Archive for the ‘Childhood Obesity’ Category

ARE THERE PUBLIC HEALTH SOLUTIONS OUT THERE FOR CHILDHOOD OBESITY?

Tuesday, March 22nd, 2011

With the success of graduated driving licenses in reducing deaths involving teenagers behind the wheel, we try to think about ways in which other regulatory solutions might impact childhood obesity.  But obesity is immediately a much thornier problem isn’t it?  No licenses or government scrutiny generally involves itself in what food is put on the table in an American household.  No government agency regulates how much TV time a child gets or how much exercise a school offers.  We tend to want our governments to stay away from issues of person responsibility and home decisions and activities.

But yet the deadliness of childhood obesity forces us to think harder and give some real thought to the possibility of a public health solution.  What kinds of ideas might be crafted?

Well, some have posed financial incentives rather than direct regulations.   For example financial breaks and discounts on things like health insurance, automobile registrations and other fees. Companies, governments and schools consider reduced rates for people with a healthier BMI since it ultimately saves money to have healthier individuals in the group. Studies have shown that financial incentives do matter when people attempt to lose weight. But would widespread use of such incentives serve to further discriminate against overweight people, who, as a group, already face a good deal of discrimination?

And where does government fit in?  California waged a very successful campaign to reduce smoking with the use of funds from a tobacco tax. A University of California multivariate regression analysis showed that the rate of decline in smoking, fell more sharply after the campaign took on tobacco with clever billboards and a carefully crafted ad campaign that made fun of smoking and portrayed it as uncool, not sexy, and just plain dumb. Could something like this work to curtail obesity? Or would it end up appearing to single out overweight individuals for ridicule?

For now, there seems to be little controversy in the idea that public health experts and government can and should influence the lunch menu and food options at public schools. But how far should even this small step be taken? Eliminating high calorie snacks and drinks from the school also eliminates a source of precious funding for school extracurriculars.

The public health solutions are thorny. But the enemy we face is more deadly than cancer, and more destructive to the workforce, and to the longevity of individuals, than other enemies that we have previously faced. So it is worth taking some time to consider unconventional solutions as well as those that have proved successful in the past.

ARE CHILDREN OF ALCOHOLICS DESTINED TO BECOME OBESE?

Tuesday, February 8th, 2011

A recent research study from the Washington University School of Medicine in St. Louis demonstrated that women with a family history of alcoholism were significantly more likely to become obese than women who did not have such a family history.  In their analysis of patients in an alcoholism survey study spanning two eras, 1991-1992 and 2001-2002, the researchers found that women with family history of alcoholism were 49% more likely to become obese.

There has been a good deal of speculation of obesity as a product of a “food addiction” and so by one line of reasoning a genetic predisposition might very well lead to a higher rate of obesity and other addictions.  This study tends to support the idea that there could possibly be an inherited propensity toward overconsumption of food or alcohol or substances.  On the other hand, such a study might play into psychological stress children of alcoholics experience and we know that consumption of food is a soothing mechanism by which people cope with psychological stress.

I am struck by many research studies which identify subgroups among us who are more likely than the rest of us to become obese.  This includes a great many people taking various medications, which are known to increase appetite, people whose own parents are obese, people whose social network and group of friends are obese, people who are less affluent, people with attention deficit disorder, depression or a host of other psychological conditions, and perhaps people whose parents were alcoholics.  While each of these subgroup studies might help in the wider effort to prevent and combat obesity, to some degree the focus on subgroups might detract a bit from the overarching conclusion that virtually everyone is at risk of obesity when placed in the type of environment that in which most of us live today in the developed world.

That is to say with most Americans now clinically overweight or obese, it stands to reason that solutions must be fairly universal and not too specifically aimed at narrower subgroups.  On the other hand, obesity prevention efforts in preschools, schools, homes, youth groups, clubs, churches, Scouts and other venues might well improve the odds of success by delivering even more potent messages and instituting more rigorous programs of obesity prevention for those of greatest risk.

