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Tackling the Childhood Obesity Problem -
Adults as Role Models
Tackling the Childhood Obesity Problem -
Adults as Role Models
Claudia Raya, RDMassachusetts
Department of Education, Nutrition Programs
and Services
Obesity Trends* Among U.S. AdultsBRFSS, 1989
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
No Data <10% 10%-14% 15-19% 20%
Are we facing a problem with
overweight and obesity in the United States?
4%
7%
11%
13%
15%
5% 5% 5%
11%
14%
16%
4%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1963-70 1971-74 1976-80 1988-94 1999 2000
Prevalence of overweight among children and adolescents ages 6-
19 years
Notes: Excludes pregnant women starting from 1971-1974. Pregnancy status not available for 1963-65 and 1966-70. Data for 1963-65 are for children 6-11 years of age; data for 1966-70 are for adolescents 12-17 years of age, not 12-19. Source: CDCNHCS, NHES, NHANES.
Age in Years6-11 12-19
Contributing factors to obesity crisis in U.S.
• Environment
• Genetics– metabolism, predisposition
• Diet/Nutrition Intake
• Physical Activity
• Cultural/Psychological
• Toxic Food Environment
Shifts in Food Practices in the United
States• Use of the microwave• Fast food consumption• Consumption of soft drinks -
increased from 27 to 44 gal/y from 1972-92
• 30,000 products in supermarkets (doubled since 1981)
• 12,000 new food products/year (doubled since 1986)
Contributing Environmental Factors
•Environment of “Ease”– cars– decrease in safe walking
paths/sidewalks– drive thru society– remote control– internet/TV
Hypothesized Impact of Television Viewing on
Obesity
ObesityTelevisionViewing
DietaryIntake
Inactivity
Prevalence of Obesity by Hours of TV perDay; NHES Youth Aged 12-17 in 1967-70 and
NLSY Youth Aged 10-15 in 1990
05
10152025
303540
0-1 1-2 2-3 3-4 4-5 5 or more
TV Hours Per Day (Youth Report)
Prevalence (%)
NHES 1967-70
NLSY 1990
Dietz WH, Gortmaker SL. Do we fatten our children at the tv set? Obesity and television viewing in children and adolescents. Pediatrics, 1985; 75:807-812.Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Archives of Pediatrics and Adolescent Medicine, 1996;150:356-362.
Consequences of overweight / obesity
crisis in U.S.• Overweight
children will grow into overweight adults
• Medical conditions– chronic
diseases– mental disease
Evaluation Checklist
Adult Risk of Associated Disease According to
BMI
• 25.0 - 29.9 = Overweight
• 30.0 - 34.9 = Obese, High
• 35.0 - 39.9 = Obese, Very High Very High
• 40 or greater= Extremely Obese
Children Risk of Associated Disease According to BMI
BMI-for age at or above the 95th percentile of CDC Growth Charts
BMI for age > 95th = Overweight
BMI for age > 85th and > 95th = At Risk of Overweight
http://www.cdc.gov/nccdphp/dnpa/growthcharts/00binaries/growthchart.pdf
What Do the Numbers Mean?
• Risk of Associated Disease According to BMI and Waist Size
• Risk of death increases as BMI over 30 increases
• Obese adults have a 50 - 100 % increased risk of premature death
• If classified as overweight, losing 5- 10 % of current body weight and keeping it off can begin to alleviate symptoms associated with chronic diseases ( i.e. high blood pressure) and lower risk of developing chronic diseases
Surgeon General asks Communities to Address Obesity, healthlink.mcw.edu/article
Health Implications of Overweight and
Obesity• Increases Risk for
Developing Chronic Diseases– Diabetes– Heart Disease (CVD)– Stroke– High Blood Pressure – Gall bladder disease– Some types of Cancer– Osteoarthritis– Sleep apnea/other
breathing problems
• High blood cholesterol• Complications of
pregnancy• Menstrual
irregularities• Psychological
disorders• Increased surgical risk
Health Care Costs for Overweight/Obese
Children?• Adult diseases are showing up in children
• States and your taxes are paying for their healthcare?– 4 million obese children are recipients of Medicare
Economic Consequences of Overweight and Obesity
• Workplace– absenteeism– lost of
productivity– depression – anxiety– higher healthcare
premiums
• US Govt.,States and YOU are paying for healthcare costs– Total cost as of 1995: $99.2
billionhttp://www.niddk.nih.gov.health.nutrit/pubs/
statobes.htm
Children 6-17 y.o.• 1979-81 $35 million
• 1997-99 $127 million
300 % increase in costs over 20 years.
