Childhood Obesity Crisis: Causes, Risks and Solutions
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Weitzman Symposium 2010
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Childhood Obesity Crisis: Causes, Risks and Solutions
- 1. Red Light, Green Light, Eat Right! www.DrDolgoff.com
- 2. Childhood obesity is rising rapidly! 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00% 20.00% 1963-1970 1976-1980 1988-1994 2003-2004 Prevalence of ObesityAge 12-19 Prevalenceof Obesity Age 12-19
- 3. Obesity is also on the rise in school-age children. 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 1976-1980 2003-2004 Prevalence of ObesityAge 6-11 Prevalenceof Obesity Age 6-11
- 4. Even the youngest children are not spared. 0% 2% 4% 6% 8% 10% 12% 14% 16% 1976-1980 2003-2004 Prevalenceof ObesityAge 2 – 5 Prevalenceof Obesity Age 2 - 5
- 5. 1 /3 OF KIDS ARE TOO HEAVY! 1 OUT OF EVERY 3 CHILDREN IS OVERWEIGHT AND AT RISK FOR MEDICAL COMPLICATIONS DUE TO THEIR WEIGHT!
- 6. Do obese children become obese adults? Yes! • 75% of overweight kids age 12-18 become obese adults. • 50% of overweight kids age 6-11 become obese adults. • If a child is overweight before age 8, he/she is more likely to be severely obese as an adult.
- 7. Why is obesity so dangerous? • No previous U.S. generation has raised children more likely to have a shorter life span than its parents. • Obesity will soon overtake smoking as the nation’s leading cause of preventable death. • Childhood obesity may shorten one’s life span, even if that person is not obese as an adult.
- 8. Medical Risks of Obesity Coronary Artery Disease Congestive Heart Failure Type II Diabetes Mellitus High Blood Pressure High Cholesterol Stroke Liver Disease Gall Bladder Disease Osteoarthritis Musculoskeletal Disease Asthma Sleep Apnea Infertility in Women Depression Psychiatric Illnesses Many Types of Cancer
- 9. Harvard Study of Boys Age 13-18 • Obese boys were twice as likely to die from heart disease • Obesity that starts in childhood or adolescence causes greater risk of early death • Abnormal changes in the hearts of overweight children seen at age 5
- 10. No More “Adult Onset” Diabetes • Children diagnosed with Type II Diabetes increased ten-fold between 1982 and 1992. • More than one third of all childhood diabetes is now Type II. • Overweight is the strongest risk factor for Type II Diabetes. • Children with Type II Diabetes may have a heart attack in their 30s or 40s.
- 11. Why do children become overweight? • Genetics • Unhealthy Eating Patterns – Fast Foods – Soda – Increased Serving Sizes • Too Little Activity • TV, Video Games, Computers • Changing Family Meal Patterns
- 12. Why do children become overweight? • Genetics • Unhealthy Eating Patterns – Fast Foods – Soda – Increased Serving Sizes • Too Little Activity • TV, Video Games, Computers • Changing Family Meal Patterns
- 13. Genetics 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Both parents normalweight One parent overweight Both parents overweight Risk of child becomingoverweight Risk of childbecoming overweight
- 14. Why do children become overweight? • Genetics • Unhealthy Eating Patterns – Fast Foods – Soda – Increased Serving Sizes • Too Little Activity • TV, Video Games, Computers • Changing Family Meal Patterns
- 15. We’re Eating More Calories 0 500 1000 1500 2000 2500 3000 Women Men 1970 2000
- 16. How many calories does a child need? Age (Years) Recommended Daily Caloric Intake Age 4-6 1,600 Age 7-11 1,900 Age 12-14 (Girls) 2,000 Age 12-14 (Boys) 2,400 Age 15-18 (Girls) 2,100 Age 15-18 (Boys) 2,900
- 17. What is a normal serving size? GRAINS (6-11/day) AGE 1 - 3 AGE 4 – 6 AGE 7 - 10 Breads ½ slice ½ slice 1 slice Rice, Pasta ¼ cup 1/3 cup ½ cup Dry Cereal 1/3 cup ½ cup ¾ cup – 1 cup Crackers 2-3 crackers 3-4 crackers 4-5 crackers PROTEIN (2-3/day) AGE 1 – 3 AGE 4 – 6 AGE 7 – 10 Meat, Fish, Poultry 1 ounce 1 ounce 2 – 3 ounces Beans ¼ cup 1/3 cup ½ cup Eggs ½ egg 1 egg 1 – 2 eggs
- 18. Normal Growth and Weight Gain • Age 1-2 Years: – Triples birth weight – Gains ½ pound per month – Grows 5 inches • Age 2 Years: – Quadruples birth weight • Above Age 2 Years: – Gains 4-5 pounds per year – Grows 3 ½ inches per year CLICK HERE TO SIGN UP NOW!CLICK HERE TO SIGN UP NOW!
