The Molten Moment
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Why is it so hard to lose weight? The Molten Moment describes the window of time when obesity interventions are most effective.
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The Molten Moment
- 1. The Molten Moment The Moment Where Obesity Interventions Have The Greatest Impact Tracy Flood, MD, PhD © 2013, All rights reserved
- 2. Outline Background • Define the Molten Moment • Obesity as a Growing Concern • Define Obesity in Children 1) Story of Fat Cell • Not too Big = Metabolic Synd • Not too small = Hunger • But Just Right 2) Many interventions reduce Metabolic Risk & CVD 3) Only interventions performed at the MOLTEN MOMENT can “cure” obesity forever.
- 3. The Molten Moment Background The Obesity Crises Defining Obesity
- 4. The Molten Moment A Cold Iron, Solid A HOT Iron, Malleable DEFINITION of Mol-ten: liquefied by heat; having warmth and brilliance, glowing
- 5. The Molten Moment Where do you strike For the biggest impact?
- 6. The Molten Moment Where do you strike For the biggest impact?
- 7. The Molten Moment Where do you strike For the biggest impact?
- 8. The Molten Moment Where do you strike For the biggest impact?
- 9. Obesity is a Growing problem 7% 20% 1980 2008 Children aged 6-11 yo 5% 18% 1980 2008 Adolescents aged 12-19 yo Since 1980, Childhood Obesity rates have tripled Prevalence Rates of Childhood Obesity
- 10. Obesity=Bad
- 11. If rising OW/OB trends continue, by 2030 it will reach 16-18% of total health-care costs in the United States. (Wang, Beydoun, Liang, Caballero, Kumanyika, 2008) Obesity is a Growing problem Atherosclerosis Currently, the world’s leading causes of death are the Atherosclerosis-related dz: 1.Ischemic heart disease (IHD) 2.Stroke (Lopez &Mathers, 2006; Mathers et al., 2009). OW/OB Increases Risk Factors Risk Factors Atherosclerosis Atherosclerosis begins at a young age
- 12. Prevalence of Obesity Throughout the Lifespan 0 0.1 0.2 0.3 0.4 0.5 0-2 yrs 2-5 yrs 6-11 yrs 12-19 yrs 20-39 yrs 40-59 yrs 60+ yrs Males FemalesPediatric Definition Adult Definition
- 15. Obese Over- weigh t Normal weight Body Mass Index=BMI 30 25 ADULTSCHILDREN > Defining Obesity NOTE: An Obese Preschooler is as Thin as a Normal Weight Adult
- 16. The Story of the Fat Cell Stem Cells can become Fat Cells Fat Cell Triglyceride (TG)FA FA FA How do we become Obese? OB OW NW BMI
- 17. The Story of the Fat Cell Stem Cells can become Fat Cells Fat Cell Triglyceride (TG)FA FA FA How do we become Obese? OB OW NW BMI
- 18. The Story of the Fat Cell Stem Cells can become Fat Cells Fat Cell Triglyceride (TG)FA FA FA How do we become Obese? OB OW NW BMI
- 19. Who Would You Target For Intervention? lebeauleblog.wordpress.com Bvwellness.com Friendlyhouseinc.org Obese 15 yo girl who is otherwise healthy Normal weight 35 yo mother wanting to lose “baby weight” Obese 55 yo man with Metabolic Syndrome
- 20. Obesity with Metabolic Syndrome lebeauleblog.wordpress.com Obese 55 yo man with Metabolic Syndrome a TOXIC type of obesity How Does a Person Develop Metabolic Syndrome? The Story of the Fat Cell
- 21. The Story of the Fat Cell Fat Cell FA = Fatty Acids Triglyceride (TG)FA FA FA
- 22. The Story of the Fat Cell Triglyceride (TG)FA FA FA Fat Cell FA = Fatty Acids
- 23. The Story of the Fat Cell FAFA FA Triglyceride (TG)FA FA FA Fat Cell FA = Fatty Acids
- 24. The Story of the Fat Cell FA Fatty Liver TG TG HDL TG TG Used for fuel if active FA FA FA Result: Higher TG Lower HDL HDL is the good cholesterol Scavenges Xtra TG then is destroyed
- 25. The Story of the Fat Cell TG TG High TG, Low HDL Hypertension Diabetes =Metabolic Syndrome Insulin Resistance TG
- 26. The Story of the Fat Cell High TG, Low HDL Hypertension Diabetes =Metabolic Syndrome Insulin Resistance TG T G TG Atherosclerosis Cardiovascular Disease Premature Death
- 27. The Story of the Fat Cell Insulin Resistance = Metabolic Syndrome Body Type & Risk
- 28. Obesity with Metabolic Syndrome lebeauleblog.wordpress.com Obese 55 yo man with Metabolic Syndrome a TOXIC type of obesity He wants to be healthier: --Americans spend over $60 billion/yr on weight loss (Marketdata, 2010) --1 in 3 adults are attempting weight loss
- 29. Testing the Effects of Interventions DIET EXERCISE GOOD ADVICEMEDICATIONS lebeauleblog.wordpress.com STARVATION
- 30. Results of Intervention Advice Alone Sibutramine Very Low Cal Diet Average weight loss of subjects completing a minimum 1-year weight-management intervention; based on review of 80 studies (N=26,455; 18,199 completers [69%]). (Franz et al, 2007) 3-6 kg Note: Built environment intervention not included lebeauleblog.wordpr ess.com
- 31. 160 lb weight 5’6” BMI 190 lb 30 25 OB OW NW MAX 6 kg 13 lb Results of Intervention After 4 years of 26,455 people undergoing weight-loss intervention, the average weight loss was 13 lbs and the obese were still obese.
