Erna Wong, MD Pediatrician

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Overweight Children The Role of Health Care in Prevention & Treatment November 30, 2005 Erna Wong, MD Pediatrician

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Today we will discuss... The Epidemic of Overweight Children Medical Office Visit Interventions Weight Management Interventions Environmental Changes and Physician Advocacy

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By the end of this address members will have the capacity to… Describe 3 overweight counteractive action systems. Analyze overweight and at hazard for overweight utilizing BMI % for age. Portray the weight objectives for overweight kids. Give Brief Focused Advice.

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About Kaiser Permanente (KP) One of the country's most seasoned not-revenue driven human services conveyance frameworks and a pioneer in quality. 8.2 million individuals across the country; 6.2 million in California. KP has made a profound and longstanding duty to good dieting and dynamic living in our groups with serious intercessions since 2001.

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How genuine is the issue of overweight youngsters in California today? Intense Somewhat Serious Not Serious No Opinion 1,068 arbitrary example CA inhabitants, phone review 10-11/2003

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what number kids are overweight? Since 1963, the quantity of overweight youngsters in the U.S. has tripled! SOURCE: CDC/NCHS, NHES and NHANES

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Some kids will probably be overweight. % Overweight Kids & Teens in 2000 Teenagers Black, Mexican American, American Indian, Alaskan Native Children of overweight guardians NHANES 1999-2000 JAMA 2002;288:1728-1732

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Do overweight youngsters grow up to be overweight grown-ups? The more established the overweight kid is, the more probable he/she will keep on being overweight as a grown-up. 8 out of 10 overweight high schoolers will keep on being overweight as grown-ups. Preventive Medicine 1993; Vol. 22:pp. 167-177 Arch Pediatr Adolesc Med Vol. 158 May 2004 pp. 449-452

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what number grown-ups are overweight? "the normal weight pick up among subjects (20-40 years of age) in the populace is 1.8 to 2.0 pounds/year." Science . 299:7;853-855 (2003)

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What wellbeing issues are identified with being overweight? Sort 2 diabetes Heart sickness Hypertension Asthma Slipped capital femoral epiphysis Nonalcoholic steatohepatitis Polycystic ovary disorder Sleep apnea Depression and low self-regard Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430

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what number overweight kids have metabolic disorder? Metabolic Syndrome (1) Criteria: TG>=110 mg/dL, HDL-C<=40 mg/dL, Waist Circ. >=90%, FBS>=110 mg/dL, BP>= 90% (3 of 5 criteria required) An indicator of Type 2 diabetes and untimely coronary conduit ailment. Predominance = 28.7% among overweight pre-adulthood. The pervasiveness of metabolic disorder expanded with the seriousness of overweight and achieved half in extremely overweight youngsters. (2) 1. Curve Pediatr Adolesc Med Vol. 157, Aug 2003 pp. 821-827 2. N Engl J Med Vol. 350, June 2004 pp. 2362-2374

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The Epidemic of Overweight Children "I believe we're taking a gander at an original of youngsters who may live less long than their folks as an aftereffect of the results of overweight and sort 2 diabetes." Francine Ratner Kaufman, MD Head, Division of Endocrinology & Metabolism Children's Hospital Los Angeles, N Engl J Med Vol. 352(11) March 2005, pp. 1138-1145

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What are the expenses of overweight and heftiness? Human services for stout grown-ups costs 37% more than for individuals of ordinary weight, adding $732 to the yearly doctor's visit expenses of each American. Treatment of ailments identified with heftiness costs America $93 billion a year. Wellbeing Affairs May 14, 2003; W3:219-226 NIHCM Obesity in Young Children: Impact and Intervention Aug 2004

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BEHAVIOR ENVIRONMENT What are the reasons for overweight and corpulence? Qualities METABOLISM CULTURE SES

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What are the hereditary qualities of overweight and stoutness? Twin investigation demonstrates a heritability of fat mass of 40–70% Adopted youngsters have BMIs that connect to those of their organic guardians Genetic Risk for Overweight One large parent (3X increment) Two fat guardians (13X increment) Early adolescence Behavioral Genetics, 1997, 27:325–351

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What practices are identified with kids getting to be overweight? Insufficient physical action. An excess of TV & computer games. Insufficient drain, dairy, foods grown from the ground. Excessively numerous sweetened beverages (e.g., pop, juice drinks, sports drinks) and an excessive amount of fast food. Skipping suppers and breakfast. Position Paper - Prevention of Childhood Overweight What Should Be Done? Place for Weight and Health - U.C. Berkeley 10/02

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Why is physical action critical? 3 out of 4 youngsters in California neglect to meet the base wellness gauges in fifth, seventh and ninth grade. Being fit as a fiddle… diminishes the danger of being overweight and coronary illness is identified with better school execution California Department of Education 12/10/02

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Why is TV hurtful? Youngsters normal 2-3 hours of TV survey each day. 30-half of kids have a TV in their room. Television review is connected with... expanded hazard for being overweight school issues forceful conduct & medicate utilize Pediatrics Vol. 107 No. 2 February 2001 pp. 423-426

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Are dairy items essential? Drain utilization in the U.S. has declined in the course of the most recent 40 years. Drain and calcium utilization has declined altogether for juvenile young ladies. Drinking milk may decrease the danger of… getting to be overweight creating osteoporosis J Am Diet Assoc. 2003;103:1626-1631.