- 19. Normal Growth and Weight Gain • Middle Childhood – 6 pounds and 2 inches per year • Early Puberty – 9 – 10 pounds and 2 inches per year • Late Puberty – 4 inches per year – Weight gain variable
- 20. Carbs vs. Fat Does it Matter? • Studies show that eating lots of fat causes higher levels of body fat than eating lots of carbs. • Low carb diets are NOT safe for children.
- 21. Fast Food • Teens eat about 1,650 calories when they eat fast food for lunch. • Children eat about 187 extra calories when they eat fast food. • 187 cal per day x 365 days = 17 pounds of fat!
- 22. Supersize Me? • At age 3 years, children eat the same amount regardless of serving size. • By age 5 years, children eat more when given larger portions. • When portion size increases, both bite size and number of bites increase.
- 23. Juice • Juice is not healthy! • Juice ingestion is associated with increased body weight.
- 24. Liquid Candy A 12 ounce can of soda contains the equivalent of 10 teaspoons of sugar Each additional serving of soda increases a child’s odds of obesity by 60%.
- 25. “You’re So Fake!” • Kids eat more processed foods with artificial ingredients than ever before. • Natural foods are almost always healthier. • If you can’t read the words on the ingredient list, SKIP IT!
- 26. “Yuck!” • Offer New Foods Repeatedly Studies show that it takes 10 – 15 experiences with a food before some children will accept them.
- 27. Why do children become overweight? • Genetics • Unhealthy Eating Patterns – Fast Foods – Soda – Increased Serving Sizes • Too Little Activity • TV, Video Games, Computers • Changing Family Meal Patterns
- 29. TV time correlates with obesity • A child’s weight increases with the number of hours he/she watches TV. • TV in the bedroom is an especially strong risk factor for obesity.
- 30. What can a parent do? • Limit TV and computer time! – Fewer than 2 hours a day! – Consider a TV allowance meter – Brainstorm ideas for replacement activities • Don’t allow your child to eat in front of the TV • Do not put a TV in your child’s bedroom • Monitor your child’s TV use!
- 31. Why do children become overweight? • Genetics • Unhealthy Eating Patterns – Fast Foods – Soda – Increased Serving Sizes • Too Little Activity • TV, Video Games, Computers • Changing Family Meal Patterns
- 32. Who’s making dinner? • Families don’t always eat together • Meals are often fast foods or frozen foods • Children often make their own meals • Children often eat alone
- 33. What can a parent do? • Intervene!!! • Don’t ignore the problem!!! • Obesity treatment DECREASES the risk of eating disorders!!! • Don’t do it alone- seek medical help!!!
- 34. Why should I call a doctor? • Medically unsupervised diets are not safe for children. • Growth may be delayed if child is not closely monitored. • Children have different nutritional and caloric needs at each stage of development. • Do-it-yourself weight loss plans don’t work well for children.
- 35. It is crucial to act immediately • Children lose weight and sustain weight loss more easily before puberty begins. • Hormonal changes of puberty make weight loss more difficult. • Puberty is associated with changes in the brain areas that control appetite. • Weight “set point” determined at puberty
- 36. General Guidelines • Restructure home environment • Family mealtimes • Model healthy behaviors • Positive reinforcement • Open communication
- 37. Offer only healthy options! Your child controls when he eats… You control what he eats
- 38. You are not the food police • Do not force foods • Do not forbid foods • Do not use foods as bribes • Do not provoke conflict • Do not scold • Do not criticize
- 39. 3 Squares a Day • Turn off TV • Clear away toys and books • Encourage conversation • Start with soup or salad • Watch serving sizes and decrease plate size • Serve vegetables • Let children help cook • Eat slowly
- 40. Tips For Packing a Healthy Lunch: A WHEAT + A MEAT + A TREAT (and a fruit or a vegetable!)