- 32. 160 lb weight 5’6” BMI 190 lb 30 25 OB OW NW MAX 6 kg 13 lb Results of Intervention After 4 years of 26,455 people undergoing weight-loss intervention, the average weight loss was 13 lbs and the obese were still obese.
- 33. 160 lb weight 5’6” BMI 190 lb 30 25 OB OW NW MAX 6 kg 13 lb Results: Exercise alone Exercise behavior can be maintained in obese participants following intervention (Gourlan et al, 2011) Primary Care Setting Best results with Doctor & Dietician = 6 kg (Flodgren, et al 2010) Built Environment Good evidence for affecting physical activity Less evidence for affecting BMI (Durand et al 2011) Meta-Analyses & Reviews
- 34. The Story of the Fat Cell FA FA FA Fat Cells 7-10% weight loss = Less Insulin Resistance
- 35. The Story of the Fat Cell Fat Cells 7-10% weight loss = Less Insulin Resistance
- 36. The Story of the Fat Cell TG TG High TG, Low HDL Hypertension Diabetes =Metabolic Syndrome Insulin Resistance TG Meta-Analyses: Exercise alone (Shaw et al., 2006) hypertension triglycerides fasting glucose & risk of diabetes Diet alone (i.e. Low Fat Diets) (Avenell et al., 2004) hypertension risk of developing diabetes Diet + Exercise (Avenell et al.; Witham et al., 2009) risk of CVD (HR 0.65, 95% CI 0.50–0.85 in those >60 yo) 7-10% weight loss = Improved Outcomes
- 37. The Story of the Fat Cell 7-10% weight loss = Improved Outcomes “Clinically Significant” Weight Loss 16% In 100 Adults (20-65 yo) Getting Treatment for Obesity 16% will have clinically significant weight loss 10% Weight loss No Weight loss
- 38. Increasing Weight Loss lebeauleblog.wordpress.com Page2live, TopGun Reeeeally was hoping to get back to pre-weight gain weight I want to lose more than 13 lbs
- 39. The Story of the Fat Cell Fat Cell If you try to lose more than 10%... Uh oh! 160 lb weight 5’6” BMI 190 lb 30 25 OB OW NW
- 40. The Story of the Fat Cell Fat Cell If you try to lose more than 10%... Uh oh! I’m HUNGRY!! I’m HUNGRY!! FEED me!! 160 lb weight 5’6” BMI 190 lb 30 25 OB OW NW
- 41. The Story of the Fat Cell I’m HUNGRY!! I’m HUNGRY!! I’m HUNGRY!! EAT MORE! BURN LESS!
- 42. The Story of the Fat Cell EAT MORE! BURN LESS!
- 43. lebeauleblog.wordpress.com Losing weight I’m HUNGRY!! I’m HUNGRY!! I’m HUNGRY!! 30 minof moderate exercise x 5 days a week to maintain 60-90 minof moderate exercise x 7 d/wk to maintain weight loss
- 44. Summary of Adult Interventions lebeauleblog.wordpress.comPage2live, TopGun A) Weight gain is a wheel and ratchet = Uni-directional B) Behavioral change is possible C) 7-10% Weight loss is improves CVD risk Is adulthood a Molten Moment? NO
- 45. lebeauleblog.wordpress.com Bvwellness.com Friendlyhouseinc.org Obese 15 yo girl who is otherwise healthy Normal weight 35 yo mother wanting to lose “baby weight” Obese 55 yo man with Metabolic Syndrome Who Would You Target For Intervention?
