Download Pediatric Obesity

Pediatric Obesity
Elizabeth H. Kwon MD, MPH
OBESITY DEFINED

According to the AMA’s Expert Committee on the Prevention,
Assessment, and Treatment of Child and Adolescent
Overweight and Obesity in 2005 (Co-funded by Health
Resources and Services Administration (HRSA) and the
Centers for Disease Control and Prevention (CDC))

Overweight
 BMI for age 85%ile to 94%ile

Obese
 BMI for age >=95%ile
Causes of Pediatric Obesity

Caloric Intake has Increased
Less supervised family meals
 More eating out/ Fast food/ Restaurants

Portions sizes are much larger
 Fried foods/ Trans fats

High Calorie Beverages
 Increased availability of calorically dense, ready-toeat food

More chips, cakes, cookies, donuts, crackers, candy…
 Pop tarts, Easy Mac, Canned Ravioli, frozen pizzas…

(From Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
Causes of Pediatric Obesity

Less Physical Activity

More sedentary activities like video games, TV and computer less
time to run around






TV/Computer --Average 2.5 hours/day with 20% >5 hours day
Studies show higher BMI’s, obesity and cholesterol with more TV
40% of low-income children 1-5y.o had a TV in their room
Schools have less or no gym time – in order to achieve “No Child
Left Behind” goals
More kids in after school programs without much physical activities
“More dangerous world”—keeps children inside more than previous
decades
(From Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
Causes of Pediatric Obesity

Genetics
One parent obese3x risk
 Two parents obese10x risk

( Hassink, A Parent’s Guide to Childhood Obesity 2006)

Environmental

Energy imbalance
(Energy In>Energy Used Energy Stored at Fat)
(From Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
Increasing Percent of Obese
Children and Adolescents
16
14
12
10
6-11 years
12-19 years
8
6
4
2
0
1963-70

1971-74
1976-80
1988-94
1999-02
From Comorbidities of Pediatric Obesity—William Cochran, MD
 12.
5 Million US Children are
Overweight today…
Racial Disparities in
Overweight/Obesity Prevalence
The NHANES in 1988-1994 versus
the NHANES in 2002 showed
overweight prevalence in nonHispanic Black (20.5%) and
Mexican-American (22.2%)
increased at a faster rate than in
Whites.
Childhood Obesity has Medical
Consequences









Diabetes Mellitus type II
Psychosocial
Hypertension
Hyperlipidemia
Asthma
Sleep Apnea
Arthritis
SCFE
Blount’s Disease








Steatohepatitis
Gallstones
Pancreatitis
Metabolic Syndrome
Polycystic Ovarian
Syndrome
Skin Infections
Back Pain
Pseudotumor Cerebri
Prevalence of Diabetes in US
1990 versus 2001

From : Narayan et al. 2003, Sinha et. Al 2002, Weiss et al, 2003
Life years lost from Diabetes
in the US
from Narayan et al., 2003

If diagnosed at age 40
years



White
 male:
 female:
Hispanic
 male:
 female:
Black
 male:
 female:

If diagnosed at age 10
years

1.01 yrs
13.5 yrs

11.5 yrs
12.4 yrs
13.0 yrs
17.0 yrs

White
 male: 16.5 yrs
 female: 18.0 yrs
Hispanic
 male: 19.0 yrs
 female: 16.0 yrs
Black
 male: 22.0 yrs
 female: 23.0 yrs
Hypertension

60% of Children with persistently elevated
blood pressure had weight >120% Ideal Body
Weight (Lauer J Pediatrics 1975;86:697-706.)