- 41. Tips For Healthy Dining Out • 1. Read the menu carefully. • 2. Don’t be afraid to special order. • 3. Skip the kids’ menu. • 4. Watch portion sizes! • 5. Don’t drink your calories. • 6. Eat slowly and enjoy each bite.
- 42. Snacking is Healthy! • Eating a small amount of food every three or four hours keeps your blood sugar stable and prevents cravings. • Be sure to include two snacks per day in- between meals. • A 3 pm snack will help ward off pre-dinner exhaustion.
- 43. Tips For Healthy Snacking “On-The-Go” • Invest in a thermal lunch box where food can be kept warm or chilled. • Plan and pack your snacks the night before. • Portion size your snacks in small baggies or air-tight containers. • Don’t forget to throw in a bottle of water. • In the morning, simply grab your lunch box and start your day!
- 45. Road Rule #1: Mind The Traffic Lights • Red Light Foods represent high-calorie foods. • Yellow Light Foods represent moderate-calorie foods. • Green Light Foods represent low-calorie foods.
- 46. Sample From Food Database • Bagel ½ bagel Yellow • Mini Bagel 1 bagel Green • Bread, Whole Wheat 1 slice Green • Bread, Reduced-Calorie 2 slices Green • Chicken Breast, Grilled 2 oz Green • Chicken Breast, Breaded, Fried 3 oz Yellow • Chicken Drumstick 1 drumstick Green • Steak, Regular 2.5 oz Red • Steak, Sirloin 3 oz Yellow
- 47. Road Rule # 2: Stay On Track! • Eat 3 meals and 2 snacks each day. • Each child gets a specific number of Green Light Servings to eat at each meal and snack (based on age, gender, and BMI). • You can trade 2 “Greens” for 1 “Yellow”
- 48. Road Rule # 3: Use Your Free Fuel! • Fruits, most vegetables, and fat-free cheeses are Free Fuel and should be eaten with every meal and snack, and as often as desired. • There is absolutely no limit on these foods! • In fact, children MUST each a fruit or vegetable with each meal or snack. • Exceptions: Potatoes, Corn, and Avocado are not Free Fuel and must be counted as Green Light Servings.
- 49. Road Rule #4: Enjoy Your Pit Stops! • Kids take two Red Light Pit Stops a week because they should feel comfortable enjoying treats and indulgences, too. • Just remember to keep it to two a week and watch those portion sizes!
- 50. Red Light, Green Light, Eat Right: General Overview • Eat 3 Meals and 2 Snacks Each Day. • Stay Within Your Allotted Colors For Each Meal and Snack. • 2 Red Light Foods Each Week. • Fruits, Vegetables, and Fat-Free Cheese are Free Fuel.
- 51. Red Light, Green Light, Eat Right! www.DrDolgoff.com
Editor's Notes
- -In the 1960s, 4.6% of children age 12-19 were obese. -Late 1970s, rose to 5% -1994, 10.5% -2004, jumped to 17.4%
- -18.8% of all school age children are now obese- -not just overweight, but actually obese! -Since the 1970s, prevalence of obesity has TRIPLED in this age group.
- 1976-1980, 5% of children age 2-5 were obese. 2003-2004, climbed to 13.9%
- -1 out of every 6 children age 2 to 19 is considered obese -another 1 out of every 6 children in this age group is considered overweight - 1/3 of all children are too heavy and at risk for medical complications from their weight.
- -Yes! -75% between the ages of 12 and 18 remain obese -50% age 6-11 become obese adults. -If child overweight before age 8, more likely to be severely obese as an adult.
- -No previous U.S. generation has raised children likely to have a shorter life expectancy than its parents. -Epidemiologists at the CDC predict that obesity will soon overtake smoking as the nation's leading cause of preventable death. -In the last two decades, "adult" diseases in overweight teenagers and children as young as age 6. -childhood obesity itself may shorten one's life span, even if that person is not obese as an adult. -must recognize and treat childhood overweight as soon as possible in order to maximize life span.
