OVERWEIGHT AND OBESITY IN SCHOOL- AGE CHILDREN Predictors of childhood obesity Age at onset of BMI rebound Normal increase in BMI after decline Early BMI rebound results in higher BMIs in children Home environment Maternal and/or parental obesity is a predictor of childhood obesity Effects of television viewing and screen time on the incidence of overweight Obesity related to hours of television viewing Resting energy expenditure decreases AAP recommends children have no more than two hours each day of screen time
OVERWEIGHT AND OBESITY IN SCHOOL- AGE CHILDREN Addressing the problem of pediatric overweight and obesity Expert committee’s evidence-based recommendations Assessment of overweight and obesity Body mass index-for-age percentile Prevention of overweight and obesity Healthy eating and increased physical activity
TREATMENT OF OVERWEIGHT AND OBESITY EXPERT COMMITTEE: RECOMMENDATIONS
OVERWEIGHT AND OBESITY IN SCHOOL- AGE CHILDREN Treatment of overweight and obesity Four stages Prevention Plus Structured Weight Management (SWM) Comprehensive Multidisciplinary Intervention (CMI) Tertiary Care Intervention (typically reserved for adolescents with severe obesity) GIRLS Age 90th 95th 97th 8-9 y.o. 7.10 1.04 -4.01 9-10 y.o. 7.41 -0.11 -6.39 10-11 y.o. 7.87 -1.15 -8.66 11-12 y.o. 7.28 -3.37 -12.24 12-13 y.o. 5.84 -6.42 -16.64 Goldschmidt, Wilfley, Paluch, Roemmich, Epstein, 2013, JAMA Peds
NUTRITION AND PREVENTION OF CARDIOVASCULAR DISEASE IN SCHOOL-AGE CHILDREN Acceptable fat range: 25 to 35 percent of energy for four to 18 years of age Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids Limit fruit juice, sugar-sweetened beverages and foods, salt, saturated fats, cholesterol, and trans fats
DIETARY RECOMMENDATIONS Iron Iron-rich foods: meats, fortified breakfast cereals, dry beans, and peas Fat Decrease saturated fat and trans fatty acids Fiber Fresh fruits and vegetables, whole grain breads, and cereals
DIETARY RECOMMENDATIONS Calcium and vitamin D Dairy products and calcium-fortified foods If lactose intolerance, do not completely eliminate dairy products; decrease only to point of tolerance Vitamin D from exposure to sunlight and fortified foods Calcium recommendation: 4-8 years: 1000 mg/day 9-13 years: 1300 mg/day Vitamin D recommendation: 4-18 years: 600 IU Fluids Cold water is the best fluid for children Limit soft drinks; they provide empty calories, displace milk consumption, and promote tooth decay
PHYSICAL ACTIVITY RECOMMENDATIONS Recommendations versus actual activity Children should engage in at least 60 minutes of physical activity each day Only 7.9 percent of middle and junior high schools require daily physical activity Determinants of physical activity Girls are less active than boys Physical activity decreases with age Physical education in school has decreased Organized sports
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- Spring '14