1. CHILDHOOD OBESITY SUZETTE M. DECASTRO, MS, RD, LD
NUTRITION COORDINATOR
WEST PALM BEACH HEAD START

2. What is considered obese?
Obesity is defined an excessive accumulation of body fat
Obesity is present when total body weight is more than 25% fat in boys and more than 32% fat in girls.
Childhood Obesity is defined as a weight for height in excess of 120% of the ideal.
Growth Charts BMI( Body Mass Index)
Greater than 95% for infants and children on growth charts

3. CHILDHOOD OBESITY
IS A SERIOUS MEDICAL CONDITION THAT AFFECTS INFANTS, CHILDREN, AND ADOLESCENTS
OBESITY ON THE INCREASE IN THE USA.
5%-25% of children and teenagers in US
VARIES WITH ETHNIC GROUP 5%-7% of Black and white children
12% of Hispanic boys
19% of Hispanic girls (Office of Maternal and Child Health, (1989)

4. CAUSES OF OBESITY
1. FAMILY- genetic predisposition. The risk of becoming obese is greatest among children who have two obese parents.
2. Low- energy EXPENDITURE. Obesity is greater among children and adolescents who frequently watch TV. Only 1/3 of elementary children have daily physical education, and fewer than 1/5 have extracurricular physical activity programs at schools.
3. Heredity- Infants born to overweight mothers have been found to be less active and to gain more weight.

5. Risk Factors
Diet- regular consumption of high calorie foods, such as fast foods, vending machine snacks and baked goods.
Inactivity.- Sedentary kids are more likely to gain weight because they don’t burn calorie through physical activity.
Genetics- If your child comes from a family of overweight people, the child may be genetically predisposed to put on excess weight, where high- calorie food is always available.

6. Risk Factors continued
Psychological factors. – Some children overeat to cope with problems or deal with emotions, such as stress or boredom.
Family factors- Parents are responsible for putting healthy foods in the kitchen at home and leaving unhealthy foods in the store. Parents need to control access to unhealthy foods.
Socio- economic factors- Children from low income backgrounds are at greater risk of becoming obese. Poverty and obesity go hand in hand .

7. When to seek medical advice
Not all children carrying extra pounds are overweight or obese. Some children have larger than average body frames.
If as a parent you are worried then talk to your doctor or health care provider. He or she can provide a complete weight assessment, your family’s weight for height history, and where your child lands on the growth charts
Determine if your child’s weight is in an unhealthy range.

8. Tests and Diagnosis
Doctor calculates your child’s body mass index (BMI)
And determines where it falls on the national BMI- for age growth chart. The BMI indicates if your child is overweight for his or her age and height.
Cutoff points on these growth charts, established by CDC - BMI for age between 85th and 94th percentiles
Overweight. BMI for age 95th percentile or above- obesity

9. Diagnosis continued
Doctor evaluates your family’s history of obesity and weight related health problems.
Your child’s eating habits and calorie intake.
Your child’s activity level
Other health conditions your child may have.

10. Medical Complications
Type 2 Diabetes
Metabolic syndrome
High blood pressure
Asthma and respiratory problems
Sleep disorders
Liver disease
Early puberty or menarche
Eating disorders
Skin infections

11. Social and Emotional Fallout
Low self-esteem and bullying. Increased risk of depression
Behavior and learning problems. Overweight children tend to have more anxiety and poorer social skills than normal- weight children. Stress and anxiety can interfere with learning.
Depression.- Social isolation and low self-esteem create overwhelming feelings of hopelessness in some overweight children.

12. Treatment and Drugs
Based on your child’s age and if he or she has other medical conditions
Changes in child’s diet and level of physical activity.
Treatment may include medications or weight loss surgery.
Children under age 7 who have no other health concerns, the goal of treatment may be weight maintence rather than weight loss
Weight loss is typically recommended for children over age 7 or younger who have related health concerns.

13. Weight Loss
Should be slow and steady, anywhere from 1 pound a week to 1 pound a month, depending on your child’s situation.
Methods -1. Child needs to eat healthy diet and increase his or her physical activity. Parents need to be committed to helping your child make healthy diet changes.
Healthy eating. Parents are the ones who buy food, cook, the food and decide where the food is eaten.

14. Healthy Eating
When buying groceries choose fruits and vegetables over convenience foods high in sugar and fat. Always have healthy snacks available. Never use food as a reward or punishment
Limit sweetened beverages, including fruit juices. These drinks provide little nutritional value and make your child feel full to eat healthier foods.
Sit down together for family meals. Discourage eating in front of screen. This leads to fast eating and lowered awareness of how much you're eating.

15. Healthy Eating continued
Limit the number of times you eat out, especially at fast- food restaurants. Many of the menu options are high in fat and calories.
Fasting or extreme caloric restriction is not advisable for children. Balanced diets with moderate caloric restriction, especially reduced dietary fat, used successfully in treating obesity.
Nutrition education
Diet management with exercise
Behavior modification, such as self- monitoring

16. Behavior Modifications
Record food intake and physical activity
Slowing the rate of eating.
Limiting the time and place of eating
Using rewards and incentives for desirable behaviors.
Problem- solving training involved identifying possible weight control problems.

17. Physical activity
Limit recreational screen time to fewer than two hours a day. Other sedentary activities also should be limited.
Emphasize activity, not exercise. Doesn’t have to be structured exercise program. Free-play activities are encouraged.
Find activities your child likes to do, such as swimming, biking, dancing, cheerleading, and sports.
If you want an active child, be active yourself. Vary the activities, and get involved with your children.

18. Medications Drugs that can be used for adolescents
Merida(sibutramine) Approved for adolescents older than 16, makes the body feel fuller more quickly
Xenical (Orlistat) approved for adolescents older than 12 prevents the absorption of fat in the intestines.
Alli- nonprescription approved by FDA similar to Orlistat but lower in strength. Not approved for children or teenagers under age 18.

19. Weight loss surgery
Safe and effective option for severely obese adolescents who have been unable to lose weight using conventional methods.
Potential risks and long-term complications. Long-term effects of weight loss surgery on a child’s future growth and development are unknown.
Uncommon in adolescents, but may be considered if child’s weight poses greater health threat than do the risks of surgery.
No guarantee that your child loses all excess weight.

20. Coping and Support for Obesity
Parents play a crucial role in helping children who are obese.
Build your child’s self –esteem. Talk to your kids directly, openly, and without being critical or judgmental.
Praise child’s efforts. Celebrate small incremental changes, but don’t reward with food.
Talk to child about his or her feelings Help child find ways to deal with emotions that don’t involve eating.
Help your child focus on positive goals

21. Prevention Schedule yearly well-child visits
SET A GOOD EXAMPLE- Eat healthy foods and exercise regularly to maintain your weight.
Avoid food related power struggles with your child.
Emphasize the positive, such as healthy lifestyle, the benefits of exercise
BE PATIENT

22. Prevention cont. Obesity is easier to prevent than treat.
Prevention focuses in large on parent education
Infancy- Parent education should center on promotion of breastfeeding, recognition of signals of satiety, and delayed introduction of solid foods.
Early childhood, education should include proper nutrition, selection of low-fat snacks, good exercise/activity habits, and monitoring of TV viewing
Where hereditary factors are involved, parent education should be on building self-esteem.