Overweight adolescents have 8.5 x increased risk
of hypertension as adults (Srinivasan Metab 1996;45:235-240)
Hyperlipidemia

Obesity in adolescence is associated with
 2.4 times more likely to have cholesterol
>240mg/dl
 3 times more likely to have LDL>160mg/dl
 8 times more likely to have HDL<35 mg/dl
by the time they are adults aged 27-31 y.o.
(From Srinivasan Metab 1996;45:235-240)
Steatohepatitis

Affects 20-25% of Obese Children (Tazewa Acta
Paeditr-1997; 86:238-241) while 83% of Children with
Steatohepatitis are Obese (Comorbidities of Pediatric Obesity,
William Cochran MD)

Can progress to fibrosis or frank cirrhosis.

Obesity and type 2 diabetes are the strongest
predictors for fibrosis progression (Angulo P. Keach JC,
Batts KP, Lindor KD, Hepatology 1999; 30(6) 1356-62.)
Cholelithiasis

Is caused by obesity in 8-33% of childhood
cases(Friesen Clin Pediatr 1989 7:294)

Is associated with obesity in 50% of adolescent
cases (Crichlow Dig Dis. 1972; 17:68-72)

May be associated with weight loss (Crichlow Dig Dis.
1972, 17:68-72).
SCFE and Blount’s
 50-75%
of SCFE
patients are obese
(Wilcox , J Pediatric Orthopedics
1988:8: 196-200)
 2/3
of Blount’s
Disease patients
are obese
(Dietz, J Pediatrics 1982: 101: 735-737)
Obstructive Sleep Apnea



40% of severely obese children had central
hypoventilation (Silvesti, Pediatric Pulmonology 1993; 16:124-139)
Abnormal sleep patterns were found in 94% of
obese children in one study
OSA leads to decreases in learning, attention
span and memory
(Rhodes, J Pediatrics 1995;127:741-744; Greengerg GD, Watson RK, Deptula D., Sleep 1987;
10(3):254-62.)
And increases in pulmonary hypertension, systemic
hypertension and right heart failure
(Tal A, Lieberman A, Margulis G, Sofer S., Pediatric Pulmonology 1988;4(3):139-43; Marcus CL,
Greene MG, Carroll JL., American J Respiratory Critical Care Medicine 1998; 157 (4 PT1):
1098-103; Massumi RA, Sarin RK, Pooya M, Reichelderfer, Dis Chest 1969; 55(2): 110-4.)
Pseudotumor Cerebri

30-80% of children with pseudotumor
cerebri have obesity
(Scott, American J Ophthalmology 1997; 124: 253-255)

Increased Intracranial Pressure can lead to
visual impairment or blindness
(Comorbidities of Pediatric Obesity, William Cochran)
Physical Exam

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Hypertension
Acanthosis Nigricans
Papilledema
Thyroid
Hepatomegaly
Bowed legs/Osgood Sclatter’s
Depression
Short Stature
Laboratory Tests

BMI 85-94%ile with no other risk-->Fasting lipid profile

BMI 85-94%ile with risk factors (family history of obesity,
family history of obesity-related diseases, elevated lipid levels, elevated
blood pressure, smoking)  Fasting lipid profile, LFT’s,
fasting glucose
BMI >=95%ile Fasting lipid profile, LFT’s, fasting
glucose
Repeat tests every 2 years after age 10.

Other possible suggested tests by endocrinologists:
 Fasting Insulin
 HbA1C
 Thyroid function tests
Obese Children are Likely to
Become Obese Adults
Percent of Obese Children Becoming Obese Adults
80
70
60
50
40
30
20
10
0
Preschool

School-age
Adolescent
From Pediatric Obesity: A Huge Problem in the USA—William Cochran MD
Obesity Increases Mortality
“Because of the increasing rates of obesity,
unhealthy eating habits, and physical
inactivity,
we may see the first generation that will be
less healthy and have a shorter life
expectancy than their parents”
--Richard H. Carmona, MD, MPH, FACS, Surgeon General
U.S. Dept of Health and Human Services, 2004
Psychosocial Impact of Childhood
Obesity



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Increased rates of Depression
Poorer Self-Esteem—may last til adulthood
10-11 year olds prefer friends with handicaps than
obese (Richardson, 1961)
6-10 year olds associate obesity with laziness (Staffieri,1967)
Obese Females have lower college acceptance rates
than non-obese females (Canning, 1966)
Obese Adolescent Females as young adults had less
education, less income, higher poverty rates and
decreased rate of marriage versus non-obese females
(National Longitudinal Survey of Youth, 1993)
Economic Consequences of Obesity

In 2002, the estimated cost of obesity in the US
was $117 billion dollars.

