Kids and obesity: will overweight children face a life of health problems?

Have you been shocked when you inadvertently caught a glimpse of your reflection in a store window. I have. Who was that person in my clothes? I wondered. I had been caught unaware and saw myself in a startling new light. Sometimes I appeared a little slouched. Sometimes my clothes were not as smart as I had thought they were. But worse than that was when I saw myself looking--well, to put it bluntly--fat. There was no denying it. It was an uncomfortable shock.

We as adults often try to excuse our behaviors and find ways around things. But with our children's problems, we rationalize that children have the whole of their lives ahead of them and things will change. We ignore difficulties, saying that we will take action at a more convenient time. A time when there is more time. Or more money; or when Jimmy gets old enough to be responsible for himself. Or later.

Science gives us a good reason not to delay our actions in regard to being overweight in childhood and adolescence. This is a growing problem (in more ways than one) which is engulfing the youth in the United States. The second National Health and Nutrition Examination Survey in 1987 showed that 27 percent of adolescents between 12 and 17 years of age were obese. A 1993 study estimated that there were as many as 11 million obese school-age children in the United States. How about now, in 1997? The rising trend will make today's figures even greater.

Obesity is usually measured by the upper arm skinfold measurement and is described as excessive body fatness. Those over the eighty-fifth percentile are categorized as obese, while the group over the ninety-fifth percentile are superobese. Superobesity has increased by 98 percent over the past 20 years.

Being a couch potato does affect weight. Science shows this to be true but American youth and adults are not into fitness per se. Oh yes, we may have friends who work out on a weekly basis, but many youth are spending more time in front of the television than ever before. In fact, research shows that the more obese a child is, the more television the child is likely to watch.

What is happening to your child's self-esteem as he or she sits in front of the television looking at the attractive, cool kids who are usually shapely and thin? Perhaps your child can only dream--and get another can of soda and some cookies. An obese child volunteering to be on the kids' football team playing outside is usually picked last. During the game the child fumbles, is afraid to tackle even though the right size for tackling, and cannot run fast enough to make a touchdown. Why bother? Being at home is more comfortable.

Michael's Story

Michael(*) was an 8-year-old, very friendly kid-helpful and pleasant. He wasn't obese, but he was over weight. Life was pretty good for him. His family loved him, and his friends would spend time talking and chatting with him. That was then. Now Michael is 16 years old. He is still friendly. He is still helpful and pleasant, but there are a few differences. He has to hitch up his pants when he bends over. When there is a sporting activity, he just sits and watches. His buddies leave him on the outside, and he withdraws, investing more time at the computer. He does that well--which is more than can be said for his attempts to eat less and get into shape. He's tried it, and it is just too tough, especially when his parents are overweight too. He tries--and gives up, and the weight goes on. Unfortunately, one of the things he is good at is eating the biggest plateful of tortilla chip "haystack" at the church social--and being proud of it. Michael has a big problem.

Research shows that obese children spend more time doing comfortable, minimal-energy-consuming activities--watching television, reading, and playing video games--than any other group of children. Of course, socialization with peers then becomes more difficult; and so the behavior becomes circular. If you have a young child or an adolescent who fits this picture, what are you doing about it? What is your child doing about it?

Studies show that child and adolescent obesity brings with it a negative body image, low self-esteem, depression, and lack of self-confidence. While these feelings may not be internalized until adolescence, according to one researcher, others recognize the early discrimination of peers, and so the passive response of the obese child leads to withdrawal and isolation. The problem of obesity is more severe in families where there is marital strife.

Obesity definitely does have its down side as far as health is concerned. There is a strong association between childhood and adolescent obesity and cardiovascular disease, especially hypertension and its complications. Coughs and colds are more frequent, and respiratory diseases may impact obese children and youth through sleep apnea syndrome and later, the effects of chronic low oxygenation of the blood and other breathing problems and respiratory infections.

