Transcript Childhood Obesitypowerpoint

Childhood Obesity
Childhood Obesity
 A child who is above the 85th percentile
for weight (weighs more than 80 percent
of children of the same age and height) is
considered overweight, and a child above
the 95th percentile for weight is
considered to be obese (Miller,
Rosenbloom & Silverstein, 2004;
Thompson, Manore & Sheeshka, 2007).
Statistics: the Significance
of the Problem
 According to Health Canada (2008), childhood obesity
has nearly tripled in the last 25 years.
 A study done by the Dieticians of Canada (2004),
reported that over half of children between the ages of
7-12 years are either overweight or obese, and nearly
half of children between the ages of 5-12 years are not
active enough for normal growth and development.
 Worldwide, 22 million children under the age of five
years are either overweight or obese and in some parts
of Africa obesity has surpassed malnutrition as the
number one nutritional disorder (Miller, Rosenbloom &
Silverstein, 2004).
The Risks Related to
Obesity
 There are several risks that are associated with
children being obese
 Research studies are reporting that obese children are
more frequently being diagnosed with type 2 diabetes,
and showing early signs of insulin resistance syndrome
and cardiovascular disease. These risks are found to
be greatest in children of African American, Hispanic or
Native American descent (Goran, Ball, & Cruz, 2003;
Thompson, Manore & Sheeshka, 2007).
 It has been estimated that about 50% of children that
are obese will also be overweight or obese into
adulthood, which will further increase their health risks
and their risk of premature death (Thompson, Manore
& Sheeska, 2007).
Children that are Overweight
are also more at risk for:
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Obstructive sleep apnea
GERD (gastroesophageal reflux disease)
Impaired balance and Joint problems
Social isolation and teasing
Low self esteem and depression
Polycystic ovary disease
(Registered Nurses Association of
Ontario, 2008).
Asthma and Obesity
 Some studies have found a correlation
between obesity and asthma-while it has
not been determined what the link is-it
has been found that there has been a
synonymous increase in both asthma
and obesity in children in the last two
decades (Hockenberry & Wilson, 2007;
Gilliland, Berhane, Islam, McConnell,
Gauderman, Gilliland, Avol & Peters,
2003).
The Causes?
 There are many hypothesized causes of this
recent childhood obesity epidemic
 While some studies have shown that genetics
may play a part to some degree, the current
increase in obesity has been too swift and
dramatic for genetics to be the major cause.
 Many studies have been looking at the marked
lifestyle changes that have taken place
throughout the world in the past two or three
decades (Miller, Rosenbloom & Silverstein,
2004).
Supersize Me!
Dramatic Changes that have
taken Place in the last few
Decades
 Most children are driven to school or take a bus
 Most children use escalators or elevators rather than
stairs
 Many children stay indoors right after school due to
having both parents working
 Television viewing by children has increased
significantly
 The introduction of video games and computers has
diverted children from playing sports or physical games
with other children
 Physical education classes and extracurricular sports
in schools have decreased
 Portion sizes in fast food restaurants have
more than doubled; with many outlets offering
the larger portions with minimal consumer cost
 Aggressive marketing of fast foods, junk foods
and video games geared towards children-in
fact studies have found that children’s food
preferences are greatly influenced by
commercials lasting as little as 30 seconds
 One-third of American children eat fast foods
on a daily basis
 The introduction of vending machines
(including in schools) containing snacks with
empty calories
(Miller, Rosenbloom & Silverstein, 2004).
Interventions: what we
can do for our Children
 Before we discuss any interventions or
strategies to combat obesity, it is important that
we understand the significance of a “healthy
weight” VS dieting. Along with the dramatic
increase in obesity, there has been an equally
dramatic increase in eating disorders such as
anorexia and bulimia in children in the past
couple of decades. In fact, even children as
young as 5 years old have been shown to
exhibit purposeful food avoidance and weight
loss behaviors due to body dissatisfaction
(Thompson, Manore & Sheeshka, 2007).
“Healthy Weight” Concept
 It is important that the emphasis be on
increasing physical activity and eating the right
types of foods, rather than restricting food.
 There should never be a stigma attached to
being overweight-the maintenance of selfesteem is integral
 Children should be encouraged to make
healthy choices from birth, with parents serving
as role models
 Food should never be given as a reward or
restricted for punishment, and children should
never be force-fed (Ontario Woman’s health
council, 2002)
Interventions: Increasing
Physical Activity
 Children should be encouraged from a
young age to participate in physical
activities.
 In fact next to prevention, increasing
physical activity has been found by
several studies to be the most effective
intervention for weight reduction in
children (Thompson, Manore &
Sheeshka, 2007; Miller Rosenbloom &
Silverstein; Ontario Woman’s Health
Council, 2002; RNAO, 2008).
