Childhood Obesity MODULE 4

Childhood Obesity MODULE 4

Objectives: 1) Identify co-morbidities associated with childhood overweight and obesity and their effects into adulthood 2) Define overweight and obesity using the WHO growth charts for Canada 3) Describe the many factors that may influence a child s food intake and physical activity pattern, and thus weight status 4) Understand the current recommendations on how to screen and identify children at-risk for obesity

Childhood Obesity

Childhood Obesity a BIG problem Physically: Increased likelihood of obesity in adulthood Increased risk of: Type 2 Diabetes Hyperlipidemia High blood pressure Orthopaedic problems Obstructive sleep apnea Early menarche (Deckelbaum and Williams, 2001 and Centre for Disease Control and Prevention, 2011)

Childhood Obesity a BIG problem Psychosocial issues: Depression Anxiety Lack of self-esteem Body image issues (Ebbeling et al, 2002 and Warschburger, 2005)

Childhood Obesity a BIG problem Stereotyped as: Unhealthy Academically unsuccessful Socially inept Unhygienic Lazy Lacking self-control and poor self-restraint (Ebbeling et al, 2002 and Warschburger, 2005)

REFLECTION: A number of studies have shown that the negative views or stereotypes that one may have on overweight people persist beyond training into professional life. How do you think this would affect our interactions with our clients, even before any kind of treatment is considered? How might this impact the care we provide?

Defining childhood overweight and obesity with the WHO growth charts for Canada Providing a piece of the puzzle

0 24 months cut-offs Growth Status Indicator Percentiles Underweight Weight-for-age <3rd Severely Underweight <0.1st Stunted Length-for-age <3rd Severely stunted <0.1st Wasted Weight-for-length <3 rd or <89% IBW Severely wasted <0.1st Risk of Overweight Weight-for-length >85th Overweight Weight-for-length >97th Obese Weight-for-length >99.9th Head Circumference Head circumference-for-age <3 rd or > 97th

0 24 months Weight-forlength cut-offs

2 19 years cut-offs Growth Status Indicator Percentiles 2-5 years 5-19years Underweight Weight-for-age <3rd <3rd Severely Underweight <0.1st <0.1st Stunted Length-for-age <3rd <3rd Severely stunted <0.1st <0.1st Wasted BMI-for-age <3rd <3rd Severely wasted <0.1st <0.1st Risk of Overweight BMI-for-age >85th N/A Overweight BMI-for-age >97th >85th Obese BMI-for-age >99.9th >97th Severely obese BMI-for-age N/A >99.9th

BMI-for-Age 2-5 yr cutoffs and 5-19 yr cut-offs Obese Severely obese Obese Overweight Overweight Risk of overweight

CASE STUDY Evan 5 years old Copyright. Province of British Columbia. 2010. All rights reserved. Reproduced and adapted with permission of the Province of British Columbia.

Childhood Obesity Energy IN > Energy OUT However, a simple focus on food intake and physical activity is unlikely to solve the problem.

Davison & Birch, 2001 Copyright 2001. John Wiley and Sons. Used with permission.

Population Health Promotion (PHP) Model Childhood Obesity

REFLECTION: Thinking of the EST model and the Population Health Promotion model, what are some of the modifiable factors that you currently address in your practice? What are some of the more difficult factors to address in your practice setting?

Curbing Childhood Obesity A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights

3 integrated strategies 1) Making childhood overweight and obesity a collective priority for action 2) Coordinating efforts on 3 key policy priorities a) Supportive environments b) Early action c) Nutritious foods 3) Measuring and reporting on collective progress

Prevention strategies Pre and Post-natal support for breastfeeding Dietary changes Physical activity (age appropriate) Behaviour and social modifications Family participation

Clinical treatment focus Behaviour change to achieve energy balance Possible pharmacological treatment Possible surgical treatment

Involve parents and caregivers Start prenatally Focus away from the child

REFLECTION: Why would you think that focusing our strategies away from the child may be beneficial?

Breastfeeding and obesity Preventative measure Breastfed infants gain predominantly more lean body mass (Dewey, 2003) Breast milk contains the hormones leptin and adiponectin which help infants regulate appetite and energy metabolism (Li et al., 2008)

Dietary strategies Exclusive breastfeeding for 6 months, and appropriate addition of complimentary foods with continued breastfeeding to 2 years and beyond Reducing energy dense foods is more effective than strict avoidance (Edmunds et al., 2001) Nutritional quality is essential, not just calories (Ebbeling et al., 2002)

Physical activity Increase energy expenditure Increase active play Increase opportunity to be active with daily living Reduce sedentary behaviours Limit screen time Ensure adequate sleep

Summary Key Practice Points 1) While not a diagnostic tool, the cut-offs for the WHO Growth Charts for Canada can be used to identify children at potential risk for overweight and obesity 2) There are many factors beyond an individual s control that influence energy intake and expenditure 3) Family participation is of crucial importance when addressing a child s health promoting behaviours 4) Breastfeeding is a preventative measure for childhood obesity

Acknowledgements Funding for this project has been made possible through a contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. Project Manager Lynda Corby MSc, MEd, RD, FDC Producer Susan Hui MPH, MSc, BEd, RD Audio Martha McCarney, RD Dietitians Advisory Service EatRight Ontario Evaluation Consultants Susan Ross MSc, RD, FDC, CHE Zena Simces MA National Advisory Committee Collaborators Dietitians of Canada Canadian Paediatric Society College of Family Physicians of Canada Community Health Nurses of Canada Canadian Obesity Network NutriSTEP Research Team National Aboriginal Health Organization Members of the National Reference Groups