Strategies for Combating the Epidemic of Obesity in ... · Obesity Epidemic In America? In general,...

Nieman DC. Professor, Health and Exercise Science, ASU-NCRC Human Performance Lab. Childhood Obesity.

Strategies for Combating the Epidemic

of Obesity in American Youth

RESEARCH STUDY RESULTS ON 762 MIDDLE-SCHOOL AGED STUDENTS, CHARLOTTE, NC

Funding, Golden Leaf Foundation STEM Initiative David C. Nieman, DrPH, FACSM; Dustin A. Dew, Pamela G. Krasen

Research Design

• Middle school students (N=458 boys, N=304 girls over a 3-year period) from school districts in the greater Charlotte, NC, area were given a battery of physical fitness tests including: – muscular strength (lower back and leg dynamometer)– anaerobic peak and sustained power (Wingate 30-second test)– treadmill VO2max

– percent body fat

Results

• Body mass index (BMI):

– 22.2±5.2 and 22.9±5.2 kg/m2

in boys and girls, respectively

• Body fat %:

– 19.8±11.0 and 24.6±8.7% in boys and girls, respectively

• 37% of boys and 36% of girls were overweight or obese using CDC BMI-for-age growth charts.

Bo

ysR

= -0

.65

, P<0

.00

1G

irls

R=

-0.5

6, P

<0.0

01

Higher body fat predicted lower aerobic fitness

0

10

20

30

40

50

60

70

80

0 10 20 30 40 50 60

VO

2m

ax (

ml/

kg/m

in)

Males, Body Fat (%)

0

10

20

30

40

50

60

0 10 20 30 40 50 60

VO

2m

ax (

ml/

kg/m

in)

Females, Body Fat (%)

39% boys below adequate level (42 ml/kg/min)

60% girls below adequate level (36 ml/kg/min)

Bo

ysR

= -0

.71

, P<0

.00

1

Gir

lsR

= -0

.58

, P<0

.00

1Anaerobic capacity (i.e., 30-second sprint power) was lower in boys and

girls with more body fat

0

2

4

6

8

10

12

0 10 20 30 40 50 60

30

-Se

c W

inga

te T

est

(w

atts

/kg)

Males, Body Fat (%)

0

1

2

3

4

5

6

7

8

9

0 10 20 30 40 50 60

30

-Se

c W

inga

te T

est

(w

atts

/kg)

Females, Body Fat (%)

Conclusions• Over one-third of the

middle school-aged boys and girls tested (N=458 males, N=304 females) were classified as overweight or obese.

• 39% boys and 60% girls below adequate aerobicfitness levels.

• Percent body fat was inversely related to aerobic and anaerobic fitness.

31%

Overweight/

Obese

• Nearly one in three

youth (31 percent),

ages 2 to 19 years, is

now overweight or

obese.


Scientific Report of the 2015 Dietary Guidelines for Americans, USDA.

2-5 y 6-11 y 12-19 y

29.8

46.2

38.1

21.9

38.139.8

20.9

29.431.2

9

19.9

24.6

Prevalence of Overweight/Obese for U.S. Youth

Hispanic Black White Asian

National Center for Health Statistics. Health, United States, 2014: Hyattsville, MD. 2015.

Overweight/Obese = ≥85% BMI for age and sex based on year 2000 growth charts.

0

2

4

6

8

10

12

14

16

18

20

1963-1970

Current

4.2

17.9

4.6

19.4

Pe

rce

nt

Ob

ese

Ages 6-11 Ages 12-19

1 in 5 U.S. youth obese

National Center for Health Statistics. Health, United States, 2014: Hyattsville, MD. 2015.

Obese = ≥95% BMI for age and sex based on year 2000 growth charts.

Childhood obesity is

reaching alarming

proportions in many

countries

(prevalence

expected to double

in next decade).

WHO, 2016


41 million children under 5 years of

age affected by overweight or obesity

0

5

10

15

20

25

30

35

40

45

U.S. U.K. Brazil Russia France Germany China India Japan

World Obesity Projections for Adults, 2025

Women Men

A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet 387, 10026, pp 1377-1396 (April 2016).