Family Activities
 Activities that can be done as a family
serve not only to facilitate bonding as a
family unit, but also improves the health
of all family members
Examples of family
activities
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Family hikes and picnics to local parks with playground equipment
Lawn bowling with plastic pins for young children
Family bike rides
Family soccer and baseball and basketball games
Playing “catch” with smaller children
Have children throw balls into a basket
Include skipping ropes and hula hoops in children’s Christmas
stockings and Easter baskets
Family gym memberships
Family swimming and skating
Dance, clap and sing with children from a very young age
Enroll children at a young age in activities such as dance and
gymnastics
Parents can be role models by engaging in physical activities
themselves
Other suggestions
 Limit Television viewing and video game
use
 Encourage the love of books from a
young age as an alternative: make the
destination of one of your family hikes be
the public library.
New Canadian Tax Credits
for Children in Organized
Physical Activities
 Effective January 1, 2007 the Canadian government
introduced a non-refundable tax credit of up to 500.00
to be awarded to parents for each child under the age
of 16 years in qualifying sports programs or activities.
 The tax credit, called the “fitness tax credit” will cover
fees incurred for children’s camps, fitness club
memberships, organized sports teams such as hockey,
soccer, baseball and basketball, skating, dancing and
gymnastics lessons and also fees incurred for
extracurricular school sports.
 To be eligible, the program must last for at least eight
weeks with a minimum of one session per week
(Canada Revenue Agency, 2008).
Promoting Healthy Eating for
Life: Nutrition for Toddlers:
It is important to re-emphasize that children’s
food intake should not be restricted nor should
they be forced to eat
Developmental
Considerations
 Developmental Considerations for Healthy
Eating for Toddlers:
 Growth slows considerably at the age of two
with the average 2 yr old being 34 inches (86.6
cm) tall and weighing 12 kg (26.5 lbs). This
slowing of growth may bring about what is
called “physiological anemia” and may cause
the child to be finicky and have a decreased
appetite, making it difficult for the toddler to
consume all of the essential nutrients they
need (Hockenberry & Wilson, 2007).
 At the age of two, children are in the stage
called the “autonomy VS Shame and doubt”
according to Erikson’s phsychosocial
developmental theory (Erikson, 1978).
Characteristics of this stage such as striving for
autonomy and insisting on do things for
themselves has several implications for their
eating habits.
Suggestions for Feeding a
Toddler According to their
Developmental Stage
 Allow the child to help prepare the food
 Give them a choice between 2 food item, such as would you like a
banana or some apple slices? These two suggestions both serve
to satisfy their need for autonomy or independence
 Use small portion sizes: the rule of thumb should be 1 tbsp of
each food for each yr of age so for a two yr old the serving size
would be 2 tbsp.
 Having large portions can be overwhelming for a toddler-being
able to consume all of a smaller portion gives the child a greater
sense of accomplishment
 Make the food look appealing; for example make a smiley face
from peas and beans on top of a serving of mashed potatoes
 Have regular times for meals and snacks-but don’t force children
to eat if they are not hungry (Hockenberry & Wilson, 2007;
thompson, Manore & Sheeshka, 2007).
Taking the entire family to a local farm to
help pick their own produce not only
facilitates family bonding, it also provides
outdoor exercise and increases the
likelihood the child will want to eat the
food they have helped to gather.
Toddler’s Energy Needs
 Toddlers need more fat than adults! They have a
continuously developing nervous system
 They require that 30-40% of their total daily energy be
fat
 The emphasis should be on eating foods that contain
“good” fats such as essential fatty acids; Linoleic acid
(omega 6 fatty acid) and Alpha Linolenic acid (omega 3
fatty acid and monounsaturated oils such as olive and
peanut oil instead of saturated fats in margarines and
deep-fried foods (Thompson, Manore & Sheeshka,
2007).
Examples
Examples of foods with omega 6 oils: peanuts,
soy, vegetables and seeds and their oils, meat
Examples of foods with Omega 3 oils: seafood
such as salmon & tuna, walnuts, flaxseed, leafy
green vegetables
Examples of monounsaturated oils: olive oil, soy
products and oils, canola oil
(Thompson, Manore & Sheeshka, 2007).
Carbohydrates
 Toddlers are very active and need a lot of energy from
carbohydrates which also provide a quick source of
glucose for the brain
 The RDA for carbohydrates for toddlers is 130 grams
per day
 The intake of carbohydrates should be from 45-65 % of
their total energy intake
 The carbohydrates should mostly be comprised of
complex carbohydrates such as whole grain breads,
cereals, muffins, fruits and vegetables
 Simple or refined carbohydrates such as white flour
products; breads, cakes, muffins, crackers, candy and
syrups should be kept to a minimum
(Thompson, Manore & Sheeska, 2007).
Proteins
 The RDA for toddlers for protein is 1.10
grams per kg of body weight per day
Good sources of protein are meats such as
poultry and fish, dairy and soy products
(Thompson, Monore & Sheeska, 2007).
Micronutrients
 As toddlers grow their micronutrient needs such as
vitamins A, C and E as well as minerals calcium, iron
and zinc
 Iron deficiency is of particular concern as not only it is
the most common nutrient deficiency in young children
(Thompson, Manore & Sheeshka, 2007), several
studies have found overweight and obese children
were at increased risk for iron deficiency anemia.
