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CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...
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CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...

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  • Bullet 2 and 3: Assoc Press, 5/2/02 Ignorance is not bliss
  • Transcript

    • 1. CHILDHOOD OBESITY AN EPIDEMIC
    • 2. INCIDENCE OF CHILDHOOD OBESITY IS INCREASING
    • 3. DEFINING OBESITY IN CHILDREN- THE PEDIATRIC BMI CHART Obese (>95 TH %) At Risk ?
    • 4. CAUSATIVE FACTORS-EXCLUDING SYNDROMES
      • PRIMARY
      • Poor food choices
      • Inactivity
      • SECONDARY
      • Psychological
      • Environmental
      • Genetics
      • Fetal environment
    • 5. CONSEQUENCES
      • The epidemic of obesity is affecting children as young as 2
      • More overweight children are developing, insulin resistance or metabolic syndrome and type 2 diabetes
      • Sleep apnea, asthma, hypertension, orthopedic problems and others
      • If we do not reverse the trend health costs will be astronomical
    • 6. EXCESS SUBSTRATE WITHOUT EXCESS EXPENDITURE=LIPOGENESIS
    • 7. OBESITY A FATAL DISEASE
    • 8. TREATMENT OF PEDIATRIC OBESITY
      • Nutrition management
      • Physical activity
      • Behavior modification / Counselling
      • Family support
    • 9. OUR PRACTICE
      • Faculty of the UNSOM
      • Full service cardiology program: Echo Cath Surgery Intervention EP
      • Full-time M.D., MPH research director, extensive data base system
      • Pediatric Risk Factor Reduction Program
    • 10. CHILDREN’S HEART CENTER - NEVADA
      • 15,000 OUT-PATIENT VISITS/YR
      • 6,000 IN-PATIENT VISITS/YR
      • MORE PATIENT VISITS THAN*
      • -UCLA
      • -UCSF
      • -STANFORD
      • -CHILDREN’S HOSPITAL OF LOS ANGELES
      • -LOMA LINDA
      • -CEDARS SINAI
      • * FROM PUBLISHED DATA AND PERSONAL CONVERSATIONS
    • 11. OUTLINE OF OUR PROGRAM
      • PATIENTS REFERRED BY PRIMARY CARE PROVIDERS
      • Primary care providers without time or staff to treat effectively
      • BMI > 95%ile for age
      • Hypertension with BMI >95%ile
      • Dyslipoproteinemias
    • 12. OUTLINE OF OUR PROGRAM
      • Initial evaluation
      • Laboratory testing
      • Intensive initial nutritional evaluation & recommendations
      • If appropriate exercise program enrollment
      • If indicated family counselling
      • Follow up
    • 13. LAB TESTS RESULTS IN 410 PATIENTS BMI >95 th %tile
      • Average age 11.4 years 44% Females 56% males
      • Average BMI 32.5
      • Total cholesterol 179 ± 45
      • HDL 42 ± 10
      • Triglycerides 149 ± 97
      • Insulin 22 ± 25
    • 14. CHILD/ADOLESCENT NORMALS
      • Total cholesterol < 170 mg/dl
      • HDL > 45 mg/dl- Probably >50 desirable
      • Triglycerides <125- Probably <100 desirable
      • Insulin level <10 (Dr. Sears <5)
    • 15. OUTLINE OF OUR PROGRAM
      • 12 WEEK INTEGRATED PROGRAM
      • Nutrition counselling
      • Simple psychological evaluation
      • Exercise RX
      • Motivational intervention and family counselling referral if indicated
    • 16. INTAKE DATA FROM OUR PROGRAM 25% Carbs HFCS
    • 17. MOST IMPORTANT NUTRTION-RECOMMENDED INTAKE
    • 18. WHO WILL WIN THE BATTLE? Soft Drink!? USDA food pyramid
    • 19. BRIEF PSYCHOLOGIC EVALUATION
      • Perera self esteem test
      • 16 true or false questions
      • Scored number of “true answers”
      • Initial and repeated at end of 12 week program
