Talking to parents about weight

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Workshop with school nurses re: talking to parents about weight issues in children

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  • most children who have a BMI for age between the 85th and 94th percentiles (overweight) do not have excess body fatness.40For example, of the 200 overweight children in the Pediatric Rosetta Study, 18% (positive predictive value) had a percent-body-fat level at or above the age-specific 85th percentile.50% moderate levels of body fatness30% normal levels of body fatnesshttp://archpedi.ama-assn.org/cgi/content/abstract/163/9/805
  • 19 Calories
  • A: 19 calories
  • Plausible reporters58.4 % (Savage, 2008)45.3% (Fulton, 2009)Implausible reporters 16.4% under reporters 25.1% over-reporters
  • Talking to parents about weight

    1. 1. TALKING TO PARENTS ABOUT WEIGHT: INSIGHTS AND TOOLS TO ENHANCE METABOLIC HEALTH IN THE FAMILY
    2. 2. OBJECTIVES ▪ Review current methods to assess weight, body composition and metabolic health ▪ Learn how to reframe weight concerns in order to minimize resistance and opposition ▪ Identify three key components to successfully address metabolic health with families ▪ Disclosures ▪ Consultant for McDonald’s Owners of Southern California (MOASC)
    3. 3. ISSUES WITH OBESITY ▪ Is everyone getting fatter in the same way? 35 30 25 ▪ California adolescents 20 White Latino Afr. Am. Asian 15 ▪ At risk for overweight and overweight statistics includes teens with BMI> 85th percentile 10 5 0 At Risk 2000 CalTeens Survey, California Department of Health Services c 2004
    4. 4. TREATMENT OF PEDIATRIC OBESITY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED TRIALS Conclusions ▪ Limited evidence supports the short-term efficacy of medications and lifestyle interventions ▪ The long-term efficacy and safety of pediatric obesity treatments remain unclear McGovern, et al. J Clin Endocrinol Metab 93: 4600–4605, 2008
    5. 5. ASSUMPTIONS ABOUT BODY SIZE
    6. 6. WHAT ABOUT WEIGHT & RELATED MEASURES? PRO CON ▪ “BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.” ▪ “Body mass index (BMI), based on the weight and height, is not an accurate measure of body fat content and does not account for critical factors that contribute to health or mortality” http://www.cdc.gov/healthyweight/ass essing/bmi/ http://www.sciencedaily.com/releases/ 2013/08/130822141948.htm
    7. 7. THE DISTORTION OF BODY WEIGHT AND BMI THINLY MUSCLED THICKLY MUSCLED
    8. 8. THE ISSUE WITH WEIGHT How weight is distributed and how fat is stored are more significant factors impacting metabolic health
    9. 9. NUTRITION EVIDENCE-BASED LIBRARY (NEL) USED TO ESTABLISH 2010 DG Methodological challenges BMI is a poor surrogate measure of adiposity ▪ Using DEXA excessive body fat was found in ▪ 77% of children w/ BMI > 95th % ▪ 20% of children w/ BMI between 85-94th % ▪ 30% of children assessed as overweight had normal body fat stores Arch Pediatr Adolesc Med. 2009;163(9):805-811.
    10. 10. ASSUMPTIONS ABOUT FOOD INTAKE
    11. 11. TREATING OBESITY ▪ Eat less ▪ Exercise more Calories in < Calories out = Weight Loss Q: IF OBESITY IS A MATH PROBLEM, How many calories do you need to overeat each day to gain 10 pounds extra fat weight over 5 years? _____
    12. 12. NUTRITION EVIDENCE-BASED LIBRARY (NEL) USED TO ESTABLISH 2010 DG Methodological challenges Dietary assessment methods generally lack the sensitivity to detect small difference in energy intake ▪ Food Frequency ▪ 1-3 day food recalls
    13. 13. RELIABILITY OF DIETARY INTAKE AND BMI ▪ Overweight subjects reported to underestimate calorie intake McCrory, et al. The Degree of Misreporting of Dietary Intake. Public Health Nutrition: 5(6A), 873–882. 2002.
    14. 14. MEAN ANTHROPOMETRIC MEASURES IN CHILDREN 2-18 YEARS OF AGE (NHANES 1999-2004) 80 70 60 T. Candy -Cons 50 T. Candy- NC 40 Choc-Cons. 30 Choc-NC 20 Sugar-Cons 10 Sugar-NC 0 Weight (kg) BMI Waist Circ. (cm) http://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675 c2011
    15. 15. CANDY CONSUMERS (N = 3,458) VS. NON-CONSUMERS (N=7,724) (NHANES 1999-2004) 2400 2300 T. Candy -Cons 2200 T. Candy- NC 2100 Choc-Cons. 2000 Choc-NC Sugar-Cons 1900 Sugar-NC 1800 Calories http://www.foodandnutritionresearch.net/index.php/fnr/article/view/5794/8675. c 2011