Hospital Costs associated with pediatric obesity
are rising:
 In 1979: $35 million
 In 1999: $127 million
From Pediattric Obesity: A Huge Problem in the USA—William Cochran, MD
What can we do about
Childhood Obesity?
PREVENTION
IS KEY SINCE
TREATMENT IS SO
MUCH MORE DIFFICULT
Prevention of Childhood Obesity

Advise Pregnant Women to gain the recommended amount of
weight during pregnancy


LGA, SGA and infants of diabetic mothers have increased rates of
obesity (Hediger M.. , Pediatrics 104, p. 33, 1999)
Encourage Breastfeeding


8 out of 11 studies noted a lower rate of obesity in children if
breastfed vs. formula fed (Dewey 2003)
Longitudinal study of breastfed vs. formula fed infants (Bergmann 2003)



BMI the same at birth
BMI at 3 & 6 months > in formula fed vs. breastfed infants
Rate of obesity at 6 years was tripled in formula fed vs. breastfed
(From Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
Prevention of Childhood Obesity

CALCULATE AND PLOT BMI on ALL CHILDREN
OVER 2 YEARS OLD at all WELL CHILD EXAMS.

PLOT WEIGHT-FOR-LENGTHS ON ALL CHILDREN
UNDER 2 YEARS OLD!

If there was an infectious disease that had…



double - tripled in prevalence,
was afflicting 25-30% of children of all ages,
had life life-long, potentially life threatening impact…
Would we be acting?
Would we take 10 sec to plot a point?
(From Krebs, N., Hassink S., Obeesity Basics 101: Role of the Pediatrician)
Prevention of Childhood Obesity

Are MD’s Using the BMI Charts?
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Use of BMI by MD’s was associated with:



31 % of pediatricians: “Never”
11% : “Always”
According to a 2006 AAP Periodic Survey, only a little more than
half the pediatricians assessed a BMI.
Greater assessment of “fatness”
Greater concern about co-morbidities
“Visual diagnosis” subject to under-diagnosis of obesity
(Perrin et al, J Peds 2004, and Krebs, N., Hassink S., Obeesity Basics 101: Role of the Pediatrician)
Can you see risk?


a)
b)
c)
4 year old girl
Is her BMI-for-age
5th to <85th percentile:
“normal”?
>85th to <95th
percentile:
“overweight”?
>95th percentile:
“obese” ?
(Photo from UC Berkeley Longitudinal Study, 1973)
(Slide Courtesy Krebs, N., Hassink S., Obeesity Basics 101: Role of the
Pediatrician)
Plotted BMI-for-Age
Measurements:
Age=4 y
Girls: 2 to 20
years
BMI
Height=99.2 cm (39.2 in)
Weight=17.55 kg (38.6 lb)
BMI=17.8
85-95th percentile
Answer:
b)“overweight”
(Slide Courtesy Krebs, N., Hassink S., Obeesity Basics 101: Role of the
Pediatrician)
Can you see risk?
3 year old boy
Is his BMI-for-age :
a) 5th to <85th percentile:
“normal”
b) >85th to <95th percentile:
“overweight”?
c) >95th percentile: “obese”?
(Slide Courtesy Krebs, N., Hassink S., Obeesity Basics 101: Role of the Pediatrician)
Photo from UC Berkeley Longitudinal Study, 1973
CDC
Plotted BMI-for-Age
Measurements:
BMI
BMI
Boys: 2 to 20 years
Age = 3 y 3 wks
Height = 100.8 cm
(39.7 in)
Weight = 18.6 kg
(41 lb)
BMI=18.3
Answer: BMI-for-age ~ 95th
percentile“obese”
BMI
(Slide Courtesy Krebs, N., Hassink S., Obeesity Basics 101: Role of the
Pediatrician)
BMI
BMI>95% strongly correlates with body fat
Slide Courtesy Krebs, N., Hassink S., Obeesity Basics 101: Role of the Pediatrician)
BMI
BMI
Boys: 2 to 20 years
Slide Courtesy Krebs, N., Hassink S., Obeesity Basics 101:
Referral
BMI
3 yr old boy
BMI
Early Identification –
BMI vs Visual Diagnosis
(Slide Courtesy Krebs, N., Hassink S., Obeesity Basics 101: Role of the Pediatrician)
85-95th %
 95th %
>> 95th%
Nutrition Advice


