The Childhood Obesity Epidemic

The childhood obesity epidemic has reached alarming levels. Multiple studies show a tripling of prevalence over the last thirty years. According to the Robert Wood Johnson Foundation,” we are raising the first generation of youth who will live sicker and shorter lives than their parents.”

As healthcare providers, we see the impact this epidemic has on the children and families we care for. It affects not only the physical and emotional health of children, but their academic and economic potential as well as the overall health and economics of our communities.

Epidemiology

As obesity rates have increased dramatically over the last 30 years in the U.S. in both adults and children, obesity has become a national epidemic. Data from the CDC from 2003-2004 and 2005-2006 indicated that two-thirds of U.S. adults were either obese or overweight. Based on representative samples of U.S. children, nationally 1/3 of children are overweight or obese.

According to the Robert Wood Johnson Foundation, we are raising the first generation of youth who will live sicker and shorter lives than their parents. Childhood obesity has become an epidemic with tripling of prevalence rates since 1980. According to a recent report published by Trust for America's Health, Nebraska ranks as having the 21st highest percent of obese and overweight children in the U.S., with 31.5% of Nebraska children measured as obese or overweight.
> The childhood obesity epidemic disproportionately affects children who are minority, live in poverty, and/or live in neighborhoods without access to healthy foods and safe play spaces. These disparities are demonstrated nationally and in our communities across Nebraska. The economic burden of the obesity epidemic on our communities is high. Rising healthcare costs, decreased workforce productivity, increased school absenteeism rates have an economic effect on all of our citizens.

Etiology

Obesity is the result of an imbalance of energy intake and energy expenditure. Genetics, environment and behavior, all contribute to obesity risk. The rapid increase in prevalence of children who are obese and overweight cannot be explained by genetics alone.

Although diet and exercise are key determinants of weight, environmental factors beyond the control of individuals (including lack of access to full-service grocery stores, high costs of healthy foods, and lack of access to safe places to play and exercise) contribute to increased obesity rates by reducing the likelihood of healthy eating and active living behaviors.
> Ubiquitous shifts in food practices, changes in our built communities, a marked increase in sedentary activities opportunities, and a food industry which spends billions marketing unhealthy food choices to children at very young ages, are some of the major causes of the epidemic

Etiology

Childhood Obesity Defined

Overweight and obesity is defined in children by the Body Mass Index (BMI) measurement, or the measure of weight adjusted for height using age and gender specific growth charts. BMI is defined as weight (in kilograms) divided by the square of height (in meters). BMI levels correlate with body fat and also correlate with concurrent health risks, especially cardiovascular risk factors. For children, the distribution of BMI changes with age. As a result, percentiles specific for age and gender define underweight, healthy weight, overweight, and obesity in children. Obesity risk is also determined by screening family history, assessing physical activity and nutrition behaviors, a review of systems and physical examination for comorbidities, which taken altogether determine the need for intervention.

Health Consequences by Body System

Obesity affects nearly every body system. Diseases, such as type 2 diabetes, formerly termed adult-onset diabetes, are now being seen in children in epidemic proportions.

Some of the Health Consequences by Body System include:

Cardiovascular- Dyslipidemia, Hypertension, Atherosclerosis

Orthopedic- Slipped Capital Femoral Epiphysis, Blounts Disease, Flat Feet, Knee and Leg pain, Gait abnormalities

Endocrine- Metabolic Syndrome, Diabetes Mellitus Type 2, Polycystic Ovarian Syndrome, Insulin Resistance, Menstrual Irregularities

Psychologic- Depression, Negative self-image, social isolation, Eating disorders

Gastrointestinal- Nonalcoholic Fatty Liver Disease, Gallstones, Gastroesophageal Reflux

Pulmonary- Asthma, obstructive Sleep Apnea

Neurologic- Pseudotumor Cerebri

Role of the Healthcare Provider

Role of the Healthcare Provider

Role of the Healthcare Provider:
> The 2007 Expert Committee Recommendations on the assessment, prevention and treatment of child and adolescent overweight and obesity define the role of healthcare providers. Nebraska’s Clinical Childhood Obesity Model was developed to assist healthcare providers to readily integrate the Expert Committee Recommendations into practice by resourcing clinicians with the tools necessary to carry out the defined roles which are to:
> Assess
> The first step in the universal assessment of children ages 2 to 18 for obesity and obesity risk is to chart BMI %. Perform a clinical evaluation, including a history and exam and order appropriate laboratory tests. Using Nebraska’s Youth Physical Activity and Nutrition (PA-N) Assessment Form assess health behaviors and attitudes, and set patient-driven healthy lifestyle goals.
> Prevent
> Prevention of obesity starts with promoting the initiation of breastfeeding and providing support for breastfeeding through the first year of life. For children ages 2 to 18 who are in the healthy weight category, follow the universal assessment steps, give consistent prevention messages, and reevaluate annually.
> Treat
> The Expert Committee recommends a staged protocol for treatment with the level of intervention to be based on a patient’s BMI% and age. The keys to successful treatment are to chart BMI% at every visit, follow the staged protocol, target comorbidities, use Nebraska’s Youth PA-N Form to set patient driven goals, engage the entire family in behavior change, and stay the course because small changes yield big rewards.
> Advocate
> As a healthcare provider, you can advocate as a role model by being physically active and making healthy food choices. Integrate Nebraska’s Clinical Childhood Obesity Model into practice by resourcing your office with the patient educational materials and office posters. Engage the entire clinic in your efforts. Serve as a conduit to community resources and programs. Advocate for environmental and policy changes in your community and join the Nebraska Medical Association’s Childhood Obesity Prevention Project. Together, we can Foster Healthy Weight in Youth.

Why Prevention?

Why Prevention?

Following the guidelines for health supervision at well child visits, pediatricians and family practice providers give anticipatory guidance regarding health, safety, and development everyday. This includes educating patients and families on age- appropriate nutrition and physical activity guidelines. Our prevention efforts are even more important in light of the severity of the childhood obesity epidemic. Not only does prevention work when put into practice, but prevention is important because:

• The probability of childhood obesity persisting into adulthood is estimated to increase from:
> o 20% at 4 years of age to
> o 80% by adolescence

• Prevention of obesity is critical because long-term outcome data for successful treatment approaches are limited.

• Early physical activity and dietary patterns track into adolescence and correlate with adult obesity risk.