Outline:
Introduction
Who Becomes Obese?
Environmental
Factors That Can Make a Child Fat
How to Change a Child's
Environment
Introduction
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.
