Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697645837291.pdf (Bahamas)
Child and Adolescent Obesity: The Country’s “Developing” Dilemma Delon Brennen MD, MPH Camille Deleveaux Nanika Braithwaite Medical Association of The Bahamas Annual Scientific Conference 2015 Disclosures • No financial interests to disclose Outline • Introduction • Scope of the problem – Global – Caribbean – Bahamas [~ 25 Years (1988-2013)] • Interventions and strategies • Challenges • Achievements/Successes Introduction Introduction • Obesity - Global public health challenge – ≥2.8 million deaths/yr due to overweight or obesity • Definitions (Adults): – Overweight  BMI ≥ 25 kg/m2 – Obesity  BMI ≥ 30 kg/m2 • Worldwide: 35% of adults (>20yrs) - Overweight (34% male, 35% female) (WHO, 2008) Introduction • Globally - Obesity in adults >20 (WHO) – Males ↑ from 5% (1980) to 10% (2008) – Females ↑ from 8% (1980) to 14% (2008) • ~Half a billion adults • Caribbean (2013 Ng et.
al.)
– Males 12.3% – Females 24.5% • Bahamas (STEPS Survey, 2012) – Adults now estimated at 49% • (little sex difference) Introduction • More prevalent in the past among older Adults – normal aging  metabolism slows down • Obesity among Children and Adolescents – Appears to be growing – Becoming a health concern (Obesity Prevention Source, Harvard University) Introduction • Overweight and obese children tend to grow up to be overweight and obese adults (Obesity Prevention Source, Harvard University) • Children living in households with overweight adults are 4 times more likely to be overweight, or at risk of becoming overweight (BLCS 2001) Scope of the Problem • Worldwide(WHO 2013) – > 42 million children <5 years overweight • Nearly 31 million live in developing countries • Caribbean – 7% children <5 in Latin America and the Caribbean were estimated to be overweight or obese (WHO growth standards, 2010) Scope of the Problem • Caribbean Food & Nutrition Institute, 2007 – Overweight/obese children account for as much as 15% of population in various Caribbean countries – Rising rates linked to increases in consumption of: • Fatty foods • Snacks • Soft drinks • High-energy foods and drinks Bahamas (1988-2013) National Health and Nutrition Survey, 1988-1989 • Children under 5 years (n=950) • Obese (> 95th %ile – Wt for Age) – 9% All Bahamas • 10% New Providence • 9% Grand Bahama • 6% Family Islands Nutritional Status of Children Under 5 Years, Based on Weight for Age, Bahamas, 1988-1989 Normal 84.3% Thin 7% Obese* 8.7% *Obesity classified as above the 95th centile; based on weight for age standards.
Data Source: National Health and Nutrition Survey, 1988/1989 National Health and Nutrition Survey, 1988-1989 • Children 5-14 years (n=773) –7% obese • Children 5-9 years (n=391) – 10% Males (New Providence) • Children 10-14 years (n=382) – 16% females (New Providence) Prevalence (%) of Obesity Among Children and Adolescents Ages 5-14 Years, by Age Group and Location - Bahamas, 1988/1989 Male Female 5-9 yrs 10-14 yrs 5-9 yrs 10-14 yrs 5-9 yrs 10-14 yrs NP GB FI ) % ( t n e c r e P 20 18 16 14 12 10 8 6 4 2 0 Male Female *Based on BMI Data Source: National Health and Nutrition Survey, 1988/1989 2.7 16 9.9 2.9 3.6 3.7 3.7 6.3 6.3 5.8 5.8 3.8 Bahamas Youth Health Survey 1997 • Students 10-19 years (n=2,007) • 28% thought they needed to lose weight – 20% males, 36% females • 14% students “not happy” with their bodies – 11% males, 17% females • 70% felt they needed to lose weight • Affected eating habits, e.g.
more likely to eat less than three meals a day • No association with amount of exercise Percent (%) Students Who Felt They Needed to Lose Weight Bahamas, 1997 (n=2,007) 36 28.1 20.2 s t n e d u t S % 40 35 30 25 20 15 10 5 0 Males Females All Students Data source: Bahamas Youth Health Survey, 1997; n=2,007 Bahamas Living Conditions Survey 2001 • Children 2-10 years (n=824) – 14% overweight • 13% male • 16% female • (6 times more than expected ~2.3%) • Overweight increased with age – 2-4 years, 11% – 5-6 years, 14% – 7-10 years, 16% • New Providence and Grand Bahama – 14% • Exuma and Long Island had highest prevalence - (20%) Bahamas Living Conditions Survey 2001 • Adolescents 11-20 years (n=927) (BMI) – 9% (>95th %ile) • 14% (>85th %ile) • Increased with age – 11-15 years, 7% – 16-20 years, 11% • Especially females, 13% • All regions similar prevalence except very rural islands – Combined 2% • Slightly higher among those from higher SES Prevalence of Overweight in Children 2-10 Years and Adolescents 11-20 Years Bahamas 2001 20.0 15.0 10.0 5.0 0.0 Male Female Total Male Female 2-10 Yrs 13.0 15.8 14.0 11-20 Yrs 8.4 9.4 8.9 *Based on BMI; n=927 Data Source: Bahamas Living Conditions Survey, 2001 Bahamas Living Conditions Survey 2001 Percent Overweight by Age Groups 16 14 11 10.9 7.4 ) % ( t n e c r e P 20 18 16 14 12 10 8 6 4 2 0 2-4 Years 5-6 Years 7-10 Years 11-15 Years 16-20 Years Healthy Lifestyle Program Screenings 2006-2010 • Among adolescents 15-19 years (373 health screenings) – 17% obese (little sex
