Transcript Childhood Obesity - University of Illinois at Chicago

Fit not Fat -Childhood Obesity and the
Environment
Helen J. Binns, MD, MPH
Ann & Robert H. Lurie Children’s Hospital of Chicago
Feinberg School of Medicine, Northwestern University
Sponsored by Region 5, Pediatric Environmental Health
Specialty Unit
Disclosure Information
• This material was supported by the Association of
Occupational and Environmental Clinics (AOEC) and funded
under the cooperative agreement award number
1U61TS000118-03 from the Agency for Toxic Substances and
Disease Registry (ATSDR).
• Acknowledgement: The U.S. Environmental Protection Agency
(EPA) supports the PEHSU by providing funds to ATSDR under
Inter-Agency Agreement number DW-75-92301301-0. Neither
EPA nor ATSDR endorse the purchase of any commercial
products or services mentioned in PEHSU publications.
• Dr. Binns has no conflicts of interest to disclose.
2
Growing Up Healthy
Parental Modeling
Parent Behaviors
Home Environment
Health Habits
Dietary Choices
Exercise
Verbal prompts to child
Parenting Skills
Support for Eating Choices
Support for Activity & Inactivity
Parental leadership
Parent-child communication
Problem-solving skills
Modeling
Child
Health Behaviors
Adapted from Golan & Weizman JNE 2001
Child
Weight Status
4
Parents Create a Healthy Home
Environment!
 Be
Active
 Limit Screens
 Have Routines
 Healthy Foods
 Safe Products
5
Physical Activity Fun


Recommended activity for children is 1 hour daily
Study of children surveyed twice (1 year apart)
 For
those who increased their activity by 7 hours per
week:


Healthy weight children achieved BMI maintenance
OBESE children had BMI fall of -0.2 kg/m2 (gained about 1
less lb than expected)
Berkey CS, et al. Pediatrics 2003;111:836-843
6
Physical Activity Fun


 screen time   physical activity
Screen time contingent upon physical activity
8
weeks intervention

Reward for activity: 1 hr activity = 1 token =1 hr TV
 Follow-up
at 16 weeks
 Intervention group compared to controls




 activity by 30 minutes/day
 sedentary behaviors by 2 hrs/day
 snacking while watching TV
BMI -0.6 kg/m2 vs.  +0.3 kg/m2 controls
Goldfield GS, et al. Pediatrics 2006;118;e157-e166
7
COUNSELING TIPS: Family Activity





Incorporate activity into your family events
Young children need play partners – that is the
parent!
Support your child’s activities
Plan to be active yourself
(30 minutes of jogging = 1 soda)
8
Home
Exercise
Program
www.chicagochildrensresearch
.org/pprg/resources/obesity/
Lisón JF Acad Pediatr 2012; 12:319-325.
9
Regulation of Eating
Family & Social
Influences
Sensory factors:
Taste
Smell
Texture
Sight
Effects of:
Variety
Sensory-specific satiety
Palatability
Food concentration
Ready availability
Cognitive factors:
Conscious rational control
Beliefs about the food
Advertising
Brain mechanisms:
Modulate sensory factors by
satiety signals to produce
reward value and appetite
Satiety/hunger signals:
Adipose tissue signals
Gut hormones
Gastric distension
10
Weight
Status
from Rolls ET. Obes Rev 2007;8(suppl 1):67-72
Food Content
Eating
Increase Intake of Fruits and
Vegetables
Fruits and Vegetables



Low in calories
High in fiber – fill you up!
Sensory appeal


Taste, texture, color
Rich in vitamins and minerals,
which are needed to fight
oxidative stress
Fight Oxidative Stress


20% of oxygen breaks down to Free Radicals &
Reactive Oxygen Species
Stressors can increase that to 80%






UV light
Poor nutrition
Inflammation
Air Pollution
Tobacco
Radiation
13
http://www.smokersrx.com/images/why2.jpg
Fruits and Vegetables


1/2 cup = 1 serving
Needs for children:
Servings of
Fruits/day
Servings of
Vegetables/day
Toddlers
2+
2+
Older children/adolescents
2+
3+
Age Group

<15% of US children get 5 daily servings!

Adult on a 2000 calorie /day diet
 NEED 9 servings/day
14
The million dollar question…

How do you get kids to eat more vegetables?
15
First thing:

How are the parents interacting with
vegetables?




