1. Childhood Obesity, Epidemic of the New Millennium Meg Fisher, MD Medical Director, The Children’s Hospital Monmouth Medical Center An affiliate of the Saint Barnabas Health Care System Long Branch, NJ

2. Objectives Following this presentation, the learner will be able to: 1. Calculate and plot the BMI 2. Counsel re: obesity prevention 3. Counsel re: active lifestyles

3. The Epidemic of Obesity Read any magazine or medical journal Weights are rising Activity is falling

4. Obesity: Definition Body mass index (BMI): Weight (kg) / Height (m) 2 Adult: overweight - BMI 25 to 30; obese – BMI 30 and above Pediatric: at risk – BMI 85 th to 95 th %; obese – BMI 95 th % and above

5. Obesity Trends Among U.S. Adults, 1991 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

6. Obesity Trends* Among U.S. Adults, 1996 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

7. Obesity Trends* Among U.S. Adults, 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

8. Obesity Trends* Among U.S. Adults, 2005 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

9. 1995 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI 30, or about 30 lbs overweight for 5’4” person) 2005 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

10. 2007 Overweight adults: 60% Obese children: 15% New Jersey Sixth Graders: 20%

11. Why? Intake exceeds Output Genetics vs. Environment

12. Increased Input Working parents Out of home eating Fast foods, soda Supersized portions Advertising, television

13. Decreased Output Television Computers Safety issues Working parents

14. Television Average viewing time of children: 4 hours per day Half of TV advertisements are for food 77% of children have a TV in their bedroom

15. Sedentary Less than 30 minutes of moderate activity per day 70% of adults 50% of children Sedentary death syndrome

16. Consequences of Obesity Type 2 diabetesInsulin resistance HypertensionHyperlipidemia Psychosocial Steatohepatitis OrthopedicSleep apnea RespiratoryGallstones

17. Acanthosis nigricans

19. Obesity: Psychosocial Affects Discrimination Low self-esteem Isolation Stigmatism

20. Prevention Always better and easier than cures Limit television time Encourage outdoor play Encourage breastfeeding Limit sugar-sweetened soft drinks

21. Role of Schools: A 2003 Questionnaire

22. The Group Child Health Statewide Leadership Council First meeting July 2002 Mission: advocate for children and families

23. Threats to Our Children The epidemic of childhood obesity Lack of mental health services Immunizations: access for all children

24. Questionnaire Developed by consensus Email very useful for the process Input from a variety of physicians Goal was to get information and raise awareness of the issues

25. Results Over 120 returned from over 90 zip codes More than 200,000 students Suburban, rural, urban areas Breakfast rarely provided Lunch almost always provided

26. Results Dieticians and food services decide menu About half have “special days” Snack and candy machines in a third Drink machines in two thirds Less machines in elementary schools

27. Results Snacks available in cafeteria Chips, cookies, ice cream, pretzels, and popcorn often sold in the cafeteria Recess occurs daily in grade school Physical education occurs 1- 5 times/wk

28. Results Sports rarely mandated Physical fitness curriculum Nutrition is taught to all Consequences of obesity are discussed Parental involvement varies

29. Barriers Students: taste, habits, food from home Costs: snack foods make money Lack of parental support State and Federal mandates Food marketing

30. Barriers Several schools felt none existed Candy and drink machines Food allergies Proximity to fast food outlets Family concern; obesity

31. What Can Pediatricians Do? Educate: parents, children, schools Visit schools, provide speakers Supply information to schools Identify and treat overweight children Advertise health!

32. NJ Public Health Association 2001 Survey: nutrition, oral health Sent to school nurses; return rate 49% Non-nutritive food in 79% Beverage machines in 56 and 87% Oral health program in 29%

33. Report Recommendations Strengthen laws regarding sale of foods Develop Healthy People 2010 objectives Expand programs for healthy eating such as “Team Nutrition” Establish an Office of Oral Health

34. Obesity Prevention Program Long Branch Early Education Three and four year olds Enroll family – family contract Teachers, nurses, after school, Prevention First, pediatricians, Club Claude

35. Long Branch Program Teachers already teach nutrition School nurses measure BMIs Activity level is after school increased Family and child conferences Visiting pediatricians at after school

36. Long Branch Program Contract with the family Prevention First curriculum: Healthy life styles Feeling good about yourself Making good choices

37. Incentives Club Claude, our vegetable eating labradoodle and his sister Fruits Bouncing cows Jump ropes, bouncing balloon balls

38. Now What? Change input: Strive for 5 fruits and vegetables 3-A-Day dairy Proper portion size Increase energy expenditure: Get and keep moving

39. What Can You Do? Understand importance of lunch and breakfast choices Remove soda and non-nutritious snacks Substitute water and milk beverages Advocate for a state wide program Recognize the importance of activity

40. Your Mission Your mission: Design a project which will result in increased activity and/or weight loss among your children and their families Your have 10 minutes

41. Projects

42. Prevention Always better and easier than cures Limit television time Encourage outdoor play Encourage breastfeeding Limit sugar-sweetened soft drinks