Public Awareness and Human Disease

Public Awareness and Human Disease Obesity in Children Instructor: Pamela Williams HCA 240 Health and Disease September 2, 2011 By: Marilyn Reeves

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Obesity in children and adolescents has tripled since 1980 based on the National Health and Nutrition Examination Survey (Centers for Disease Control and Prevention CDC). The overall public is not aware of how serious this health issue is and do not realize that one in every five children in the United States are thought to be overweight or obese (BusinessWeek, 2005). One out of every three adults is overweight or obese (Mayo Clinic). The public must be educated on the causes, consequences, and prevention if we are going to stop obesity, not only in our children and young adults but in older adults as well. Obesity is a health problem that is 100% preventable. We must somehow create interest and engage our adult population in making lifestyle and eating habit changes carrying it forward to their children. Obesity is a gateway to diseases that kill, such as diabetes, stroke, cardiovascular disease and others. Below is an article defining overweight and obese from athealth.com. Results of the National Health and Nutrition Examination Survey (NHANES) 1999, 2000 report an estimated 64 percent of U.S. adults are either overweight or obese, defined as having a body mass index (BMI) of 25 or more. Overweight: Overweight refers to increased body weight in relation to height, when compared to some standard of acceptable or desirable weight (NRC p.114; Stunkard p.14). NOTE: Overweight may or may not be due to increases in body fat. It may also be due to an increase in lean muscle. For example, professional athletes may be very lean and muscular, with very little body fat, yet they may weigh more than others of the same height. While they may qualify as "overweight" due to their large muscle mass, they are not necessarily "over fat," regardless of BMI.

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Desirable weight standards are derived in a number of ways:

By using a mathematical formula known as Body Mass Index (BMI), which represents weight levels associated with the lowest overall risk to health. Desirable BMI levels may vary with age.

By using actual heights and weights measured and collected on people who are representative of the U.S. population by the National Center for Health Statistics. The Metropolitan Life Insurance Company, based on their client populations, has created other desirable weight tables.

These sources are consistent with the U.S. Dietary Guidelines and with the National Heart, Lung, and Blood Institute's Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.

Obesity:

Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. (NRC p114; Stunkard p14) The amount of body fat (or adiposity) includes concern for both the distribution of fat throughout the body and the size of the adipose tissue deposits. Body fat distribution is estimated by skin fold measures, waist-to-hip circumference ratios, or techniques such as ultrasound, computed tomography, or magnetic resonance imaging.

Overweight and Obesity Among Children and Adolescents

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The percentage of children and adolescents who are defined as overweight has more than doubled since the early 1970s.

About 15 percent of children and adolescents are now overweight.

In spite of the public health impact of obesity and overweight, these conditions have not been a major public health priority in the past. Halting and reversing the upward trend of the obesity epidemic will require effective collaboration among government, voluntary, and private sectors, as well as a commitment to action by individuals and communities across the nation.

Body Mass Index (BMI):

BMI is a common measure expressing the relationship (or ratio) of weight-to-height. It is a mathematical formula in which a person's body weight in kilograms is divided by the square of his or her height in meters (i.e., wt/(ht)2. The BMI is more highly correlated with body fat than any other indicator of height and weight (NRC p563).

Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI of 30 or more are considered obese.

What BMI levels are risky?

According to the NIH Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, all adults (aged 18 years or older) who have a BMI of 25 or more are considered at risk for premature death and disability as a consequence of

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overweight and obesity. These health risks increase even more as the severity of an individual's obesity increases (Defining Overweight and Obesity, athealth.com)

Causes of Obesity: Although we have to look at other factors and consider inherited genes, behavior and environment play a large role in what our weight is. Calories we take in verses calories out through body functions and physical activities in most cases determine whether we will become overweight or obese. Childhood obesity is caused by kids eating too much and exercising too little most of the time. Far less common than lifestyle issues are genetic diseases and hormonal disorders that can make a child more likely to be obese. These diseases, such as Prader-Willi syndrome and Cushings syndrome, affect a very small number of children (Mayo Clinic, Childhood obesity). Children who have obese parents are more likely to become obese. If parents over eat and are not physically active; that is the model their children will most likely follow. Health and Obesity: Obesity rates among all children in the United States: Approximately 17% (12.5 million) of children and adolescents aged two-19 years are obese. Since 1980, obesity prevalence among children and adolescents has almost tripled. There are significant racial and ethnic disparities in obesity prevalence among U.S. children and adolescents. In 2007-2008, Hispanic boys, aged two-19years, were significantly more likely to be obese than non-Hispanic white boys, and non-Hispanic black girls were significantly more likely to be obese than non-Hispanic white girls (CDC, Data and Statistics).