    • 20. EXERCISE
      • INITIAL EVALUATION
      • Rockport walk test
      • Timed 1 mile walk
      • Score based on time and heart rate
      • Gender and weight
      • Max VO2 estimate
      • <25 Poor, 25-30 Fair, 30-40 Average, 40-50 good, >50 excellent
    • 21. EXERCISE RX
      • AEROBIC
      • Treadmill, bike or walking
      • At home we recommend 30-45 min 3-5x/week
      • Supervised in program 2x per week
      • Our exercise staff tries to achieve 40-70% of VO2 max(estimated)
    • 22. EXERCISE RX
      • ADDITIONAL PROGRAM ACTIVITIES
      • Weights
      • Calisthenics
      • Stretching
    • 23. PROGRAM MATERIALS
      • Hand outs
      • Homework
      • Off site exercise
      • Behavior modification
      • Positive rewards
    • 24.  
    • 25. OUR ON SITE EXERCISE FACILITY
    • 26.  
    • 27. INITIAL BIOMETRIC & SELF ESTEEM RESULTS FROM THE 12 WEEK PROGRAM
    • 28. RESULTS FROM 12 WEEK PROGRAM
      • N=76
      • Average age 12.5 (7-18)
      • Male 56%
      • Female 44%
      • Reported at Society of Pediatric Research in San Francisco May 2004
    • 29. RESULTS FROM 12 WEEK PROGRAM N=76
      • RESTING HR
      • Pre=111 Post=98 NS
      • SYSTOLIC BP
      • Pre=123 Post=113 *
      • * P <.05
    • 30. RESULTS FROM 12 WEEK PROGRAM N=76
      • BMI
      • Pre=33 Post=32*
      • % BODY FAT
      • Pre=40 Post=38 *
      • * P <.05
    • 31. RESULTS FROM 12 WEEK PROGRAM N=76
      • SELF ESTEEM
      • Pre=10.6 Post=12.4*
      • WALK TEST SCORE
      • Pre=10 Post=27 *
      • * P <.05
    • 32. PARENTAL SURVEYED PHYSICAL ACTIVITY AND NUTRITIONAL CHANGES RESULTS FROM 12 WEEK PROGRAM
    • 33. * * * * * P-value < 0.05 TV watching on weekends TV watching on school days Gross Activity Daily Activity
    • 34. Breakfast freq . Fruits consump. Vegetables consump. Sodas / Juices * * * * * P-value < 0.05
    • 35. INSULIN RESISTANCE IN OUR PATIENTS
    • 36. INSULIN RESISTANCE IN OUR PATIENTS
      • Quicki (1/log insulin +log glucose)*
      • Glucose/Insulin ratio**
      • Increasing IR with age and with BMI in euglycemic patients with BMIs >95 th %ile. Presented at the AHA LJ Filer San Francisco in March
      • * J Clin Endocrinol Metab. 2000 Jul;85(7):2402-10 ** J Clin Endocrinol Metab. 1998;83:2694-2698
    • 37. INSULIN RESISTANCE
      • N=334
      • * J Clin Endocrinol Metab. 2002 Jan;87(1):144-7 .
      2 - 8.2 7.7 - 173.6 2 - 16.1 12.3 - 173.6 Range 0.49 1.87 0.37 2.31 S.E. 6.65 24.49 9.66 28.88 Mean Insulin (µU/ml) ≥ 0.357 < 0.357* ≥ 6 < 6     Quicki Glucose/Insulin ratio  
    • 38. QUICKI VS AGE
    • 39. GLUCOSE/INSULIN VS AGE
    • 40. QUICKI VS BMI
    • 41. GLUCOSE/INSULIN VS BMI
    • 42. CURRENT RESEARCH
      • Analysis of metabolic abnormalities in our population
      • Biometric, psychological and metabolic abnormalities pre and post treatment intervention
      • Effects of Omega 3 fish oil supplementation effect on eicosanoids and inflammation
      • Vascular reactivity
      • Urinary / salivary inflammatory markers
    • 43. CURRENT RESEARCH
      • Maternal factors on fetal environment
      • Infants born SGA/LGA and relationship to obesity in our population
      • Cardiac function/ LV Hypertrophy/ BNP
      • Measured VO2 studies
      • Possible animal studies
    • 44. CURRENT RESEARCH
      • Long term follow up and longitudinal studies
      • Possible pharmacologic intervention
      • ? Cannabinoid receptor inhibitors
      • ? Surgical intervention

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