Jorge

If you saw Jorge(*) you would have to take a second look--and maybe a third. You surely could not miss him, or his family. They were so huge you would not believe your eyes. I met Jorge in the hospital. He was only 6 years old and the same height as any kid his age, but he weighed a huge 160 pounds. His family rolled around the unit wearing shorts as wide as they were long. Their fat hands often wrapped around a king-size burger, french fries, and a 44-ounce soda. They gorged and gulped their way through their snacks before coming into the unit with extra supplies in their pockets, which they planned to give to Jorge, if they could get away with it.

Jorge had sleep apnea because of his weight. The first night we heard him rumble and snort his way through the hours of darkness. On the second night he was wired and ready for a sleep study.

Most of the day Jorge sat in the recliner with his little legs extended onto the footrest. In fact, he could not sit on a regular chair, as he would be propelled forward onto the floor. He was always assisted by his parents or his grandparents to the chair or the restroom (six feet away) and back to the chair and then to the bed, and so on. His parents yelled at each other over his head and twice had to be dismissed from the unit for their disturbance. The divorce had not been finalized, and both parents wanted Jorge, as did two sets of grandparents. As the family fought, Jorge ate, and manipulated, and whined, and ate.

Jorge stayed on the unit only a matter of days and then went to another floor. He was a sad example of an abused child. Perhaps his parents were not physically violent toward him, but their behavior and lack of control over his eating habits meant that Jorge was abused both emotionally and physically. Jorge had big problems.

Fortunately, obese children do not have to become obese adults. The more stable the obesity, and the shorter the duration of the child's obesity, the less chance there is that he or she will be an obese adult.

Further good news is that childhood obesity is treatable. It is not a life sentence. A 1995 study showed that by reducing the sedentary behavior of children and involving families in counseling, dietary changes and exercise always produced positive results.

Many high school students are dieting today. It is encouraging to know that the majority of those trying to lose weight know how to diet effectively and sensibly. Healthy dieting consists of increasing exercise, decreasing the fat intake in the diet, and reducing snacks and general food intake. Unhealthy dieting behaviors, such as fasting, taking diet pills, or vomiting, can be dangerous themselves, but thankfully these practices are followed by comparatively few students.

The consequences of not dealing with the problem of obesity in childhood or adolescence can be far-reaching and devastating. So make that decision today and take your health seriously. After all, your child's whole life lies ahead. Let him or her use it, not lose it.

(*) Names have been changed to conceal identity.

RELATED ARTICLE: What can be done for a child who is overweight?

So what can be done if your child is withdrawn, perhaps watches too much television every day, and lacks the confidence to join in activities with peers because of a weight problem?

Here are five simple steps that may help your child or adolescent to avoid becoming an obese adult, while also improving the health of your family:

1. Acknowledge that there is a problem with your child's weight and read about healthy food preparation and eating practices. Become informed. Do not follow fad diets, and do not limit the variety of foods eaten.

2. Talk to your child about his or her problem with love and support, and offer help. Gently take charge of the situation with his or her permission. Help can come from you, your doctor, or a dietitian. A psychologist may be able to give your family counseling as a unit, or you may prefer to consult a marriage counselor and so take the first step in helping your child. There is help available. Do not give up.

3. Buy healthy foods. Do not be tempted to fill your cupboards with convenience foods high in fats and sugars. Provide balanced meals, and serve portions that suit the needs of each family member. Provide alternative low-calorie foods, if necessary, for snacking.

4. Involve your child in more activities. Take things gently at first. Make some fundamental rules regarding the time to be spent watching television, and involve the family in physical activities that your child and you will enjoy. Keep a record of your child's weight and encourage the venture. Reward him or her for even small steps of success.

5. Finally, if you are overweight, nothing is better than being a good example. Work together on the problem. Be your child's buddy.

Tabitha Abel-Cooper is a pediatric intensive care nurse at Loma Linda University Medical Center and a doctoral candidate at Loma Linda University's School of Public Health.