Reducing Childhood Obesity

Americans continue to gain weight rapidly, despite growing evidence that being overweight is bad for your health. According to the latest National Health and Nutrition Examination Survey, in 1999-2000, the number of obese adults reached 31 percent, more than doubling since 1976-80. Sixty-four percent are now overweight.

Perhaps even more alarming, given its implications for the future, is obesity among U.S. children and adolescents. In the 1960s, only 4 percent of the nation's 6- to 11-year-olds were overweight. Today, it is just over 15 percent.

Obesity is "something our whole society is going to have to address," says Dr. Nancy F. Krebs, chair of the committee on nutrition for the American Academy of Pediatrics. Current medical costs are $93 billion per year, and health impacts can extend beyond obese individuals themselves. For instance, a study published in the May Pediatrics showed that obese women are more likely than women of average weight to give birth to children with spina bifida and heart defects. The U.S. Department of Health and Human Services has announced a national objective of reducing obesity in adults and children by the year 2010.

Obese adults are at risk for heart disease, type 2 diabetes, kidney problems, blindness, high blood pressure, stroke and some cancers, including those of the breast, ovaries, colon, prostate and testes. For children, some of the most common complications associated with obesity are diabetes, sleep apnea and gall- bladder diseases. Type 2 diabetes, known as adult-onset, was practically unheard of among children ten to twenty years ago, many pediatricians say. In 2002, Yale researchers reported in The New England Journal of Medicine that 25 percent of the obese children in their study showed signs of impaired glucose tolerance, a precondition of type 2 diabetes. "We are in the process of training primary pediatricians in how to care for children with type 2 diabetes because we won't be able to handle the numbers otherwise," says William J. Klish, professor of pediatrics at Baylor College of Medicine and a doctor at Texas Children's Hospital.

In a 1999 study in Pediatrics, researchers found that overweight children had an increased risk of cardiovascular disease, as well as higher cholesterol and blood pressure, fasting insulin levels (a precursor to diabetes), and triglyceride levels than average-weight children. The authors concluded that preventing and treating childhood obesity might reduce the adult incidence of cardiovascular disease. "It's not as if children who are obese are having heart attacks, but we just don't know how much earlier they are going to be developing what used to be thought of as adult diseases," Krebs says.

Overall, "We have seen dramatic changes in the kinds of diseases that are prevalent in our children, and many of them are related to obesity and inactivity," says Richard J. Jackson, M.D., director of the National Center for Environmental Health at the Centers for Disease Control and Prevention. There are two very basic reasons for this change, doctors agree. "Kids are not as active as they used to be, and it starts at a very young age. The other whole side of the equation is food," Krebs says. "It is a big deal to have kids getting more and more calories and exercising less and less," Jackson notes.

Not to be overlooked is the psychological pain: In April, 2003, The Journal of the American Medical Association reported that severely obese children and adolescents viewed their quality of life as low as did young cancer patients on chemotherapy. "Almost every obese child lacks self-esteem," says Klish. "If you take an overweight child and make them normal weight their personality just blossoms." That alone is a good enough reason to help children manage their weight.

"Parents are going to have to get involved if they want their children to lead healthy lives," Krebs says.

What You Can Do

Make sure children eat three meals a day and have scheduled healthy snacks. Allowing children to graze all day promotes unhealthy eating habits. If they skip meals they'll be hungrier and more likely to overeat at a later time, Krebs advises.

Provide a healthy diet. Children should eat plenty of fresh fruits and vegetables, whole grains, low-fat dairy products (children ages two and younger should drink whole milk) and muscle-building protein, found in nuts, fish, dairy products and meats. "Carbohydrates are an important part of the diet, but kids need to eat less of them," says Dr. Suparna Jain, a pediatric endocrinologist in Santa Monica, California. Because refined carbohydrates metabolize quickly, they make kids hungry again sooner, Jain says. She tells her overweight patients to look at what they've put on their plates and take off 1/3 of the carbohydrates. After two weeks, she asks them to remove another 1/3, "because the body will accommodate to the change easier if it is done gradually," Jain says.

Avoid fast foods, which are disproportionately heavy in saturated fat, which has been linked to heart disease.

Read labels when shopping and avoid foods with saturated fats, partially hydrogenated vegetable oils (trans-fatty acids) and high sugar content. (See "Look at the Label.")

Eat out less. Restaurant portions tend to be excessive in size and contain too many calories. By cooking and serving at home, you can control calories. Sit down and eat regular family meals together. In May 2003, The Journal of Adolescent Health reported that adolescents ate more fruits, vegetables and dairy foods when they ate dinner with a parent.

Eliminate or limit consumption of sugar-sweetened drinks. Soft drinks are the leading source of added sugars in the diet. According to a Harvard study published in the Lancet in 2001, for every additional serving over baseline levels (about one 12-oz. can/day) of sugar-sweetened beverages, one's odds of being overweight increased 1.6 times. "I feel that elimination of sugar-sweetened beverages is a really easy thing parents can do to control obesity," says Karen E. Peterson, an associate professor at the Harvard School of Public Health. Sweetened drinks also tend to replace nutrition-rich foods. While 100-percent fruit juice is a nutritious food, it is high in calories and should be limited to one or two servings a day, Peterson advises.

Do not eat meals in front of the TV, and do remove the television set from your child's room. "Television viewing is clearly associated with childhood obesity," says William H. Dietz, director of the Division of Nutrition and Physical Activity at the CDC. The American Academy of Pediatrics recommends against television for children under two years old, and advises limiting media time to two hours a day for older children and adolescents. "We know that the more television a child watches the more likely they are to eat while watching it, and to want the food they see advertised, including calorically dense foods such as sugared breakfast cereals, candy bars, cakes, cookies and soft drinks," Dietz says.

Get involved with your child's school to reduce calories in cafeteria meals and serve fresh whole foods. "One of the strategies we tried to pursue is teaching school food-service directors that there are lower-calorie options available," says Dietz. He also suggests negotiating with companies to make sure they stock healthier alternatives, like water, 100-percent fruit juice, fruit snacks and milk instead of soda, candy and cookies in vending machines. Pack school lunches with healthy foods that children help select.

Incorporate physical activity into your family's daily life. "Walk your kids to school. It's a good way to spend time with them," suggests Howard Frumkin, professor and chair of the Department of Environmental and Occupational Health at Emory University's Rollins School of Public Health. Go on family walks, hikes, swims or bike rides. Encourage participation in sports. A Stanford study has shown that letting children choose what sports they want to play has helped reduce overweight.

Drive less and walk/bike more every day and in addition to burning more calories you will reduce the pollution that worsens asthma. (See sidebar.)