- 46. Bvwellness.com Obese 15 yo girl who is otherwise healthy The Obese Teen An Obese Teenager is already at risk for early death & disease
- 47. Risk for Early Death Bvwellness.com Obese 15 yo Note: Subjects with BMI 25th to 75th percentile (CDC charts) were the referent group. Adapted from Bjorge, Engeland, Tverdal, & Smith (2008). Figure. Mortality in adulthood (<55 y/o) of OW/OB adolescents (males and females) compared to normal weight peers. The health risk in adulthood for OW/OB adolescents If OW/OB teen Normal Weight by adulthood Risk Factors & Atherosclerosis associated with adiposity DECREASE (Oren et al., 2003; Weiss et al., 2009)
- 48. Risk for Early Death Bvwellness.com Obese 15 yo Note: Subjects with BMI 25th to 75th percentile (CDC charts) were the referent group. Adapted from Bjorge, Engeland, Tverdal, & Smith (2008). Figure. Mortality in adulthood (<55 y/o) of OW/OB adolescents (males and females) compared to normal weight peers. The health risk in adulthood for OW/OB adolescents If OW/OB teen Normal Weight by adulthood Risk Factors & Atherosclerosis associated with adiposity DECREASE (Oren et al., 2003; Weiss et al., 2009) But our patient has a 92% chance of remaining obese at the age of 40. (Nader, 2008)
- 49. BMI nadir BMI associated with CVD Early pressures = Later Disease Link between Childhood BMI and adult CV death Begins as early as: 8 yo in boys 13 yo in girls Every 12 lb increase associated with risk of fatal cardiac death CVD Risk: Sun et al., 2008 Trajectory: Ventura, Loken, & Birch, 2009 BMI Percentile Chart Very High Risk o’ Future CVD Finished w/ Linear Growth Increased Adiposity = Increased Risk of CVD
- 50. 5’6” BMI %ile 95th %ile 85th %ile OB OW NW Meta-Analyses (Teens) MAX 3 kg/ m2
- 51. 5’6” BMI %ile 95th %ile 85th %ile OB OW NW Meta-Analyses (Teens) MAX 3 kg/ m2
- 52. 5’6” BMI %ile 95th %ile 85th %ile OB OW NW Treatment of Obesity in Teens & Older Children both treatment and controls gained weight Behavioral Interventions up to 3.3 kg/m2lighter vs. controls (Whitlock et al, 2010) Clinic-Based Interventions up to 2.4 kg/m2lighter vs. controls (Whitlock et al., 2010) Meta-Analyses (Teens) Prevention in Teens Cochrane Review of 55 Obesity Prevention Efforts BMI change not significant in teenagers (Waters et al., 2011) Sedentary Behavior Decreased = <1 hr/wk (Wahi et al., 2011) MAX 3 kg/ m2
- 53. BMI Percentile Chart Very High Risk o’ Future CVD Finished w/ Linear Growth Increased Adiposity = Increased Risk of CVD TEEN INTERVENTION: Alters Trajectory Prevents wgt gain Minimal Decr BMI
- 54. BMI Percentile Chart Very High Risk o’ Future CVD Finished w/ Linear Growth Increased Adiposity = Increased Risk of CVD TEEN INTERVENTION: Alters Trajectory Prevents wgt gain Minimal Decr BMI Intervene
- 55. BMI Percentile Chart Adult Obesity 20% In 100 Teens (11-15 yo) Getting Treatment for Obesity 20% have clinically Significant weight loss
- 56. Summary of TEEN Interventions WARMER A) Behavioral change is achievable B) Prevention of excessive weight gain is achievable C) After adult height is reached, weight loss may be challenging birth 10 20+5 15 Age:
- 57. lebeauleblog.wordpress.com Bvwellness.com Friendlyhouseinc.org Obese 15 yo girl who is otherwise healthy Normal weight 35 yo mother wanting to lose “baby weight” Obese 55 yo man with Metabolic Syndrome Who Would You Target for intervention?
