CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...

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CHILDHOOD OBESITY AN EPIDEMIC INCIDENCE OF CHILDHOOD OBESITY ...

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

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