Wang G and Dietz WH, Pediatrics, 2002, 109 (5)
What Can I Do?
• Look at you own programs• What does your food resemble?
– Are you serving USDA fast food– Is it enough to meet USDA recommended
guidelines?– Evaluate your menu
Surgeon General asks Communities to Address Obesity,healthlink.mcw.edu/article
What Can I Do?
• Look around lunch room?• Do you have vending machines a la carte
sales?– Are they in direct competition with school
meals program?
• Promotions & Fund raisers with food?• What are your school communities’ eating
habits?• Surgeon General asks Communities to Address
Obesity,healthlink.mcw.edu/article
What Can I Do?
• Survey the students, parents, teachers• Invite parents to come eat with kids• Team-up with teachers to encourage
healthy eating and PA• Start exercise program at school• Change perception of obesity to focus
on improved long-term health
Surgeon General asks Communities to Address Obesity ,healthlink.mcw.edu/article
References and Resources
• SHPPS, 2000. Department of Health and Human Services, Center for Disease Control and Prevention. http://www.cdc.gov/shpps.
• Flegal K; Carroll MD; Ogden CL; et al.
Prevalence and Trends in Obesity Among US Adults, 1999-2000. JAMA 2002;288:1723-1727
• The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity
• http://www.doe.mass.edu/cnp• http://www.fns.usda.gov/cnd/Default.htm• http://www.fns.usda.gov/cnd/PowerPanther/
power.panther.htm
Fighting Obesity
with our Forks and our Feet…
Bite by Bite and Step by
Step
Fighting Obesity
with our Forks and our Feet…
Bite by Bite and Step by
Step
Erin Coffield, RD, LDN
Alarming Trends
• Diets are falling short of the mark
• Desirable physical activity levels arenot being met
• Obesity rates are skyrocketing
• Adult diseases are showing up inchildren
Actual Causes of Death in the United States, 1990
Source: McGinnis JM, Foege WH. JAMA 1993;270:2207-12.
400,000
300,000
100,000 90,000
30,000 20,000
0
100,000
200,000
300,000
400,000
500,000
Tobacco Diet/Activity Alcohol Microbialagents
Sexualbehavior
Illicit use ofdrugs
Percent of children, aged 5-10, with 1 or more adverse CVD risk factor levels:
27.1%27.1%
Adverse CVD Risk FactorLevels in Children
Source: Freedman DS et al. Pediatrics 1999; 103:1175-82
Percent of overweight children, aged 5-10,with 1 or more adverse CVD risk factor levels:
60.6%60.6%
Challenges in the Diets of U.S. Children
High intakes – energy – total fat– saturated fat– added
sugars
Low intakes – calcium– fiber– fruits– vegetables– dairy– whole
grains
Munoz et al. Pediatrics 1997;100:323-329.
Percent of Children Meeting Recommended Intakes
Actual: All children 2-19 31.6 Percent
Recommended: 6-11 ServingsSource: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.
Recommended: 3-5 Servings
Actual: All Children 2-19
36.4 Percent
Percent of Children Meeting Recommended Intakes
Source: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.
Actual: All Children 2-19
26.0 Percent
Recommended: 2-4 Servings
Percent of Children Meeting Recommended Intakes
Source: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.
Consumption • Present
– 31% of adults (BRFSS 2000)– 13% of high school students (2001 YRBSS) consume 5
or more servings of fruits and vegetables a day
• Future – National goals
• By 2010, 75% meet recommendations– MA 5 A Day Coalition Vision
• All residents meet recommendations
5 A Day in Massachusetts
Recommended: 2-3 Servings
Actual: All Children 2-19
33.2 Percent
Percent of Children Meeting Recommended Intakes
Source: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.
Mean calcium (mg) intakes ofU.S. children
0
200
400
600
800
1000
1200
1400
3-5 years 6-11 years 12-19 years
MalesFemales
USDA CSFII 1994-96, 1998
1997 DRI
Children’s milk consumption and calcium intake
• Only children who consume milk at the noon-time meal meet their calcium requirements
Johnson et al. Child Nutr and Mngt,1998;2:95-100
Children’s beverage consumption patterns
0
50
100
150
200
250
300
350
Soft Drinks Fluid Milk Fruit Juice Fruit Drink
1977-781994-96
Grams
US Department of Agriculture
Recommended: 5-7 Ounces
Actual: All Children 2-19
28.0 Percent
Percent of Children Meeting Recommended Intakes
Source: USDA CSFII, 1989-91, From Munoz et al, Pediatrics 100:323, 1997.