WHY SKIPPING BREAKFAST LEADS TO WEIGHT GAIN

Thursday, November 18th, 2010

A number of studies have described the association between skipping breakfast and weight gain and obesity.  It has been postulated that the reason for weight gain stems from the fact that we tend to eat more food and higher calories foods later if we skip breakfast in the morning.  There is also a belief that calories consumed early in the day are more likely to be burned by the body, whereas the calories consumed late in the evening are more likely to be stored as fat.

A study out of the Institute of Population Health at the University of Ottawa, uncovers some of the reasons why children gain more weight when they skip breakfast.  Published in the Public Health Nutrition Journal in January of 2009, the study by Dubois et al, provided some detailed analysis of the 1,549 children who were previously studied in their 2006 paper on breakfast skippers.

The detailed study examines the association between breakfast skipping and the intake of daily calories, nutrients and food in the preschool children.  Interviews and eating behavior questionnaires were used to develop the data.

One of the key findings was that skipping breakfast was associated with the consumption of snacks in the afternoon and evening, which were higher in calories and higher in carbohydrates.  Skipping breakfast was also associated with weight gain and being overweight, having a higher BMI.  A specific correlation was found between overweight/obesity and the dinner time consumption of higher calories and higher carbohydrates among the breakfast skippers.

Interestingly, the total daily calorie consumption was not significantly different between the breakfast skippers and the breakfast eaters, even though the body mass index was higher in the breakfast skippers.  These findings support the idea that a more even distribution of calorie intake throughout the day is healthier and less likely to lead to weight gain.  Skipping breakfast leads to behavior in which children eat more calories and more carbohydrates late into the afternoon and night, a pattern associated with weight gain and obesity.

It is one more study that demonstrates there is more to metabolism than “calories in = calories out” while the overriding principal of calories in = calories out is roughly true, it can differ significantly when the calories are consumed at different times of day.  Consuming the same amount of calories late into the evening and night is associated with weight gain and obesity, and this is one more study illustrating that principal.  And it helps explain why breakfast skipping is a behavior to be avoided and discourage in children (and adults too!).

BREAKFAST SKIPPING AMONG CHILDREN AND ADOLESCENTS IN THE UNITED STATES: A LARGE US STUDY

Tuesday, November 16th, 2010

Published in the Journal of the American Dietetic Association in June 2010, a Baylor College of Medicine and US Department of Agriculture study reports interesting data about the association between breakfast skipping and obesity.  The study examined 4,320 children age 4-13 years in addition to 5,339 children age 14-18 years.  The data is an analysis of data collected from what is called the National Health and Nutrition examination survey, which ran from 1999 -2006.  It involved a type of survey using 24 hour dietary recall and then some sophisticated statistical analysis using multivariate analysis.

Interestingly, 20% of the children age 9-13 and 31.5% of the adolescents were breakfast skippers.  This number is quite a bit higher than the percentages reported for preschool age children.  It probably more closely approximates that of adults who are known to develop behaviors of breakfast skipping as the demands of more advanced education and work become paramount.

Additionally, the study found that approximately 36% of the children and 25% of the adolescents consumed what were called “ready-to-eat” cereals, the kind of breakfast that comes in a box with lots of nice illustrations on the outside.  While those “ready-to-eat” or RTE cereal consumers were taking in higher levels of helpful micronutrients and dietary fiber, they were also taking in higher amounts of total carbohydrates.  They did have lower intakes of total fat and cholesterol.

The key finding was that the breakfast skippers had a higher body mass index and higher waist circumference than the breakfast eaters who ate boxed cereal.  Obesity was higher in the breakfast skippers.

So what this study tells us, from examination of nearly 10,000 young people in the United States, is that while the ready-to-eat boxed cereals may not be perfect, eating them for breakfast every day is probably far better than skipping breakfast.  We’ve seen that skipping breakfast is associated with higher waist circumference, poorer eating behaviors later in the day and greater changes of obesity.  Studies from Fiji, to Canada to the United States support this finding.  And while the boxed breakfast cereals may not be the ideal nutrition, they are clearly better than the eating behavior of skipping breakfast altogether.

