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?