epidemiology childhood obesity abdelaziz elamin, md,phd,frcp,frcpch professor of child health...
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Epidemiology Childhood ObesityEpidemiology Childhood Obesity
Abdelaziz ElaminAbdelaziz Elamin, , MD,PhD,FRCP,FRCPCHMD,PhD,FRCP,FRCPCH
Professor of Child Health Professor of Child Health
University of Khartoum, SudanUniversity of Khartoum, Sudan
Consultant in pediatric Endocrinology & Consultant in pediatric Endocrinology & Clinical NutritionClinical Nutrition
EpidemiologyEpidemiology
The study of how a disease The study of how a disease or health outcome is or health outcome is distributed in populations distributed in populations and what factors influence or and what factors influence or determine this distribution.determine this distribution.
DefinitionDefinition
Obesity is a serious degree of Obesity is a serious degree of Overweight caused by excessive Overweight caused by excessive storage of fat & usually measured storage of fat & usually measured using a Body Mass Index . using a Body Mass Index .
BMI is defined as body weight in BMI is defined as body weight in kilograms divided by the square kilograms divided by the square height in meters.height in meters.
WHO: Overweight and ObesityWHO: Overweight and Obesity
For Adolescents & AdultsFor Adolescents & Adults
BMI between 18.5 & 24.9: Healthy weightBMI between 18.5 & 24.9: Healthy weightBMI between 25 and 29.9: OverweightBMI between 25 and 29.9: OverweightBMI 30 & above: ObeseBMI 30 & above: ObeseBMI 40 & above: Morbid obesityBMI 40 & above: Morbid obesity
For ChildrenFor Children
BMI between 5BMI between 5thth & <85 & <85th th percentile: Healthy percentile: Healthy weightweightBMI between 85BMI between 85thth & 95 & 95th th percentile: percentile: OverweightOverweightBMI >95th percentile: ObesityBMI >95th percentile: Obesity
Overweight and Obesity in the USOverweight and Obesity in the US
• Epidemic state in the United StatesEpidemic state in the United States• 25% of children are obese25% of children are obese• More than ½ of all adults are overweight More than ½ of all adults are overweight
and nearly a quarter are obeseand nearly a quarter are obese• Rate of obesity has doubled since 1960 Rate of obesity has doubled since 1960
and continues to riseand continues to rise• If current trends continue, all Americans If current trends continue, all Americans
will be overweight by the yr 2030.will be overweight by the yr 2030.
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)
<10% 10-20%
21-30% 31-40% 41-50% >51%
© B.Popkin 2009
BMI (Kg/m2)
0.0
2.0
4.0
6.0
8.1
K d
ensi
ty B
MI
10 15 20 25 30 35 40 45 50 55 60 65
1988
1999
2006
From Juan Rivera
BMI Distribution Shifts among Mexican women 18-49 y (National Surveys 1988, 1999 y 2006)
BMI Distribution Shifts Among Chinese Adults, ages 19 and Older
Per
cen
t
China Health and Nutrition Survey. Males: 10.4-27.1; Females 15.4-27.7
Childhood ObesityChildhood 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 Childhood Obesity PrevalencePrevalence
In USA In USA :: Doubled in children 6-12 year .Doubled in children 6-12 year . Tripled in adolescents. Tripled in adolescents. 20% of 6-19 year are obese. 20% of 6-19 year are obese.
Worldwide : Worldwide : Range from ( 10% to 25%).Range from ( 10% to 25%).
00
55
1010
1515
2020
00
55
1010
1515
2020
Perc
en
tPerc
en
t
Perc
en
tPerc
en
t6-11 years old6-11 years old
12-19 years old12-19 years old
Trends in U.S. Child and Trends in U.S. Child and Adolescent OverweightAdolescent Overweight
1963
-196
7
1963
-196
7
1999
-200
0
1999
-200
0
2001
-200
2
2001
-200
2
2003
-200
4
2003
-200
4
1971
-197
4
1971
-197
4
1976
-198
0
1976
-198
0
1988
-199
4
1988
-199
4
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)1
,7
0,5
0,7
0,4
-0,0
2
0,5
0,1
0,1
0,9
-0,2
0,0
0,2
0,4
0,6
0,8
1,0
1,2
1,4
1,6
1,8
Australia U.K. U.S.A. Brazil Russia China Indonesia Vietnam Mexico
An
nu
al p
erc
en
tag
e c
ha
ng
e
Popkin (2007) nature reviews, cancer 7:61
Childhood Obesity in GermanyChildhood 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 Prevalence of Childhood Obesity in Italy
05
10152025
-
Pre
vale
nce
(%
)P
reva
len
ce (
%)
Boys over wt Girls over wt
Boys obese Girls obese
1994198419741964
Obesity In Developing CountriesObesity In Developing Countries
The burden of obesity & its complications is shifting rapidly towards the poor.
SSimultaneous malnutrition & overweight exist.imultaneous malnutrition & overweight exist. Obesity is now Obesity is now 4X4X more common than more common than
malnutritionmalnutrition in some developing countries. 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.
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
Prevalence of Childhood Obesity in the RegionPrevalence of Childhood Obesity in the Region(9-18 yrs)(9-18 yrs)
Causes of Childhood ObesityCauses of Childhood Obesity
Childhood obesityChildhood obesity
Pathological causes
Genetics
Socioeconomic
Behavioral Nutritional
Obesity: Environmental InfluenceObesity: Environmental Influence
Current environment
Past environment
Genetic susceptibility
BM
I %
SPECIAL ISSUESPECIAL ISSUE
November 8, 1999
WILL WE KEEP GETTING FATTERFATTER?