- 58. The Mother of a Preschooler Friendlyhouseinc.org Normal weight 35 yo mother wanting to lose “baby weight” Parents and Adult Caretakers must be the agent of change in this age group. Preschoolers mimic parents’: Fruit & Vegetable consumption Portion sizes Snacking frequency TV Physical activity Grocery shopping Adult Intervent’n= Preschooler Intervent’n
- 59. The Mother of a Preschooler Friendlyhouseinc.org Normal weight 35 yo mother wanting to lose “baby weight” “When mothers improve their diets in order to control their weight, their child (1-3 y/o) improves their diet as well, even if that was not the original intent” (Klohe-Lehman, et al., 2007)
- 60. The BMI nadir and “Adiposity Rebound” are good predictors of future OW/OB The Preschooler At the nadir High TG, Low HDL Hypertension Insulin Resistance =Metabolic Syndrome
- 61. The BMI nadir and “Adiposity Rebound” are good predictors of future OW/OB The Preschooler At the nadir Intervene
- 62. The Preschooler a Problem of Perception 80% of Parents & 50% of all adults cannot see OW/OB in Preschoolers (Baughcum, Chamberlin et al., 2000)
- 63. 5’6” BMI %ile 95th %ile 85th %ile OB OW NW Promising Interventions: Diet+Exercise Educational Setting Interventions, changing culture Parental Support for home activities (Waters et al., 2011) Interventions to Decrease Sedentary Behavior = 4 hr/wk in Preschooler (Wahi et al., 2011) Meta-Analyses (Children) 0 1 2 3 4 5 Preschooler Teenager Hours Less of Sedentary Behavior After Intervention Interventions during preschool are needed
- 64. 5’6” BMI %ile 95th %ile 85th %ile OB OW NW Built Environment (Review) Walkability& Access to Recreation = Activity (Ding et al., 2011) Cochrane Review of 55 Obesity prevention efforts Teens BMI change not significant in teenagers 6-12 yo BMI change by 0.15 kg/mg2, significant 0-5 yo BMI change by 0.26 kg/mg2, significant (Waters et al., 2011) Meta-Analyses (Children)
- 65. 6-12 yo Intervention and Average BMI Change OB OW NW OB OW NW OB OW NW -0.3 -0.25 -0.2 -0.15 -0.1 -0.05 0 0-5 yrs 6-12 yrs 13-18 yrs Weight Change After Intervention by Age (in kg/m2) ns
- 66. 20% 16% 90% Danielsson et al., 2012 (0.5 SD BMI) Intervention and % Success of clinically significant weight loss Kraschnewskiet al., 2010
- 68. lebeauleblog.wordpress.com Bvwellness.com Friendlyhouseinc.org Obese 15 yo girl who is otherwise healthy Normal weight 35 yo mother wanting to lose “baby weight” Obese 55 yo man with Metabolic Syndrome Behavior CVD Risk Behavior Behavior Less Wt Gain True Change
- 69. High RiskBorderlineThinnest Weight Successful Interventions Moldable Habits
- 70. High RiskBorderlineThinnest Weight Successful Interventions Moldable Habits
- 71. High RiskBorderlineThinnest Weight Successful Interventions Moldable Habits
- 72. Moldable Habits birth 10 20+5 15 Age: MOLTEN MOMENT Prevention of Obesity High Risk Successful Interventions Thinnest Weight
- 73. birth 10 20+5 15 Age: Define The Molten Moment MOLTEN MOMENT Prevention of Obesity Strike now. The iron is hot.
- 74. Summary 20+birth 105 15Age: MOLTON MOMENT Intervention = Prevention of OB Behavior Change Possible Can Improve Outcomes
- 75. Summary Molten Moment 1) Story of Fat Cells • Not too Big = MetS • Not too small = Hunger • Just Right via Prevention 2) Metabolic Risk can be Reduced 3) The MOLTEN MOMENT for obesity is in preschool & sooner.
- 76. Part 2: The Big 5 The 5 Behaviors that protect your fat cells
- 77. Eat Five Times a Day Recommendations: Do not skip Breakfast (Skipping Meals in General)= BMI Eat 5x a day (3 meals, 2 snacks) Eat Family Meals at Home 5x a week
- 78. Television Recommendations: 1) Watch TV ≤ 2 hrs/day 2) Those under age 2 should not watch TV 3) Remove TV from where children sleep
- 79. Physical Activity Recommendations: 1 hour of physical activity or active play accumulated throughout the day.
- 81. Sweetened Beverages Each Serving of Sugar-Sweetened Beverages per day is associated with an increase in BMI (Forshee, Anderson,Storey, 2008) Meta-analysis Recommendations: No zero zilch sweetened beverages and ≤ 4 oz of 100% Fruit Juice per day
- 82. Half a Plate
- 83. 7 “ plate for children
- 84. How to Assess 1: What do you do after school? Do you live in a safe neighborhood? 2: How often is the TV on? What are your favorite shows? Is there a TV in the bedroom? 0: What do you drink? 1/2: Is half of everything you eat a fruit or a vegetable? 5: Describe what you eat on a regular day? Questionnaires like REAP & WAVE
- 85. Part 2: The Big 5 SUMMARY: You can’t kill a fat cell After 8 is too late. 5, 2, 1, 0… And half a plate. Part 1: Molten Moment
- 86. THANK YOU! Questions, Comments? Hatemail? Contact me: tflood131@gmail.com
Editor's Notes
- As more about preschooler’s parent not realizing it is a problemThe effect of one person in the family adopting a healthy lifestyle even if no weight change, it affects others.