Are the parents buying vegetables?
Are the parents serving vegetables?
Are the parents eating vegetables?
Children pattern their behavior after their
parents
16
Parental Modeling and Pressure to
Eat


191 families; Girls age 5 yrs
Measures:

F&V servings/day




had girls with higher levels of F&V intake (about 1 more/day)
Parents with lower F&V intake


Parental pressure to eat scale
Parents with high F&V intake


Girls: 3/day
Parents 2/day
had higher levels of pressure to eat
High pressure decreased F&V intake

about 1 less/day, after controlling for parental intake
17
Fisher J et al. J Am Dietetic Assoc 2002;102:58-64
Changing Food Preferences

Intervention study

Children 2-6 yrs

“Tasting” method:



Taste vegetable for 14 consecutive days

Parent taste & provide positive verbal cues

No forcing
Significant increase in liking and consumption after
using the method (compared to controls)
Repeated “tasting” can transform dislike into like
18
Wardle J et al. Appetite 2003;40:155-62
Birch LL. Annu Rev Nutr 1999;19:41–62
Positive Messages: Increasing Healthy
Eating vs. Reducing High Energy-Dense Foods

Family-based obesity
intervention


13 groups sessions over
5 months
2 groups



Healthy Eating = more fruit,
vegetables, and low-fat
dairy
Reducing High EnergyDense Foods = less highfat, high-sugar foods
BMI reduction sustained
only in Healthy Eating
group

BMI of parents in
Healthy Eating group
improved more, too!
19
Epstein LH, et al. Obesity 2008;16:318-26
Parents set an example!

Buy, cook, serve, and eat more vegetables





To start, double what you’re currently doing
Put vegetables in everything you’re cooking
Bring fruit and vegetable snacks with you
Eat a fruit at every meal and two vegetables
at dinner
Learn to like new vegetables
20
Increase Intake of Whole Grains
and Fiber
What are Whole Grains?
Whole grain foods contain all the grain layers,
including:
Bran (outer layer, contains seed fiber)
Endosperm or Kernel
(contains vitamins and minerals)
Germ
(concentrated source of nutrients)
What is Fiber?
A group of compounds including lignin (plant cell walls) and
complex carbohydrates that cannot be digested by human
enzymes in the small intestine
Sources of Fiber
Fiber/serving
Legumes (beans, peas) (cooked)
6-8 grams/ 1/2 cup
Fruits and Vegetables (cooked)
2-6 grams/ 1/2 cup
Whole Grains and Cereals
2-5 grams/ serving
Nuts and Seeds
2-4 grams/ ounce
Fiber: Health benefits



Increases satiety (the feeling of fullness)
Helps prevent constipation (increases fecal bulk)
Lower cholesterol absorption and LDL synthesis




May decrease insulin resistance


 5-10 g/day reduces LDL cholesterol by about 5%
↓ serum triglycerides
↓ cholesterol synthesis
Additional 5 g fiber/day→ 10% ↓ in belly fat deposition*
May help reduce weight gain


Higher fiber inversely associated with BMI in major observational
studies
Role of fiber in weight control is not yet clear
24
*Ventura E, et al. Arch Pediatr Adolesc Med 2009;163:320–7
Dietary Fiber: HOW MUCH?

How many grams of
fiber do children need?

Ages 1-3 years 19 g/day

Mean Fiber Intake, US Children by Age
Ages 14 -50 years
Male 38 g/day
Female 29 g/day
Note: 14 g fiber / 1000 calories
gms fiber/day
Ages 4 – 8 years 25 g/day
Ages 9 – 13 years
Male 31 g/day
Female 26 g/day
US adults typically get
14-15 g fiber/day
Children:
16
14
12
10
8
6
4
2
0
2-5 yr
6-11 yr
Girls
12-18 yr
Boys
12-18 yr
25
Saldanha et al, Pediatrics 1995;96:994-7
Dietary Fiber: Contrasting Foods
High Fiber
Low Fiber
Potato with skin
(one)
2 g
Potato w/out skin
(one)
1 g
Dry beans (cooked)
(1/2 cup)
6 g
Potato chips
(1 serving)
1 g
Broccoli
(1 cup)
5 g
Lettuce
(1 cup)
1 g
Whole wheat bread
(1 slice)
3 g
White bread
(1 slice)
1 g
Cereal: oat circles
(1 cup)
3 g
Cereal: corn flakes (1 cup)
Brown rice (cooked)
(1/2 cup)
2 g
White rice
(1/2 cup)
0 g
Orange
(one)
3 g
Orange juice
(1/2 cup)
0 g
0.5 g
26
Read It Before You Eat It!


