A burger and fries: the increasing dilemma of childhood obesity. (For Parents Particularly).

Obesity, considered the number one health risk for children in the United States today, is now reaching epidemic proportions. The number of children who are overweight has doubled in the last two to three decades; currently, one child in five is overweight (Torgan, 2002). In her informative article, "Evaluation and Treatment of Childhood Obesity," Dr. Rebecca Moran (1999) claims that 25 to 30 percent of children suffer from obesity, and yet the condition remains underdiagnosed and undertreated. Another study (Axmaker, 2001/02) shows that if a child is overweight at age 6, his or her likelihood of adult obesity is more than 50 percent.

A person is considered obese if his or her body weight is more than normal for a particular age, gender, and height. The degree of obesity can be assessed through BMI (Body Mass Index) calculations that are based on a person's height and weight. A person gains weight when the energy input (food) exceeds energy output (exercise, activity.). Energy output comprises the thermal effect of food and activity. Even a small imbalance between energy input and output can lead to significant weight gain over time. Most obese children demonstrate a slow but consistent weight gain over several years.

Obesity presents numerous health problems for children. It is the leading cause of pediatric hypertension and Type II diabetes, increases the risk of coronary heart disease, increases stress on weight-bearing joints, lowers self-esteem and affects relationships with peers, and increases the risk for chronic health problems in adulthood. One of the most severe problems is sleep apnea (interrupted breathing while sleeping), which, in some cases, can lead to problems with learning and memory (Torgan, 2002). Many authorities believe that social discrimination associated with obesity presents the most devastating consequences for children. Children who are teased a lot can develop low self-esteem and depression, which often has implications for long-term happiness and success in life.

Couch Potatoes

While genetics play a role, genes alone cannot account for the huge increase in obesity rates over the past few decades. Eating too much and moving around too little are the main causes of obesity. Most experts agree that watching excessive amounts of television is a significant risk factor associated with obesity; almost half of children ages 8-16 years watch three to five hours of television daily (Torgan, 2002). Children who are the most overweight watch the most television and eat too many snacks with a high fat content (Axmaker, 2001/02). Television viewing, video games, and surfing the Internet often take the place of physical activity for many children. The trance-like state associated with these activities can slow children's metabolism so much that they resemble children at complete rest (Murata, 2001/02).

Soda Equals Sugar Intake

Soft drinks are the leading source of added sugar in the daily diet of American children. A recent long-term research study examined soda consumption and its effect on children's body weight. The study found that for each additional daily serving of a sugar-sweetened soft drink, the incidence of obesity was significantly increased. Researchers also discovered that the odds of becoming obese increased 1.6 times for each additional glass of sugar-sweetened soft drink consumed above the daily average (Gortmaker, 2001).

What Can Parents Do?

It is critical that you talk with your child's doctor if you are concerned about a weight problem. Also remember that you, the parents, are the primary role model for your children. Having a healthy, active lifestyle yourself increases the chances that your children will, too.

Bring Back Physical Activity. Many parents enroll their children in organized sports with the hope of keeping them physically fit. When it comes to sports, however, only five percent of children are superstars, explains Dr. Dan Cooper of the medical center at the University of California, Irvine (Murata, 2001/ 02). Because there is such an emphasis on winning, many children who are athletically average or below average lose interest in physical fitness. Cooper insists that the value of exercise for everyone should supersede winning; exercise helps build strong bones and healthy hearts and lungs, while instilling good lifestyle habits that prevent disease (Murata, 2001/02).

The National Association for Sport and Physical Education (1998) issued guidelines stating that young children should strive for physical activity each day to promote health and well-being. At least 60 minutes a day is recommended, although that amount can be broken down into shorter segments.

Advocate for Recess. With the continued emphasis on testing and the academic curriculum, many schools have significantly reduced or eliminated regular, daily outdoor recess for students. Research has proven that children (and older people, too) perform better and are more focused when given regular, periodic breaks. Parents can help protect their children's health and support their achievement by advocating for increased, or reinstatement of, outdoor recess time for children at school. To raise awareness, talk with other parents, teachers, and the principals. PTAs are often a good starting point for parent advocacy.

The American Academy of Family Physicians offers these tips:

* Respect your child's appetite: children do not need to finish every drink or clean off their plates

* Avoid pre-prepared and sugared foods when possible

* Keep a limited amount of high-calorie foods at home

* Provide healthful meals, with 30 percent or fewer of the calories derived from fat

* Provide ample fiber in the child's diet

* Skim milk may safely replace whole milk at 2 years of age

* Do not provide food for comfort or as a reward

* Do not offer sweets in exchange for a finished meal

* Limit television viewing

* Encourage active play

* Establish regular family activities such as walks, ball games, and other outdoor activities. (Moran, 1999)

References

Axmaker, L. (2001/02). Childhood obesity should be taken seriously. Retrieved from Vanderbilt University, HEALTH Plus, Health and Wellness Web site: http://vanderbiltowc.comdh.content.asp?10=8

Gortmaker, S. (2001). Increased consumption of soda promotes childhood obesity. Retrieved from Harvard School of Public Health Web site: www.research matters.harvard. edustory.php?article_ID=21

Moran, R. (1999). Evaluation and treatment of childhood obesity. American Academy of Family Physicians, February 15. Available at www.aafp.org/aft/990215ap/861.html

Murata, P. (2001/02). Childhood obesity. Couch-potato kids. (2003). Retrieved from University of California, Irvine, Medical Center Web site: www.ucihealth.com/News/ UCI%20Halth/pedsobes.htm

Torgan, C. (2002). Childhood obesity on the rise. Available at: www.nih.gov/news/ WordonHealth/jun2002/childhood obesity.htm

MaryJane Blasi is Director, Judy Hoyer Early Care and Education Center, St. Mary's County, Maryland.