Public Awareness and Human Disease

Obesity rates among low-income preschool children: One of seven low-income pre-school-aged children is obese. County obesity rates are variable within states. Even states with the lowest prevalence of obesity have counties where many low-income children are obese and at risk for chronic disease (CDC, Data and Statistics). Obesity leads to other health problems and affects our body in many ways. Below is a list of health risks for children now and later (CDC, Basics about childhood Obesity) Now: 1. High blood pressure and cholesterol, which are risk factors for cardiovascular (CVD) disease. In one study, 70% of obese children had at least one CVD risk factor, and 39% had two or more. 2. Increased risk of impaired glucose tolerance, insulin resistance and type II diabetes. 3. Breathing problems such as sleep apnea, and asthma. 4. Joint problems and musculoskeletal discomfort. 5. Fatty liver disease, gallstones, and gastro-esophageal reflux (heartburn). 6. Obese children and adolescents have a greater risk of social and psychological problems, such as discrimination and poor self-esteem, which can continue into adulthood. Health risk later: 1. Obese children are more likely to become obese adults. Adult obesity is associated with a number of serious health conditions including heart disease, diabetes, and some cancers.

Public Awareness and Human Disease

2. If children are overweight, obesity in adulthood is likely more severe. Educating parents and children about the intake of calories, activities needed to burn those calories, and the need to cut back or cut out certain foods in exchange for healthier lower calorie foods, could decrease obesity in our children and adults. We should note that age does make a difference. When we get older, our physical activities normally slow down and our metabolism slows down as well, therefore we need to adjust our calorie intake to maintain a healthy weight. Calories in and calories out must balance. Treatment Options: Treatment has changed over time. Treatments such as thyroid hormone treatments, a combination of phentermine and fenfluramine (phen/fen), dexfenfluramine, an isomer of fenfluramine, was approved by the FDA in 1996. The inhibitors sibutramine and orlistat were used also. These drugs were heralded as the answer to the management of obesity until reports began appearing associating their use with cardiac valvulopathies and primary pulmonary hypertension. These drugs have subsequently been withdrawn from the market. Results of all drug trails have been disappointing. (DukeHealth.org) Other past treatments: Acupuncture, jaw wiring, gastric bubble, surgery (DukeHealth.org.) Current Treatments: If You have a child that is overweight or obese there are things you can start to implement at home along with making an appointment with your childs primary care giver to determine if there are other medical problems that may be contributing to your childs weight problem or caused by the weight problem. Remember this is a family affair. Do not expect your child to make lifestyle changes if you are not willing to do so yourself.

Public Awareness and Human Disease

1. Start making healthy changes in your diet and stay away from fast food. eat more fruits, vegetables and whole grains and reduce portions. Eat breakfast. 2. Track the familys eating and drinking habits each day so that you get a sense of how many calories everyone is taking in. Have each family member track their own. It is easy to underestimate how many calories you are actually taking in everyday. 3. Begin a gradual increase in physical activity making it a family activity that will be fun for the children. Depending on your age, you may need to discuss this with your doctor. 4. Prepare for your doctors visit for you and your child by making a list of questions to ask your doctor such as what other health problems might my child and I have 5. What are the treatment options for obesity? 6. Is weight loss surgery an option? 7. What can I do to help my family? 8. are there brochures or other printed material that I can take home for the family to read? 9. What websites do you recommend visiting? What you can expect from your doctor: During your appointment, your doctor is likely to ask a number of questions about your eating, activity, mood, and thoughts, and any symptoms you or child may have. 1. What and how much do you eat in a single day? 2. When did you and your child gain weight? 3. What are the factors that you believe has affected you and your childs weight? 4. How committed are you to helping your child as well as yourself lose weight.

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5. What medication or over the counter medications are being taken. Your willingness to be open and honest with your doctor is extremely important If the doctor believes you or your child is overweight/obese he will typically review your family history, perform a physical examination and recommend some test. The test to be taken will depend on yours and your childs health. The test may include a cholesterol test, liver function test, fasting glucose, a thyroid test and others, depending on your health situation. Your doctor will most likely want to schedule an appoint separate from yours for your child to prevent confusion. Losing weight will involve making lifestyle changes such as taking in fewer calories, increase in physical activity and behavior change. You may lose weight quickly at first, but slow and steady weight loose of one to two pounds a week over the long term is considered the safest and the best way to keep it off permanently. 150 minutes a week of moderateintensity activity is the recommendation to prevent further weigh gain and to lose a modest amount of weight. a behavioral modification program can help you make lifestyle changes, lose weight and keep it off. Steps to take include examining your current habits to find out what factors or situation has contributed to your obesity/overweight. In certain situations, prescription weight-loss medication is an option. weight loss medication is meant to be used along with diet, exercise, and behavior changes. If you do not make the other changes in your life, medication is unlikely to work. In severe cases surgery may be an option (Mayo Clinic, Obesity).

The safest treatments are dieting and exercise, which do not come with other health risk.