 difference) Primary Health Care Reports 2004-2012 Percent Overweight Children Seen by School Health Services, All Bahamas, 2004-2012 2004 4.8 2005 5.9 2006 6.3 2007 8.7 2008 9.2 2009 10.4 2010 10.4 2011 8.3 2012 7.4 ) % ( t n e c r e P 12.0 10.0 8.0 6.0 4.0 2.0 0.0 Grade 1 Data source: Primary Health Care Clinic Reports, Department of Public Health, 2014 Primary Health Care Reports 2004-2012 Percent Overweight Children Seen by School Health Services, All Bahamas, 2004-2012 2004 10.6 2005 15.7 2006 10.6 2007 18.3
 2008 16.5 2009 17.1 2010 23.3 2011 19.2 2012 17.9 ) % ( t n e c r e P 25.0 20.0 15.0 10.0 5.0 0.0 Grade 6 Data source: Primary Health Care Clinic Reports, Department of Public Health, 2014 Primary Health Care Reports 2004-2012 Percent Overweight Children Seen by School Health Services, All Bahamas, 2004-2012 2004 19.0 2005 14.9 2006 14.0 2007 23.7 2008 13.0 2009 18.8 2010 14.3 2011 9.8 2012 12.7 ) % ( t n e c r e P 25.0 20.0 15.0 10.0 5.0 0.0 Grade 10 Data source: Primary Health Care Clinic Reports, Department of Public Health, 2014 Primary Health Care Reports 2004-2012 Percent Overweight Children Seen by School Health Services, All Bahamas, 2004-2012 2004 2005 2006 2007 2008 2009 2010 2011 2012 11.5 12.3 10.0 16.6 13.1 15.9 16.2 12.6 12.7 ) % ( t n e c r e P 18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 Total Percent (%) Overweight Data source: Primary Health Care Clinic Reports, Department of Public Health, 2014 Primary Health Care Reports 2004-2012 Percent Overweight Children Seen by School Health Services, All Bahamas, 2004- ) % ( t n e c r e P 25.0 20.0 15.0 10.0 5.0 0.0 Grade 1 Grade 6 Grade 10 Total Percent (%) Overweight Data source: Primary Health Care Clinic Reports, Department of Public Health, 2014 Obesity and Overweight as it Relates
 to Blood Pressure in 10th Grade Students Attending Public Schools in New Providence, Bahamas, 2008/2009 S. Taylor, S. Carroll et.
al.
•Overweight and Obesity in Students (n=719 in 10th Grade (Ages ~ 14-15 years) Nutritional Status/Age % Overweight/Obese 27.9 (35.3 girls, 20.5 boys) Overweight 13.9 (16.4 girls, 11.5 boys) Obese 14.0 (18.9 girls, 9 boys) Association Between Obesity and Impaired Glucose Intolerance Among High School Adolescents, New Providence, Bahamas (2012) K. Rivers, C. Hanna-Mahase, M. Frankson, et al Overweight and Obesity in 861 Adolescents, 13-19 Years Nutritional Status/Sex Overweight/Obese Overweight Obese Sex Males Females (%) 38.1 15.0 23.1 33.1 40.4 Prevalence of Elevated Blood Pressure in Adolescents in Nassau, Bahamas, 2012 C. Conliffe, C. Hanna-Mahase, M. Frankson, et al Overweight and Obesity in Students (n=785) in Selected Grades 9, 10, 11 (2012) Nutritional Status/Age Overweight/Obese Overweight Obese % 34.3 14.4 19.9 Mean Age (Yrs) 14.6 (± 1.2) BMI Classifications: overweight (≥ 85th <95th percentile); obese (>= 95th percentile Global School Health Survey Bahamas 2013 • Students 13-15 years (n=962) • 45% overweight or obese (No significant sex difference) – 21% obese • 18% males • 24% females • When overweight and obesity were tested for association with risk factors such as fast food consumption and low physical activity, results were unexpected.
Percent (%) Differences in Overweight by Whether or Not Students Ate Fast Food (n=949) 48.6 36.8 Yes No Students who ate fast food 3 or more days during past 7 days ) % ( t n e c r e P 60 50 40 30 20 10 0 Percent (%) Differences in Overweight by Whether or Not Students Ate Salty Food (n=953) 47.4 41.1 Yes No ) % ( t n e c r e P 60 50 40 30 20 10 0 Students who usually ate salty foods 2 or more times per day during past 30 days ) % ( t n e c r e P 60 50 40 30 20 10 0 Percent (%) Differences in Obesity by PE Class Attendance (n=923) 25.6 20.3 Yes No Students who went to PE class on 3 or more days each week during school year ) % ( t n e c r e P 60 50 40 30 20 10 0 Percent (%) Differences in Obesity by Sitting Activities (n=914) 18.9 24 Yes No Students who spent 3 or more hours per day during typical day doing sitting activities Global School Health Survey Bahamas 2013 • Exploring self-perception and dieting behaviours: – 45% of O/O students think they are slightly/very overweight – 46% of O/O students tried to lose weight in the past month.
– 62% of obese students think they are slightly or very overweight.