CANADIAN STUDY SHOWS A LINK BETWEEN BREAKFAST SKIPPING AND EXCESS WEIGHT IN PRESCHOOL CHILDREN

Saturday, November 13th, 2010

In searching for clinical evidence linking eating behaviors and weight gain among children, I recently read a study out of Ottawa, Canada published by a group of epidemiologists in the Public Health Nutrition Journal, June 2006, entitled Breakfast Eating and Overweight in a Preschool Population: Is There a Link. The study was designed as a population based study involving nutritional interviews with parents of preschool age children between four and five years old.  The study is part of a longitudinal study of child development and included 1,549 children.  And a pretty strong link was found between skipping breakfast and being overweight.

9.8% of the children did not eat breakfast every day.  Many of the children who did not eat breakfast had immigrant mothers and less educated mothers (no high school diploma).  Additionally, a higher percentage of the breakfast skippers came from low income families.

Analysis of the study data found that skipping breakfast nearly doubled the chances that the preschool child would be overweight when the authors controlled for the other variables involved.  Using what is called an odds ratio, a common statistical method in describing the increased chances of obesity, the authors reported an odds ratio of 1.9 for breakfast skippers, meaning a nearly doubled chance of being overweight stemming from breakfast skipping.

In this large, well designed study, the evidence associating breakfast skipping with overweight status among preschoolers is pretty strong.  In fact, it is a bit startling that the association with breakfast skipping emerges in such a young age group.  The study also identifies groups that are more likely to have breakfast skippers among their toddlers, groups that may be better targets for educational outreach.

CRITICAL STUDY SHOWS BREAKFAST SKIPPING IS CORRELATED WITH OBESITY IN ADOLESCENT GIRLS

Thursday, November 11th, 2010

In a recently published study out of the Asian Pacific Journal of Clinical Nutrition, epidemiologists from Harvard Medical School showed a significant correlation between breakfast skipping and being overweight or obese among a study population of 523 adolescent girls.  One of the theories in the study was that specific behavior s could be measured and then correlated with weight gain, overweight and obesity.  It is hoped that this kind of measure would lead to some specific behavioral interventions and teachings that might improve the epidemic of adolescent weight gain and obesity.

The study was conducted among Fijian adolescent girls and published in volume 19 in the 2010 journal.  The various behaviors were assessed and among them, skipping breakfast was found to have a high correlation to the adolescent girls who were overweight and obese.  In this study population, 41% of the adolescent girls were considered overweight and 15% were considered obese.  A more sophisticated analysis, which involved a multivariate analysis technique, found frequent breakfast skipping associated with a higher odds ratio of overweight and obesity.  The association was considered statistically significant, but the odds ratio was around 1.15, not an especially strong correlation.  A further, even more sophisticated statistical analysis called regression modeling that adjusts for other types of eating problems and pathology lead to the breakfast skipping being found to have a non-significant influence on overweight and obesity.

So what we might take from this study is that breakfast skipping is associated or correlated with weight gain and obesity among adolescent girls.  It may not however be causative and may not be the specific behavior that needs to be targeted, but may be one of several different abnormal eating behaviors that lead to weight gain and obesity.

AESTHETICS CHANGE BUT HEALTH STATISTICS DO NOT

Wednesday, November 3rd, 2010

When speaking to parents about overweight children I occasionally encounter some resistance by the parents that seems based on what is “the norm”.  And what I sometimes come to understand is that many parents, like many kids, see the peers of children and do not see themselves or their kids standing out as being obese.

This phenomenon in which parents and kids look around and see that they stand out from “the norm,” has the effect of decreasing the sense of importance or urgency to medical recommendations to lose weight.  After all, if you weight just a little bit more than all your friends and peer group then how serious a problem could it really be?

The real problem is the norm has changed, but health statistics for body mass index have not.  What this means is our aesthetic of what looks normal or what looks healthy even, may wax and wane over time (remember the Rubinesk artistic renderings of the human form), but this aesthetic sensibility does not change the fact that increasing BMI is closely correlated with rapidly increasing diabetes respiratory problems, bone and joint abnormalities and shorter life expectancy.

The challenge for all of us who are aiming at preventing obesity among young people is to elevate the sense of urgency and convince parents, teachers, community leaders and kids that weight gain is in fact unhealthy and needs to be addressed with a serious plan of attack.  The slow motion nature of health deterioration with obesity tends to discourage a sense of urgency.  But the shifting standard of the aesthetic norm further weakens the resolve of parents and kids to take on a weight problem with some urgent seriousness.