- http://www.cdc.gov/obesity/childhood/data.html64% are OW/OB adults 2001, CDC BRFSS)31% of 2-3 yo are OW or OB (2011, CDC Peds Nutrition Surveillance Syst)(25% of high shool students are OW/OB (2011, CDC YRBSS)
- Describe the incidence and prevalence of overweight and obesity from birth through adulthoodOgdenFlegal Carol 2012 etc.
- Exercise alone Exercise behavior can be maintained in obese participants following intervention (Gourlan et al, 2011) Aerobic Exercise program x 1 year = 1.7 kg (Thorogood et al, 2011) Aerobic Exercise better than resistance training for visceral fat (Ismail et al, 2012)Diet alone Diet intervention = 2.2 ±6.2 kg at 36 mo F/U (Franzet al., 2007) Sustained weight loss after 3 years (Avenell et al., 2004)Diet + Exercise is better than Diet alone 1.1 kg more weight reduction vs. Diet alone (Shaw et al., 2009) 0.4 kg/m2 more BMI reduction vs. Diet alone (Shaw et al., 2009)Primary Care Setting Best results with Doctor & Dietician = 6 kg (Flodgren, et al 2010)Built environment (Review) Good evidence for affecting physical activity (Durand et al 2011) Less evidence for affecting BMI (Durand et al 2011)
- Exercise alone Exercise behavior can be maintained in obese participants following intervention (Gourlan et al, 2011) Aerobic Exercise program x 1 year = 1.7 kg (Thorogood et al, 2011) Aerobic Exercise better than resistance training for visceral fat (Ismail et al, 2012)Diet alone Diet intervention = 2.2 ±6.2 kg at 36 mo F/U (Franzet al., 2007) Sustained weight loss after 3 years (Avenell et al., 2004)Diet + Exercise is better than Diet alone 1.1 kg more weight reduction vs. Diet alone (Shaw et al., 2009) 0.4 kg/m2 more BMI reduction vs. Diet alone (Shaw et al., 2009)Primary Care Setting Best results with Doctor & Dietician = 6 kg (Flodgren, et al 2010)Built environment (Review) Good evidence for affecting physical activity (Durand et al 2011) Less evidence for affecting BMI (Durand et al 2011)
- Exercise alone Exercise behavior can be maintained in obese participants following intervention (Gourlan et al, 2011) Aerobic Exercise program x 1 year = 1.7 kg (Thorogood et al, 2011) Aerobic Exercise better than resistance training for visceral fat (Ismail et al, 2012)Diet alone Diet intervention = 2.2 ±6.2 kg at 36 mo F/U (Franzet al., 2007) Sustained weight loss after 3 years (Avenell et al., 2004)Diet + Exercise is better than Diet alone 1.1 kg more weight reduction vs. Diet alone (Shaw et al., 2009) 0.4 kg/m2 more BMI reduction vs. Diet alone (Shaw et al., 2009)Primary Care Setting Best results with Doctor & Dietician = 6 kg (Flodgren, et al 2010)Built environment (Review) Good evidence for affecting physical activity (Durand et al 2011) Less evidence for affecting BMI (Durand et al 2011)
- Adults (OW or OB)Data from Kraschnewski et al., 2010 Clinically meaningful weight loss = 10% or more in about 15% to 17% of those aged 20-64%
- Martins, Robertson, Morgan 2008
- Oren and colleagues (2003) found that subjects who remained in upper BMI distribution from adolescence to young adulthood had higher carotid intima-media thickness (CIMT) than those who had lost weight over time. Those experiencing weight loss had CIMT values comparable to those with constantly low BMI (Oren et al., 2003). Longitudinal (19 mo) FU of 186 obese adolescents. Subjects who decreased BMI-z score decreased fasting & 2-hr glucose, and TG, and increased HDL versus those who increased their BMI z score (Weiss R, Shaw M, Savoye M, Caprio S, 2009) Adolescents (16-17 y/o) with BMI >=85th-<95th% (62% of males, 92% females became obese) BMI >=95%ile 80% males, 92% females became obese at 37/39 y/o. National Longitudinal Study of Youth 1979. (Wang, Chyen, Lee, Lowry, 2008) Tracking of BMI from adolescence (mean age 15 y/o) to adulthood is high, but changes in LTPA also predict the risk of adult OW independent of adolescent BMI (BMI >=25). Oslo Youth Study (Kvaavik, Tell, Klepp, 2003).
