Childhood Obesity - | Lufkin and Nacogdoches, Texas

Childhood Obesity

Cathy Nonas, MS, RD, C.D.E.


Obesity in America has increased among every age group, including children. Using the 85th percentile for body mass index, experts report that 22% of children and adolescents are obese.

Childhood obesity is a significant cause for concern: more children are being diagnosed with adult conditions associated with obesity, such as sleep apnea (pickwickian syndrome), type 2 diabetes, hypertension, and high cholesterol. In addition, approximately 25-50% of obese children become obese adults. Finally, the social aspects of obesity can be devastating for a child; they include being made fun of, not being able to participate in sports, and not being invited to parties.

This article will tell you when you should seek help and what kind of help is appropriate in different situations.

Who Becomes Obese?

Genetics are clearly influential. When both parents are obese, the chances that the offspring will become obese are estimated at 80%. Furthermore, where the fat is distributed -- in the upper body or the lower body -- is also determined genetically.

Can a child who is obese grow out of it? Certainly. One of the dangers in prescribing rigid diets for children, however, is that weight can change profoundly during growth spurts, particularly during puberty, when children need calories in order to grow.

It's therefore important, when making an assessment of obesity in any child, to look carefully at these four points:

1) where the fat is distributed;

2) whether there are any medical conditions related to the obesity;

3) the level of obesity (e.g., is it extreme, reducing the quality of life? or is it little more than baby fat needing to be watched over time so it doesn’t increase?); and

4) factors in the child's environment.

Certainly, if the child's weight is causing a reduction in quality of life -- for instance, the child cannot move well, or can’t fit into normal seats, or if walking causes breathing problems -- then the child must lose weight immediately.

If the annual pediatric weight/height graph is showing uneven growth (the child's weight is continuing to increase more than his or her height), then it's important to make some adjustment in caloric intake (how much and what foods the child is eating), as well as how much physical activity the child engages in.

If the child is overweight, but weight and height continue to grow at an even pace, and the overweight is not interfering with health or quality of life, then changes in the direction of a healthy lifestyle are warranted, but a lot of dietary restriction is not. A healthy lifestyle does not include reducing calories so much as increasing lower-calorie foods like vegetables and whole fruits, and increasing physical activity.

Environmental Factors That Can Make a Child Fat

Sedentary Lifestyle

American children are less active today than ever, with television viewing, video games, and computer activities becoming the "baby-sitter" for children from all economic groups. These activities, especially television viewing, make vigorous physical activities less and less common.

To make matters worse, public schools today tend to offer fewer opportunities for physical activity, both during the school day and after school. This `couch potato' lifestyle is even more insidious since it’s been shown that television watching itself usually includes additional consumption of food. One recent study showed that this lack of physical activity results in a 25% lower expenditure of energy. So if your child eats all that's recommended but doesn't have a high level of physical activity, in effect your child will be eating more than she or he is expending.

Food Selection

It has become easier than ever to eat junk food. Snacks abound: from chips to pretzels, beef jerky to individual packets of cookies and cakes. Bagels are bigger than ever. And sodas come in 20 ounce bottles instead of the 6 oz bottles of thirty years ago.

It’s clear that American children continue to eat too much fat and sugar. In addition, because parents tend to exert significant control over their children's eating, the child's ability to self-regulate things such as hunger and taste is reduced. We tell our children when to eat, when they should be hungry, when they will spoil their appetites.

But studies have consistently shown that children can adjust their calorie intake from one meal to another and, if offered a variety of foods, they will choose a healthy complement of foods. As parents, we tend to feed our children what they will eat, reducing their exposure to new foods because we don't want to hear their complaints.

Further, many parents have misconceptions about what is good nutrition. Forexample, they believe that all juices are good. This is patently untrue, sincejuices such as apple and grape have very few vitamins, and the same number of calories as soda. All juices contain a high amount of sugar but without the fiber which is part of whole fruit. Corn and peas are considered vegetables, but they are starchy vegetables and therefore have more calories. Furthermore, vegetables tend to be served in small portions and often sautéed or covered in a fatty cheese sauce or olive oil. Iceberg lettuce and cucumbers have no nutritive value, and when covered in salad dressing, they contain more fat and calories than vitamins and minerals.

Finally, there is enormous confusion between fats: Does margarine have fewer calories than butter? Does corn oil have more calories than olive oil? (The answer is that all these fats have the same calories.)

How to Change a Child's Environment

Increasing Exercise and Physical Activity

There is one rule -- get the children moving! Often parents are as much to blame as children, since it's the parent’s job to get the children to the parks and playgrounds and then play ball or tag with them. Physical activity can be a great way to spend quality time with children, whether bicycling or walking, hiking or playing baseball, walking up stairs or lifting weights. Although physical activity does not result in a great deal of weight loss, it is integral to weight maintenance, and helps reduce body fat.

Also, being active in small ways begets more activity. Although most parents do not have access to a comprehensive physical activity program for children, reducing television watching and increasing activity -- including after-school sports, family outings, and baby-sitting or big brother sports-- can help increase their strength, endurance, and coordination. Finally, becoming part of a parent-teacher association and organizing after-school activities such as basketball, dodge ball or even calisthenics, will help improve a child's lifestyle.

To Diet or Not to Diet

Diet comes from a Greek word that means "way of life." Indeed, what we'd all like is for children to eat healthier, without feeling deprived or guilty. Among the many things to consider when constructing a diet for a child are: age (is the child still growing?); educational level (how much can the child understand about the situation? is he or she still very reliant on adults or more swayed by peers?); level of family support (can the family change so that it supports the child, and possibly improve the health of other family members?); and the child's weight (is the child very obese with medical complications, or pudgy without any ill effects?).

A diet should be high in fiber and complex carbohydrates. Foods such as brown rice, vegetables, and a variety of fruits, contain these complex carbohydrates. While it’s true that many children don't like some of these foods, this is usually because they haven't had much exposure to them. Therefore, it's helpful if the family continues to serve them until the child begins to develop a taste for them and starts to enjoy them (the same could be said for the entire family).

Protein is usually not something we worry about, since it is easily found in foods and the American diet tends to be higher in protein than it needs to be. Besides emphasizing complex carbohydrates, then, the biggest change should be made in the area of sugar and fat. Fat tends to be very prevalent in children’s and adolescents’ diets. Ice cream, cookies, chips, muffins, whole milk, red meats, fried foods, fast foods, all tend to be high in fat. Add to this soda, lots of white breads (bagels, rolls, Italian breads, etc.) and drinks with only 10% juice, and much of what a child consumes consists of what we call "empty" calories -- calories that contain a minimum of vitamins and other nutrients.

Unless a child is morbidly obese (100% or more overweight), the best strategy is to reduce fat and sugar, and hope that calories will be reduced enough to result in a slow but steady weight loss. We don’t suggest that parents be very restrictive, nor that the child be isolated from the rest of the family, which tends to be experienced as punishing.

Instead, it’s helpful if modest reductions are taken on by the entire family -- such as serving fruit for dessert instead of cake, or vegetables lightly steamed instead of with gravy, or macaroni with tomato sauce instead of cheese. This way the child will be more accepting of dietary changes, as well as be more apt to achieve a permanent lifestyle change. A family can institute a fruit or vegetable of the week club, where each member gets an opportunity to choose a new food to taste, and the child, depending upon his or her age, can be taught how to prepare foods. When children are given some responsibility for developing a menu or making food, they are more likely to enjoy it.

If significant restriction of dietary intake is required, then it’s advisable to seek outside help. And you should always consult your pediatrician before putting your child on a diet.

(c) 2001 Healthology, Inc.

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