WHO. Report of the commission on ending childhood obesity. 2016.

• Has the potential to

negate gains in life

expectancy.

• Obesogenic environment

encourages weight gain.

• Requires a whole-of-

government approach.

WORLD HEALTH

ORGANIZATION 2016


WHO: Childhood obesity is reaching alarming proportions in many

countries, with prevalence expected to double in the next decade.

WH

O.

Re

po

rt o

f th

e c

om

mis

sio

n o

n e

nd

ing

ch

ild

ho

od

ob

es

ity.

20

16

.

Childhood Obesity:

Critical Threat to Public Health

• According to the Institute

of Medicine:

• Childhood obesity involves

significant risk to physical

and emotional health.

• About six in 10 obese

children ages 5 to 10 years

have at least one heart

disease risk factor.


Medical Complications of Obesity

Phlebitis

Coronary heart disease

Pulmonary disease

Gallstones

Gout

Diabetes

Osteoarthritis

Fatty liver disease

Hypertension

Dyslipidemia

Cataracts

Skin disorders

Pancreatitis

Cognitive dysfunction; Depression, anxiety

Cancerbreast, uterus, cervix, ovary, prostate, kidney, colon, esophagus, pancreas, gallbladder, liver

Gynecologic abnormalities

Stroke

46% higher inpatient costs, 27% more physician visits and outpatient costs, 80% higher

spending prescription drugs = $147 billion/year (Circulation 2014;129:S102-138)

Ann Intern Med.

2013;159(11):758-769

ObesityNot just an adult concern anymore…

Conditions Seen in Children

• High Cholesterol

• Type 2 Diabetes/

Impaired Glucose Tolerance

• High Blood Pressure

• Social Problems and

Poor Self-Esteem

• Sleep Disturbances

• Orthopedic Problems

-60

-50

-40

-30

-20

-10

0

10

Body Weight WaistCircumference

Systolic BP Cholesterol Triglycerides InsulinInsensitivity

Re

lati

ve C

han

ge (

%)

Risk Factor Change (%) in N=167 Obese Children After 6 Weeks

Control girls (N=43) Control boys (N=38) Lifestyle girls (N=43) Lifestyle boys (N=52)

A 6-week diet and exercise intervention alters metabolic syndrome risk factors in obese Chinese children aged 11-13 years.

Luo B, Yang Y, Nieman DC, et al. J Sport Health Sci 2:236-241, 2013.

Lifestyle = 1600-2000 kcal/day, high volumes of moderate exercise (6 days/week,

twice daily, 2-3 h brisk walking, jogging, swimming in morning, and 2-3 h table

tennis or badminton in the afternoon) (emphasis on fun, play).

What Factors Best Explain The

Obesity Epidemic In America?

In general, 3 factors are

most responsible for

weight gain leading to

obesity:

• genetic and parental

influences

• high calorie, high fat diets

insufficient physical

activity.

The

Obesity

Epidemic

“The decline in daily activity that

came from industrialization,

mechanized transportation,

urbanization, and other aspects of

technology created the largest decline

in activity and created the right

conditions under which an increase in

food access, availability, and

decreased cost could have a major

impact on body weight.” James O. Hill, PhD. Circulation. 2012;126:126-132

Nieman DC. Professor, Health and Exercise Science, ASU-

NCRC Human Performance Lab. Childhood Obesity.

Genetic and Parental Influences

• Inheritance accounts for 25%

of variance in fatness, with

lifestyle/ environment 45%.

• Genetic makeup can make an

individual prone to obesity if

the lifestyle is poor.

