August 2003 - Kid's Health Difficult to Swallow The cost of obesity in the United States in 2000 surpassed $117 billion, while poor nutrition and physical inactivity prematurely claim approximately 300,000 lives in the U.S. each year, according to information provided by the Surgeon General. "The problem keeps getting worse, said Health and Human Services Secretary Tommy G. Thompson. We've seen virtually a doubling in the number of obese persons over the past two decades, and this has profound health implications. In addition, over 10 percent of younger preschool children between ages 2 and 5 are overweight, up How did we get here? We live in a time and place that affords us a greater selection of products designed to accommodate our hectic lifestyles and manufacturers' desires for astronomical profits. But this perceived convenience carries a hefty price - our nutritional well being. The proliferation and increased accessibility Obesity among children is "super-size" epidemic from seven percent in 1994." Yet, in spite of these facts, and regardless how many messages bombard us daily touting the dangerous consequences of poor nutrition, the nation's obesity epidemic continues to spiral out of control. And it's not only adults who are suffering, but millions of America's youth. The Surgeon General indicates that the percentage of children and adolescents who are defined as overweight has more than doubled in the past 30 years and that, currently, approximately 15 percent of U.S. children and adolescents are overweight. Not only do these children face possible emotional challenges, they are also at greater risk for potentially deadly illnesses such as heart disease, diabetes, stroke, arthritis, and cancer. According to the Centers for Disease Control and Prevention's (CDC) 1999 statistics, approximately 13 percent of children aged 6 to 11 years and 14 percent of adolescents aged 12 to 19 years in the United States were overweight. The Surgeon General reports that overweight adolescents have a 70% chance of becoming overweight or obese adults - this increases to 80% if one parent is overweight or obese. Risk factors for heart disease, such as high cholesterol and high blood pressure, occur at a higher rate in overweight children and adolescents compared to children who have a healthy weight. Noninsulin-dependent diabetes mellitus (type 2 diabetes) is the most common type of diabetes in the United States and was previously considered an adult disease - an illness that develops later in life. However, the disease has increased drastically among our youth and this increase has been linked to obesity and poor diets. Experts say that type 2 diabetes reduces your body's ability to control blood sugar and is a major cause of early death, heart disease, kidney disease, stroke, and blindness. Fortunately, they agree that people can reduce their risk of developing this type of diabetes by losing weight and increasing physical activity. The causes Although some experts believe that genetics and lifestyle play important roles in determining a child's weight, many agree that overweight in children and adolescents is generally caused by lack of physical activity, unhealthy eating patterns, or a combination of the two. "Despite obesity having strong genetic determinants, the genetic composition of the population does not change rapidly. Therefore, the large increase in (obesity) must reflect major changes in non-genetic factors." (Hill, James O., and Trowbridge, Frederick L. Childhood obesity: future directions and research priorities. Pediatrics. 1998; Supplement: 571). While it may be tempting to blame the problem on genetics, the truth is that our society has become extremely sedentary. Television, computers and video games, while rich with benefits when used in moderation, contribute to inactive lifestyles. According to the Surgeon General, 43 percent of adolescents watch more than two hours of television each day. Prior to the television age, or computer age, most children spent a great deal of time outdoors - running, jumping, playing kicking balls and engaging in other athletic activities. A large percentage of today's kids watch television in the morning, sit in classrooms during the day, then return home for more television, or spend a great deal of time with other sedentary activities such as surfing the Internet. Most likely, kids perform these activities while consuming junk food or sugary beverages. Considering that one eight-ounce soda might contain approximately ten teaspoons of sugar, and that many kids are not engaging in physically demanding activities, some parents may hastily perceive their kids as "hyperactive" or as suffering from attention deficit disorders. Artificial sugar substitutes are a popular fix, but some research indicates that these pose health risks as well. Some foods are marketed as healthy, lowfat, or fatfree, but may be more caloric because they contain additional sugar to make up for absence of taste enhancing fat. Kids are also eating bigger portions today. Marketers offer "super" meals with enough calories for four individuals, while consumers gorge themselves under the misconception that they're getting a good value. And experts say that children, especially girls, become less active as they move through adolescence. This is why it is so important