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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
Epidemiology

The study of how a disease


or health outcome is
distributed in populations
and what factors influence or
determine this distribution.
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.
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
Overweight and Obesity in the US

Epidemic state in the United States


25% of children are obese
More than 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.
Patterns Of Overweight & Obesity Globally For Nationally Representative
Samples (Percentage overweight + Obese)
<10% 10-20% 21-30% 31-40% 41-50% >51%

Arctic Arctic Ocean


Ocean

North
Pacific
Ocean

Indian
Ocean
South South Atlantic Ocean
Pacific
Ocean

B.Popkin 2009
BMI Distribution Shifts among Mexican women 18-49 y
(National Surveys 1988, 1999 y 2006)
.1
1988

1999
.08

2006
K density BMI
.06
.04
.02
0

10 15 20 25 30 35 40 45 50 55 60 65
BMI (Kg/m2)
From Juan Rivera
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


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
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%).
Trends in U.S. Child and
Adolescent Overweight
20 20

15 15
Percent

Percent
6-11 years old

10 10

12-19 years old


5 5

0 0
0
4

4
7

-2 2
20 - 2 0

4
97
96

98

99

03 0 0
01 0 0

00
-1
-1

-1

2 0 -2
-1

71

76

88
63

99
19
19

19

19

19
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


Childhood Obesity in Germany

Source: National Center for Health Statistics, 1999 National Health and Nutrition Examination
Survey.
Percent increase in Prevalence of Childhood obesity in
Sweden
(1969-2005)
Prevalence of Childhood Obesity in the
UK (1995-2002)
Prevalence of Childhood Obesity in Italy
25
Prevalence (%)

20
15
10
5
0
1964 1974 -
1984 1994

Boys over wt Girls over wt


Boys obese Girls obese
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.
Prevalence of Childhood Obesity in the Region
(9-18 yrs)

Country % Overweight % Obesity


Iran 32.0 14.5
Jordon 17.3 8.9
Oman 19.2 9.6
Syria 16.5 11.2
Sudan 12.4 7.6
Causes of Childhood Obesity

Genetics

Pathological causes Socioeconomic

Childhood obesity

Behavioral Nutritional
Obesity: Environmental Influence

Current environment
BMI %

Past environment

Genetic susceptibility
November 8, 1999

SPECIAL ISSUE

WILL WE KEEP GETTING FATTER?


FATTER
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

23
Obesity Is Caused by Long-Term
Positive Energy Balance

Fat
Stores
obesity
Weight gain:
Energy Out
Energy In
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


From Traditional food to Modern Meals
From Traditional to Modern Snacking
From Traditional Food Marketing to Modern
Food Supermarkets
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
From Traditional to Modern Leisure
Trends in Physical Education
45
40
35 % of 9 -12 graders
30
25 enrolled in Daily PE
% 20
15
10
5
0
1991 1993 1995 1997 (CDC 2000 Review)
Obesity Hazards
What bothers you the most?
Anthropometric parameters
Comorbidities
Health Complications of Obesity
Stroke Idiopathic intracranial
Pulmonary disease
hypertension
abnormal function
Cataracts
obstructive sleep apnea
hypoventilation syndrome Coronary heart
Pancreatitis disease
Diabetes
Nonalcoholic fatty liver
Dyslipidemia
disease
steatosis Hypertension
steatohepatitis
Gynecologic abnormalities
abnormalitie
cirrhosis
abnormal menses
Gall bladder infertility
disease polycystic ovarian syndrome
Cancer
breast, uterus, cervix, prostate, kidney
Osteoarthritis
colon, esophagus, pancreas, liver

Skin Phlebitis
venous
Gout stasis
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.
The Bottom Line

Obesity causes 300,000 premature


deaths per year in the US

Mar 31, 2017 M.Miqdady, M.D. 41


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.
The probability of obesity in adults in
relation to BMI at various ages during
childhood
100 BMI < 85th BMI > 85th BMI >95th
83
% obese as adults

75 77
80
69 67

60 52 55

40 36
26
16 17 19
20 15 12 11 10 9

0
Birth 1 to 3 3 to 6 6 to 10 10 to 15 15 to 18
Age of child (years )
Common Complications in Children
Metabolic Syndrome.
Hypertension
Fatty Liver .
Early Sexual Maturation.
Asthma
Sleep apnea
The first wealth is health.

Thanks for your attention


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?