2323
Cause of Present Obesity EpidemicCause of Present Obesity Epidemic
Energy intake Energy intake unequal unequal energy output energy output Decreasing physical activityDecreasing physical activity Increasing consumption of calorie dense foodsIncreasing consumption of calorie dense foods
More meals eaten outside of homeMore meals eaten outside of home Increased portion sizesIncreased portion sizes
Lack of concern about obesityLack of concern about obesity
Obesity Is Caused by Long-Term Obesity Is Caused by Long-Term Positive Energy BalancePositive Energy Balance
FatFatStoresStores
Energy In
Energy Out
obesityobesity
Weight gain:
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 ModernFood Supermarkets
Decreased Physical activityDecreased Physical activity
Excess TV; computer, & play station timeExcess TV; computer, & play station time Children are home alone (dual income parents)Children are home alone (dual income parents) Decreased physical activity at school & at homeDecreased physical activity at school & at home Transportation by car or school busTransportation by car or school bus Neighborhood safetyNeighborhood safety Few public parks, sidewalks, swimming Few public parks, sidewalks, swimming
pools ..etcpools ..etc
From Traditional to Modern Leisure
Trends in Physical EducationTrends in Physical Education
05
1015202530354045
%
1991 1993 1995 1997
% of 9 -12 graders
enrolled in Daily PE
(CDC 2000 Review)
Obesity HazardsObesity Hazards
What bothers you the most?What bothers you the most? Anthropometric parameters Anthropometric parameters ComorbiditiesComorbidities
PhlebitisPhlebitisvenous venous stasisstasis
Coronary heart Coronary heart diseasedisease
Pulmonary diseasePulmonary diseaseabnormal functionabnormal functionobstructive sleep apneaobstructive sleep apneahypoventilation syndromehypoventilation syndrome
Gall bladder Gall bladder diseasedisease
GoutGout
DiabetesDiabetes
OsteoarthritisOsteoarthritis
Nonalcoholic fatty liver Nonalcoholic fatty liver diseasediseasesteatosissteatosissteatohepatitissteatohepatitiscirrhosiscirrhosis
HypertensionHypertensionDyslipidemiaDyslipidemia
CataractsCataracts
SkinSkin
PancreatitisPancreatitis
CancerCancerbreast, uterus, cervix, prostate, kidneybreast, uterus, cervix, prostate, kidneycolon, esophagus, pancreas, livercolon, esophagus, pancreas, liver
Gynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesabnormal mensesinfertilityinfertilitypolycystic ovarian syndromepolycystic ovarian syndrome
StrokeStroke
Health Complications of ObesityHealth Complications of ObesityIdiopathic intracranial Idiopathic intracranial
hypertensionhypertension
RED FLAGRED FLAG
Obesity and overweight account for more Obesity and overweight account for more than 300,000 premature deaths annually in than 300,000 premature deaths annually in United States, 2United States, 2ndnd only to tobacco-related only to tobacco-related deaths.deaths.
Obesity would surpass Obesity would surpass tobacco tobacco as the as the leading cause of death worldwide in the leading cause of death worldwide in the
next decadenext decade..
Apr 19, 2023Apr 19, 2023 ©M.Miqdady, M.D.©M.Miqdady, M.D. 4141
The Bottom LineThe Bottom Line
Obesity causes 300,000 prematureObesity causes 300,000 premature
deaths per year in the USdeaths per year in the US
Complications Specific to Children …Complications Specific to Children …
Persistence of Obesity at Adulthood:Persistence of Obesity at Adulthood: Overweight adolescents have a 70% Overweight adolescents have a 70%
chance of becoming overweight chance of becoming overweight adults.adults.
Increases to 80% if one or both Increases to 80% if one or both parents are obese. parents are obese.
Obese 6 year old has a 25% chance Obese 6 year old has a 25% chance of becoming obese adultof becoming obese adult
Obese 12 year old has a 75% chance Obese 12 year old has a 75% chance of becoming a obese adult.of becoming a obese adult.
The probability of obesity in adults in The probability of obesity in adults in relation to BMI at various ages during relation to BMI at various ages during
childhoodchildhood
16 15 12 11 10 917 19
55
7567
26
52
69
8377
36
0
20
40
60
80
100
Birth 1 to 3 3 to 6 6 to 10 10 to 15 15 to 18
Age of child ( years )
% o
bes
e as
ad
ult
s
BMI < 85th BMI > 85th BMI >95th
Common Complications in ChildrenCommon Complications in Children
Metabolic Syndrome.Metabolic Syndrome. HypertensionHypertension Fatty Liver .Fatty Liver . Early Sexual Maturation.Early Sexual Maturation. AsthmaAsthma Sleep apneaSleep apnea
““The first wealth is health.” The first wealth is health.”
Thanks for your attention
Review Questions (Developed by the Review Questions (Developed by the Supercourse team)Supercourse team)
• Russia is one of the few countries where Russia is one of the few countries where children are becoming less obese. Why children are becoming less obese. Why might this be?might this be?•In developing countries, what is more In developing countries, what is more important, obesity or malnutrition and why?important, obesity or malnutrition and why?•Describe the concept of energy balanceDescribe the concept of energy balance•What are the main diseases associated with What are the main diseases associated with obesity?obesity?
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