Transcript Childhood Obesity: world epidemic

Childhood Obesity:
The World Epidemic
Mostafa El-Hodhod
Ain Shams University, Cairo, Egypt
Agenda
 How much common?
 Why common?
 How to diagnose?
 How much serious?
 Some basic facts underpinning?
 How to prevent?
 How to treat?
Childhood
obesity has
increased
tremendously in
the past 30 years
(CDC)
Childhood
obesity has
increased
tremendously in
the past 30 years
(CDC)
Some of the
reasons for this
problem include
family history,
lack of exercise
and overeating
(AACAP)
Worldwide, 22 million children
under the age of five years are
either overweight or obese
In some parts of Africa, obesity
has surpassed malnutrition as the
number one nutritional disorder
(Miller, Rosenbloom & Silverstein, 2004).
Definitions
Obesity is defined as
excess body fat.
Obesity is defined as
excess body fat.
Because body fat is difficult to
measure directly, obesity is often
measured by weight or body mass
index (BMI)
For infants
 Above the 85th percentile for weight for
length is considered overweight, and
 Above the 95th percentile is considered to
be obese
(Miller, Rosenbloom & Silverstein, 2004; Thompson, Manore & Sheeshka, 2007).
For older age
 Adults with a BMI between 25 and 29 are
considered overweight, those with a BMI of 30
or more are considered obese, and those with
a BMI of 40 or more are considered extremely
obese
 For children and adolescents, these BMI
categories are further divided by sex and age
CDC BMI charts for children
and adolescents
 BMI between the 85th and 94th percentiles are
generally considered overweight,
 BMI at or above the sex-and age-specific 95th
percentile of population on this growth chart are
typically considered obese
 There are BMI calculators one of them is on
CDC site
BMI = screening tool
BMI ≠ measure of health
A clinical assessment
and other indicators
must also be
considered when
evaluating a child’s
overall health and
development
Risks
 Obese children are more frequently being
diagnosed with type 2 diabetes, and showing
early signs of insulin resistance syndrome and
cardiovascular disease. 1
 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. 2
1-(Goran, Ball, & Cruz, 2003; Thompson, Manore & Sheeshka, 2007).
2 (Thompson, Manore & Sheeska, 2007).
 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).
 Some studies have found a correlation
between obesity and asthma-while it has not
been determined what the link is-
(Hockenberry & Wilson, 2007; Gilliland, Berhane, Islam, McConnell, Gauderman, Gilliland, Avol &
Peters, 2003).
Causes of obesity and causes
of increase
It is a matter of imbalance between intake and
expinditure. So Causes are not actual causes
they are risk factors
The Causes?
 Genetics ?
 Endocrinal
 Marked life-style changes (diet and
Activity)?
(Miller, Rosenbloom & Silverstein, 2004).
Modern food style
Modern tech
Care giver effects
Dramatic Changes that have taken
Place in the last few Decades
(Miller, Rosenbloom & Silverstein, 2004).
Portion sizes
The introduction of vending machines
“Healthy Weight” Concept
Avoid Early Life risk factors
Genetic
- Strong player
- Not a cause of
recent rise
- Susciptiplity
waiting for non
genetic
Non genetic
1- Materanl
- Nutrition
- Smoking
- DM
2- Newborn and
infancy rapid
growth
Environmental Factors
During Childhood
 Lifestyles changes
Prevention of the national
problem
 Girl and women Care + antenatal care
 Improving eating habits and
 Increasing physical activity are two critical strategies
 Tobacco prevention and control,
 comprehensive, multi-sectoral approaches
Policies
 (1) material incentives, such as the cost of food or the
desire to avoid poor health;
 (2) social norms, such as the nutritional and physical
activity habits of friends and family, which influence us
greatly; and
 (3) the broader environment, such as whether grocery
stores and playgrounds are near by or far away
Revise the medical report by a task force
group submitted to president of USA to
combat obesity in USA
Solving the problem of childhood obesity
within a generation
Treatment of individual cases
Eliminate the individual risk
Increase Physical Activity
Encourage Family Activities
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.
Nutrition
It is important to re-emphasize that children’s
food intake should not be restricted nor should
they be forced to eat
Good food not mere
restriction
 Decrease of intake should be slower than
in adults
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
 Eat “good” fats such as essential fatty acids; Linoleic
acid (omega 6 fatty acid) and Alpha Linolenic acid
(omega 3 fatty acid)
(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
 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
(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.
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 being one serving
 (Health Canada, 2008).
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 Kool-aid, sports and
energy drinks, candy and chocolate, cakes pastries,
doughnuts, granola bars, cookies, potato chips, nachos
and french fries
Wrap up
 Prevent obesity better than treating it
 National programs are needed
 Treatment of individual cases is tailored for every case
 Take care of the balance between restricion and
deficiency.
 Go ahead and take a course on infant nutrition.
Thank you