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Tag: Childhood Obesity

Increases in Pediatric Hypertension

More children and teens are likely to be categorized as having abnormal blood pressure during their annual wellness visits, based on new recommendations released this week by the American Academy of Pediatrics.

High blood pressure is mostly a “silent” condition, with no visible symptoms. Yet it can have long-term health consequences, including cardiovascular disease. The new guidelines, aimed at prevention, were published Monday in the journal Pediatrics. They include new diagnosis tables based on normal-weight children.

The academy convened a 20-person committee to update the previous guidelines, issued in 2004, and develop new evidence-based recommendations. As part of its work, the committee reviewed nearly 15,000 articles focused on diagnosis, evaluation and early management of abnormally high blood pressure in children and teens.

An estimated 3.5% of all children and teens in the United States have hypertension, according to the guidelines. “The prevalence of 3.5% is based on fairly recent large-scale screening studies,” said Dr. Joseph T. Flynn, lead author of the guidelines and a professor of pediatrics at University of Washington. In the past, the percentage of children diagnosed with high blood pressure was lower, he said: “based on previous studies, maybe 1% to 2%.”

The cause of hypertension depends on the age group. “In infants and very young children, we worry about an underlying cause like kidney disease,” Flynn said. With older school-age children and teenagers, the cause is more likely to be primary hypertension, sometimes called essential hypertension, “where there’s no specific problem,” he said. “This is like adults.”

Obesity does contribute to higher blood pressure, yet the physiological mechanisms causing high blood pressure are very complicated, and not all kids who are overweight or obese are hypertensive, while some normal-weight kids may be.

“If, for example, a child is known to have kidney disease or heart disease, then they would be at higher risk for hypertension. Another group would be kids whose parents have hypertension,” Flynn said. The guidelines include updated blood pressure tables based on normal-weight children for more precise classifications of hypertension. As a result, more children will be categorized as needing treatment.

“Untreated, we believe that high blood pressure in a child will lead to high blood pressure when that child becomes an adult, so that would potentially lead to an increased risk of cardiovascular disease later in life,” Flynn said, adding that untreated hypertension can also cause heart and kidney damage. The new guidelines are aligned with those for adults, according to Flynn. “The blood pressure levels that are concerning in adults would also be concerning in an older teenager,” meaning those age 13 and older. “It simplifies things for doctors,” he said.

The major thing parents need to know is that their children should have their blood pressure checked when they see a doctor, Flynn said. Also, know that hypertension can be managed with lifestyle change: for example, more exercise or changing the diet. Sometimes, though, the condition requires medication. Another change in the new guidelines is an emphasis on confirmation of the diagnosis.

“Ambulatory blood pressure monitoring is a procedure in which the person wears a blood pressure cuff for 24 hours, and their blood pressure is measured periodically over 24 hours,” Flynn said. “This is very important in children because there’s a very high rate of what’s called white coat hypertension, where blood pressure is high in the office (due to fear of doctors) but not at home.”

The new recommendation is that ambulatory blood pressure should become standard practice in children after any abnormal in office reading, Flynn said. Dr. Sophia Jan, director of general pediatrics at Cohen Children’s Medical Center in New Hyde Park, New York, said the rationale behind the new guidelines makes sense. With evidence that there may be consequences for kids whose high blood pressure is not treated at lower thresholds, it makes sense to treat them earlier than in the past, said Jan, who was not involved in the new recommendations.

What she would tell parents is that “we’re not doing anything majorly different. We’re still going to check your child’s pressure when he or she comes for wellness child visits. That’s what we’ve done always in the past.” What’s new is that “we may be quicker to recommend that you and your family help your child engage in lifestyle changes if your child’s pressure is within a threshold that is lower than in the past. “Everyone’s loath to put kids on medicines if you don’t have to, but we may need to get there a little bit faster than we have traditionally in the past,” Jan said.

“As doctors, we recommend these lifestyle changes, yet in reality, it requires partnership with schools and public health agencies,” she said. “We in the pediatric community did not necessarily appreciate to what degree kids were starting to exhibit what is traditionally thought of as an adult condition. Kids can show early signs of organ damage and increased risk for cardiovascular disease despite the fact that they’re young.”

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Why Are Different Countries Obese?

Recently published studies dictate different causes and factors behind the public health epidemic of obesity, focusing on several different countries–many of which have varying reasons for their respective obesity epidemics.

The Pacific Islands, Middle East and Americas lead the way in terms of regions with the greatest obesity rates. In 2014, more than 48% of the population of the Cook Islands was classified as obese. Qatar led the way in the Middle East with 34%, followed closely by the United States at 33%, according to the World Health Organization.

Obesity is defined using a person’s body mass index, the ratio between weight and height, with a BMI of 25 to 29.9 considered overweight and over 30 obese. The number of overweight or obese infants and children under the age of 5 increased from 32 million in 1990 to 42 million in 2013, according to the World Health Organization, with numbers increasing from 4 million to 9 million in the African region alone over that period.