- Oren and colleagues (2003) found that subjects who remained in upper BMI distribution from adolescence to young adulthood had higher carotid intima-media thickness (CIMT) than those who had lost weight over time. Those experiencing weight loss had CIMT values comparable to those with constantly low BMI (Oren et al., 2003). Longitudinal (19 mo) FU of 186 obese adolescents. Subjects who decreased BMI-z score decreased fasting & 2-hr glucose, and TG, and increased HDL versus those who increased their BMI z score (Weiss R, Shaw M, Savoye M, Caprio S, 2009) Adolescents (16-17 y/o) with BMI >=85th-<95th% (62% of males, 92% females became obese) BMI >=95%ile 80% males, 92% females became obese at 37/39 y/o. National Longitudinal Study of Youth 1979. (Wang, Chyen, Lee, Lowry, 2008) Tracking of BMI from adolescence (mean age 15 y/o) to adulthood is high, but changes in LTPA also predict the risk of adult OW independent of adolescent BMI (BMI >=25). Oslo Youth Study (Kvaavik, Tell, Klepp, 2003).
- Trajectory above the 75th percentile Ventura, Loken, & Birch (2009) BMI child CIMT adult. Further adjustment for adult cardiovascular risk factors did not change the relationship (linear regression coefficient=2.1 microm/s.d.; 95% CI: 1.0; 3.1) between adult (28 yo) CIMT and adolescent BMI. Adjustment for adult BMI attenuated the association (linear regression coefficient=0.9 microm/s.d.; 95% CI: -0.3; 2.2) as the majority of overweight and obese adolescents remained overweight or became obese young adults. (Oren et al., 2003). Elevated BMI in boys as early as 8 and girls as early as 13 is significantly associated with developing metabolic syndrome at >or=30 years. OR 14-18 y/o males 1.8 (1.3, 2.5 95% CI) and females 2.8 (1.9 to 4 95% CI). However, “elevated” BMI is along the 75th%ile of boys’ 12-17 CDC chart and girls 13-17 60th percentile…. much much lower than the Expert Committee cutoffs. (Sun, Liang, Huang, Daniels, et al 2008)Denmark: Childhood BMI (7-13 y/o boys, 10-13 y/o girls) is associated with adult CHD (a fatal or nonfatal event) (adult >=25 y/o). As BMI increased, the risk increased. Each 1 unit increase in BMI (5.6 kg (12.3 lbs) boys, 6.3 kg (13.9 lbs) girls) increased the risk for fatal cardiac events with a hazards ratio adjustede for bw, in 13 y/o boys (HR 1.24) and girls (HR 1.23) (Baker, Olsen, Sørensen, 2007). BMI at 13 y/o predicts cholesterol and glucose resistance in adulthood (Steinberger, Moran, Hong 2001) ‘Overweight’ in adolescents (13-18 y/o) predicts CHD morbidity in men and women (Must, Jacques, Dallal, Bajema, Dietz,1992). Harvard Longitudinal Study. 1922-1935 to 1988. Overweight=”75th percentile in subjects of the same age and sex in a large national survey” ‘Overweight; in adolescents (13-18 y/o) predicts mortality in men (not women): RR of 1.8 for all-cause mortality and 2.3 RR for CHD mortality. (Must, Jacques, Dallal, Bajema, Dietz, 1992). Harvard Longitudinal Study. 1922-1935 to 1988. Overweight=”75th percentile in subjects of the same age and sex in a large national survey” Norway: 227,003 14-19 y/o followed for 31.5 years. Increased risk of mortality became apparent after the age of 30. (Engeland, Bjorge, Sogaard, Tverdal 2003) - Mortality in males (vs. 25th-75%iles CDC charts): -85-95% 30% increased risk ->95% 80% increased risk - Mortality in females -85-95% 30% increased risk ->95% 100% increased risk White-black cohort of Bogalusa Heart Study 13-17 y/oSrinivasan SR, Bao W, Wattigney WA, Berenson GS. Teenage OW (BMI>=75%ile (as compared to 25-50th%ile)) increases risk of adulthood(27 to 31 y/o): - Hypertension: Prevalence increased 8.5-fold - Dislipidemia: Prevalence increased 3.1 to 8.3-fold
- Comprehensive (Whitlock, et al 2010) if all: (1) counseling for weight loss or healthy diet; (2) counseling for PA or a PA program; and (3) instruction in and support for sustaining
- Comprehensive (Whitlock, et al 2010) if all: (1) counseling for weight loss or healthy diet; (2) counseling for PA or a PA program; and (3) instruction in and support for sustaining
- Comprehensive (Whitlock, et al 2010) if all: (1) counseling for weight loss or healthy diet; (2) counseling for PA or a PA program; and (3) instruction in and support for sustaining