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Future Treatment Options: There is a great deal of research concerning obesity and with this health issue at epidemic proportions, it will continue to research medications and other treatments. However the facts remain the same, eating healthier and exercising are the keys to battling obesity. Education Program: Due to the inability to find a program in the three surrounding local counties this program is based on the state of Georgia: Governor Perdue and the Georgia Department of Human resources created the Live Healthy Georgia Campaign and Georgias Nutrition and Physical Activity Plan to increase awareness of obesity among all Georgians. The Georgia Department of Agriculture operates seasonal State Farmers markets with sales of fruits and vegetables in 15 cities around the state. The Department of Early Childcare and learning received a USDA Team Nutrition grant in 2005 to develop the Healthy Eating for Life program. Georgia is building a Safe Routes to Schools program through the Department of Transportation with funding provides by the Federal Highway Administration. School Policies: Physical Activity: The Georgia Board of education only requires PE in grades K-5 for 90 hours of instruction per year (-30 minutes/day). One unit of health and PE is required for high school students. National recommendations are 150 minutes/week for elementary and 225 minutes for middle school students. The Georgia Youth Fitness Assessment found that almost 90% of schools do not meet national recommendations. In 2007 the Georgia Department of Education (DEO) began to fill the position of state Physical Education coordinator.

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Nutrition: Georgias school nutrition standards are at the level of the federal government, limiting total and saturated fat, cholesterol, and sodium in school meals. Some foods of minimal nutritional value can compete directly with more healthful options in school cafeterias through a la carte and vending machine sales based on the current standards. Evaluation and Surveillance efforts in Georgia: Department of Human resources assessed height and weight measurements in the 2005 Oral Health Screening in a statewide sample of third graders. Georgias HIV Prevention Program, funded by the CDC, conducts the Youth Risk Factor Survey, which includes assessment of dietary and physical activity behaviors in a sample of sixth through 12th grade students across the state. Health care Georgia Foundation is funding the University of Georgias Nutrition Inventory Lab and Policy Leadership for active youth separately to provide evaluation expertise to various childhood obesity initiatives around the state. The Philanthropic Collaborative for a Healthy Georgia funded the Georgia Youth Fitness assessment in 5000 fifth and seventh grade students during 2006-2007. The Georgia DOE Division od School Nutrition is funding an inventory and evaluation of Georgia school districts, local wellness policies. Georgia Childhood Obesity Taskforces: Georgia Action for Health Kids, Georgia Center for Obesity and Related Disorders, Georgia Coalition for Physical Activity and Nutrition, Obesity Action Network, Policy Leadership for Active Youth, and Take Charge of Your Health, Georgia! Taskforce.

Policy Opportunities for Georgia Communities:

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Encourage communities to assess their environments by offering tools and incentives, Support for the Department of Transportation to enhance the Safe Routes to School program (SRTS). Additional support for the State Farmers Market programs to include more nutrition education. Work to increase the number of grocery stores for lowincome and rural communities. A small tax added to beverages or foods to fund various obesity-prevention programs. Policy Opportunities for Georgia Schools: Use incentives to encourage implementation of local wellness policies; however unless policies are tied to a consequence, many schools may not prioritize implementation. Consider revised state PE requirements. Over one-half of the fifth and seventh grade students in the Georgia Youth Fitness Assessment failed the fitness tests. An additional 44% of students were not getting enough physical activity; annual measurement of BMI and assessment of obesityrelated behaviors in schools should be implemented. The IOM recommends a strong evaluation component to monitor changes in prevalence and the impact of interventions. Offer incentives for schools to implement curriculum-driven programs. Curriculum-integrated programs, such as Planet Health, Take 10!, or Coordinated Approach to Child Health (CATCH), will not replace classroom time devoted to other core subject areas. Georgias statewide plan is thorough. It can be improved upon if certain things are put into laws that schools must abide by, such as physical education being mandatory in every school with the correct amount of time allotted depending on age. It should be mandatory from first 12th grades. Nutrition standards for food in the lunchrooms and vending machines should be revised and mandatory statewide.

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In order to combat obesity everyone must get involved. Parents must turn off TVs and video games and get involved in physical activities with their children as well as educating themselves and their children about healthy living. Cook healthy meals and stay away from fast food. One of the best strategies to reduce childhood obesity is to improve the diet and exercise habits of your entire family. Treating and preventing childhood obesity helps protect the health of your child/children now and in the future (Mayo Clinic, Childhood Obesity) Overweight and obesity have tremendous consequences on our nations health and economy. Overweight and obesity is linked to a number of chronic diseases, including coronary heart disease, stroke, diabetes, and some cancers. Many American communities are characterized by unhealthy options when it comes to diet and physical activity. We need Public health approaches that make healthy options easy, affordable, and available for all Americans (CDC). We must get everyone involved, schools, parents, local and state governments as well as the federal government. It is time to pay attention and take action.

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Resources: Center for Disease Control http//:www.cdc.gov Childhood Obesity DukeHealth.org, Current Strategies to prevent Childhood Obesity in Georgia http://www.ovpr.uga.edu Mayo Clinic, Obesity http://www.mayoclinic.com/health/obesity/DS00314 http://www.mayoclinic.com/health/childhood-obesity/DS00698 Defining Overweight and Obesity athealth.com