    16. 16. TEN PUTATIVE CONTRIBUTORS TO THE OBESITY EPIDEMIC ▪ Food supply & marketing practices ▪ Maternal age ▪ ▪ Assortative mating Physical activity ▪ Infections; gut microbes ▪ Sleep debt; stress; cortisol ▪ Perinatal epigenetic factors ▪ Endocrine disruptors ▪ maternal obesity ▪ over/undernutrition ▪ hyperinsulinemia ▪ Pharmaceutical iatrogenesis ▪ Ambient temperature Critical Reviews in Food Science and Nutrition 49(10) 868-913 (2009)
    17. 17. WHERE CAN WE START?
    18. 18. STOP FOCUSING ON WEIGHT ▪ Everything that we link to weight can be discussed in terms of metabolic health ▪ Target true bio markers of poor health ▪ Focus on beliefs, attitude, emotion s, behavior ▪ Avoid shame and blame
    19. 19. TRUE BIOMARKERS OF METABOLIC HEALTH ▪ Biomarkers of poor metabolic health ▪ Elevated blood pressure ▪ Elevated liver enzymes/Fatty liver ▪ Hyperinsulinemia/hyperglycemia/co mpromised OGTT ▪ Elevated markers of inflammation (C reactive protein) ▪ Dyslipidemia ( especially elevated triglycerides/depressed HDL) ▪ Low hemoglobin, hematocrit ▪ Poor thyroid function
    20. 20. OTHER MEASURES OF METABOLIC HEALTH ▪ How the body is using energy ▪ Hunger, satiety ▪ Fatigue, stamina ▪ Focus, concentration ▪ Temperament ▪ Body composition (higher ratio of fat to muscle) ▪ Pattern of fat stores (central body fat)
    21. 21. NUTRITION FACTORS LINKED TO METABOLIC HEALTH ▪ Function of food choices ▪ Poor food distribution ▪ Poor food composition at meals ▪ Excess/inadequate intake to meet energy needs ▪ Nutrient density of food choices ▪ Excessive refined starches and/or sugar ▪ Inadequate protein ▪ Inadequate fiber rich foods (fruits/ vegetables, beans & legumes, whole grains)
    22. 22. 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
    23. 23. 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
    24. 24. WHAT STARTS THE DAY?
    25. 25. WHAT’S FOR BREAKFAST AT LAUSD ? Friday Monday No Milk Wednesday French Toast Thursday Breakfast Burrito With Milk Tuesday LAUSD Coffeecake Pancakes Fruit and Oatmeal Bar 58% CHO 22% PRO 61% CHO 21% PRO 57% CHO 14% PRO 71% CHO 18% PRO 61% CHO 14% PRO 63% CHO 22% PRO 68% CHO 13% PRO 60% CHO 5 % PRO 85% CHO 7 % PRO 66% CHO 6 % PRO http://www.schoolmenu.com/menu/ca/lausd/los-angeles-elementary/ JAN 6-10, 2014
    26. 26. CORE MESSAGES ▪ 1. Move every day ▪ Not just about calories burned ▪ Improved energy metabolism ▪ Greater glucose tolerance ▪ Improve insulin sensitivity ▪ Improved capacity to burn fat for fuel ▪ Increased focus, well being and satiety ▪ Lower inflammation
    27. 27. CORE MESSAGES ▪ 1. Eat through the day ▪ Consider actual waking hours of day ▪ Avoid getting over-hungry ▪ Eating too little through the day often triggers over eating /excessive snacking later on ▪ Reasonable meals usually last 3-5 hours ▪ Ideally meals meet needs as opposed to needs fitting into a rigid meal structure
    28. 28. CORE MESSAGES ▪ 2. Adequate balance of protein, carbohydrate and fat to meet needs ▪ Different for different people ▪ Variable depending on activity, stress, and other factors
    29. 29. CORE MESSAGES ▪ 3. Determine how much is enough ▪ Avoid getting over hungry ▪ Discern the difference between feeling satisfied versus feeling full or overfull ▪ Portions count ▪ Check distorted assumptions ▪ More is better ▪ I already paid for it ▪ It’s free! ▪ Getting your money’s worth ▪ I don’t like to waste food
    30. 30. CORE MESSAGES ▪ 4. Allow food it’s rightful place ▪ Adequately address other needs ▪ Suggest , provide adequate language to express feeling ▪ Build emotional intelligence ▪ Acknowledge without having to fix ▪ Build tool box to build resilience ▪ Effectively self regulate ▪ What works at 6 y/o ? 10 ? 14? 18? ▪ What works at 30, 50, 70 yrs of age? ▪ Effectively self soothe ▪ Cultivate wide enough range of options
    31. 31. CORE FUNCTIONAL CAPACITY RESILIENCE: SELF REGULATION: THE ABILITY TO ACT IN YOUR LONGTERM BEST INTEREST, CONSISTENT WITH YOUR DEEPEST VALUES. BUILDING SKILLS TO ENDURE HARDSHIP
    32. 32. Willingness Readiness Ability Knowledge Access Resources Self regulation Resilience BASIC REQUIREMENT S FOR CHANGE
    33. 33. TALKING TO PARENTS ABOUT WEIGHT: Thank you Q&A Bonnie Y. Modugno, MS, RD www.muchmorethanfood.com

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