- BMI child CIMT adult. Further adjustment for adult cardiovascular risk factors did not change the relationship (linear regression coefficient=2.1 microm/s.d.; 95% CI: 1.0; 3.1) between adult (28 yo) CIMT and adolescent BMI. Adjustment for adult BMI attenuated the association (linear regression coefficient=0.9 microm/s.d.; 95% CI: -0.3; 2.2) as the majority of overweight and obese adolescents remained overweight or became obese young adults. (Oren et al., 2003). Elevated BMI in boys as early as 8 and girls as early as 13 is significantly associated with developing metabolic syndrome at >or=30 years. OR 14-18 y/o males 1.8 (1.3, 2.5 95% CI) and females 2.8 (1.9 to 4 95% CI). However, “elevated” BMI is along the 75th%ile of boys’ 12-17 CDC chart and girls 13-17 60th percentile…. much much lower than the Expert Committee cutoffs. (Sun, Liang, Huang, Daniels, et al 2008)Denmark: Childhood BMI (7-13 y/o boys, 10-13 y/o girls) is associated with adult CHD (a fatal or nonfatal event) (adult >=25 y/o). As BMI increased, the risk increased. Each 1 unit increase in BMI (5.6 kg (12.3 lbs) boys, 6.3 kg (13.9 lbs) girls) increased the risk for fatal cardiac events with a hazards ratio adjustede for bw, in 13 y/o boys (HR 1.24) and girls (HR 1.23) (Baker, Olsen, Sørensen, 2007). BMI at 13 y/o predicts cholesterol and glucose resistance in adulthood (Steinberger, Moran, Hong 2001) ‘Overweight’ in adolescents (13-18 y/o) predicts CHD morbidity in men and women (Must, Jacques, Dallal, Bajema, Dietz,1992). Harvard Longitudinal Study. 1922-1935 to 1988. Overweight=”75th percentile in subjects of the same age and sex in a large national survey” ‘Overweight; in adolescents (13-18 y/o) predicts mortality in men (not women): RR of 1.8 for all-cause mortality and 2.3 RR for CHD mortality. (Must, Jacques, Dallal, Bajema, Dietz, 1992). Harvard Longitudinal Study. 1922-1935 to 1988. Overweight=”75th percentile in subjects of the same age and sex in a large national survey” Norway: 227,003 14-19 y/o followed for 31.5 years. Increased risk of mortality became apparent after the age of 30. (Engeland, Bjorge, Sogaard, Tverdal 2003) - Mortality in males (vs. 25th-75%iles CDC charts): -85-95% 30% increased risk ->95% 80% increased risk - Mortality in females -85-95% 30% increased risk ->95% 100% increased risk White-black cohort of Bogalusa Heart Study 13-17 y/oSrinivasan SR, Bao W, Wattigney WA, Berenson GS. Teenage OW (BMI>=75%ile (as compared to 25-50th%ile)) increases risk of adulthood(27 to 31 y/o): - Hypertension: Prevalence increased 8.5-fold - Dislipidemia: Prevalence increased 3.1 to 8.3-fold
- BMI child CIMT adult. Further adjustment for adult cardiovascular risk factors did not change the relationship (linear regression coefficient=2.1 microm/s.d.; 95% CI: 1.0; 3.1) between adult (28 yo) CIMT and adolescent BMI. Adjustment for adult BMI attenuated the association (linear regression coefficient=0.9 microm/s.d.; 95% CI: -0.3; 2.2) as the majority of overweight and obese adolescents remained overweight or became obese young adults. (Oren et al., 2003). Elevated BMI in boys as early as 8 and girls as early as 13 is significantly associated with developing metabolic syndrome at >or=30 years. OR 14-18 y/o males 1.8 (1.3, 2.5 95% CI) and females 2.8 (1.9 to 4 95% CI). However, “elevated” BMI is along the 75th%ile of boys’ 12-17 CDC chart and girls 13-17 60th percentile…. much much lower than the Expert Committee cutoffs. (Sun, Liang, Huang, Daniels, et al 2008)Denmark: Childhood BMI (7-13 y/o boys, 10-13 y/o girls) is associated with adult CHD (a fatal or nonfatal event) (adult >=25 y/o). As BMI increased, the risk increased. Each 1 unit increase in BMI (5.6 kg (12.3 lbs) boys, 6.3 kg (13.9 lbs) girls) increased the risk for fatal cardiac events with a hazards ratio adjustede for bw, in 13 y/o boys (HR 1.24) and girls (HR 1.23) (Baker, Olsen, Sørensen, 2007). BMI at 13 y/o predicts cholesterol and glucose resistance in adulthood (Steinberger, Moran, Hong 2001) ‘Overweight’ in adolescents (13-18 y/o) predicts CHD morbidity in men and women (Must, Jacques, Dallal, Bajema, Dietz,1992). Harvard Longitudinal Study. 1922-1935 to 1988. Overweight=”75th percentile in subjects of the same age and sex in a large national survey” ‘Overweight; in adolescents (13-18 y/o) predicts mortality in men (not women): RR of 1.8 for all-cause mortality and 2.3 RR for CHD mortality. (Must, Jacques, Dallal, Bajema, Dietz, 1992). Harvard Longitudinal Study. 