involve the entire family in making changes </li></ul><ul><li>Establish a monitoring/assessment tool </li></ul>
    • 53. Goals for Anthony <ul><li>Eat 3 meals per day (establish regular meals) </li></ul><ul><li>Have 1 piece of fruit each day (introduce new food groups) </li></ul><ul><li>NO calorie containing beverages except skim milk (eliminate empty calories) </li></ul><ul><li>Daily exercise (increase energy expenditure) </li></ul><ul><li>Keep a notebook of food intake and exercise (self-monitoring) </li></ul>
    • 54. Follow-up <ul><li>Weekly visits or as frequent as possible </li></ul><ul><li>lipid profile, HgbA1c, fasting insulin and glucose, blood pressure </li></ul><ul><li>Identify and reinforce positive changes </li></ul><ul><li>Set new goals based on goals achieved </li></ul>
    • 55. Anthony’s Lab Data <ul><li>Lipid panel </li></ul><ul><ul><li>Total cholesterol 156 (&lt;200) </li></ul></ul><ul><ul><li>Triglycerides 129 (35-250) </li></ul></ul><ul><ul><li>HDL 34 (35-82) </li></ul></ul><ul><ul><li>LDL 96 (&lt;100) </li></ul></ul><ul><li>HgbA1C 5.8 (4.3-5.3) </li></ul><ul><li>Fasting glucose 77 </li></ul><ul><li>Insulin 30.3 (0-30) </li></ul>
    • 56. <ul><li>Weight </li></ul><ul><ul><li>97 kg </li></ul></ul><ul><ul><li>Down 53# </li></ul></ul><ul><li>Height </li></ul><ul><ul><li>179 cm </li></ul></ul><ul><ul><li>Up 4 cm </li></ul></ul>
    • 57. <ul><li>BMI </li></ul><ul><ul><li>30 </li></ul></ul><ul><ul><li>Down from 40 </li></ul></ul>
    • 58. Brian <ul><li>13 yrs, 10 mo </li></ul><ul><li>Referred for elevated cholesterol </li></ul><ul><li>Weight: 74 kg </li></ul><ul><li>Height: 166 cm </li></ul><ul><li>BMI: ? </li></ul><ul><li>What do you want to know? </li></ul>
    • 59. Brian cont: <ul><li>Medical history </li></ul><ul><ul><li>uncomplicated </li></ul></ul><ul><li>Results of lipid panel </li></ul><ul><ul><li>Total chol, 208, LDL 150, HDL 41 </li></ul></ul><ul><li>Blood pressure </li></ul><ul><ul><li>105/61 </li></ul></ul><ul><li>Family history </li></ul><ul><ul><li>Father died at age 48 from heart attack, maternal aunt died at 45 from CHD, paternal grandfather had type II diabetes </li></ul></ul><ul><li>Diet </li></ul><ul><ul><li>Low in fruits and vegetables and dairy products </li></ul></ul><ul><li>Exercise </li></ul><ul><ul><li>Plays basketball with friends after school, no organized sports </li></ul></ul><ul><li>Physical exam </li></ul><ul><ul><li>Acanthosis nigricans </li></ul></ul>
    • 60. Childhood Obesity Can be prevented Shaping Habits That Shape America’s Children
    • 61. PREVENTION: PRECONCEPTION <ul><li>Prevention starts prior to conception </li></ul><ul><ul><li>Obese adolescents have an 80% probability of being obese as adults </li></ul></ul><ul><ul><li>Today&apos;s adolescents are tomorrows parents </li></ul></ul><ul><ul><li>Parents are role models for their children </li></ul></ul><ul><ul><li>Obesity risk in a child born to obese parents is significantly increased </li></ul></ul><ul><ul><li>Educate and intervene at this time to help prevent obesity in subsequent generations </li></ul></ul>
    • 62. PREVENTION: POST CONCEPTION <ul><li>Routine prenatal care </li></ul><ul><li>Achieve normal weight gain during pregnancy </li></ul><ul><ul><li>LGA infants and infants of diabetic mothers have higher rates of subsequent obesity </li></ul></ul><ul><ul><li>SGA infants also at higher risk </li></ul></ul><ul><ul><ul><li>Hediger ML et: Pediatrics 104:e33, 1999 </li></ul></ul></ul><ul><li>Promote breast feeding </li></ul>
    • 63. &nbsp;
    • 64. PREVENTION: SCHOOL <ul><li>Promote physical activity </li></ul><ul><li>Provide nutritious meals </li></ul><ul><li>Control vending machines </li></ul><ul><li>Have nutrition education incorporated into regular school curriculum. </li></ul><ul><li>Encourage children to walk or bike to school safely. </li></ul>
    • 65. PREVENTION: COMMUNITY <ul><li>Have safe playgrounds </li></ul><ul><li>Provide safe places for bike riding and walking </li></ul><ul><li>Promote physical activity outside of school </li></ul>
    • 66. PREVENTION: INSURANCE AND GOVERNMENT <ul><li>Acknowledge obesity as a medical condition for which one can be reimbursed. </li></ul><ul><li>Provide reimbursement for anticipatory guidance for nutrition and physical activity </li></ul>