– 50% of obese students tried to lose weight in the past month.

Recap: Children Under 10 Years Bahamas, 1988-2001 BLCS (2001) 16 14 13 Total Males Females NHNS (1988-1989) 8.7 NHNS (1988-1989) 6.6 5.4 4.1 n.a.

n.a.
1988 (< 5 yrs) 1988 (5-9 yrs) 2001 (2-10 yrs) % 20 18 16 14 12 10 8 6 4 2 0 Recap: Percent Overweight/Obese Young Adolescents (10-15 Years) Bahamas, 1988-2013 6.4 7 1988 (10-14 Yrs) 2001 (11-15 Yrs) ) % ( t n e c r e P 50 45 40 35 30 25 20 15 10 5 0 Recap: Percent Overweight/Obese Young Adolescents (10-15 Years) Bahamas, 1988-2013 6.4 7 14.9 1988 (10-14 Yrs) 2001 (11-15 Yrs) 2005 (14-15 Yrs) ) % ( t n e c r e P 50 45 40 35 30 25 20 15 10 5 0 Recap: Percent Overweight/Obese Young Adolescents (10-15 Years) Bahamas, 1988-2013 27.9 14.9 6.4 7 1988 (10-14 Yrs) 2001 (11-15 Yrs) 2005 (14-15 Yrs) 2008-2009 (14-15 Yrs) ) % ( t n e c r e P 50 45 40 35 30 25 20 15 10 5 0 Recap: Percent Overweight/Obese Young Adolescents (10-15 Years) Bahamas, 1988-2013 ) % ( t n e c r e P 50 45 40 35 30 25 20 15 10 5 0 34.3 27.9 14.9 6.4 7 1988 (10-14 Yrs) 2001 (11-15 Yrs) 2005 (14-15 Yrs) 2008-2009 (14-15 Yrs) 2012 (Mean age 14.6 Yrs) Recap: Percent Overweight/Obese Young Adolescents (10-15 Years) Bahamas, 1988-2013 45 34.3 27.9 14.9 6.4 7 ) % ( t n e c r e P 50 45 40 35 30 25 20 15 10 5 0 1988 (10-14 Yrs) 2001 (11-15 Yrs) 2005 (14-15 Yrs) 2008-2009 (14- 15 Yrs) 2012 (Mean age 14.6 Yrs) 2013 (13-15 Yrs) Recap: Percent Overweight/Obese Older Adolescents (15-20 Years) Bahamas, 2001-2012 33 38.1 ) % ( t n e c r e P 50 45 40 35 30 25 20 15 10 5 0 11 2001 (16-20 Yrs) 2006-2010 (15-19 Yrs) 2012 (13-19) Fictional Cohort from Childhood to Young Adults, % Obese/Overweight 1988-2012 STEPS (2012) 43 NHNS (1988-1989) 9 BLCS (2001) 9 1988 (0-5 yrs)
 2001 (11-20 yrs) 2012 (25-34 yrs) % 50 45 40 35 30 25 20 15 10 5 0 Overweight and Obesity: Challenges Challenges • Growing overweight/obesity epidemic • Health sector competing against fast food corporations • Ill health of the population • Making the healthy choice the easy choice Interventions & Strategies Interventions & Strategies Initiatives used to Combat Childhood/Adolescent Obesity: • Mandatory physical education (PE) classes in school curriculum (MOE Policy) • Revision of compulsory standards for
 tuck shops and healthy lunch in schools (MOE/MOH Collaboration) Interventions & Strategies Initiatives, Cont’d: • MOE Healthy Lifestyle Committee established – Focus: Consumption of food while at school – Two booklets produced with nutritional guidelines: Interventions & Strategies Initiatives, Cont’d: • Garden-based learning project (MOE) – Garden labs created to integrate nutrition into all subjects – Aim to integrate nutrition into the primary school curriculum and into all subjects – Reference manual developed for primary school teachers Interventions & Strategies Initiatives, Cont’d: – Reference manual developed for primary school teachers Interventions & Strategies Possible Future Initiatives: • Regularly review the nutrition component of the Family Life Education curriculum to reflect changing diet and exercise recommendations • Restrict areas for lunch/snack vendors in school zones.
Interventions & Strategies Possible Future Initiatives, Cont’d: • Enforce regulations for school cafeterias, tuck shops and lunch vendors – Healthy meal/snack choices • School “Walking Bus” Interventions & Strategies Future Population Measures: • Create more healthy and open spaces for eating, physical activity and recreation • Healthy food choices at restaurants and other food outlets • Differential pricing for healthy vs. unhealthy food • Promotion of exclusive breastfeeding & accommodations for breastfeeding mothers in the workplace Achievements/Successes • Growing adoption of backyard farming (Min.
of Agr) • “Get Well Bahamas” campaign • Increased awareness of healthy living and physical activity: – Greater visibility of community wellness/fitness groups – Frequent Fun Run/Walks • complemented by free health screenings Achievements/Successes • Increased number of sidewalks – support healthy lifestyle and pedestrian safety • Development of National Dietary Guidelines & Food Guide Drum Acknowledgements •Camille Deleveaux, HIRU, MOH •Nanika Braithwaite, HIRU, MOH •Dr.
Marcellus Taylor, Deputy Director MOE •Ms.