OBESITY PREVENTION AND YOU: TO PARENTS

Wednesday, August 11th, 2010

Many times I am asked what are a few straightforward and simple things I can do as a parent to help prevent obesity in my own child.  And while there are some more thorough discussions I have written in other articles on this website and on obesityprevention.org, I will describe here a few of the most important steps you can take today to prevent childhood obesity at home.

  1. Set a great example.  Parents are powerful influences on children, but we lead more by example than by words so you must walk the walk quite literally speaking.  Be active and keep your own weight at a healthy level.  Avoid eating high calorie, high carb food, snacks and treats so you set the example for your child.
  2. Read every label and encourage your children to read every label.  While the labels can be confusing and full of lots of useless information, they do contain some important bits of information so that you should encourage your child to always be aware of.   And here they are:  One, know the number of calories in every serving that you eat.  And two, know the number of grams of carbohydrates or sugars in everything you eat.  That’s enough, that’s all you really need to focus on and the rest will take care of itself if you stay mindful of these two figures.
  3. Protein first.  This means every time you prepare a meal or snack you should be thinking             about protein first and foremost.  Protein provides greater satisfaction and does not result in immediate sense of rebound hunger like sugar does.  As a parent you are well aware of the sugar rush followed by the sugar crash, but you may not be as aware of the surges in hormones produced by sugar intake and how those result in rapid resurgence of hunger within about an hour.   Protein satisfies.  It is a good, healthy source of calories and don’t worry, your child will get plenty of carbs even without trying.  Let the protein (cheese sticks, protein bars, beans, nuts, meats and fish) satisfy them and they won’t be hungry for junk food so fast.
  4. Clear out the pantry.  That’s right, you got it, this is tough love, but you need to get rid of all the high carbohydrate, high calorie snacks and treats, M&Ms, Ding Dongs, candies, chips and all those goodies that kids (and everyone else) love to eat.  It’s not doing anyone any good.  Stock your house instead with fresh fruits and vegetables and your kids will be just fine.  In fact they will be far healthier and less overweight as a result.  Sometimes parents tell me “my kid won’t eat anything but junk food.”  Trust me, if the house is full of delicious fruits and veggies and there is no junk food in the house then he or she will eat what is available and learn to love it.
  5. Stay active and have fun at it.  Every kid should have 30-60 minutes of regular exercise every single day.  So make it a priority and find ways to make sure your kid is getting that activity.  Yes schools have cut physical education and we as parents no longer let our kids run loose in the neighborhoods like our parents did, but with a little effort you can certainly come up with an hour of physical activity for your kid.  Better yet do it with them.  Ride bicycles, take a hike, take the dogs out, sign up for sports, lessons, competitions, meets and tournaments.  Make sports and physical activity fun.  Find something your kid enjoys and support them.   Time will be a great investment in your child’s health.

WHEN SHOULD CHILDREN BE CONSIDERED CANDIDATES FOR WEIGHT LOSS SURGERY?

Monday, May 17th, 2010

The subject of children and adolescents potentially undergoing weight loss surgery has evolved greatly in a short number of years. When it was initially proposed the only operations were invasive procedures such as the open Roux-en-Y gastric bypass. With the advancements of minimally invasive surgery and laparoscopic instrumentation, there are now several minimally invasive choices, most notably the laparoscopic adjustable gastric band (LAGB, Lap-Band or REALIZE Band). The LAGB procedure does not involve any cutting, rerouting, reconnecting or other irreversible changes to the gastrointestinal system of a young person and so has emerged as a potential procedure, perhaps more worthy of consideration on a wider scale in young people.

The rationale for weight loss surgery being performed among young people is that serious comorbid conditions are developing in young people and extremely important formative events are occurring in social, intellectual, academic and career realms for the young person, all of which are profoundly negatively impacted by obesity. Weight loss surgery performed at a young age offers the potential benefit of impacting not only the young person’s health and quality of life, but also substantially enhancing long term prospects for improved career, earnings, relationship formation and social development. For this reason many advocates of childhood health and adolescent well being have endorsed the concept of offering weight loss surgery to obese adolescents and young people.