ALL children should be counseled (not just those
with BMI’s>85%ile)
Beverages Guidelines—
Lowfat Milk (3 dairy servings/day)
 Juice/juice drinks (120calories/8oz.)

Ages 1-6  4-6 oz/day
 Ages 7-188-12 oz/day
 Don’t buy it for the house—>just drink it when out/school/afterschool

No Soda/Iced Tea/ Lemonade/Gatorade unless it’s diet
 Lots of Water


Make it inviting and convenient -> put bottles in the fridge, fun sippy
cups with iced water, pitchers of water with lemon wedges etc.
Nutrition Advice

5 Fruits and Vegetables per day

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Draw out a plate with 2/3 plate with fruit vegetables, and 1/3
carbs and meat…
Whole Grains and High Fiber foods (Fiber=Age+5)
Use Canola/Vegetable oils not butter
Limit Fried Foods
No Trans Fats
Keep track of what child eats at school, afterschool,
daycare etc.
Do not use food as a reward
Do not skip meals
f
NUTRITION ADVICE
Pediatric Annals March 2010
Nutrition Advice

Give appropriate portions for age: Allow child to decide
on how much he/she wants (within reason)




Studies showed children consumed 25% less of an entrée when
allowed to serve themselves rather than being served a large
portion (Fisher et al., AJCN, 2003)
Don’t force a child to clean the plate
Try to eat at home rather than out
Eat food at the table (not in front of the TV)

Eating in front of the TV is associated with:






higher intake of fat and salt
Lower intake of fruits/ vegetables
Eating without awarenessencourages overeating
60-80% of commercials during children’s shows relate to food
Eat slowly/Stop when full
Read Labels
Nutrition Guidelines
frrom Pediatric Annals March 2010
Encourage Physical Activity


COUNSEL ALL CHILDREN at WELL CHILD
CHECKS (not just those with BMI>85%ile)
Limit screen time with TV and video games to less than 2
hrs/day



Make it active by running/dancing during commercials or
requiring running/ dancing for the first 30 minutes to be able to
watch the next 1-1/2 hours.
Don’t use the remote control
Encourage 60 minutes/day of activity




Encourage organized sports
Encourage outdoor time
Parents have to support the child’s activity--Otherwise it will not
likely happen.
Plan family field trips on weekends
(Slide Courtesy of Krebs, N., Hassink S., Obeesity Basics 101: Role of the Pediatrician)
(Slide Courtesy Krebs, N., Hassink S., Obeesity Basics 101: Role of the Pediatrician)
Treatment of Obesity

“The new recommendations detail
treatment strategies organized in a stepwise
protocol format. By facilitating a more
aggressive approach to weight management
in the primary care setting (eg. More
frequent follow-up visits, more timely and
appropriate referrals to nutritionists and
exercise specialists), the greater the
likelihood of success.”

