5-2-1-Almost None Let’s Make Delaware’s Kids the Healthiest in the Nation

5-2-1-Almost NoneLet’s Make Delaware’s Kids the Healthiest in the Nation

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

No Data <10% 10%–14% 15%–19%

No Data <10% 10%–14% 15%–19% ≥20%

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

2007 State Obesity Rates

State % State % State % State %

(1) Colorado 18.7 (14) New Mexico 24.0 (27) Minnesota 25.6 (40) Michigan 27.7

(2) Connecticut 21.2 (15) Nevada 24.1 (28) Nebraska 26.0 (41) North Carolina 28.0

(3) Massachusetts 21.3 (16) Virginia 24.3 (29) South Dakota 26.2 (42) Oklahoma 28.1

(4) Vermont 21.3 (17) New Hampshire

24.4 (30) North Dakota 26.5 (43) Texas 27.1

(5) Hawaii 21.4 (18) Idaho 24.5 (31) Indiana 26.8 (44) Georgia 28.2

(6) Rhode Island 21.4 (19) Wisconsin 24.7 (32) Iowa 26.9 (45) South Carolina 28.4

(7) Washington DC 21.8 (20) Maine 24.8 (33) Kansas 26.9 (46) Arkansas 28.7

(8) Montana 21.8 (21) Illinois 24.9 (34) Pennsylvania 27.1 (47) West Virginia 29.5

(9) Utah 21.8 (22) New York 25.0 (35) Delaware 27.4 (48) Louisiana 29.8

(10) California 22.6 (23) Washington 25.3 (36) Kentucky 27.4 (49) Tennessee 30.1

(11) New Jersey 23.5 (24) Arizona 25.4 (37) Alaska 27.5 (50) Alabama 30.3

(12) Florida 23.6 (25) Maryland 25.4 (38) Missouri 27.5 (51) Mississippi 32.0

(13) Wyoming 23.7 (26) Oregon 25.5 (39) Ohio 27.5

2007 State Obesity Prevalence and State Rankings

Body Mass Index (BMI) = weight(kg)/height (m)2

www.kidshealth.org

What is BMI?

A calculation that estimates how much body fat a person has based on his or her weight and height. The BMI formula uses height and weight measurements to calculate a BMI number.

http://www.cdc.gov/nccdphp/dnpa/bmi/

Trends of Obesity* in Children and Adolescents

*BMI > 95th Percentile

Data Source: CDC NCHS

1517 17 18

101214161820

1963-70 NHES II,III

1971-74NHANES I

1976-80NHANES II

1988-94NHANES

1999-00NHANES

2001-02NHANES

2003-04NHANES

2005-06NHANES

Age 6 to 11Age 12 to 19

Healthy Weight(BMI 5th to <85th Percentile)

(BMI > 95th Percentile)

Data Source: Nemours Delaware Survey for Children’s Health, 2006; Note: Data are not adjusted for demographics or co-morbid conditions.

Healthy Weight(BMI 5th to <85th Percentile)

Underweight

(BMI < 5th Percentile)

Overweight(BMI 85th – 94th

Percentile)

Obese(BMI > 95th Percentile)

Percentage of Delaware Children and Youth Ages 2-17 by Weight Status

More than one-third of Delaware children and youth are overweight or obese

Body Mass Index (BMI) = weight(kg)/height (m)2

www.kidshealth.org

What is BMI?

A calculation that estimates how much body fat a person has based on his or her weight and height. The BMI formula uses height and weight measurements to calculate a BMI number.

What is obesity and overweight?

• Adults– Overweight = BMI at 25.0 – 29.9

– Obesity = BMI at 30.0 or above

• Children: BMI is age and gender specific, so BMI-for-age is the measure used

– Overweight = heavier than 85% of children

– Obesity = heavier than 95% of children

(using growth charts)

• BMI is a good screening tool but it has limitations

• Discrimination

• Persistence into adulthood

• Abnormal cholesterol

• High Blood Pressure

• Type 2 diabetes

• Liver and Gallbladder Disease

• Depression

Consequences of childhood and adolescent obesity

• Anxiety

• Asthma

• Sleep problems

• Earlier maturation

• Reproductive problems

• Bone complications

Quality of Life

Schwimmer et al. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813-1819.

• Severely overweight children and adolescents are 5x more likely than healthy weight children to report a low quality of life.

• This risk is similar to children diagnosed with cancer

Adapted with permission from NICHQ

Economic Burden• “Obesity-related health expenditures are

estimated to have accounted for more than 25% of the growth of health care spending between 1987-2001” -Health Affairs

(2004)

• “In 2003, an estimated $207 million was spent for health-related expenditures due to obesity in Delaware -Finkelstein (2004)

Adapted with permission from NICHQ

• More calories eaten

• Less physical activity

• More inactivity

What are the causes of obesity?

The New Social Norm?