When should a young person be considered for weight loss surgery?

  1. When the body mass index is over 35 it is reasonable to begin consideration.

  2. When the body mass index is over 40 weight loss surgery should be included in any discussion with the patient and family of the weight loss options.

  3. Attempts at non-surgical weight loss: young people by virtue of their higher resting metabolic rate than older persons, often have a greater ability to lose weight through non-surgical means. Additionally, young people may have a greater power to make behavior and lifestyle change than older people. So, determined efforts should be made to engage in non-surgical weight loss programs with a structured medically supervised approach involving dietary change, counseling, exercise, psychotherapy, use of protein based meal replacements and support groups. If these efforts fail then weight loss surgery should be considered.

  4. Health status: For adolescents who have already shown health problems stemming from obesity such as type 2 diabetes, high blood pressure and obstructive sleep apnea, weight loss surgery should be a consideration.

  5. Age: At what age should weight loss surgery be considered? This remains a debated topic. Our own center chose a lower range cutoff of age 15 below which we offer non-surgical, medically supervised weight loss. At 15 and above we will offer laparoscopic adjustable gastric banding weight loss surgery. At age 18 and above patients and families generally have the option of LAGB or laparoscopic Roux-en-Y gastric bypass surgery. Other centers around the country have chosen a lower age cutoff of, for example age 12 and above for consideration of weight loss surgery.

Tips for success with adolescents and weight loss surgery:

  1. This must be a whole family effort. Everyone must be educated and motivated to help the young person succeed.

  2. Support groups for the young person and the parents and siblings. This is not a “go-it-alone” journey. Quite the opposite is true. Support, encouragement and coaching from parents, siblings and peers enhances successful weight loss.

  3. 0-calorie beverages. This principle must be enforced within the household to avoid “drinking all your calories” and maintaining resuming obesity.

  4. Protein first. This principle means that everything eaten, drunk, prepared, bought, opened, sniffed or dreamed about must be protein first. This guarantees a greater sense of satiety and an emphasis on lower intake of simple carbohydrates, which are appetite stimulating.

  5. Exercise for life. The habit must be engrained not only for the young person, but for the whole family that daily exercise is part of life even if it is simple walking. Exercise is a powerful predictor of long term weight loss success

Thank You To Joanie Greggains From KGO A.M. Radio In San Francisco

Wednesday, April 7th, 2010

Joanie has a great health show on the radio in San Francisco called the Joanie Greggains Show and I had the great privilege of appearing as a guest on her show this morning on March 27, 2010. We talked about Life Changing Weight Loss, the book, Joanie has some great questions about the inner motivation and the need to except internal change as a foundation for losing weight and keeping it off. We also talked quite a bit about obesity prevention among children and what it takes to fight that battle.

I think one thing many people in the public don’t comprehend is that times have changed and the environment surrounding our children is quite different now than it was thirty years ago. It definitely requires a much more active battle plan to prevent our children from becoming overweight and obese. It’s not just going to happen automatically. The environment is too rich in calories and carbohydrates and the environment also deters exercise and activity to such a great extent that most children are heading toward a path to overweight and obesity as they progress to adulthood. So as parents we must take a tougher line. We must cut against the grain of the school environments, the neighborhood environments, what is going on television and at our friend’s houses. We have to eliminate sugar beverages from the household, toss out all the snacks, candies, cookies and ice cream in the pantry and freezer and make those kinds of treats special occasion treats a couple of times a month, but not an everyday or every meal occurrence. We have to encourage ways for our children to get regular exercise and this can take some creativity given the demands and time pressures that most young students face and also the safety concerns that most parents have about letting children run loose in the neighborhoods. The battle can be won it just requires determination and a real effort.


Dr. Kent Sasse, Medical Director | 75 Pringle Way Suite 804 Reno, NV 89502 | Phone: 775-829-7999

Dr. Kent Sasse serves the entire city of Reno and all the surrounding areas. Dr. Sasse is one of the nation's foremost medical weight loss and bariatric surgical experts.
Dr. Sasse has educated patients about food nutrition and weight loss for many years.

Copyright © 2007-2010 Kent Sasse, M.D. All Rights Reserved.

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