Child and Adolescent Obesity Flashcards
How is obesity measured?
Age(yrs)
BMI (kg/m^2)
Which percentile of the growth curve says a child is overweight?
85th-96th percentile
Which percentile is a child with obesity in?
97th+
What is the trend in prevalence of obesity in Canada?
It has been increasing over the years
What is the percentage of overweight/obese children in Canada?
26%
What two provinces are under the national percentage of obese/overweight children?
Alberta (22%)
Quebec (23%)
What do the portraits of 12 year olds in 1981 vs 2007-2009 show us?
Our body composition numbers have increased
Our fitness test numbers have decreased
We have gotten worse overall
What is the percentage of children and adolescents classified as having overweight or obesity?
31.5%
What is the percentage of adolescents with obesity that have obesity in adulthood?
80%
What are the spheres of influence of overweight/obesity?
Weight-related issues<==> individual characteristics <==> familial influences <==> peer influences <==> school & other institutional factors <==> community factors <==> societal factors
What are the problematic social trends that lead to an increased incidence of obesity?
Increased use of motorized transport
Decreased opportunities for recreational PA
Increased sedentary recreation
24/7 TV
Increased quantity and variety of energy-dense foods available
Increased promotion and marketing of energy-dense foods
Increased frequency and opportunities to purchase food
Increased use of restaurants and fast food
Larger portions, better “value”
Increased number of eating occasions
Water being replaced
What are some causes of childhood obesity?
Sleep debt
Endocrine disruption
Decreased variability of ambient temperature
Smoking
Pharmaceuticals
Age and ethnic groups
Increasing maternal age
Intra-uterine and intergenerational effects
Genetic predisposition
Assortative mating
Weak evidence for:
Calcium insufficiency
Increased maternal age
Breastfeeding
Endocrine disruptors
At what age does the adiposity rebound happen?
6years old
What are critical periods in obesity?
developmental stages where physiological alterations increase risk of obesity
What are the three critical periods?
Prenatal
Adiposity rebound
Adolescence
What happens if the adiposity rebound happens earlier than 6 y/o?
5.5 y/o or earlier is associated with increased risk of adult obesity
What happens to the baby when mothers with OW/OB give birth?
give birth to large babies (LGA)
fetal BW tracks into adulthood
What happens when the mother gains excessive gestational weight? And what is the normal amount of weight gain during pregnancy?
Increased maternal postpartum weight retention
Mothers should gain 25-35 lbs during a normal pregnancy
What are some consequences of obesity towards maternal and fetal health?
Mom: increased risk for gestational diabetes, T2D, CVD
Baby: increased risk for obesity and CVD as kids
What increases the likelihood of having a large baby?
Being overweight and even more so if you’re obese
What are the factors associated with greater risk of childhood obesity and intergenerational cycle of obesity throughout the lifespan?
Higher pre-pregnancy weight
Excessive gestational weight gain
Babies born LGA
What are some Familial obesity causes?
significant driver of childhood OW/OB (genetic, social factors)
Parental obesity (1 OW parent= 50% chance of child OW/OB, 2 OW parents=80% chance of child OW/OB)
Family meals (12% less likely to be obese when getting at least 3 family meals per week)
Family PA patterns
Family lifestyle
What are some obesity causes at school?
PE
Food environments
School lunch programs
Weight-based teasing
What happens during adolescence that could increase the risk of obesity?
Change in diet and behavior
Puberty
Change in quantity and distribution of fat
Decrease in physical activity
Decrease fitness
Changes to circadian rhythm which affects eating habits
Between 1995-2008 weight bias increased by how much?
by 66%
Weight-based teasing starts at what age?
According to the article: 4y/o
According to the slides: 3-5 y/o
What is the most frequent source of employment discrimination that adults describe?
weight bias
What are some effects of weight stigma?
Stress
Binge eating
Maladaptive weight control
Disordered eating
Elevated BP
Poorer treatment adherence
Less trust of health providers
Avoidance of follow-up care
Depression/anxiety
Low self-esteem
Poor body image
Poor glycemic control
Less effective chronic disease self-management
What is the trend with consumption of sugar-sweetened beverages?
Increased dramatically in recent decades
Increased fast food consumption and at home
What are excess sugar sweetened beverages associated with?
Increase energy intake
High in fructose corn syrup==> increased lipogenesis==> inhibit satiety signals==> reduce energy expenditure
Increase risk of weight gain
What is the link between food marketing and children?
Children view more than 25 million food and beverage ads online (3/4 for unhealthy food)
Children view 15-20 ads per hour
What are the different sphere where municipalities can ensure micro-environments provide and encourage healthy food choices?
physical
Communication
Economic
Social
Political
What does the food environment look like around schools?
About 70% of schools have 1 or more unhealthy food vendor within 500m of them
What are the WHO and United Nations stances on food marketing?
WHO: Need to manage marketing to children, “settings where children gather should be free from all forms of marketing of foods…
United Nations: recommended action on marketing and advertising to children
What is the Quebec government stance on food marketing to children?
Quebec Consumer Protection Act
Only province that prohibits all commercial advertising to children (not just food and beverages)
Specifically during peak viewing times
What is the federal government’s stance on food marketing to children?
Health Canada’s Healthy Eating Strategy
Senate Bill “the Child Health Protection Act” seeks to prohibit marketing of unhealthy food and beverages to children <17 y/o ==> Never received final approval
What is the gut microbiota involved in?
Involved in the control of BW, energy homeostasis and inflammation
What variables influence the gut microbiota ecology?
Host genetics, delivery method, diet, age, environment, and the use of pre, pro and antibiotics
What are some long term complications of Obesity
Type 2 diabetes Mellitus
Metabolic syndrome
Dyslipidemia
Hypertension
Non-alcoholic fatty liver disease
Polycystic ovarian syndrome
Infertility
Malignancies: uterine, colon, breast
What are the effects of obesity on a child’s quality of life?
Often experience depression, low self-esteem
Health related quality of life scores similar to kids undergoing chemotherapy
What is the hypothetical pathway from Obesity to T2D?
Childhood obesity ==> adulthood obesity==> obesity related event ==> increased insulin resistance ==> increased blood glucose ==> T2D
What is the hypothetical pathway from obesity to hypertension?
Increased demand on the CV system ==> Increased BP ==> Hypertension
What is the hypothetical pathway from obesity to stroke?
Increased blood lipids==> atherosclerosis==> heart attack/stroke
What is the hypothetical pathway from obesity to cancer?
Increased cellular stress ==> increased malignant cell formation ==> cancer
What causes systemic inflammation in children with obesity?
Excessive fat tissue expansion (obesity) ==> stress response ==> inflammation
Chronic elevated systematic inflammation is linked to T2D and CVD
Atherosclerosis develops over how long?
Over the course of 50 years beginning in the early teenage years
What is the link between childhood obesity and insulin resistance?
52.1% of obese children have insulin resistance
When is it safe to carry excess weight?
There is no safe time to carry excess weight
Effects of obesity on our systems begin in childhood not adulthood
Consequences appear later in life
What do we do to help obesity?
Difficulties in pediatric weight management
Attrition/dropout/low adherence
transition from child to adult care
Terminology and words used
Parent buy in (clinical interventions that focus on the family are most effective)
