Obesity and Type 2 Diabetes

in Children

A presentation to initiate awareness and advocacy for an

international health epidemic

Developed by

Jeanne Fenn, RN, BC, MEd, CDE

Cecilia Rosales, MD, MS

Claire Logue

The purpose of this presentation is to:• Explain the obesity and type 2

diabetes crisis• Discuss methods of curbing

this epidemic• Encourage participation within

your family, school, and/or community in developing a healthier lifestyle

What is Obesity?• A condition resulting from

excessive storage of fat in the body. (Best measured by BMI)

What is BMI?

• BMI (Body Mass Index) is the ratio of weight in kilograms to square of height in meters. BMI correlates with more accurate measures of body fatness.

• Pediatrics:– At risk: BMI between 85th – 95th percentile for age

and sex – Overweight/Obese: BMI at or above the 95th

percentile for age and sex

American Academy of Pediatrics; Prevention of Pediatric Overweight and Obesity, 2003

Example Calculation

• Weight (lb) ÷ Height (in) ÷ Height (in) x 703 = BMI

• Ex:13 year old boy, wt;146 pounds, ht; 64 in

• 146 ÷ 64 ÷ 64 x 703 = 25• BMI of 25 per growth chart = 95%• This young man is overweight/obese

http://www.cdc.gov/growth charts

Examples of Children At Risk

By Mayo Clinic Staff

The prevalence of childhood overweight and obesity has

doubled in the past 20 years.

American children are less physically active as a group than

were previous generations.

American Academy of Pediatrics Policy Statement: Prevention of Pediatric Overweight

and Obesity, 2003

What are common medical problems in obese children?

• Type 2 diabetes• Heart disease• Mental health; depression, low

self-esteem• Pulmonary or Respiratory

problems

How Does Arizona Fare?

• The number of overweight/obese adults has increased from 44.7% (1994) to 56% (2001)

• Currently it is estimated that 58% of Arizonans are overweight/obese

• 34% of children enrolled in Headstart programs are overweight.

Trends in Prevalence of Overweight* in US Boys 12-17 Years Old

02468

10121416

1966-1970 1971-1974 1976-1980 1988-1994

Caucasian African-AmericanCaucasian, non-Hispanic African-American, non-HispanicMexican

*BMI at or above sex- and age-specific 95th percentile CDC, National Center for Health Statistics. 1998.

Prevalence (%)

Trends in Prevalence of Overweight* in US Girls 12-17 Years Old

0

5

10

15

20

1966-1970 1971-1974 1976-1980 1988-1994

Caucasian African-AmericanCaucasian, non-Hispanic African-American, non-HispanicMexican

Prevalence (%)

*BMI at or above sex- and age-specific 95th percentile CDC, National Center for Health Statistics. 1998.

U. S. Obesity Rates: Past 20 Years

• Today’s obese children could be the 1st generation of Americans with a life expectancy less than their parents!

Richard Carmona MD, US Surgeon General

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1985

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1986

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1987

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1988

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1989

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1990

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1991

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1992

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1993

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1994

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1995

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1996

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1997

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Prevalence of Obesity* Among U.S. AdultsBRFSS, 1998

(*Approximately 30 pounds overweight)

Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16.

<10% 10% to 15% >15%

Obesity Trends* Among U.S. AdultsBRFSS, 1999

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 2000

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 2001

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Source: Behavioral Risk Factor Surveillance System, CDC

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

1991 1995

2002

Obesity Trends* Among U.S. AdultsBRFSS, 1991-2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Children Then….

Children Now…….

From Childhood & Adolescent Obesity and Type 2 Diabetes by Francine Kaufman MD

Factors Related to the Onset of Obesity

• Altered dietary intake

• Decreased physical activity

• Increased inactivity

Altered dietary intake

• Nutritional content • Portion size

Decreased physical activity

• Not as much participation in physical activities; walking, active play, recess

Increased inactivity

Look at time spent watching TV, playing electronic games

Enrollment in daily physical education classes

From the Surgeon General's Report on Physical Activity and Health, 1996

Percentage of High School Students Who Reported Not Being Enrolled in Physical Education Class,

1999

                                                                                                                 

CDC, Youth Risk Behavior Surveillance System

The Burden of Obesity(Adapted from American Obesity Association source, 2002)

Prevention is the Key!

• Tommy Thompson, Secretary of Health & Human Services

• Dr. Richard Carmona, U.S. Surgeon General

• Center for Disease Control (CDC)

• American Academy of Pediatrics (AAP)

• American Diabetes Association (ADA)

Why Target Children?

• Prevention is more cost effective than cure

• Children can be reached through schools

• Effects of chronic disease accumulate over time; so need long-term changes– We need to begin awareness at an early age

E. Sanchez, MD, MPH

Why Should Schools Care About Health?

• As a society, we value good health.• Good health is necessary for effective

learning• Healthy students become healthy,

productive citizens• Schools are the one place where the

majority of our nations youth can be foundE. Sanchez, MD, MPH

How Do You Initiate Change?

• Environmental/Policy– Obtain baseline assessments– Make physical activity and

nutrition a priority in schools– Fund preventative programs

and services in community– Develop a comprehensive

approach

How Do You Initiate Change?

• Community Action:– Utilize local data/community input to

assess your needs– Increase awareness of obesity problem in

culturally appropriate ways– Develop partnerships for community-wide

healthy lifestyle actions

How Do You Initiate Change?

• Schools can provide:– Quality daily P.E. classes– Nutrition awareness campaign– Parent education/awareness campaign– Psychosocial education/intervention– School nutrition policy

What Can We Do In Our School?

• Ask for support from the school board and superintendent

• Incorporate students, parents, teachers in providing strategies and ideas

• Look at your school practices• Focus on health and activity,

not weight• HAVE FUN!!!

Governor Napolitano’s Call to Action Reports January 30, 2004

• SELECTED REQUESTS:• Keep recess sacred, not used as a punishment• Daily P. E. classes• Provide healthy vending machine choices• Educate students about marketing ploys for

unhealthy snacks• Age appropriate nutrition education• Omit unhealthy fundraisers/limit candy rewards

for good behavior

Behavior Change Strategies

• Increase physical activity:– Provide exercise choices to children– Encourage age appropriate and creative

exercises– Start with 30 minutes of moderate activity

per day

– Make it fun!

Behavior Change Strategies

• Increase awareness of food choices:– Moderate food portions– “5 a day” Vegetables and Fruits

• Limit inactivity– American Academy of Pediatrics

recommends limiting TV viewing to 1-2 hrs/day

CDC’s Guidelines for Promoting Lifelong Physical Activity

• Physical activity of moderate intensity for 5 days of the week– Walking 2 mi X30’– Running 11/2 mi X 15’– Bicycling 5 mi X30’ / 4 mi X 15’– Basketball X 15-20’

A Pound of Prevention….…

• Life-long healthful eating

• Daily physical activity throughout life

• All things in moderation

TIP: Everyone needs to do these things, whether they

are obese, overweight, or normal weight.

What are

your views?