Obesity & children's health.

As frightening as the overweight epidemic is in adults, it's nothing compared to what's happening with children. Today, one in five children ages two to five is overweight or obese, as is one in three children ages six to 19. Those numbers have doubled for kids 6 to 11 in the past 20 years; tripled for those 12 to 19. (19)

"It's the most serious medical disease that's ever hit children," says pediatrician William Sears, MD, an associate clinical professor of pediatrics at the University of California-Irvine. That's because kids rarely grow out of their weight problems, with an overweight adolescent having an 80 percent chance of being overweight through adulthood. (20)

Overweight kids also face significant health challenges. About 60 percent have at least one risk factor for cardiovascular disease, including high cholesterol, elevated insulin levels and elevated blood pressure; 25 percent have two or more. (21) Today pediatricians treat ever-increasing numbers of children with type 2 diabetes, sleep apnea, osteoarthritis, back pain and other weight-related conditions.

The bottom line: unless American families change the way they eat and live, the U.S. Centers for Disease Control and Prevention (CDC) predicts one in three children born in 2000 will develop diabetes in their lifetime. (22)

There's no one reason for the epidemic, not even fast food companies. Studies find connections between everything from the amount of TV kids watch and having a television in their bedroom to skipping breakfast, less physical education in school and the demise of the family dinner. (23,24)

"The entire environment is the problem," says Robert H. Lustig, MD, professor of clinical pediatrics in the Division of Endocrinology at the University of California, San Francisco. "It's toxic."

As with adults, diets are not the answer, warns Dr. Sears. "Parents need to stay away from crash diets," he says. "Eating needs to be pleasurable." Plus, children's nutritional needs are much greater than adult needs. Even a 100-calorie a day reduction without professional oversight could lead to nutritional deficiencies in a child.

The most successful weight-loss programs for kids use a comprehensive approach, including behavioral modification therapy. They also tend to involve the entire family, not just the child. "My personal bias is that parents who try to make changes for their kids aren't going to have that much success," says Joseph A. Skelton, MD, assistant professor of pediatrics at the Medical College of Wisconsin, who directs a program for overweight children at Children's Hospital of Wisconsin. "If you do it as a family, though, you're changing the micro-environment."

And don't try to change everything at once, he warns. "Focus on those things you can get the biggest bang for the change," he says, like cutting out soda and other sweetened beverages; eating out once a month instead of five times; going for a walk or bike ride three nights after dinner instead of plopping down in front of the TV.

Dr. Sears uses a similar approach in his program, LEAN (lifestyle, exercise, attitude, nutrition), which the state of California is piloting in Boys' and Girls' Clubs and YMCAs. He asks children to make one change a day and write it down. So instead of a bag of chips, they might choose an apple. "Often, one 'instead of' healthy choice a day is all they need," he says. "The average child is only 100 calories a day over what they need to be."

He also doesn't focus on weight. "Instead, we start with the child, and the first thing we ask is 'What would you change if you could?'" says Dr. Sears. "And they say, 'I'd like to run faster,' so we say, 'OK, call this 'Dr. Bill's Run Faster program.'"

And he, like Dr. Skelton, believes parents must be involved. "Parents have to take this seriously," he says. "I use scare tactics sometimes, because the parents are not getting the message. I say, 'I know you love your child, but if your child continues on this track, she's going to get diabetes, arthritis, cardiovascular disease, behavior and learning problems, vision problems and self-image problems.'" Then, he says, they start to listen.

References

19 Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004 Jun 16;291(23):2847-50.

20 Daniels SR. The consequences of childhood overweight and obesity. Future Child, 2006 Spring;16(1):47-67. Review.

21 Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa Heart Study. Pediatrics 1999;103:1175-1182.

22 Narayan KM, Boyle JP, Thompson TJ, et al. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003 Oct 8;290(14):1884-90.

23 Dubois L, Girard M, Potvin Kent M. Breakfast eating and overweight in a pre-school population: is there a link? Public Health Nutr. 2006 Jun;9(4):436-42.

24 Krebs NF, Jacobson MS; American Academy of Pediatrics Committee on Nutrition. Prevention of pediatric overweight and obesity. Pediatrics. 2003 Aug;112(2):424-30.