1. Epidemiology Childhood Obesity Abdelaziz Elamin, MD,PhD,FRCP,FRCPCH Professor of Child Health University of Khartoum, Sudan Consultant in pediatric Endocrinology & Clinical Nutrition

2. Epidemiology  The study of how a disease or health outcome is distributed in populations and what factors influence or determine this distribution.

3. Definition  Obesity is a serious degree of Overweight caused by excessive storage of fat & usually measured using a Body Mass Index.  BMI is defined as body weight in kilograms divided by the square height in meters.

4. WHO: Overweight and Obesity For Adolescents & Adults BMI between 18.5 & 24.9: Healthy weight BMI between 25 and 29.9: Overweight BMI 30 & above: Obese BMI 40 & above: Morbid obesity For Children BMI between 5 th & <85 th percentile: Healthy weight BMI between 85 th & 95 th percentile: Overweight BMI >95th percentile: Obesity

5. Overweight and Obesity in the US Epidemic state in the United States Epidemic state in the United States 25% of children are obese 25% of children are obese More than ½ of all adults are overweight and nearly a quarter are obese More than ½ of all adults are overweight and nearly a quarter are obese Rate of obesity has doubled since 1960 and continues to rise Rate of obesity has doubled since 1960 and continues to rise If current trends continue, all Americans will be overweight by the yr 2030. If current trends continue, all Americans will be overweight by the yr 2030.

6. Obesity Worldwide  Serious concern  Big challenge  Increasing at an alarming rate  Very high cost of health care. >150 billion dollars/ yr in the US  15%-25% of children are over wt. or obese  30-35% of adults are over wt. or obese

7. South Atlantic Ocean South Pacific Ocean Indian Ocean Arctic Ocean North Pacific Ocean Patterns Of Overweight & Obesity Globally For Nationally Representative Samples (Percentage overweight + Obese) <10% 10-20% 21-30%31-40%41-50%>51% © B.Popkin 2009

8. BMI (Kg/m 2 ) 0.02.04.06.08.1 K density BMI 101520253035404550556065 1988 1999 2006 From Juan Rivera BMI Distribution Shifts among Mexican women 18-49 y (National Surveys 1988, 1999 y 2006)

9. BMI Distribution Shifts Among Chinese Adults, ages 19 and Older Percent China Health and Nutrition Survey. Males: 10.4-27.1; Females 15.4-27.7

11. Childhood Obesity  MORE THAN 1 IN 4 Of World CHILDREN IS OVERWEIGHT or OBESE.  CHILDHOOD OBESITY IS INCREASING EVEN IN THE POOR COUNTRIES.  OBESE CHILDREN GROW AS OBESE ADULTS.  The metabolic syndrome & IRS IS PREVALENT IN OBESE ADOLESCENTS same Degree as in adults

12. Childhood Obesity Prevalence In USA : In USA :  Doubled in children 6-12 year.  Tripled in adolescents.  20% of 6-19 year are obese. Worldwide : Worldwide :  Range from ( 10% to 25%).

13. 0 5 10 15 20 0 5 10 15 20 PercentPercent 6-11 years old 12-19 years old Trends in U.S. Child and Adolescent Overweight 1963-1967 1999-20002001-2002 2003-2004 1971-19741976-19801988-1994

14. Annual Absolute Change in the Prevalence of Childhood Overweight and Obesity in 7 Countries from 1985/1995 to 1995/2006 (IOTF definition for childhood obesity) Annual percentage change Popkin (2007) nature reviews, cancer 7:61

15. Childhood Obesity in Germany Source: National Center for Health Statistics, 1999 National Health and Nutrition Examination Survey.

16. Percent increase in Prevalence of Childhood obesity in Sweden (1969-2005)

17. Prevalence of Childhood Obesity in the UK (1995-2002)

18. Prevalence of Childhood Obesity in Italy 0 5 10 15 20 25 - Prevalence (%) Boys over wtGirls over wt Boys obeseGirls obese 1994 1984 19741964

19. Obesity In Developing Countries   The burden of obesity & its complications is shifting rapidly towards the poor.  Simultaneous malnutrition & overweight exist.  Obesity is now 4X more common than malnutrition in some developing countries.   Evidence from Brazil & China points to a clear shift in obesity and overweight from middle class to the poor.   These observations are replicated across many countries in Asia, Africa & Latin America.

