Childhood Obesity

You have probably heard that we are raising the most overweight, out-of-shape generation of children in history. Although there was no increase in childhood obesity between 1960 and 1980, since 1980 the percent of overweight children has been rising dangerously, and the problem keeps increasing year after year.

Obesity among children is literally an epidemic. Unless we get kids moving and teach them to enjoy healthy foods, the outlook for their long-term health is bleak. But we can change things. Tobacco use was once thought to be inevitable; now its use has fallen by half.

What is Child Obesity?

Obesity is the generalized accumulation of fat both beneath the skin and throughout the body. Some children are big, or stocky, because they have large skeletal frames. They are not obese. There are general guidelines for appropriate weight for a given height, but these are only general guidelines.

Obesity is usually caused by an individual's eating more food than is necessary for him or her. Less activity than the individual needs can also cause obesity, but this is less common in children. Certain children inherit a genetic predisposition to obesity. They may eat the same diets as thinner children, but store more of the calories as fat.

Who Gets it?

Overweight children are not gluttonous or lazy. In fact, many studies have shown that obese children do not eat more calories than their peers. By measuring caloric expenditure, investigators have shown that obese children actually expend more energy than their non-obese counterparts. Obese children need less food and more activity than their peers.

A variety of hormonal disorders, including problems with insulin, hypothalamic hormones, and pituitary hormones, can cause severe obesity. There are also a number of rare inherited syndromes that produce obesity. If a child's height is appropriate or advanced for her age, one of these underlying medical conditions is extremely unlikely. On the other hand, an obese child with slow height growth should certainly be evaluated.

What are the Symptoms?

Is your child overweight? Underweight? When it comes to teens, both parents and children are surprisingly poor at judging appropriate weight. Forty-seven percent of teens who reported that they were very overweight were not obese at all, according to objective body mass index ( BMI) calculations. But among teens who were objectively obese, most parents and most children themselves did not recognize it!

How long does it last?

The body stores new fat either by increasing the number of fat cells or by increasing the size of existing cells. It is particularly important to control childhood obesity since new fat cells are primarily formed during childhood. Each year of adding these extra fat cells makes adult obesity more difficult to fight.

How is it Treated?

Obesity can be very difficult to treat, since it involves permanently changing basic eating and exercise habits. Successes almost always involve changing the whole family's habits to those that are appropriate for the obese child.

Cutting excess intake is best achieved by first keeping a careful record of food consumed to identify particular problem areas in the diet. The entire family must learn which foods are healthy.

Whole fruit, whole vegetables, and whole grains should make up the bulk of the diet. Parents need to know that white bread vs. whole wheat is not a trivial question. Whether or not children eat whole grains could have a major impact on their health. A study in The American Journal of Clinical Nutrition analyzed data from the large, ongoing Framingham Offspring Study. The study found that after adjusting for other variables, there remained a b correlation between the amounts of whole grain consumed over a four year period, and healthier weight, healthier waist-to-hip ratio, and decreased risk for diabetes. This was true no matter how much refined grain was eaten, and no matter how much fiber.

While changing eating habits, the family also will benefit from changing their active play habits. Whatever the daily activity level of the family, it should be modestly increased.

A report to the Centers for Disease Control and Prevention identified the single most powerful change teens can make to bring their weight under control. "Of all the ways of tackling this problem, TV reduction appears to be the most effective measure in reducing weight gain in this population," Dr. William Dietz, Director of the Division of Nutrition and Physical Activity, told the CDC Advisory Board. Bike, dance, play ball - have fun being active!

Most families are not able to make these lasting changes on their own, and will benefit from meeting with a nutritionist or an expert in weight management. In many cities, pediatric weight management programs such as Shapedown are available and are very effective.

How can it be Prevented?

Whether your child is a baby or a teen, now is the best time to be sure that active, physical play is a part of her life for at least 30 minutes every day. Look for anything fun that gets kids walking, running, rolling, balancing, jumping, kicking, throwing or dancing. One of our important tasks as parents is to teach a lifelong habit of active fun.

A study published by the American Journal of Public Health offers real hope. Children were 400% to 500% more likely to be physically active if they were given an attractive place to play and were supervised by adults. Among middle-school students, basketball hoops and courts, baseball backstops, volleyball nets, tennis courts, and racquetball courts made the biggest impact. Realistic changes in our schools, parks, neighborhoods, and homes can revolutionize the health of our children.