Pacific MBA

S. Eric Anderson, PhD, MBAChair, Department of Health Policy & Management

Pacific MBA Program Director

Pediatric Obesity: What is it and what can we do about it?

Kiti Freier Randall, PhDKim Hamai, MD

Loma Linda University Children’s Hospital

Pediatric Obesity

• Prevalence of pediatric overweight/obesity has tripled in the past several decades– Multivariate Problem

• Physical and psychosocial ramifications are becoming more marked and necessitate societal concern

US Epidemic

• Recent estimates indicate 15% of children ages 6-19 are considered obese

• Estimated that 25% are overweight• Public health crisis with long-lasting

medical and psychological implications.– (National Institute of Environmental

Health Sciences (NIEHS) Office of Management, 2007)

Pandemic• Nearly half of the children in North and South

America will be overweight by 2010. • In the European Union, about 38 percent of all

children will be overweight if present trends continue.

• The percentages of overweight children are expected to increase significantly in the Middle East and Southeast Asia.

• Mexico, Chile, Brazil and Egypt have rates comparable to fully industrialized nations

• One in five children in China will be overweight by 2010

– Associated Press 2006

Pediatric Obesity: Medical Factors

• Overweight and Obese– What are they?

BMI (body mass index)

• BMI = wt (kg) = wt (lb) x 703

ht 2 (m2) ht 2 (in2)

->95% for age is obese

-85-94% for age is overweight

Body Mass Index(BMI Boys 2-20 yrs)

Body Mass Index(BMI Girls 2-20 yrs)

Obesity evaluation

• BMI

• Physical examination

• Family history

• Laboratory evaluation

Abnormal physical Examination

• High blood pressure (for age)

• Acanthosis nigricans

• Increased waist circumference

High-risk Family History

• Type 2 diabetes

• Premature cardiovascular disease

• Hyperlipidemia

Laboratory evaluation

• Fasting blood sugar

• Fasting lipid panel (total cholesterol, HDL, LDL, TG)

• Liver enzymes (AST, ALT)

Metabolic Syndrome

• Excess abdominal fat

• High blood pressure

• High TG

• Low HDL

• High blood sugar

Pediatric Obesity: Medical Consequences

• Diabetes• High blood pressure• Osteoarthritis• High total blood cholesterol• Gastroesophageal reflux disease• Back pain• Increased risk for heart disease

Pediatric Obesity:Medical Consequences

• “This is going to be the first generation that’s going to have a lower life expectancy than their parents”

– Associated Press, 2006

Pediatric Obesity:Psychological Consequences• Depression

• Lower Self Esteem

• Behavioral Problems

• Psychological Distress

Pediatric Obesity:Psychological Consequences

Suicidal Ideation & Intent

Pediatric Obesity:Family Factors

• Parenting values, beliefs, and practices

• Family physical activity

• Family television viewing.

• Gable and Lutz (2000)

Pediatric Obesity:Public Health Consequences• Impact on health care systems

– Premature illness

• High risk of obesity into adulthood• Younger mortality rates• Communities of poor mobility/health• Effects on workforce and economics

Treatment Works

• Treatment programs, which encompass the child, the family, and a peer group, have achieved sustainable results.

• Obesity Prevention Center for Children & Youth

Growing Fit Program Pediatric overweight/obesity program • 12 week• Community-based• Multidisciplinary• Family-peer approach

– Mental Health Screening– Medical Examination & Follow-up – Exercise– Support groups

• Child• Parent

– Nutrition education

Readiness for Change & Self-Esteem

• Children who feel more popular (feeling less teased and/or less isolated from peers, etc) showed a greater emotional readiness to change

• Children who perceived higher intellectual and school status (feeling competent and smart at school) demonstrated a greater cognitive readiness to change

Prevention works:What we can do?

• Monitor advertising• Promote physical activity on a global scale • Advocate for ‘safe’ outdoor play areas in the

community• Make healthy foods available to all communities

– Educate families on healthy eating– promote healthy eating to dampen demand for junk

food • Encourage and offer non-sedentary activities• TIME IN

LLU Children’s Hospital Growing Fit Program

• Director: Kiti Freier Randall, PhD• Medical Director: Kim Hamai, MD• Counseling Coordinator: Vidhya

Krishnamurthy, PhD• Exercise Coordination: LLU Drayson Center• Nutrition Coordination: LLU School of Allied

Health Professions Nutrition Department