1. Exercise and obesity in children Rob Truax, DO Assistant Professor, Family Medicine University Hospitals Case Medical Center

4. What is my biggest health concern??? DECONDITIONING The gradual loss of ability to perform activities – from high-caliber activities to the routine

5. Why are we talking about “obesity”?  The 4 fundamentals of Health:  Good Nutrition  Good Exercise  Good Sleep  Good Stress Management  Obesity is a disruption of the above fundamentals and, over time, causes severe deconditioning  For Example: There are very few obese individuals who exercise on a daily basis

6. Routine Physical: “So, Doc. How am I doing?”  What is often meant:  “Doc, do I have any diseases or conditions that will harm me now or in the future?”  Predicting the future is still a work in progress....  Gene and the Genome project – it is an attempt to predict the future

7. “So Doc, How am I doing?” Here are the things we can address:  Current Medical issues  Family History  Social history (smoking, alcohol, lifestyle)  Vaccinations  Only a few objective data  Blood Pressure  Height/Weight  Body Mass Index  Blood Glucose  Cholesterol?

8. Objective Information at a Physical – the best we have at predicting your health future  Elevated Blood Pressure:  Hypertension, Heart Disease, Kidney Disease, Strokes  Elevated Blood Sugar  Diabetes, vascular disease  Elevated Body Mass Index  Obesity related problems (joint pain, skin damage)  Elevated Blood Pressure  Elevated Blood Sugar  Muscle Deconditioning

9. Obesity and Body Mass Index (BMI)  Adult BMI – weight/height x height  <20 – malnutrition  20-25 = normal  25 – 30 = overweight  30-35 = obesity  >35 = morbid obesity  Children BMI: age and gender are used to compare  <5% of age/gender – risk of malnutrition  5-85% age/gender – normal  85-95% age/gender – overweight  >95% age/gender - obese

10. BMI – predicts risk for future illnesses Alex Mack CC Sabathia Both are at risk for Diabetes 6’4”/311# = 37.96’7”/305# = 34.4

11. LeBron BMI 6;8”/250# = 27.5 He is soo physically active, he probably is low risk for diabetes and high blood pressure

12. Fear of child being too thin, under- nourished can lead to over-feeding  Typical adolescent – they are not as active as professional athletes so the BMI is very helpful. But, many parents can state “my child is big-boned.”  That is really not a medical conditioned, being big-boned.  16 year-old girl  5’5’’/134# = (BMI) 22.3, 69%  5’5”/200# = (BMI) 33.3 >95%  For the same 200# girl to have a normal BMI, she would need to be 6’8”!!!  6’8”/200# = 22.0

13. So, what is the BIG deal about BMI?  BMI is one of the most useful means to PREDICT future health  Those who have elevated BMI have risks of:  Elevated sugars/diabetes  Elevated blood pressure/hypertension  Deconditioning/not exercising  Obesity: complex issue with multiple factors: biological, social, behavioral, environmental, economical  However, the BMI is the most MODIFIABLE risk factor!!!!

14. What do the experts have to say??  11% of children are obese  25% of children are overweight  American Heart Association: 1/3 of children are overweight/obese, triple from 1963  American Academy of Pediatrics: reducing childhood obesity is one of its top priority  Former Surgeon General Richard Carmona (3/2/2004)  Because of the increasing rates of obesity, unhealthy eating habits and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents.”

15. Surgeon General Richard Carmona – testimony given to HoR 7/16/2003  In the year 2000, the total annual cost of obesity in the United States was $117 billion. While extra value meals may save us some change at the counter, they’re costing us billions of dollars in health care and lost productivity. Physical inactivity and super-sized meals are leading to a nation of oversized people.  This year, more than 300,000 Americans will die from illnesses related to overweight and obesity.  Obesity contributes to the number-one cause of death in our nation: heart disease.  Excess weight has also led to an increase in the number of people suffering from Type 2 diabetes. There are at least 17 million Americans with diabetes, and another 16 million have pre-diabetes. Each year, diabetes costs America $132 billion. It can lead to eye diseases, cardiovascular problems, kidney failure, and early death.

16. Obesity  Obese Children are now developing Adult diseases  Elevated Cholesterol in children might now need medication  Elevated blood sugar/Diabetes being diagnosed in children  Juvenile-Onset Diabetes  Type 1 diabetes: some adults get this  Adult-Onset Diabetes  Type 2 Diabetes: children are now getting it  Mossberg, Lancet – 40-year follow-up of overweight children  Higher-than-expected illness and death in those adolescent who were excessively overweight

18. Obesity and Exercise  Delany, American Journal of Clinical Nutrition  Studies point to fatness associated with physical activity energy expenditure  Floriani, Current Opinions in Pediatrics,  Physical Activity protected children from accumulating fat  Improves cardiovascular health  Positive effects on behavioral and academic outcome

19. Exercise in kids – what are the benefits??  Strengthens muscles and bones  reduces deconditioning, muscle wasting  Lowers blood pressure  reduces heart disease and strokes  Controls sugar and insulin levels  reduces diabetes risk  Increases life expectancy  Improves cognitive development  Improves motor skills

21. Exercise in Kids – how much?  Toddlers  5 years old: 2 hours a day of high activity  Adolescents  60 minutes a day of high activity  CDC:  60 minutes of high intensity of endurance activity every day (4 x 15 min)  Minimum of 3 days/week of muscle-building activity – push-ups, pull-ups  Bone strengthening activity mixed in – jumping rope

22. What is the purpose of school?  To prepare our kids for success in the future  Intellectually  Socially  Jobs  Physically??  Does a school athletic program equip all the students for a life-time of physical fitness??  Fitness Education is critical to keep our children healthy in the jobs our schools are preparing for them to do.

23. Thank you

24. References  http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/ChildhoodO besity/Overweight-in-Children_UCM_304054_Article.jsp?appName=MobileApp http://www.heart.org/HEARTORG/GettingHealthy/HealthierKids/ChildhoodO besity/Overweight-in-Children_UCM_304054_Article.jsp?appName=MobileApp  http://www.cdc.gov/HealthyYouth/obesity/facts.htm http://www.cdc.gov/HealthyYouth/obesity/facts.htm  http://www.healthychildren.org/English/health- issues/conditions/obesity/Pages/default.aspx http://www.healthychildren.org/English/health- issues/conditions/obesity/Pages/default.aspx  Lambourne, K and Donnelly. The Role of Physical Activity in Pediatric Obesity. Pediatric Clinics of North America 58 (2011):1481-1491.  Floriani, V and Kennedy, C. Promotion of physical activity in primary care for obesity treatment/prevention in children. Current Opinions in Pediatrics. 2007, 19:99-103.  Mosseberg HO 40-year follow-up of overweight children.Lancet 1989;2:491-3.  Delany J Role of energy expenditure in the development of pediatric obesity American Journal of Clinical Nutrition 1998;68(supplement):950S-5S.