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
Underweight
Indicator
Percentiles
Weight-for-age
<3rd
Severely Underweight
Stunted
<0.1st
Length-for-age
Severely stunted
Wasted
<3rd
<0.1st
Weight-for-length
Severely wasted
<3rd or <89% IBW
<0.1st
Risk of Overweight
Weight-for-length
>85th
Overweight
Weight-for-length
>97th
Obese
Weight-for-length
>99.9th
Head circumference-for-age
<3rd or > 97th
Head Circumference
0 – 24 months
Weight-forlength cut-offs
2 – 19 years cut-offs
Growth Status
Underweight
Indicator
Weight-for-age
Severely Underweight
Stunted
Length-for-age
Severely stunted
Wasted
BMI-for-age
Severely wasted
Percentiles
2-5 years
5-19years
<3rd
<3rd
<0.1st
<0.1st
<3rd
<3rd
<0.1st
<0.1st
<3rd
<3rd
<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
Severely
obese
Obese
Overweight
Obese
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