While physical inactivity is said to be aiding the growing rate of obesity worldwide, for example as urbanization leads to more sedentary lives, experts point out that in some populations, exercise simply isn’t a priority.

This is evident in the Middle East and China, they say, namely through perceptions of exercise and its place on residents’ list of priorities. In Kuwait, focus groups from the World Health Organization found that locals consider exercise as sport rather than something done with a group of friends or at home, according to Temo Waqanivalu, team leader of population-based prevention of noncommunicable diseases at the WHO. “There’s a whole cultural barrier,” he said.

In addition, in the Middle East overall, it’s not considered the norm for women to take part in outdoor exercise or physical activity for leisure. “Having women exercise openly is a cultural issue,” he said. Across Asia and the Middle East, Hu thinks there is a great deal of misunderstanding. “Most people are not aware of the benefits of being physically active on their health,” he said.

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1/3 of World = Overweight

A new study reports that more than two billion adults and children across the globe are overweight or obese, and suffer from related health problems. Spurred by poor nutrition and low levels of physical activity, this number equates to one-third of the world’s population.

While 2.2 billion people can be classified as overweight or obese, more than 710 million are obese: 5% of all children, and 12% of all adults, can be categorized in this segment. The United States has the greatest percentage of obese or overweight children and young adults, at 13%.

The study, published in the New England Journal of Medicine, states that a growing number of people across the globe are dying from poor health, and problems linked to being overweight. “People who shrug off weight gain do so at their own risk–risk of cardiovascular disease, diabetes, cancer, and other life-threatening conditions,” said Dr. Christopher Murray, director of the Institute for Health Metrics and evaluation at the University of Washington, who worked on the study.

Researchers analyzed data collected between 1980 and 2015 from 68.5 billion people, and revealed that the number of people affected by obesity has doubled since 1980 in 73 countries, and continued to rise across most other countries in the analysis. Although the percentages of obese children were lower than adults, that rate at which their numbers have increased was greater–indicating greater future risk if nothing is done to alleviate and curb the growing problem.

“This raises the alarm that we may be facing a wave of obesity in the coming years across high and low income countries,” states Goodarz Danaei, assistant professor of global health at the Harvard T.H. Chan School of Public Health. Because obesity levels have risen in all countries, irrespective of income levels, the issue does not simply boil down to wealth. The paper reads: “Changes in the food environment and food systems are probably major drivers.”

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Less Screen Time, More Sports: Childhood Obesity & Cardiovascular Disease

A host of studies have confirmed the correlation between childhood obesity and adult cardiovascular disease, illustrating the consequences of obesity during childhood.

Because obese and overweight children are more likely to become obese adults than those who were not obese as children, they face an increased risk of developing chronic diseases such as CVD, type II diabetes, and certain cancers. Accelerated BMI (body mass index) in children puts children at the highest risk for cardiovascular disease in adulthood.

Therefore, it is critical to trace the growth of children in order to detect and prevent elevated and accelerated BMI gains during early development periods. There are pragmatic measures that parents can take to ensure that their children prevent the onset of heart disease, and lessen risk factors. Identifying opportunities to promote physical activity and a healthy diet will potentially limit the development of risk factors associated with CVD in adults, namely hypertension, high cholesterol, hyperglycemia, and being overweight or obese.

The strong correlation between obesity and CVD indicates a need for early intervention; early life is the most significant target time to address prevention and treatment of obesity. According to the American Academy of Pediatrics, “It is never too early for the family to make changes that will help a child keep or obtain a healthy weight.” Both parents and physicians must encourage children to maintain a healthy weight, in addition to promoting educational materials that illustrate potential risk factors for cardiovascular disease.

Current recommendations include reducing screen time—during which children are generally physically inactive—and increasing participation in extracurricular athletics and sports. The CDC has confirmed that sources such as families, schools, communities, and the media are all highly influential in the success of the aforementioned initiatives.

Parents must model healthy behaviors for children, spurring even small changes like healthier snacks in the home, adjusting bedtime to allow for at least 9 hours of sleep per night, and ensuring at least an hour of physical activity each day.

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Childhood Obesity: A Nationwide Epidemic

childhood-obesityOn Tuesday, the U.S. Preventive Services Task Force released proposed guidelines in an attempt to further combat childhood obesity—a nationwide epidemic that has progressively worsened in the past decade. Today, 17% of America’s children qualify for the official categorization and definition of obesity.

The publication is intended to help healthcare professionals and decision makers to make well-informed judgments and choices, thereby improving the quality of health services, and ultimately help curb the increase in childhood obesity. The report outlines the benefits and harms of screening and treatment for obesity in children and adolescents; obesity is not only commonplace in children and adolescents in the United States, but also produces a variety of negative, detrimental health effects—including, but not limited to, asthma, high blood pressure, insulin resistance, and a host of other physical and psychological problems. Read more

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