1. Obesity and Type 2 Diabetes in Children A presentation to initiate awareness and advocacy for an international health epidemic

2. The purpose of this presentation is to: Explain the obesity and type 2 diabetes crisis Discuss methods of curbing this epidemic Encourage participation within your family, school, and/or community in developing a healthier lifestyle

3. What is Obesity? A condition resulting from excessive storage of fat in the body. (Best measured by BMI)

4. What is BMI? BMI (Body Mass Index) is the ratio of weight in kilograms to square of height in meters. BMI correlates with more accurate measures of body fatness. Pediatrics: –At risk: BMI between 85 th – 95 th percentile for age and sex – Overweight/Obese: BMI at or above the 95 th percentile for age and sex American Academy of Pediatrics; Prevention of Pediatric Overweight and Obesity, 2003

5. Example Calculation Weight (lb) ÷ Height (in) ÷ Height (in) x 703 = BMI Ex:13 year old boy, wt;146 pounds, ht; 64 in 146 ÷ 64 ÷ 64 x 703 = 25 BMI of 25 per growth chart = 95% This young man is overweight/obese http://www.cdc.gov/growth charts

6. Examples of Children At Risk By Mayo Clinic Staff

7. The prevalence of childhood overweight and obesity has doubled in the past 20 years. American children are less physically active as a group than were previous generations. American Academy of Pediatrics Policy Statement: Prevention of Pediatric Overweight and Obesity, 2003

8. What are common medical problems in obese children? Type 2 diabetes Heart disease Mental health; depression, low self-esteem Pulmonary or Respiratory problems

10. How Does Arizona Fare? The number of overweight/obese adults has increased from 44.7% (1994) to 56% (2001) Currently it is estimated that 58% of Arizonans are overweight/obese 34% of children enrolled in Headstart programs are overweight.

11. Trends in Prevalence of Overweight* in US Boys 12-17 Years Old *BMI at or above sex- and age-specific 95th percentile CDC, National Center for Health Statistics. 1998. Prevalence (%)

12. Trends in Prevalence of Overweight* in US Girls 12-17 Years Old Prevalence (%) *BMI at or above sex- and age-specific 95th percentile CDC, National Center for Health Statistics. 1998.

13. U. S. Obesity Rates: Past 20 Years Today’s obese children could be the 1 st generation of Americans with a life expectancy less than their parents! Richard Carmona MD, US Surgeon General

28. Obesity Trends* Among U.S. Adults BRFSS, 1999 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

29. Obesity Trends* Among U.S. Adults BRFSS, 2000 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

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

31. Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Obesity Trends* Among U.S. Adults BRFSS, 2002

32. 19911995 2002 Obesity Trends* Among U.S. Adults BRFSS, 1991-2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

33. Children Then….

34. Children Now……. From Childhood & Adolescent Obesity and Type 2 Diabetes by Francine Kaufman MD

35. Factors Related to the Onset of Obesity Altered dietary intake Decreased physical activity Increased inactivity

36. Altered dietary intake Nutritional content Portion size

37. Decreased physical activity Not as much participation in physical activities; walking, active play, recess

38. Increased inactivity Look at time spent watching TV, playing electronic games

39. Enrollment in daily physical education classes From the Surgeon General's Report on Physical Activity and Health, 1996

40. Percentage of High School Students Who Reported Not Being Enrolled in Physical Education Class, 1999 CDC, Youth Risk Behavior Surveillance System

41. The Burden of Obesity (Adapted from American Obesity Association source, 2002)

42. Prevention is the Key! Tommy Thompson, Secretary of Health & Human Services Dr. Richard Carmona, U.S. Surgeon General Center for Disease Control (CDC) American Academy of Pediatrics (AAP) American Diabetes Association (ADA)

43. Why Target Children? Prevention is more cost effective than cure Children can be reached through schools Effects of chronic disease accumulate over time; so need long-term changes –We need to begin awareness at an early age E. Sanchez, MD, MPH

44. Why Should Schools Care About Health? As a society, we value good health. Good health is necessary for effective learning Healthy students become healthy, productive citizens Schools are the one place where the majority of our nations youth can be found E. Sanchez, MD, MPH

45. How Do You Initiate Change? Environmental/Policy –Obtain baseline assessments –Make physical activity and nutrition a priority in schools –Fund preventative programs and services in community –Develop a comprehensive approach

46. How Do You Initiate Change? Community Action: –Utilize local data/community input to assess your needs –Increase awareness of obesity problem in culturally appropriate ways –Develop partnerships for community-wide healthy lifestyle actions

47. How Do You Initiate Change? Schools can provide: –Quality daily P.E. classes –Nutrition awareness campaign –Parent education/awareness campaign –Psychosocial education/intervention –School nutrition policy

48. What Can We Do In Our School? Ask for support from the school board and superintendent Incorporate students, parents, teachers in providing strategies and ideas Look at your school practices Focus on health and activity, not weight HAVE FUN!!!

49. Governor Napolitano’s Call to Action Reports January 30, 2004 SELECTED REQUESTS: Keep recess sacred, not used as a punishment Daily P. E. classes Provide healthy vending machine choices Educate students about marketing ploys for unhealthy snacks Age appropriate nutrition education Omit unhealthy fundraisers/limit candy rewards for good behavior

50. Behavior Change Strategies Increase physical activity: –Provide exercise choices to children –Encourage age appropriate and creative exercises –Start with 30 minutes of moderate activity per day –Make it fun!

51. Behavior Change Strategies Increase awareness of food choices: –Moderate food portions –“5 a day” Vegetables and Fruits Limit inactivity –American Academy of Pediatrics recommends limiting TV viewing to 1-2 hrs/day

52. CDC’s Guidelines for Promoting Lifelong Physical Activity Physical activity of moderate intensity for 5 days of the week –Walking 2 mi X30’ –Running 11/2 mi X 15’ –Bicycling 5 mi X30’ / 4 mi X 15’ –Basketball X 15-20’

53. A Pound of Prevention….… Life-long healthful eating Daily physical activity throughout life All things in moderation TIP: Everyone needs to do these things, whether they are obese, overweight, or normal weight.

55. What are your views?