On Average, Adolescents Aged 12-17 Get:
*Soft drinks = carbonated beverages, fruit-flavored and part juice drinks, and sports drinksSource: USDA, Continuing Survey of Food Intake by Individuals, 1994-96
15 teaspoons of sugar per day
11% of their calories
from soft drinks*
Child health consequences of Child health consequences of soft drink consumptionsoft drink consumption
• Consumption of sugar-sweetened beverages is associated with childhood obesity*
• For every additional serving of sugar-sweetened drink consumed, the odds of becoming obese increased by 60 percent
* sugar-sweetened beverages defined as soda, Hawaiian punch, lemonade, Kool-Aid or other sweetened fruit drink, iced tea (not artificially sweetened)
Ludwig et al. The Lancet 2001;357:505-508
Nutritional consequences of soft drink consumption
Soft drink intake is associated with:
– higher energy intakes
– lower intakes of vit C, folate, protein, riboflavin, vitamin A, calcium and phosphorus
Harnack et al. JADA 1999;99:436-441
Mean intake of added sugars by U.S. children
0
5
10
15
20
25
30
35
40
2-5 yrs 6-11 yrs 12-17 girls 12-17 boys
tsp. added sugarsrecommended
Guthrie and Morton JADA 2000;100:43-48.
34%
16%19%
11%
9%
4%4% 3%
Soft DrinksSweets/candySweetened grainsFruit drinksMilk productsCerealsOther beveragesOther
Sources of added sugars in the U.S. diet
Guthrie and Morton, JADA 2000;100:43-48.
How to Eat a Healthy Diet
USDA Food Guide Pyramid
The Pyramid -- UnstackedThe Pyramid -- Unstacked
Food Groups & Key Nutrients Unlock the Pyramid
• Grain iron, fiber• Vegetables vit. A, vit. C, fiber• Fruit vit. A, vit. C, fiber• Meat protein, iron• Dairy protein, calcium
• Fats, Sweets and others
USDA Nutrients
• P rotein• I ron• C vitamin• C alcium• A vitamin
• Fat (<30% total fat)– Saturated fat (<10% saturated fat)
Variety
Moderation
Balance
Portions
It Adds UpConsumed twice a week for 36
weeks in addition to the 1/3 RDA
for calories provided by NSLP
½ cup of oven french fries
1 cup of oven french fries
1½ cup of oven french fries
Potential increase in body weight in one school year
2.3 lbs.
4.5 lbs.
7 lbs.
Do You Know Your Portions?
Who wants to
volunteer???
(Energy In) - (Energy Out)
= loss, balance or gain
* Balance exercise with portions
Popular DietsWho do I believe?
NO FAT
NO CARBS
HIGH PROTEIN
NO SUGAR
LOW FAT
HIGH FAT
CABBAGE SOUP DIET
Seriousness of the Issue
• Adverse health consequences• How quickly is weight lost• Will the weight stay off• Motivation and barriers to
losing/maintaining weight
USDA Nutrition Committee is researching the effectiveness of popular diets:
The AHA has declared “war” on fad diets
Red FlagsRecommendations that promise a quick fix.
Dire warnings of danger from a single product or regimen.
Claims that sound too good to be true.
Simplistic conclusions drawn from a complex study.
Recommendations based on a single study.
*Source: Food and Nutrition Science Alliance (FANSA) comprised of the American Dietetic Association, American Institute of Nutrition, American Society for Clinical Nutrition, and the Institute of Food Technologies.
Red Flags (cont.)Dramatic statements that are refuted by reputable scientific organizations.
Lists of “good” and “bad” foods.
Recommendations made to help sell a product.
Recommendations based on studies published without peer review.
Recommendations from studies that ignore differences among individuals or groups.*Source: Food and Nutrition Science Alliance (FANSA) comprised of the American Dietetic Association, American Institute of Nutrition, American Society for Clinical Nutrition, and the Institute of Food Technologies.
Physical Activity
“Late 20th century urban life is a paradise of energy conservation at the level of the individual. People never need to run, they rarely need to walk, and they can often sit.”
Int J Obes 1996; 20:S1-S8
C 2002 Health Management Resources Corporation, Boston, MA
Percentage of Children Involved in Daily Physical Education Programs
0
10
20
30
40
50
60
70
80
1969 1979 1989 1999
C 2002 Health Management Resources Corporation, Boston, MA
We Can Prevent This From Happening!