1. Childhood Obesity Dimitrios Stefanidis, MD, PhD, FACS, FASMBS Associate Professor of Surgery, Carolinas Healthcare System Medical Director, Carolinas Simulation Center

2. What is Obesity? Obesity is a condition in which excess body fat has accumulated in the body to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems Obesity is a condition in which excess body fat has accumulated in the body to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems

3. How is Obesity Measured? Body mass index (BMI) Body mass index (BMI) a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 and 30 kg/m2, and obese when it is greater than 30 kg/m2 a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 and 30 kg/m2, and obese when it is greater than 30 kg/m2

5. How Common Is It? Childhood obesity has more than tripled in the past 30 years Childhood obesity has more than tripled in the past 30 years The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 20% in 2008 The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 20% in 2008 In 2008, more than one third of children and adolescents were overweight or obese In 2008, more than one third of children and adolescents were overweight or obese

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

7. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

8. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

9. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

10. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

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

12. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

13. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

14. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

15. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

16. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

17. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

18. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

19. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

20. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

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

22. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

23. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

24. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

25. Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

27. What Causes Obesity?

28. Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors

29. Risk Factors Diet: Regularly eating high-calorie foods, such as fast foods, vending machine snacks, soft drinks, candy and desserts Diet: Regularly eating high-calorie foods, such as fast foods, vending machine snacks, soft drinks, candy and desserts Lack of exercise: Watching too much television or playing video games Lack of exercise: Watching too much television or playing video games Family history and habits: Obese parents Family history and habits: Obese parents Psychological factors: coping with problems or to deal with emotions, such as stress, or to fight boredom Psychological factors: coping with problems or to deal with emotions, such as stress, or to fight boredom Socioeconomic factors: less expensive or an easier option than fresher, healthier foods. Socioeconomic factors: less expensive or an easier option than fresher, healthier foods.

30. Risk Factors

31. Immediate Health Effects of Obesity Obese children are more likely to have risk factors for heart disease such as high cholesterol and high blood pressure Obese children are more likely to have risk factors for heart disease such as high cholesterol and high blood pressure Obese adolescents are more likely to have prediabetes Obese adolescents are more likely to have prediabetes

32. Immediate Health Effects of Obesity Children are at higher risk Children are at higher risk bone and joint problems bone and joint problems sleep apnea sleep apnea social social psychological problems psychological problems stigmatization stigmatization poor self esteem poor self esteem

33. Long-term Effects of Obesity Children and adolescents who are obese are likely to be obese adults Children and adolescents who are obese are likely to be obese adults Obese adults are at risk at developing Obese adults are at risk at developing diabetes diabetes heart disease heart disease stroke stroke cancer cancer and other problems and other problems

34. Prevention Healthy lifestyle habits Healthy lifestyle habits Healthy eating and physical activity Healthy eating and physical activity Risk factors to be addressed: Risk factors to be addressed: Socio-economic deprivation Socio-economic deprivation >11 hrs/week TV/videogames >11 hrs/week TV/videogames Low participation in school sports Low participation in school sports Few interests involving active play Few interests involving active play Few siblings Few siblings

35. Prevention Treat the family as it has the most influence on childhood obesity (most obese children have obese parents) Treat the family as it has the most influence on childhood obesity (most obese children have obese parents) Educate at school Educate at school Create healthy habits Create healthy habits Physical activity Physical activity Healthy dietary choices Healthy dietary choices

36. Prevention

37. Weight Loss Surgery