- A Harvard study of individuals age 13-18, followed over 50 years - obese boys twice as likely to die from heart disease -Obesity that develops in childhood or adolescence causes a greater risk of early death -Child obesity causes long-lasting medical problems, even if that child loses weight and is no longer obese as an adult. -Autopsies of children who have died in accidents have shown abnormal changes in the hearts of overweight children as young as 5 years old. -fatty deposits -narrowing in the arteries of the heart
- -Type II Diabetes used to be called “Adult Onset” Diabetes. -name changed to Type II diabetes due to the large number of children developing what used to be an exclusively adult problem. -Not long ago, nearly all childhood diabetes was type 1. -Now more than 1/3 are type 2. -Being overweight is the single strongest risk factor for Type 2 Diabetes. -An adult diagnosed with Type II Diabetes may require kidney dialysis or have a heart attack in their 60s or 70s whereas a teen diagnosed with Type II Diabetes may develop these problems in their 30s or 40s.
- - complex interaction among genetic and environmental factors. -While the obesity rate is skyrocketing, the gene pool remains stable; -so genetics are not entirely to blame. -7% risk overweight if both parents are normal weight -40% if one parent is overweight. -80% if both parents are overweight -Children under the age of 10 whose parents are overweight are more than twice as likely to become overweight adults as kids the same age with normal weight parents. -But is this genetic or environmental? Probably a little of both.
- The role of genetics on the development of obesity is not fully understood and cannot be changed. There are other causes of obesity that we can control.
- - 2000, women eat 335 more calories a day than 1970. -Men eating 168 more calories per day -The number of calories ingested daily by children has also greatly increased.
- -see table -weight maintenance -included in handout
- -Most parents are not sure -few children follow -in handout
- -Is a calorie simply a calorie? -A study of 9 and 10 year-olds -boys and girls who ate a lot of fat had more body fat than those whose diets were high in carbs- -even when they ate the same number of calories and got the same amount of exercise. - children’s bodies process fat calories differently than carb calories. -It is NEVER safe for a child to be on a low carb diet.
- -Fast food plays large role -Children are eating more and more fast food -Children don’t pick healthy options -A recent study -teens served a fast food lunch ate about 1650 calories - more than 60% of their daily requirement. -Children eat 187 extra calories on days that they eat fast food. - more fat and sugar -less fiber, milk, fruit, and vegetables. -Over the course of a year -an extra 187 calories a day = 68,255 calories per year or 17 extra pounds of fat. -Granted, most children don’t eat fast food DAILY- but even once a week = 2 ½ pounds in a year
- -Do supersized portions affect the number of calories eaten? -Rolls et al did a study -children were served macaroni and cheese. -3 year olds ate the same amount regardless -The 5 year olds ate more when given larger portions. -As kids get older, environmental cues begin to override internal cues about hunger and fullness. -Another Rolls et al study -when doubled the size of a child’s lunch entrée, child increased the size of each bite and increased the number of bites- and ate 25% more calories.
- -As a pediatrician, what age a child should be introduced to juice? - same as chocolate- late, small doses, and as a treat -common misconception that juice is healthy. It is not. - loaded with calories and sugar- even fresh squeezed. -Juice is certainly not as healthy as a piece of fruit. -higher in sugar -not a good source of fiber. -may induce a child to develop a preference for sweet drinks. -AAP recommends restricting juice in children
- -12 ounce can of soda contains 10 tsp of sugar -liquid calories don’t fill you up -Each additional soda increases child’s odds of obesity 60%
- Think your child doesn’t like healthy foods? You may not be giving them enough of your chance. Taste is not black and white. 10 – 15 tries.
- -Chubby children teased in school -left out when children are picking teams in gym class. -They tend to have some discomfort in their knees and ankles when running. -become embarrassed that they can’t keep up -turn to more sedentary activities, such as watching - more weight gain -overweight child starts to avoid sports altogether -further increases TV and computer time. -Eventually the child becomes obese and unable to do even simple activities, such as walking.
- -study published in Lancet in 2004 followed 1000 children over the course of 26 years. -Almost 50% who consistently watched 3 or more hours of TV per day were overweight. -Only 25% who consistently watched less than 1 hour of TV were overweight. -Putting a TV in a child’s bedroom raises the risk of obesity even further. -A 2002 study from Columbia -preschoolers with a TV in their bedroom were 31% more likely to be overweight -TV in the bedroom instantly adds about an hour of increased TV time per day. - what is cause and what is effect? Does watching TV make a child overweight or does being overweight cause a child to watch a lot of TV? It is not clear.