Sugar and fat: cheap and abundant

Food environment

Vending Machines

Fast Food

Food marketing to children

Determinants of weight

Energy INTAKE

Energy OUTPUT

INTAKE

OUTPUT

INTAKE

OUTPUT

What do we know?

• No single culprit

• No magic bullet

• MODERATION—such a boring word!

• There are some things we can do…

Children could reduce their risk of preventable disease if:

They consumed 5 or more servings of fruits and vegetables each day.

They reduced screen time to fewer than 2 hours each day.

They engaged in a total of at least 1 hour of physical activity each day.

They limited drinks with added sugars, specifically soft drinks, non-100% fruit drinks and sports drinks.

5-2-1-Almost None

5 or more servings of fruits and vegetables per day

What’s a serving?

• Fruit: 1 medium whole fruit, ½ cup of cut fruit, ½ cup 100% juice or ¼ cup of dried fruit

• Vegetable: 1 cup of leafy vegetables, ½ cup of raw or cooked vegetables or 100% juice

• Fresh, frozen or canned?

• It is important to eat a variety of colors

Fruits and vegetables:

• May help your stomach feel full.• May decrease the chance of becoming

overweight• Decrease chance of chronic disease:

– Cancer– Heart Disease

Dietary Guidelines for Americans, 2005; Rolls, 2004.

Nationwide, only 21.4% of teens eat 5 fruits and vegetables a day.

Source: Youth Risk Behavior Surveillance System, 2007.

• Fruit and vegetable intake in infants and toddlers

does not meet national nutrition recommendations.

• French fries are one of three most common vegetables fed to infants 9-11 months.

• By 15-18 months, French fries become the most common vegetable consumed.

Poor dietary patterns are beginning at early stages.

Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers study: what foods are infants and toddlers eating? J Am Diet Assoc. 2004;104:S22-S30.

2 hours or less of screen time per day

Overweight by Hours of TV per Day:

0-1 1-2 2-3 3-4 4-5 5+

Dietz WH, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics. 1985;75:807-812.

• Increased snacking and consumption of high caloric foods

• Increased exposure to food and beverage advertising

• Displacement of physical activity

Screen Time and Obesity

Dietz, 1985; Gortmaker, 1996; Robinson, 2001.

• 28% played video games, computer games, or used a computer for 3 or more hours a day

• 39% watched television for 3 or more hours a day

Sedentary Behaviors of Delaware Youth (2007)

Youth Risk Behavior Surveillance Survey (2007).

• Violent and aggressive behavior

• Substance use• Sexual activity• Body image• Academic performance

TV Can Have Negative Affects On:

American Academy of Pediatrics. Children, adolescents, and television. Pediatrics. 2001;107:423-426.

1 or more hours of physical activity per day

• Any movement that uses energy

• Wide range of physical activities including:

– Household: cleaning, raking leaves

– Transportation: walking or biking to work

– Occupational: lifting boxes

– Leisure time: team sports,

exercise classes, walking, biking

What is physical activity?

• Helps control weight and build muscle

• Helps prevent chronic disease: heart disease, diabetes

• Reduces feelings of depression and anxiety

• Helps build and maintain healthy bones

• Leads to being more physically active as an adult

• May help kids perform better in school

• May help kids make better health and lifestyle choices

Benefits of physical activity

• In 2007,

– 60% did not meet the recommended levels of physical

activity (at least 60 minutes per day on 5 or more days a week)

– 43% attended PE classes, while only 28% attended on

a regular basis

Delaware Youth

Youth Risk Behavior Surveillance Survey (2007).

65% of kids who live within 1 mile of school are driven to school

• •

Almost no sugary beverages

• Drinks with added sugars– Regular soft drinks, fruit drinks, sweetened

teas, and sports drinks.

• Contribute to childhood obesity because they are high in sugar and calories

• Displace more nutritious drinks that children need to grow, like low-fat milk

• Contribute to dental cavities

Sugary Beverages

Beverage Intake Among Adolescents Aged 11-18, 1965-1996

SOURCE: Cavadini C et al. Arch Dis Child 2000;83:18-24 (based on USDA surveys)

1965 1977 1989 1996

Boys Girls

(Soft drinks, diet soft drinks, and fruit drinks)

Source: Cavadini C et al. Arch Dis Child 2000;83:18-24 (based on USDA surveys)

National Health and Nutrition Examination Survey, 1988-94.

Beverage Intake Among Americans

For children 12-24 months, the top 3 sources of total energy were reported to be:

– Milk – 100% juice – Sugar Sweetened Beverages

Poor dietary patterns are beginning at early stages

Source: Fox, MK, Reidy K, Novak T, Ziegler P. Sources of energy and nutrients in the diets of infants and toddlers. J Am Diet Assoc. 2006;106:1992-2000.

Excessive juice intake in children may be associated with:

– Obesity or persistence of obesity in childhood

– Dental cavities

Why limit juice?

Welsh, 2005; Konig, 1995

5-2-1-Almost None

5-2-1-Almost None Let’s Make Delaware’s Kids the Healthiest in the Nation

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