for parents to encourage activity, even household chores, to keep kids moving. Monkey see, monkey do. While the phrase may be cliché, its loaded with wisdom. If the parents are sedentary and embrace poor health habits, the likelihood that their children will emulate their behavior and "inherit" health risks is extremely high. You can't tell your kids to eat broccoli, while you harbor an aversion to vegetables and wolf down a pound of fries, or tell them to go play outside while you tune in to another reality show. How is obesity and overweight determined? Doctors and other health care professionals are the best people to determine whether your child or adolescent's weight is healthy, and they can help rule out rare medical problems as the cause of unhealthy weight. A Body Mass Index (BMI) can be calculated from measurements of height and weight. Health professionals often use a BMI "growth chart" to help them assess whether a child or adolescent is overweight. But as BMI only takes height and weight into consideration, physicians will also consider your child's age and growth patterns to determine whether their weight is healthy. Taking it to heart experts say that the most immediate ramification of overweight, as perceived by the children themselves, is social discrimination. This is associated with poor self-esteem and depression. Understandably, most parents are concerned about their child's appearance as well, but overweight children probably know better than others that they have a weight problem, and should be assured that they are loved and respected regardless. Experts emphasize that overweight children should receive support, acceptance, and encouragement and that parents should focus on the child's health and positive qualities, not just their size. Possible solutions Overweight children who are still growing may not need to lose weight, but simply slow down weight gain. You shouldn't make your child feel unique if he or she is overweight, but focus on gradually altering the entire family's physical activity and eating habits. Sometimes the appropriate goal for overweight children is to maintain current weight while they grow into their height. Your child's diet should be balanced and nutritious and should include all of the Recommended Dietary Allowances (RDAs) for vitamins, minerals, and protein, as well as foods from all major food guide pyramid groups. All weight-loss plans should be low in calories (energy), but not in vital nutrients. Even with extremely overweight children, weight loss should be gradual. Fad diets and quick-fix pills can compromise growth and are not recommended by many health care professionals. According to the CDC, children need to be motivated to change their eating habits and activity levels for a lifetime. This will reduce the likelihood of weight regain. Also, weight management programs for children should be supervised by a physician or expert health professional. Physical fitness tips Experts agree that we need to be more physically active and recommend that Americans accumulate at least 30 minutes (adults) or 60 minutes (children) of moderate physical activity most days of the week. Even greater amounts of physical activity may be required to prevent weight gain, for weight loss, or for maintaining weight loss. You can engage in family activities that are fun and provide ample exercise, provide a safe environment for your children and their friends to play, or encourage swimming, biking, skating, ball sports, and other activities. Reducing the amount of time your family spends in sedentary activities, such as watching TV or playing video games, will go a long way. Ideas for healthy eating The government offers the following dietary guidelines for healthy eating (www.health.gov/dietaryguidelines): o Guide your family's choices rather than dictate foods. o Encourage your child to eat when hungry and to eat slowly. o Eat meals together as a family as often as possible. o Carefully cut down on the amount of fat and calories in your family's diet. o Don't place your child on a restrictive diet and avoid the use of food as a reward or punishment. o Children should be encouraged to drink water and to limit intake of beverages with added sugars, such as soft drinks, fruit juice drinks, and sports drinks. o Plan healthy snacks. Stock the refrigerator with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks and snacks that are high in fat, calories, or added sugars and low in essential nutrients. o Aim to eat at least five servings of fruits and vegetables daily. o Discourage eating meals or snacks while watching TV. o Eating a healthy breakfast is a good way to start the day and may be important in achieving and maintaining a healthy weight. o Be a good role model for your child. If your child sees you enjoying healthy foods and physical activity, he or she is more likely to do the same now and in the future. Proper nutrition and well-being are essential keys to good living. While the issues of obesity and overweight will not be resolved immediately, we must work harder, and smarter, to help our children embrace healthier lives. We must lead by example and stop irresponsible consumption. We cannot control every bite of food our children ingest, but we can offer support and education to make healthy choices a bit easier for them to swallow.