--Contemporary Pediatrics Volume 25, no. 4
Stage 1:Prevention Plus Protocol


The Committee recommends a staged approach based on age
and progress on decreasing BMI as follows:
The MD should recommend:









>=5 servings of fruits and vegetables /day
<2 hours of screen time/day and no tv or computers in the child’s
sleeping area
>1 hours of physical activity/day
No sugar-sweetened beverages
Eat breakfast every day
Limit fast food
GOAL weight maintenance decrease BMI
Follow patients as often as monthly for 3-6 months
If there is no progress GO TO STAGE 2
Stage 2: Structured weight management protocol

Physicians should:
 Develop a plan for an organized diet with structured daily
meals and snacks with nutritionist advice
 Recommend that the child have active play for at least 1 hour a
day and further restrict screen time to one hour or less per day
 Suggest improved monitoring of exercise, screen time or diet
by patient and/or family
GOAL maintain weight or lose weight
(no more than 1 lb./month in children aged 2 to 11 OR 2
lbs./week in those aged 12 and older)



Follow patients as often as monthly for 3-6 months
If there is no progress GO TO STAGE 3
Stage 3: Comprehensive multidisciplinary protocol

REFER to a multidisciplinary team for more aggressive
and coordinated management including evaluation by a
psychologist with consideration given to behavior
modification and motivational counseling

Stage 3 interventions include the same eating and
activity goals as stage 2 plus psychological counseling
that may involve the entire family

GOAL weight maintenance or loss (no more than 1
lb./month ages 2-5, or 2 lbs./week ages 6 and up )til
BMI<85%ile

Follow up may be provided weekly
Stage 4: Tertiary Care Protocol
For patients with BMI>95%ile with comorbidities or
who have not responded to Stage 1-3 strategies
OR
 For patients with BMI>99%ile with no improvement
after 6-12 months of a Stage 3 regimen

MUST be referred to a tertiary weight management
center that usually include dietary and activity
counseling, low-calorie diets and sometimes even
medications and surgery.
From Contemporary Pediatrics Volume 25, No. 4 April 2008
From Contemporary pediatrics Volume 25, no. 4 April 2008

An obesity action plan for children
Treatment of Obesity



Important to communicate effectively with
patient and family
Try to assess a typical day—to better identify
ways to change diet and activity
Try to be sensitive and not use words that may
offend (“obese”, “fat”). Try to avoid being
judgmental and stigmatizing.
“Are you concerned about your child’s weight?”
 “I’m concerned that your child’s weight is getting
ahead of his height”
 (older child) “Is your weight ever a problem for
you?”

Motivational Interviewing
“Recent studies have demonstrated the efficacy of
motivational interviewing in helping patients
change their health behaviors.”
“MI is a patient-centered method for enhancing
intrinsic motivation to change by exploring and
resolving ambivilance.”
 “MI is patient centered, not doctor centered.”
 “The physician listens to the patient’s perspective on
how the problem affects daily life and seeks to
understand the patient’s point of view without
judging or criticizing the behavior.”

from Pediatric Annals March 2010
3 Communcation Styles of Motivational
Interviewing

Following (history taking)



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
Directing


Open-ended questions
Reflective listening
Agenda setting
Asking permission
Commonly used by physicians—clinicians tells patients what
to do and how to do it
Guiding


The physician helps the patient find his/her way and acts
more like a tutor.
The patient is encouraged to explore his/her own motivation
and goals. The patient makes the case for change
Four Guiding Principles of
Motivational Interviewing

Resist arguing and trying to persuade your patient to
change behavior


Understand your patient’s motivation


Ask them why they might want to change and might do it
Listen to your patient


Otherwise patient will become defensive
For example Your patient may have the answers as to how to defeat
the barriers to exercise in his daily life.
Empower your patient

A physician’s belief in the patient’s ability to change can be all a patient
needs to succeed.
frrom Pediatric Annals March 2010
frrom Pediatric Annals March 2010
Motivational Counseling Script (cont’d)
Treatment of Obesity

Negotiate for family change—otherwise, it will be
almost impossible for the patient to change.