Read the food label
Look for High Fiber and Whole Grain


 5 g fiber/serving is HIGH for cereal and bread
Find the LOW SUGAR food

4 g sugar = 1 teaspoon sugar




Sugary circles: 12 g sugars; 3 g fiber
Sugary flakes: 11 g sugars; 1 g fiber
Look for those with < 8 g sugar per serving
Mix brands of cereals to increase fiber and lower
sugar content
27
Reduce/Avoid Sugar-Sweetened
Beverages and Foods
Sugar-Sweetened Beverages (SSB)

What are SSBs?




Soda, fruit drinks, juice blends, lemonade, sweetened tea
Other carbonated or uncarbonated drinks (ie, sports and
energy drinks)
Most consumption happens at home (55-75%)
Daily calories from juice and other SSB (among
those consuming):



2-5 yrs,
6-11 yrs,
12-19 yrs,
190 calories
220 calories
345 calories
29
Vartanian, et al. Am J Pub Health. 2007;97:667-75
NHANES 1999-2004
Juices & Sugar-Sweetened Beverages

OZ
Calories
Vit C, mg
Sugar,
teaspoons
Apple Juice
12
180
12-60
10
Orange Juice
12
168
150
8
Grape Juice
12
240
0
15
Cola
12
145
0
10
Sports drink
12
75
0
6
Vitamin waters
12
75
36
5
Vanilla frappuccino
12
320
0
11
Theoretically, if added to the typical US diet:


1 soda/day =  15 lb/year
Studies show switch to calorie free saves 1-3 kg/yr gain in
children & lowers fat deposition
30
Sugar-Sweetened Beverages

Sugar types



Fructose has more negative health effects (compared to glucose)






Sucrose (cane/beet sugar = 50% glucose + 50% fructose)
High fructose corn syrup (55% fructose + 45% glucose)
An increase in visceral fat (in organs)
Less sensitivity to insulin
Increased fat production in the liver
Higher LDL cholesterol
Higher triglycerides
Effects on energy intake


↑ hunger & ↓ satiety
Displace appetite for nutrient-balanced foods
31
Stanhope et al, J Clin Invest 2009;119:1322-34
Wang et al, Pediatrics 2008;121:e1604-14
Diet Beverages



(Non-nutritive sweetened beverages)
Typically sugar-free, artificially sweetened, nonalcoholic, carbonated beverages
Marketed towards:
 health-conscious people, diabetics, athletes
 people who want to lose weight or stay fit
Replacing sugar-sweetened beverages with water
and diet beverages can lower total calories
consumed.
32
Raben et al. Am J Clin Nutr 2002;76:721-9
However…

Sweet goes with fatty and
salty!

When consumed alone,
diet beverages may
increase hunger
EVEN BETTER WITH A DIET COKE AND FRESH LIME
The food item alone has 710 cals
(40 grams fat, 13 grams saturated
fat) and that is without the 300-600
calories from French fries!
http://www.foodfacts.info/blog/uploaded_images/sonic-bacon-cheddar-sheeses.jpg
33
Mattes et al. Am J Clin Nutr 2009;89:1-14
Diet Beverages

No benefits for weight loss
or slowing weight gain,
UNLESS accompanied by
total energy restriction and
improved energy balance
Oh yeah…
a diet soda
too.
http://www.cartoonstock.com/directory/d/diet_drinks.asp
34
Counseling Tips: Beverages

Plain water is best! Drink plenty of it.

Flavor water with lemon or lime. Keep it cold in
the refrigerator.

While diet drinks are preferred over regular
soda, the sweet taste can increase your intake
of high calorie foods.
35
Less & Safer Chemical Exposures

Effects
cell regulation -- PPAR – peroxisome proliferatoractivated receptors
 Endocrine disruptors
 Fat

Products w/ potential for harm
 BPA
-- 7
 Phthalates – 3
 Organotins – PVC - 3
 PBDE (polybrominated diphenyl ethers)
36
Less & Safer Chemical Exposures



Choose safer plastics
Avoid heating plastics
Wash produce
 Buy
organic if you can, but Eating Fruits and Veggies
is more important than eating only organic F & V

Peel – but think about fiber
37
Summary




Be a role model for healthy habits!
Be positive about healthy foods.
Make changes to the home environment to
promote healthy habits.
A few changes can have a big impact.
38