1922-1935 to 1988. Overweight=”75th percentile in subjects of the same age and sex in a large national survey” Norway: 227,003 14-19 y/o followed for 31.5 years. Increased risk of mortality became apparent after the age of 30. (Engeland, Bjorge, Sogaard, Tverdal 2003) - Mortality in males (vs. 25th-75%iles CDC charts): -85-95% 30% increased risk ->95% 80% increased risk - Mortality in females -85-95% 30% increased risk ->95% 100% increased risk White-black cohort of Bogalusa Heart Study 13-17 y/oSrinivasan SR, Bao W, Wattigney WA, Berenson GS. Teenage OW (BMI>=75%ile (as compared to 25-50th%ile)) increases risk of adulthood(27 to 31 y/o): - Hypertension: Prevalence increased 8.5-fold - Dislipidemia: Prevalence increased 3.1 to 8.3-fold
- Children (OB) (Danielsson, 2012)age prental, <1, and 1-5 derived from Danielsson 6 yo data6-9 44% had clinically significant treatment10-13 yo 20% had clinically significant14-16 yo had 8%Clinically meaningful = 0.5 SD of BMI change
- Educational Setting Interventions that work: Increase PA, Improve nutritional quality of food,Change culture, support teachers al quality of foodReview of built environment and PA 3-18 yearsThe most supported correlates for children’s reported PA were walkability, traffic speed/volume, access/proximity to recreation facilities, land-use mix, and residential density. The most supported correlates for reported PA (not objective PA)adolescents were land-use mix (closely associated with objective measures) residential density (increase in density, increases PA)(Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE, 2011)
- Cochrane review: 0-5 y/oBMI by 0.26 kg/mg2, significant6-12 y/oBMI by 0.15 kg/mg2, significant13-18 y/oBMI by 0.09 kg/mg2, nsReview of built environment and PA 3-18 yearsThe most supported correlates for children’s reported PA were walkability, traffic speed/volume, access/proximity to recreation facilities, land-use mix, and residential density. The most supported correlates for reported PA (not objective PA)adolescents were land-use mix (closely associated with objective measures) residential density (increase in density, increases PA)(Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE, 2011)
- (Waters, et al., 2011).Cochrane review of 55 studies. Meta-analysis on 37 studies, 27,946 childrenMost studies 6-12.
- Children (OB) (Danielsson, 2012)age Danielsson 6 yo data 90% had clinically sign weight loss6-9 44% had clinically significant treatment10-13 yo 20% had clinically significant14-16 yo had 8%Clinically meaningful = 0.5 SD of BMI changeAdults (OW or OB)Data from Kraschnewski et al., 2010 Clinically meaningful weight loss = 10% or moreData for 85+ derived from Kraschnewski dataData for prenatal derived from 20-34 yo
- Lets stick to the younger children
- Int J Behav Nutr Phys Act. 2011 Sep 21;8:98.Systematic review of sedentary behaviour and health indicators in school-aged children and youth.Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, Goldfield G, Gorber SC.
- How soon is too soon?Not soon enough. Laboratory tests over the last last few years have proven that babies who start drinking soda during that early formative period have a much higher chance of gaining… acceptance and “fitting in: during those awkward pre-teen and teen years. So, do yourself a favor, do your child a favor. Start them on a strict regimen of sodas and other sugary carbonated beverages right now, for a lifetime of guaranteed happiness.--Promotes active lifestyle--Boosts Personality--Gives body essential sugars
- How soon is too soon?Not soon enough. Laboratory tests over the last last few years have proven that babies who start drinking soda during that early formative period have a much higher chance of gaining… acceptance and “fitting in: during those awkward pre-teen and teen years. So, do yourself a favor, do your child a favor. Start them on a strict regimen of sodas and other sugary carbonated beverages right now, for a lifetime of guaranteed happiness.--Promotes active lifestyle--Boosts Personality--Gives body essential sugars
- Am J Clin Nutr. 2008 Jun;87(6):1662-71.Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis.Forshee RA, Anderson PA, Storey ML.
- Am J Clin Nutr. 2008 Jun;87(6):1662-71.Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis.Forshee RA, Anderson PA, Storey ML.