Try to get all family members to come to at least one visit so
everyone is on the same page.
The family’s kitchen and habits have to change.
Food diaries
Activity logs
Pedometers.
Handouts




on food nutritional content/ portion sizes
on healthy recipes snacks
on exercise ideas
reviewing eating habits, activity goals
Treatment of Obesity

BUT TREATMENT IS VERY DIFFICULT

Thus, PREVENTION OF PEDIATRIC
OBESITY IS THE MOST EFFECTIVE
WAY TO COMBAT CHILDHOOD
OBESITY.

IT IS VITAL that pediatricians help
develop, encourage healthy eating and
activity habits.
BARRIERS TO THERAPY OF
PEDIATRIC OBESITY

Lack of commitment of primary care physicians
Many physicians do not address obesity
 Price 1989

17% of pediatricians felt physicians did not need to
counsel parents of obese children
 33% did not feel that normal weight is important to child
health
 22% felt competent in treating obesity
 11% felt treatment of obesity was gratifying

(Slide Courttesy of Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
BARRIERS TO THERAPY OF
PEDIATRIC OBESITY


Time commitment
Lack of reimbursement

Tershakovec 1999



Median reimbursement rate 11%
Lack of standard treatment protocol
Social / environmental barriers
Slide Courtesy of Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
PREVENTION: SCHOOL





Promote physical activity
Provide nutritious meals
Control vending machines
Have nutrition education incorporated into
regular school curriculum.
Encourage children to walk or bike to school
safely.
Slide Courtesy of Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
PREVENTION: COMMUNITY



Have safe playgrounds
Provide safe places for bike riding and walking
Promote physical activity outside of school
Slide Courtesy of Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
PREVENTION: INSURANCE
AND GOVERNMENT


Acknowledge obesity as a medical condition for
which one can be reimbursed.
Provide reimbursement for anticipatory
guidance for nutrition and physical activity
Slide Courtesy of Cochran, W., Pediatric Obesity: A Huge Problem in the USA)
LET’S MOVE Campaign
The White House Obesity Initiative and Your Family
 What is the White House Obesity Initiative?


The First Lady’s national campaign against childhood obesity
called “Let’s Move” is a comprehensive and coordinated
initiative with many partners. The focus is to prevent
childhood obesity.
The campaign has four pillars:
healthy schools,
 access to affordable and healthy food,
 raising children’s physical activity levels,
 and empowering families to make healthy choices.
The American Academy of Pediatrics (AAP) is proud to join the White
House in this initiative

White House Obesity Initiative FAQ
for Families

Why do parents need to know their child’s
BMI?
Parents need to know their child’s BMI because
prevention is the best medicine.
 By plotting BMI and monitoring physical activity
and nutrition throughout childhood, parents and
pediatricians can keep an eye out for children at-risk
of becoming overweight and take action early to
prevent future obesity.
 By catching at-risk children early, families in
partnership with their pediatrician can explore ways
to make changes to live healthier active lives.

From the

House Obesity Initiative FAQ for
Families
How do I talk with my children about
making healthy active changes?
Talk with your children about the importance of the
whole family being healthy. Get together with your
family and decide ways your family can make
healthier choices.
 Talk with the whole family and decide what changes
to make together. Remember to make it fun to try
new things together.

What can families do to lead healthier
lives?

Healthy active living can be fun and family-oriented.
Make healthy choices together – grow a garden, play
outdoor games, cook as a family. Have fun! As
parents, it’s important to set a good example.