Camelta Barnes, Coordinator, Nutrition Unit, MOH •Ms.

Shandera Smith, Nutritionist, Nutrition Unit, MOH References • • • • "Child Obesity."

Obesity Prevention Source.

Harvard University, 20 Oct. 2012.

Web.

20 Feb. 2015.

<http://www.hsph.harvard.edu/obesity-prevention-source/obesity- trends/global-obesity-trends-in-children/#Latin-America-and-the-Caribbean>.

Caribbean Unity to Fight Chronic Diseases Epidemic : Obesity a Major Target.
Caribbean Community Secretariat (CARICOM), 28 Aug. 2007.

Web.

20 Feb. 2015.

<http://caricom.org/jsp/pressreleases/pres194_07.jsp>.

"Childhood Overweight and Obesity."

WHO.

World Health Organization, 2015.

Web.

11 Feb. 2015.

<http://www.who.int/dietphysicalactivity/childhood/en/>.

“Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013” Ng, Marie et al.
The Lancet , Volume 384 , Issue 9945 , 766 – 781 • National Health and Nutrition Survey 1988-1989.

Nassau, Bahamas: Ministry of Health, PAHO, CFNI, 1989.

• Bahamas Living Conditions Survey 2001.

Nassau, Bahamas: Ministry of Finance, Dept.

of Statistics, 2004.

Print.

References • Bahamas Youth Health Survey 1997.

Nassau, Bahamas: Ministry of Health, 1998.

• K. Rivers, C. Hanna-Mahase, M. Frankson, et al.


Association Between Obesity and Impaired Glucose Intolerance Among High School Adolescents, New Providence, Bahamas 2012.

Nassau, Bahamas (Abstract).

• C. Conliffe, C. Hanna-Mahase, M. Frankson, et al.

Prevalence of Elevated Blood Pressure in Adolescents in Nassau, Bahamas.

2012 (Abstract).

• S. Taylor, S. Carroll et.

al.


Obesity and Overweight as it Relates to Blood Pressure in 10th Grade Students Attending Public Schools in New Providence, Bahamas, 2008/2009 (Abstract).

• Global School Based Student Health Survey.

PAHO.

2013 • Food and Nutrition Policy.

Ministry of Health.

2012 (Unpublished).

Questions ?