- -limit TV time- (AAP fewer than 2 hours of TV per day) -children usually can be persuaded -brainstorm all the different activities they can do instead - pie chart of what they do -interview a grandparent or great-grandparent -make trying new activities into a game. -do not allow your child to eat in front of the TV. -do not put a TV in your child’s bedroom -monitor your child’s TV use -be aware -TV is not a babysitter
- Changing family meal patterns also contribute to obesity.
- - family used to sit down together -nutritious, home-cooked meal every evening -Mom and Dad aware of exactly what children were eating -Now, both parents often work and everybody is rushing from activity to activity. -Sometimes children are responsible for grabbing their own dinner. -Very often, nobody is fully aware of exactly what the children are eating. -Parents are relying on fast food or pre-made foods for quick dinner options. These choices rarely are as healthy as a home cooked meal. -It is imperative that SOMEBODY is monitoring what a child is eating each day. Children (including teens) should not be making these decisions.
- -Intervene -Don’t worry about causing psychological trauma -Won’t make child weight obsessed or trigger eating disorder -Overweight children know they are overweight -Cause more physical and psychological harm ignoring obesity -no evidence that treating obesity, in a sensitive manner, increases the risk of disordered eating. -some studies suggest that teaching healthy nutrition to overweight children DECREASES the incidence of eating disorders. -All children must be closely monitored when starting a weight loss program.
- -must work with physician -not safe for a child to on a diet unless medically supervised - if not monitored closely, a child’s growth can be affected -unlike adults, children have different nutritional and caloric needs at each stage of development -child weight loss programs can not be “one size fits all”. They must be continually modified. - do-it-yourself plans tend to backfire and cause weight gain.
- -easier lose weight and sustain weight loss before puberty. -during puberty, hormonal changes cause weight gain and make weight loss more difficult. -changes in the brain areas that control appetite -weight “set point” is determined at puberty -once determined, if lose weight, lowering resting metabolism and increasing hunger -fight starvation -why most who lose weight gain it back -before the set point is determined, these responses do not happen. A child can lose weight without inciting this “starvation” response.
- - restructuring the home environment -eating meals as a family -modeling healthy behaviors -showering your child daily with praise -allowing for open communication, and avoiding force.
- While young children are in control of when they eat, parents are in control of what they eat -clear your house of junk food -offer only healthy options -let your child choose whatever they want to eat (from the available choices) -no need to have chips and candy in the house; these foods should be special treats. -if it is in the house, your child will eat it.
- - three meals and two snacks each day -time for the family to relax and enjoy -turn the TV off, clear away all the toys and books, and sit at a table (not in front of the TV) -encourage family conversation -start each meal with a non-cream based soup or a salad (with low fat or fat-free dressing) -serve recommended portion sizes on smaller plates. Studies show that people eat fewer calories when served their meals on smaller plates because the plate looks very “full” -always serve a vegetable with dinner -let your children help cook dinner- they are more likely to eat the healthy foods that you make if they have assisted in their preparation -encourage your children to eat slowly- it takes time to realize that you are full.
- Include a lean source of protein, such as turkey breast, ham, roast beef, or peanut butter. Choose a low-calorie, high-fiber bread, such as light whole-wheat bread or light rye bread. Allow your child to indulge in a small treat. Just make sure you measure your portion size carefully. Add in a fruit, vegetable, and water!
- Kids feel grown up when out to eat. But kids (and adults) eat many more calories when out. KNOW WHAT YOU ARE ORDERING: Pay attention to descriptions. Avoid deep-fried, pan-fried, breaded, creamy, or crispy. SPECIAL ORDER: May be healthy if prepared differently. Small substitutions lead to major calorie savings. AVOID KIDS MENU: Often least healthy part of menu. Order half adult order or share. WATCH PORTION SIZES! Single serving often enough for 2 or 3 meals! Share or bring leftovers home. DON’T DRINK CALORIES: EAT SLOWLY: Takes 20 minutes to tell if you are full. Put down forks or take sip of water b/w bites. No seconds until 20 min has passed.