Color Me Healthy WIC Conference

1. Color Me HealthyWIC Conference John Tyler Community College Richmond, VA 10-13-10

2. Tipping Point: Childhood Obesity From Inception, Conception, and Beyond John Harrington MD Associate Professor of Pediatrics Eastern Virginia Medical School Director of General Academic Pediatrics Children’s Hospital of The King’s Daughters

4. Objectives • Obesity risks before, during, and soon after pregnancy • Tipping Point Study • Breast versus Bottle • Self Regulation of Oral Feeding • Guidelines for Feeding, Sleeping and Exercise • Environment and Advocating • Conclusions

5. So who contributes to the weight of the infant mom or dad?

6. No such thing as fat sperm

7. Mom and Dad • Mom’s pre-pregnancy BMI is correlated with child’s BMI at age 3. • Dad’s BMI is less correlated in most studies • Maternal history of Diabetes increases risk of ↑ BMI • Maternal history of smoking associated with obesity in child at age 5

8. Opposites do not necessarily attract

10. Couple’s risk • Overweight/Obese female likely to marry or procreate with Overweight/obese male • Recent study shows overweight/obese girls more likely to start having sex earlier and to get pregnant. • Eating habits inherited, but can be modified by geography (American couple in East Asia)

12. Obesity in pregnancy • If women gains > than 30-35 pounds for pregnancy 48% more likely to have obese child by age 7. • Japanese OB 8-12 kg limit weight gain • If mom obese baby likely to have some insulin resistance, especially if LGA or SGA • Heritability of BMI between 40-70% • Pre-gestational and gestational DM=increased risk for child obesity

14. After birth • Babies who are SGA have impaired beta-cell activity in response to glucose tolerance test. • SGA prone to truncal fat deposition and metabolic syndrome • LGA also at increased risk for abnl weight increase • Rapid weight gain in infancy correlates with obesity.

15. Study at EVMS • Identifying the “Tipping Point” Age for Overweight Pediatric Patients • John W. Harrington MD,Vu Q. Nguyen, James F. Paulson PhD,Ruth Garland, Lawrence, Pasquinelli MD, Donald Lewis MD • Over 250 charts reviewed in 2 practices of children who were overweight or obese.

16. Overweight before age 2

17. Findings • Over half the children in study became overweight before age 2. • All patients were obese or overweight by age 10 • The rate of gain is approximately 1 excess BMI unit/year, therefore causing most children to be overweight by age 2. • Critical period for preventing childhood obesity in this subset of identified patients is during the first 2 years of life and for many by 3 months of age.

19. Intervention for obesity will have to be earlier!!!! But what can we do?

20. Recognize Early!!!

21. Growth Curve

22. The Rapidly Gaining Infant • 2 %iles crossed should raise a red flag ■ ■ ■

23. Do Fat Babies Grow Faster? • Parents always say he is hungry and growing (The Buddha Baby) • Overweight/Obese infants and children will grow faster due to growth hormone overload. • The problem is their overall height will be unchanged. They just grow faster earlier.

24. Feeding

25. VS

26. Breast vs Bottle and Obesity • Breast feeding is protective- probably due to the infants ability to “self-regulate” • Longer breast feeding more protection up until 1 year. • This is an inverse proportion • ↑ in time breastfeeding, ↓ BMI • Bottle feeding increased risk for obesity • ↑ protein in formula may stimulate insulin

27. Warning signs for overfeeding • Rapid weight gain in infant (crossing 2 %iles upward from 25 to 75%) • Weight outpacing height • Parent shows skills of feeding while not watching infant- missing satiety cues • Bottle propping

28. Bottle fed • Must watch for infant cues of being full • Head turning • Regurgitant • Paced feeding • Tongue thrust • Drool feeding

29. Making the diagnosis in infants • Obese infants in large practice in Texas 16% • Obese child at 6 months 20X more likely to be obese at 24 months • Only 10% of infants at 24 months who were obese were diagnosed as that in practice

30. Can Intervention Work? • Study done by one solo pediatrician in NY • Followed 100 infant pairs to age 2 • One group taught to self-regulate intake by 15 months. Other group did not, parent fed. • Self-regulating group only one BMI > 85% • 42% of non-regulated group with BMI> 85% • This difference continued even after attempts to crossover groups

31. Feeding is hard-wired to take in the amount of calories you need. Strong Satiety Signal

32. Guidelines for feeding advice in the infant/toddler

38. And No TV !!! At least limited

40. Obesigenic Society

41. Solid foods • Later introduction of solids after 6 months shows correlation with lower BMI • Self regulation as early as possible • Let the infant/toddler feed themselves by 11-12 months

43. Sleeping

44. Sleep • Regular and consistent bedtime routine • Infant who sleeps > 12 hours has less risk of obesity. This was a negative linear relationship. • Less sleep more obesity • Greater affect on boys versus girls

45. Family Dynamics

46. Three important household routines • Eating an evening meal as a family • Getting 8-10 hours of sleep at night • Limited TV/Screen time • 40% lower obesity

47. BMI increase risk • Subtle neglect • Inadequate supervision • Poor social engagement • Ethnicity • African American • Hispanic • American Indian

48. What about Exercise?

49. Let’s Move

50. What we need (0-5 years) • More physical activity, less screen time • Need to actually move! • Need safe parks, playgrounds, and recreational facilities. • Daycares need to be promoting activity and movement • Less energy dense foods and sugar in diet • Walking school buses