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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

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

  1. 1. Fit KidsWhy “Exercise More, Eat Less”Is Not EnoughBonnie Y. Modugno, MS, RDwww.muchmorethanfood.com
  2. 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. 3. Treating Obesity• Eat less• Exercise more Calories in < Calories out = Weight Loss
  4. 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. 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. 6. How good are the studies?Methodological challenges1. BMI2. Dietary assessment – Food frequency surveys – 1-3 day food recalls3. Dietary approach
  7. 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. 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. 9. BMI BMI32.5 30.6
  10. 10. What are we measuring?
  11. 11. What is the purpose of measuring?• Body size ? – Height/weight – BMI – Body composition• Health ?
  12. 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. 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. 14. What are we eating?• Weekly food costs• California, USA• $159.18 Menzel and DiAluisio. Hungry Planet: What the World Eats. C 2005
  15. 15. What are we eating?• Weekly food costs• Mexico• $189.09
  16. 16. What are we eating?• Weekly food costs• Guatemala• $76.70
  17. 17. USDA Food Disappearance Data
  18. 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. 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. 20. Childhood Obesity by State Assembly Districthttp://healthyamericans.org/reports/obesity2005/CaliforniaEndowmentReport.pdf
  21. 21. Antidote to a Food Desert/Food Swamp:More Full Service Supermarkets
  22. 22. Are Supermarkets the Answer?
  23. 23. Where are we purchasing our food?70605040302010 1972 0 2008www.usda.ers.usda.gov/Briefing/CPIFoodandExpenditures/Data
  24. 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. 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. 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. 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. 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. 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. 30. Changesover timefor studyoutcomes Ebbeling, C. B. et al. Arch Pediatr Adolesc Med 2003;157:773-779.Copyright restrictions may apply.
  31. 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. 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. 33. What starts the day?
  34. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 44. State of the Californiahttp://healthyamericans.org/reports/obesity2005/CaliforniaEndowmentReport.pdf
  45. 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. 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. 47. Dietary Guidelines for Fit Kids• Eat when your are hungry; stop when your hunger is gone • Self regulation • Resilience
  48. 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. 49. Fit KidsQ&A Thank You Bonnie Y. Modugno, MS, RD www.muchmorethanfood.com

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