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Are eating foods grown from the ground essential? In California, of seventh, ninth and eleventh graders overviewed not as much as half reported eating organic products or vegetables at any rate once every day in the previous week. Eating 5 servings of foods grown from the ground each day can decrease the danger of overweight. Nourishment Review. 2002;25:28-31.

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Why are sweetened beverages unsafe? Youngsters drink a normal of 20 ounces of pop each day. Drinking more than 12 ounces a day of sweetened beverages is connected with… an expanded danger of being overweight drinking less drain an expanded danger of depressions J PEDIATRICS Vol. 142 June 2003, pp. 604-610 BMJ. May 22, 2004;328:1237

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What about eating out and fast food? Eating out has expanded from 16% to 27%. Some fast food divide sizes have tripled from 1960 to 2000. Fast food and eating out might be connected with an expanded hazard for overweight. Int J Obes Relat Metab Disord. 2004;28:282-289.

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What are the dangers of skipping breakfast? Having breakfast by high schoolers has declined by 20% in the course of the most recent 20 years. 44% of high schoolers said they skipped dinners to get more fit. Skipping breakfast is connected with… eating all the more later in the day and the danger of getting to be overweight. J Am Diet Assoc. Vol. 101, 2001, pp. 798-802

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Small changes after some time can have a major effect! 15 minutes of play as opposed to sitting in front of the TV can keep some weight issues.

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Fetus Preventing: Infants • SGA • LGA Promoting: Toddlers • Breastfeeding Diagnosing: Children • Early Adiposity Rebound Increasing: Adults • Physical Activity Decreasing: Increasing: • TV Viewing • Physical Activity • Sweetened Decreasing: Beverage • Portion Size Consumption Encouraging: • Weight The Permanente Journal/Summer 2003/Volume 7 No. 3 pp. 6-7 Maintenance A Longitudinal Approach to Preventing Overweight

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Can overweight among youngsters be forestalled? Breastfeed for the principal year. Wean from the jug at 12 months of age. Restrain juice and other sweetened beverages to 4-6 ounces for every day max. Restrict TV - none before 2 years, 1 hour or less more than 2 years old. Abstain from utilizing nourishment as a reward for good conduct. J Pediatr Vol. 141 No. 6 December 2002 pp. 764-769 JAMA Vol. 285 No. 19 May 2001 pp. 2461-2467

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Primary Care Interventions

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Kaiser Permanente's Approach to Preventing Overweight

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First Steps. . . Changing the Message Active bodies are sound bodies Healthy bodies come in all shapes and sizes Anticipatory direction Breastfeeding advancement Improved nourishment Increased physical movement Identification, Risk Stratification, and Early Intervention BMI Targeted assessment and training

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A Practical Approach to Overweight Children Well Child Care Visit Calculate BMI and Plot BMI% for Age Perform In-Depth Medical Assessment Determine Weight Goals Order Screening Lab Tests (if showed) Provide Brief Focused Advice Arrange for Follow-Up Visit or Phone Call 1-4 Weeks Follow-Up Visit or Phone Call Review Labs Discuss Treatment Options and Referrals Provide Brief Negotiation or Motivational Interviewing Arrange for Follow-Up as Necessary Proposed Treatment Approach to Overweight Children, Kaiser Permanente, © 2004

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Primary Care Interventions Diagnosis of overweight utilizing body mass file (BMI)% for age at well kid mind visits 2 years and more established inside and out therapeutic evaluation Appropriate weight objectives Counseling - motivational meeting Referral and follow-up Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430

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BMI = 28 BMI Does Not Measure Body Fat How would you compute body mass file (BMI)? BMI (English): [ weight (lb)/stature (in)/tallness (in) ] x 703 BMI (metric): [ weight (kg)/stature (cm)/stature (cm) ] x 10,000 BMI Conversion Tables: Calculator: Calculator and Growth Chart: Calculator Wheel:$5 Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430

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Why do we utilize BMI? Predictable with grown-up benchmarks and tracks adolescence overweight into adulthood BMI for age identifies with wellbeing dangers including cardiovascular infection, hypertension and sort 2 diabetes BMI meas