Int J Obesity 1988;12:205-214

Nutr Rev 1997;55:S21-S30


0

10

20

30

40

50

60

70

80

PreschoolSchool-aged

Adolescent

33

50

80

% W

ho B

ecom

e O

bes

e A

du

lts

OBESE GROUPS

The Risk of Adult Obesity is High for

Obese Adolescents

Prev Med 1993;22:167-177


1.3

4.7

8.8

22.3

17.5

3.2 3 2.6 2.2 2.2

13.6

15.3

5

2

5.6

0

5

10

15

20

25

1-2 yrs 3-5 yrs 6-9 yr 10-14 yrs 15-17 yrs

Od

ds

Ra

tio f

or

Ob

esit

y i

n Y

ou

ng

Ad

ult

ho

od

Odds of Obesity in Young AdulthoodHigh before the age of 10 if parents obese;

High after age 10 if child/teen is obese

Childhood obesity One parent obese Two parents obese

Retrospective study of 854 U.S. males/females. N Engl J Med 1997;337:869-873.

Physical activity declines from the age of school entry.

Globally, 81% of adolescents aged 11–17 years are insufficiently physically active.

Adolescent girls are less active than adolescent boys.

Low physical activity is rapidly becoming the social norm in most countries.

Physical Activity Guidelines

• The 2008 Physical Activity Guidelines for Americans recommend that youth engage in ≥1 h/day or more physical activity.

• Activity should be appropriate for age, enjoyable, and varied.

• Youth should have <2 h/day screen time from TV, computer games, etc. (separate from school tasks).

High-Calorie, High Fat and Sugar Foods and Beverages

• The most important reason for obesity in America is that children and adults are eating too much relative to their physical activity and total energy expenditure (including RMR).

• Studies show that obese compared to lean people choose high fat foods more often, tend to binge eat, and eat faster.


THE RISE IN CHILDHOOD OBESITY

• The rise in childhood

obesity is due to complex

social, environmental, and

policy interactions that

have led to excessive

eating relative to physical

activity and growth energy

demands.

• Institute of Medicine, 2005. Preventing Childhood Obesity: Health in the Balance.

Washington, DC: National Academies Press


MEDIA

GOVERNMENT

AGENCIES

SCHOOLS

FAITH-BASED

ORGANIZATIONS

HEALTH CARE

PROVIDERSPOSTSECONDARY

INSTITUTIONS

FAMILY

EMPLOYERS

YOUTH-SERVING

ORGANIZATIONS

Y O U T H

Important steps to confront the epidemic of

childhood obesity include:

• 1. The federal government should

develop nutrition standards for foods

and beverages sold in schools, and

develop guidelines regarding

advertising and marketing to children

and youth.

• 2. Industry and media should develop

healthier food and beverage product

and packaging innovations, and

expand consumer nutrition

information.


Institute of

Medicine, 2005. Preventing Childhood

Obesity: Health in the

Balance. Washington, DC:

National Academies Press

• 3. State and local governments should expand and

promote opportunities for physical activity and access

to healthful foods within communities.

• 4. Health-care professionals should routinely track

BMI in children and youth and offer appropriate

counseling and guidance.

• 5. Schools should improve the nutritional quality of

foods and beverages served and sold in schools, and

increase opportunities for frequent, more intensive, and

engaging physical activity during and after school.

• 6. Parents and families should engage in and promote

more healthful dietary intakes and active lifestyles.


GUIDELINE

Policies and Practices

1Use a coordinated approach to develop,

implement, and evaluate healthy eating

and physical activity policies and

practices.

Centers for Disease

Control and Prevention

FOCUS ON SCHOOLS

Assess*

Develop and Implement

Evaluate

Policies and Practices

School

Health

Council

School

Health

Team

School

Health

Coordinator* Using the School Health Index (www.cdc.gov/HealthyYouth/SHI)

GUIDELINE 1

http://www.cdc.gov/HealthyYouth/SHI

GUIDELINE

School Environments

2Establish school environments that

support healthy eating and physical

activity.

School Environments

Selected Strategies to Encourage

Healthy Eating and Physical Activity

• Promote access to healthy foods and physical

activity at school.

• Provide suitable facilities for healthy eating.

• Establish safe spaces and facilities for

physical activity.

• Avoid using physical activity as punishment.