    • 67. PREVENTION: PRIMARY CARE PROVIDER <ul><li>Be an advocate </li></ul><ul><li>Provide anticipatory guidance to families </li></ul>
    • 68. NUTRITION ANTICIPATORY GUIDANCE <ul><li>Beverages </li></ul><ul><ul><li>Encourage water intake </li></ul></ul><ul><ul><li>Limit sweet beverages </li></ul></ul><ul><ul><ul><li>Juice, juice drinks: 120 calories / 8 oz </li></ul></ul></ul><ul><ul><ul><ul><li>No nutritional need for any juice &lt;6 months of age </li></ul></ul></ul></ul><ul><ul><ul><ul><li>1-6 years: 4-6 oz </li></ul></ul></ul></ul><ul><ul><ul><ul><li>7-18 years: 8-12 oz </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Discourage free use of box drinks </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Discourage continuous access to sippy cups </li></ul></ul></ul></ul><ul><ul><ul><li>Soda: 150 calories / 12 oz </li></ul></ul></ul>
    • 69. NUTRITION ANTICIPATORY GUIDANCE <ul><li>Eat 5 fruits and vegetables a day </li></ul><ul><li>Structured meal and snack time </li></ul><ul><li>Do not use food as a reward </li></ul><ul><li>Know what the child is eating outside the home: school meals, day care etc. </li></ul>
    • 70. NUTRITION ANTICIPATORY GUIDANCE <ul><li>Encourage child’s autonomy in self-regulation of food intake </li></ul><ul><ul><li>Parents provide, child decides! </li></ul></ul><ul><ul><li>Do not use the clean the plate rule. </li></ul></ul><ul><li>Provide choice </li></ul><ul><li>Educate parents regarding healthy nutrition </li></ul><ul><ul><li>Healthy snacks </li></ul></ul><ul><ul><li>Consider using pediatric food pyramid </li></ul></ul><ul><ul><li>Portion size: Intake of children &gt;5 years is dependent on how much they are provided </li></ul></ul><ul><li>Do not skip meals </li></ul>
    • 71. ACTIVITY ANTICIPATORY GUIDANCE <ul><li>Encourage active play for young children </li></ul><ul><li>Promote physical activity for school age children and teens </li></ul><ul><li>Encourage participation in organized sports </li></ul>
    • 72. ACTIVITY ANTICIPATORY GUIDANCE <ul><li>Decrease sedentary activity </li></ul><ul><ul><li>Limit TV, video games and computer to 1-2 hours per day </li></ul></ul><ul><ul><ul><li>&gt; 2 hours a day associated with higher rates of obesity and hyperlipidemia </li></ul></ul></ul><ul><ul><li>Do not have a TV in the child’s room </li></ul></ul><ul><ul><ul><li>Children with TVs in bedroom watch more TV </li></ul></ul></ul>
    • 73. BEHAVIORAL ANTICIPATORY GUIDANCE <ul><li>Encourage parents to act as role models </li></ul><ul><ul><li>Nutrition </li></ul></ul><ul><ul><li>Activity </li></ul></ul><ul><li>Promote parent child interaction </li></ul><ul><li>Have special “family time” that is physically active </li></ul>
    • 74. BEHAVIORAL ANTICIPATORY GUIDANCE <ul><li>Limit eating out </li></ul><ul><ul><li>More calorically dense food </li></ul></ul><ul><ul><li>Larger portion sizes </li></ul></ul><ul><ul><li>Less intake of fruits and vegetables </li></ul></ul>
    • 75. BEHAVIORAL ANTICIPATORY GUIDANCE <ul><li>Eat as a family </li></ul><ul><ul><li>Provides “quality time” </li></ul></ul><ul><ul><li>Slows down the eating process </li></ul></ul><ul><ul><li>Parents act as role model </li></ul></ul><ul><ul><li>Parents monitor intake </li></ul></ul><ul><ul><li>Associated with lower fat intake and greater intake of fruits and vegetables </li></ul></ul>
    • 76. BEHAVIORAL ANTICIPATORY GUIDANCE <ul><li>Do not eat in front of the TV </li></ul><ul><ul><li>Associated with higher intake of fat and salt </li></ul></ul><ul><ul><li>Lower intake of fruits and vegetables </li></ul></ul><ul><ul><li>Encourages over eating </li></ul></ul><ul><ul><ul><li>60-80% of commercials on during children programs are related to food </li></ul></ul></ul><ul><ul><ul><li>Eating without awareness </li></ul></ul></ul>
    • 77. Summary <ul><li>Pediatric obesity is epidemic </li></ul><ul><li>Overweight kids become overweight adults </li></ul><ul><li>Treatment is difficult </li></ul><ul><li>Prevention is the key </li></ul>

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