This is one in an occasional series about children’s health issues. We know that many of our readers are grandparents keenly interested in the health and well-being of grandchildren. We hope this series will provide readers useful health information you can share with your family.
There may be reason for limited optimism in the fight against childhood obesity: For the first time since the 1960s, obesity rates have dropped in very young children, age 2 to 5. According to an ongoing government survey, it has dropped about 40 percent from its peak in the early 2000s.
“Parents have control over what their very young kids eat and their levels of activity, so this could be an outcome of families changing some habits for the better, but the truth is we really don’t know the cause, or if this positive trend will continue,” said Felice Haake, DO, a diplomate of the American Board of Obesity Medicine and a member of the Obesity Medical Association.
Regardless of the survey, Dr. Haake told us childhood obesity still is a problem of epidemic proportions. It’s estimated that 17 percent of young people age 2-19 are obese (about 13 million); as a point of comparison, only about 6 percent of children were obese in the 1960s and 1970s. When you factor in children who are overweight but not obese, the rate climbs to about 30 percent. (For children, the distinction between “overweight” and “obese” is based on percentiles of the Body Mass Index: over the 85th percentile is considered overweight; over the 95th percentile is considered obese.)
The first significant study of American children’s heights and weights was conducted by a Boston physician named Henry Bowditch in 1877. He had teachers in Boston schools do the measurements and accountants crunch the numbers. At a time when undernourishment was a major children’s health issue, it was a point of pride that American children were both taller and heavier than their European counterparts.
And American kids just kept getting bigger. In 1963, the federal government’s Centers for Disease Control and Prevention launched the National Health and Nutrition Examination Survey, a program of studies designed to assess the health and nutritional status of adults and children in the United States. Early results showed that the average 11-year-old boy was about 4 inches taller and 16.5 pounds heavier than a boy of the same age in Bowditch’s time.
In the early 1960s, many experts thought that “bigger” was still a good thing – that better housing, nutrition and overall health were allowing children to achieve their genetic potential for growth. But around 1970, it was recognized that children were proportionally getting heavier than they were getting taller, and with this increased bulk came potential health problems.
Childhood obesity is linked to an alarming number of physiological problems; as outlined by the CDC:
• High blood pressure and high cholesterol, which are risk factors for cardiovascular disease
• Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes
• Breathing problems such as sleep apnea and asthma
• Joint problems and musculoskeletal discomfort
• Fatty liver disease, gallstones, and gastroesophageal reflux (i.e., heartburn)
It can also result in psychological stress such as depression, behavioral problems and bullying issues in school, along with impaired social, physical and emotional functioning. Vero’s Dr. Haake said, “Obese children have a negative body image and low self-esteem. They are bullied and shunned by other children. There was a study that showed obese children have the same quality of life as children with terminal cancer.”
If there is not a successful intervention, the strong likelihood is that an obese child will grow up to be an obese adult. As a consequence, childhood obesity is strongly linked to early mortality and morbidity (incidence of disease) in adulthood, including ill-health caused by heart disease, diabetes, metabolic syndrome and cancer.
The reasons for the childhood obesity epidemic are well understood. Our society is “obesogenic”; it encourages people, including children, to eat unhealthily and be physically inactive. A couple of points about that:
• In 1970, when childhood obesity rates were a third of what they are now, the fast food industry in the United States had sales of $6 billion. In 2015, sales were $200 billion. A recent study from the CDC says about one-third of U.S. children and teens eat pizza or other fast food every day. Although most fast food chains offer what they tout as healthy choices, kids tend to gravitate to menu items that are high calorie, highly processed, and low in nutritional value.
• Today’s children have far more to keep them from being active than did their parents and grandparents. From the 1950s through the 1980s, TV was cast as the main villain in encouraging inactivity; it’s still around, but so are smartphones, laptops and tablets, which can keep our kids and grandkids occupied and virtually motionless for hours on end.
Even though the problem is well-defined, there are no easy answers. In 2010, first lady Michelle Obama launched Let’s Move, an initiative dedicated to solving the challenge of childhood obesity within a generation by giving parents useful information, fostering environments that support healthy choices, providing healthier foods in our schools and helping kids become more physically active.
No one disagrees with the premise of Let’s Move, but its impact, at least so far, seems to be minimal, as the overall childhood obesity rate has not declined in the 5+ years of the initiative’s existence. Regarding school lunches, Dr. Haake said there have been improvements in portion control, and that the substitution of skim or nonfat milk for whole milk is good, but there is still a lot of room for improvement. She said, “It’s a huge challenge. In an ideal world, parents would make a healthy lunch for their child to take to school, or the child would willingly and happily eat the healthy choices offered at school. That’s not what always happens in the real world.”
Dr. Haake is the mother of two slim and healthy children, Daylan, 9, and Matthew, 7. She shared some of the behaviors that have become habit in her household:
• There is close parental monitoring of meals and snacks. “Sure, the kids have a cookie now and then, but if they want a snack later, it will be something healthy, like a cheese stick or an orange,” Dr. Haake said. “And they very rarely eat fast food.”
• Water is the only beverage her kids drink. “Soda and juices have too much sugar, and there’s even a lot of sugar in milk,” she said. “There are plenty of other ways for them to get calcium.” Drinks with non-nutritive sweeteners (e.g. aspartame, saccharin, sucralose, stevia) are strictly off-limits.
• There is physical activity of some sort for at least an hour each day. She said, “Sometimes the kids are just running around playing, sometimes they’re biking or swimming. And we are physically active as a family. When it’s appropriate, my husband and I involve them in our workouts, or we bike or walk together.”
Dr. Haake also noted that many pediatric obesity experts recommend limiting “screen” time to no more than two hours a day as a preventative measure, and to no more than one hour a day if a child is being treated for obesity.
Family involvement in the prevention and treatment of childhood obesity is essential. “It all begins with the parents,” Dr. Haake said. “Children with one obese parent have a 50 percent chance of being obese; if they have two obese parents, the chance increases to 80 percent. These parents need to change their behaviors and instill good habits in their children.”
If there is an overweight or obese child in the family, the parents and siblings – regardless of their own weight – need to participate in creating and maintaining a home environment focused on healthy eating and physical activity. And it’s critical that parents stand up to other family members (especially grandparents) who may be unintentionally undermining the effort by offering snacks or meals high in calories and low in nutrition.
In addition to her memberships and associations, Dr. Haake is a Family Practitioner and Medical Bariatrician affiliated with the Indian River Medical Center. Her office is located at 880 37th Place, Suite 105 in Vero Beach; the office phone is 772-562-9707.