• Avoid using food items to reward students.

GUIDELINE 2

GUIDELINE

Nutrition Services

3Provide a quality school meal program and

ensure that students have only appealing,

healthy food and beverage choices offered

outside of the school meal program.

Align all foods

with Dietary

Guidelines for

Americans

Nutrition Services

Promote

access to and

participation

in school

meals

Make all foods

nutritious and

appealing

GUIDELINE 3

GUIDELINE

Physical Education and

Physical Activity

4Implement a comprehensive physical

activity program with quality physical

education as the cornerstone.

Walk- or Bike-to-

School Programs

Daily Recess for

Elementary Schools

Classroom-Based

Physical Activity BreaksIntramural and Physical

Activity Clubs

Quality Physical Education

Interscholastic

Sports

Physical Education and Physical Activity

Comprehensive School-Based

Physical Activity Program

GUIDELINE 4

1. Pediatricians: identify children early on the path to obesity.2. Base prevention efforts on family dynamics and reduction

in high-risk dietary and activity behaviors. 3. Promote a diet free of sugar-sweetened beverages, of

fewer foods with high caloric density, and of increased intake of fruits and vegetables.

4. Promote a lifestyle with reduced sedentary behavior and with 60 minutes of daily moderate to vigorous physical activity.

PEDIATRICS Volume 136, number 1, July 2015

American Academy of PediatricsThe Role of the Pediatrician in

Primary Prevention of Obesity


“Base prevention efforts on family dynamics and reduction in high-

risk dietary and activity behaviors.” American Academy of Pediatrics, 2015.

Understandable nutrition guidelines and

labels, tax sugar beverages, better access

to healthy foods, control marketing.

Ensure adequate activity

facilities, spaces, and

guidance.

Monitor and manage

gestational weight gain

and hyperglycemia.

Promote breastfeeding, whole-of-

community support to promote healthy

lifestyles for young children.

Healthy school

standards for meals

and beverages,

health and P.E. in

curriculum, food

prep classes for

families.

Weight management

services that are

family-based, and

delivered by multi-

professional teams.

World Health

Organization 2016

Understandable nutrition guidelines

and labels, tax sugar beverages,

better access to healthy foods,

control marketing.

Ensure adequate activity facilities,

spaces, and guidance.Monitor and manage gestational

weight gain and hyperglycemia.

Promote breastfeeding, whole-of-

community support to promote

healthy lifestyles for young

children.

Healthy school standards for meals

and beverages, health and P.E. in

curriculum, food prep classes for

families.

Weight management services that

are family-based, and delivered by

multi-professional teams.

Battle of the Bulge

Two

Weapons DIET

CONTROL

Exercise

Intake of added sugars as a percent of calories is particularly high

among children, adolescents, and young adults.

Dietary Guidelines for Americans, 2015-2020

“Implement an

effective tax on

sugar-sweetened

beverages…

limit the

consumption of

foods and beverages

high in fat, sugar

and salt by infants

and young

children.”

WHO, 2016

8 Healthy Eating Goals for Childrenhttp://www.fitness.gov/eat-healthy/how-to-eat-healthy/

• Drink water instead of sugary drinks

• Limit soda, energy drinks, sports drinks

• Cut back on solid fats and foods containing solid fats

• Limit cakes, cookies, desserts, pizza, sausages, hot dogs, bacon, ice cream

• Make half the plate fruits and vegetables

• Make half the grains eaten whole grains

• Switch to fat-free or low-fat milk

• Choose a variety of lean protein foods

• More turkey and chicken breast, dry beans, eggs, nuts, seeds

• Compare sodium in foods

• Limit foods with visible salt like chips; reduce processed foods

• Eat some seafood



“Childhood obesity undermines the physical, social, and

psychological well-being of children and is a known risk

factor for adult obesity and chronic diseases. There is an

urgent need to act now to improve the health of this

generation and the next.” WHO, 2016.

Strategies for Combating the Epidemic of Obesity in ... · Obesity Epidemic In America? In general,...

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