20. WHOSIS data 2009

21. Country% Overweight% Obesity Iran32.014.5 Jordon17.38.9 Oman19.29.6 Syria16.511.2 Sudan12.47.6 Prevalence of Childhood Obesity in the Region (9-18 yrs)

22. Causes of Childhood Obesity Childhood obesity Pathological causes Genetics Socioeconomic Behavioral Nutritional

23. Obesity: Environmental Influence Current environment Past environment Genetic susceptibility BMI %

24. SPECIAL ISSUE November 8, 1999 FATTER WILL WE KEEP GETTING FATTER?

25. 25 Cause of Present Obesity Epidemic  Energy intake unequal energy output  Decreasing physical activity  Increasing consumption of calorie dense foods  More meals eaten outside of home  Increased portion sizes  Lack of concern about obesity

26. Obesity Is Caused by Long-Term Positive Energy Balance Fat Stores

28. Energy In Energy Out obesity Weight gain:

29. Changing Dietary Habits   Increased intake of caloric sweeteners & edible oil   Increased intake of processed foods, refined carbohydrates & salty high fat snacks   Reduced intake of fruits and vegetables   Increased global beverage due to: increased accessibility, lower price, income dynamics and marketing

30. From Traditional food to Modern Meals

31. From Traditional to Modern Snacking

32. From Traditional Food Marketing to Modern Food Supermarkets

33. Decreased Physical activity  Excess TV; computer, & play station time  Children are home alone (dual income parents)  Decreased physical activity at school & at home  Transportation by car or school bus  Neighborhood safety  Few public parks, sidewalks, swimming pools..etc

37. From Traditional to Modern Leisure

38. Trends in Physical Education 0 5 10 15 20 25 30 35 40 45 % 1991199319951997 % of 9 -12 graders enrolled in Daily PE (CDC 2000 Review)

40. Obesity Hazards  What bothers you the most?  Anthropometric parameters  Comorbidities

41. Phlebitis venous stasis Coronary heart disease Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Gall bladder disease Gout Diabetes Osteoarthritis Nonalcoholic fatty liver disease steatosissteatohepatitiscirrhosis Hypertension Dyslipidemia Cataracts Skin Pancreatitis Cancer breast, uterus, cervix, prostate, kidney colon, esophagus, pancreas, liver Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Stroke Health Complications of Obesity Idiopathic intracranial hypertension

42. RED FLAG  Obesity and overweight account for more than 300,000 premature deaths annually in United States, 2 nd only to tobacco-related deaths.  Obesity would surpass tobacco as the leading cause of death worldwide in the next decade.

43. 5-Oct-15©M.Miqdady, M.D.43 The Bottom Line Obesity causes 300,000 premature deaths per year in the US

44. Complications Specific to Children …  Persistence of Obesity at Adulthood: Overweight adolescents have a 70% chance of becoming overweight adults. Overweight adolescents have a 70% chance of becoming overweight adults. Increases to 80% if one or both parents are obese. Increases to 80% if one or both parents are obese.  Obese 6 year old has a 25% chance of becoming obese adult  Obese 12 year old has a 75% chance of becoming a obese adult.

45. The probability of obesity in adults in relation to BMI at various ages during childhood 16 15 12 11 10 9 17 19 55 75 67 26 52 69 83 77 36 0 20 40 60 80 100 Birth1to33 66 10 to15 to18 Age of child(years) % obese as adults BMI < 85 th BMI > 85 th BMI >95th

46. Common Complications in Children  Metabolic Syndrome.  Hypertension  Fatty Liver.  Early Sexual Maturation.  Asthma  Sleep apnea

48. “ The first wealth is health.” Thanks for your attention