Epidemiology Childhood Obesity PowerPoint Presentation

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Epidemiology Childhood Obesity Abdelaziz Elamin, MD,PhD,FRCP,FRCPCH Professor of Child Health University of Khartoum, Sudan Consultant in pediatric Endocrinology & Clinical Nutrition

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Epidemiology The study of how a disease or health outcome is distributed in populations and what factors influence or determine this distribution.

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Definition Obesity is a serious degree of Overweight caused by excessive storage of fat & usually measured using a Body Mass Index . BMI is defined as body weight in kilograms divided by the square height in meters.

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WHO: Overweight and Obesity For Adolescents & Adults BMI between 18.5 & 24.9: Healthy weight BMI between 25 and 29.9: Overweight BMI 30 & above: Obese BMI 40 & above: Morbid obesity For Children BMI between 5th & <85th percentile: Healthy weight BMI between 85th & 95th percentile: Overweight BMI >95th percentile: Obesity

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Overweight and Obesity in the US Epidemic state in the United States 25% of children are obese More than ½ of all adults are overweight and nearly a quarter are obese Rate of obesity has doubled since 1960 and continues to rise If current trends continue, all Americans will be overweight by the yr 2030.

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South Atlantic Ocean South Pacific Ocean Indian Ocean Arctic Ocean Arctic Ocean North Pacific Ocean Patterns Of Overweight & Obesity Globally For Nationally Representative Samples (Percentage overweight + Obese) © B.Popkin 2009

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BMI (Kg/m2) 0 .02 .04 .06 .08 .1 K density BMI 10 15 20 25 30 35 40 45 50 55 60 65 1988 From Juan Rivera BMI Distribution Shifts among Mexican women 18-49 y (National Surveys 1988, 1999 y 2006)

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BMI Distribution Shifts Among Chinese Adults, ages 19 and Older Percent China Health and Nutrition Survey. Males: 10.4-27.1; Females 15.4-27.7

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Childhood Obesity MORE THAN 1 IN 4 Of World CHILDREN IS OVERWEIGHT or OBESE. CHILDHOOD OBESITY IS INCREASING EVEN IN THE POOR COUNTRIES. OBESE CHILDREN GROW AS OBESE ADULTS. The metabolic syndrome & IRS IS PREVALENT IN OBESE ADOLESCENTS same Degree as in adults

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Childhood Obesity Prevalence In USA : Doubled in children 6-12 year . Tripled in adolescents. 20% of 6-19 year are obese. Worldwide : Range from ( 10% to 25%).

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0 5 10 15 20 0 5 10 15 20 Percent Percent 6-11 years old 12-19 years old Trends in U.S. Child and Adolescent Overweight 1963-1967 1999-2000 2001-2002 2003-2004 1971-1974 1976-1980 1988-1994

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Annual Absolute Change in the Prevalence of Childhood Overweight and Obesity in 7 Countries from 1985/1995 to 1995/2006 (IOTF definition for childhood obesity) Annual percentage change Popkin (2007) nature reviews, cancer 7:61

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Childhood Obesity in Germany Source: National Center for Health Statistics, 1999 National Health and Nutrition Examination Survey.

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Percent increase in Prevalence of Childhood obesity in Sweden (1969-2005)

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Prevalence of Childhood Obesity in the UK (1995-2002)

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Prevalence of Childhood Obesity in Italy 0 5 10 15 20 25 - Prevalence (%) Boys over wt Girls over wt Boys obese Girls obese 1994 1984 1974 1964

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Obesity In Developing Countries The burden of obesity & its complications is shifting rapidly towards the poor. Simultaneous malnutrition & overweight exist. Obesity is now 4X more common than malnutrition in some developing countries. Evidence from Brazil & China points to a clear shift in obesity and overweight from middle class to the poor. These observations are replicated across many countries in Asia, Africa & Latin America.

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Prevalence of Childhood Obesity in the Region (9-18 yrs)

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Causes of Childhood Obesity Childhood obesity Pathological causes Genetics Socioeconomic Behavioral Nutritional

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Obesity: Environmental Influence Current environment Past environment Genetic susceptibility BMI %

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SPECIAL ISSUE TIME 2000 November 8, 1999 WILL WE KEEP GETTING FATTER?

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23 Cause of Present Obesity Epidemic Energy intake unequal energy output Decreasing physical activity Increasing consumption of calorie dense foods More meals eaten outside of home Increased portion sizes Lack of concern about obesity

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Obesity Is Caused by Long-Term Positive Energy Balance FatStores

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Energy In Energy Out obesity Weight gain:

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Changing Dietary Habits Increased intake of caloric sweeteners & edible oil Increased intake of processed foods, refined carbohydrates & salty high fat snacks Reduced intake of fruits and vegetables Increased global beverage due to: increased accessibility, lower price, income dynamics and marketing

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From Traditional food to Modern Meals

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From Traditional to Modern Snacking

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From Traditional Food Marketing to ModernFood Supermarkets

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Decreased Physical activity Excess TV; computer, & play station time Children are home alone (dual income parents) Decreased physical activity at school & at home Transportation by car or school bus Neighborhood safety Few public parks, sidewalks, swimming pools ..etc

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From Traditional to Modern Leisure

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Trends in Physical Education 0 5 10 15 20 25 30 35 40 45 % 1991 1993 1995 1997 % of 9 -12 graders enrolled in Daily PE (CDC 2000 Review)

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Obesity Hazards What bothers you the most? Anthropometric parameters Comorbidities

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Phlebitis venous stasis Coronary heart disease Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Gall bladder disease Gout Diabetes Osteoarthritis Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Hypertension Dyslipidemia Cataracts Skin Pancreatitis Cancer breast, uterus, cervix, prostate, kidney colon, esophagus, pancreas, liver Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Stroke Health Complications of Obesity Idiopathic intracranial hypertension

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RED FLAG Obesity and overweight account for more than 300,000 premature deaths annually in United States, 2nd only to tobacco-related deaths. Obesity would surpass tobacco as the leading cause of death worldwide in the next decade.

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6-Mar-14 ©M.Miqdady, M.D. 41 The Bottom Line Obesity causes 300,000 premature deaths per year in the US

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Complications Specific to Children … Persistence of Obesity at Adulthood: Overweight adolescents have a 70% chance of becoming overweight adults. Increases to 80% if one or both parents are obese. Obese 6 year old has a 25% chance of becoming obese adult Obese 12 year old has a 75% chance of becoming a obese adult.

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The probability of obesity in adults in relation to BMI at various ages during childhood

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Common Complications in Children Metabolic Syndrome. Hypertension Fatty Liver . Early Sexual Maturation. Asthma Sleep apnea

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“The first wealth is health.” Thanks for your attention

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Review Questions (Developed by the Supercourse team) Russia is one of the few countries where children are becoming less obese. Why might this be? In developing countries, what is more important, obesity or malnutrition and why? Describe the concept of energy balance What are the main diseases associated with obesity?