Following the Canada’s food guide will help to meet these
needs as well as the Macronutrient energy needs listed
previously
Following Canada’s Food
Guide to Healthy eating for
Native Americans
Vegetables and Fruit group
Toddlers require at least 4 servings daily
from this group
Examples From Vegetable
Fruit Group
 dark green and orange vegetables (such as broccoli
carrots or squash), with ½ a cup or 125 mL equaling
one serving
 Leafy Vegetables and wild plants (such as spinach,
fiddleheads & spring greens mix), with ½ cup equaling
1 serving if cooked and 1 cup equaling a serving if raw.
 Berries such as blue berries, strawberries and
blackberries with one cup equaling 1 serving
 Raw fruit such as a banana or an apple or peach with 1
whole fruit or ½ cup equaling 1 serving
 ½ cup or 125 mL of fruit juice equals 1 serving
(Health Canada, 2008).
Grain Products:
Toddlers Require 3 Servings
Examples of Grain
Products
 Whole grain bread or bannock with 1
slice being 1 serving
 Whole grain cereals with 30g of cold
cereal and 175 gram or one cup being 1
serving
 Whole-grained or white or wild rice with
¾ cup being one serving (Health
Canada, 2008).
Milk and Alternatives
 Toddlers require 2
servings a day
of milk or other
dairy products
or alternatives
Examples of Milk and
Alternatives
 Whole, 2% or skim milk (children under 2
should not have reduced fat milk), with 1 cup
being one serving
 Calcium fortified soy beverage, with one cup
being 1 serving
 Yogurt (preferably with minimal added sugars)
with ¾ cup being one serving
 Cheese with 1/2 cup or roughly 2 1 inch cubes
being one serving
 (Health Canada, 2008).
Alternatives to dairy
Products if you are lactose
intolerant
 Wild plants and seaweed
 Bannock made with baking powder
 Fish with bones, shellfish, nuts and
seeds
Meat and Alternatives- 1
Serving a day is required for
toddlers from this group
Examples of Meat and
Alternatives
Meats:
 Traditional meats such as deer and wild game
with 75 grams or ½ cup being one serving
 Fish and shellfish, with 75 grams or ½ cup
being one serving
 Lean meat and poultry, with 75 grams or ½ cup
being one serving
(Health Canada, 2008).
Meat alternatives
 Eggs, with two eggs being one serving
 Beans-cooked with ¾ cup being one serving
 Peanut butter or other nut butters with 2 tbsp
being one serving (care should be taken to
spread the peanut butter thinly as could be a
choking hazard for a 2 yr old)
(Health Canada, 2007).
Foods to Limit or have in
Small Quantities
 Pop, fruit flavored drinks such as Koolaid, sports and energy drinks, candy and
chocolate, cakes pastries, doughnuts,
granola bars, cookies, potato chips,
nachos and french fries
The Philosophy of the
Guide
 Respect your body………Choices matter
 For strong mind and be active every
body be active every
day
Review of Interventions
 The first line of defense for obesity is its
prevention: implementing the next two
interventions at an early age can accomplish
this
 Increase physical activity including activities
done as a family and decrease television
viewing, video games and computer use
 Encouraging children to eat healthier foods
rather than to restrict eating using a “healthy
weights” philosophy for optimal self-esteem
(Women’s Health Council, 2002).
References
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Carter, B. & McGoldrick, M., (1988). The changing family life cycle: A framework for
family therapy. (2nd ed.). New York: Gardner Press.
Canada Revenue. (2008). Canada’s Fitness Tax Credit. Ottawa: Canada Revenue
Agency. Retrieved March 9, 2008 from http://cra-arc.gc.ca.
Finance Canada. (2008). Canada’s New Government Establishes Program
Eligibility for the Children’s Fitness Tax Credit. Ottawa: Department of Finance
Canada. Retrieved March 9, 2008 from http://fin.gc.ca.
Erickson, E.H., (1980). Identity and the lifecycle. New York: Norton
Gilliland, D.F., Berhane, K., Islam, T., McConnell, R., Gauderman, J.W., Gilliand,
S.S., Avol, E. & Peters. M.J. (2003). Obesity and the Risk of Newly Diagnosed
Asthma in School-age Children. American Journal of Epidemiology.158 (5), 406415.
Groan, I.M., Ball, C.D.G. & Cruz, L. M. (2003). Obesity and Risk of Type 2
Diabetes and Cardiovacular Disease in Children and Adolescents. The Journal of
Clinical Endocrinology & Metabolism. 88 (4), 1417-1427.
Health Canada. (2008). Eating Well with Canada’s Food Guide-First Nations, Inuit
and Metis. Ottawa: Public Health Agency of Canada. Retrieved March 9, 2008 from
http://www.hc-sc.gc.ca.
Hockenberry, J.M. & Wilson, D. (2007). Wong’s nursing care of infants and
children. (8th Ed.). Missouri: Mosby Elsevier.
Hockenberry, J.M. & Wilson, D. (2008). Wong’s Clinical Manual of Pediatric
Nursing. (7th Ed.). Missouri: Mosby Elsevier.
Miller, J., Rosenbloom, A. & Silverstein, J. (2004). Childhood Obesity. The Journal
of Clinical Endrocrinology & Metabolism. 89 (9), 4211-4218.