There are a lot of things families can do to be
healthier and it can be overwhelming trying to decide
where to start.
From the House Obesity Initiative FAQ for Families
5-2-1-0- RX


But it is important to remember that small
changes can make a big difference.
The AAP recommends starting with one of
these behaviors:
5 – Eat 5 fruits and vegetables a day.
2 – Limit screen time (TV, computer, video
games) to 2 hours each day.
Children younger than 2 should have no screen time at all.
1 – Strive for 1 hour of physical activity a day.
0 – Limit sugar-sweetened drinks.
From the House Obesity Initiative FAQ for Families
5-2-1-0 Rx. For Healthy Active Living
5-2-1-0 Rx. Cont’d
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To start, families can pick one of these behaviors and
set specific goals to improve their health.
In addition to 5, 2, 1, 0, goals, families can make small
changes in their family routines to help everyone lead
healthier active lives. Science suggests these activities
can help prevent obesity:
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· Eating breakfast every day;
· Eating low-fat dairy products like yogurt, milk, and cheese;
· Regularly eating meals together as a family;
· Limiting fast food, take-out food, and eating out at
restaurants;
· Preparing foods at home as a family;
· Eating a diet rich in calcium; and
· Eating a high fiber diet.
From the House Obesity Initiative FAQ for Families
How do we start to make changes to
our family’s routine?
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You can start in small steps. Small changes can make a big
difference in your child’s health.
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First Lady Michelle Obama gives a few concrete examples of
doing just that – putting water in your child’s lunch box,
providing a fruit serving at breakfast, and curbing fast food
consumption.
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TheAAP’s healthy active living prescription available at
www.aap.org/obesity/whitehouse is designed to help you and
your pediatrician identify some areas where you might want to
begin. Small changes you make every day can make a big
difference in your family’s health in the long run!
From the House Obesity Initiative FAQ for Families
How can our communities support
healthy active children?
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The environments our children live in have a profound
impact on the foods they eat and the amount of activity
they get.
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Some communities lack full-service grocery stores, but
have an abundance of fast food restaurants. In turn,
families may fall back on these fast food options
because healthy, fresh foods are not available nearby.
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Working with community leaders to encourage the
creation of healthy, fresh food options can make a
difference in the choices available for families.
From the House Obesity Initiative FAQ for Families
How can our communities support
healthy active children? (cont’d)
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Communities can also ensure that children have
a safe place to play.
Community centers, green space, parks – these all
provide an opportunity for kids to be active.
 Encourage your community to have fun and safe
places for children to play – inside and outside – so
they have options for fun and safe activities.
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From the House Obesity Initiative FAQ for Families
How can pediatricians and parents
partner on healthy active living?
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Your pediatrician can partner with you on a
prescription for healthy active living that is right for
your family.
He or she knows your family and understands the
nutritional and physical activity needs for your child.
Your pediatrician is also familiar with your community
and may be able to help you find needed resources to
support your healthy active lifestyle goals.
Together, you and your pediatrician can help your
family get started on the path to leading healthier lives.
From the House Obesity Initiative FAQ for Families
EAT WELL PLAY HARD
or else……
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Relevant WEBSITES
www.aap.org/obesity/whitehouse/index.html
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www.nichq.org/NICHQ/Programs/ConferencesAndTra
ining/ ChildhoodObesity/ActionNetwork/htm
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CDC site for 9-13 year olds to promote physical activity
www.aap.org/obesity/index.html
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Pediatrician can join the Childhood Obesity Action Network
http://www.verbnow.com
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Let’s move campaign by First Lady Michele Obama endorsed
by the AAP
American Academy of Pediatrics web site regarding obesity
http://www.bam.gov
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Site to answer kids questions
Relevant WEBSITES
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http://147.208.9.133/
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http://www.kidnetic.com/
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An interacitve website for 9-13 year olds and families re
healthy eating and activity
http://www.trowbridge-associates.com
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A free dietary assessment tool to keep up to a 20-day food
log
Pediatric BMI wheels
http://www.usda.gov/cnpp/kidspyra
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Pediatric food pyramid
(From Cochran, W., Pediatric Obesity: A Huge Problem in the USA)