Helping Your Child With Obesity

Detailed information on childhood obesity, how to prevent childhood obesity and how to help your overweight child.

How can parents halt the creeping epidemic that threatens our kids' futures? The solution: Change the environment so they can move more and eat well.

In our push-button, remote-control, car-oriented culture—where pizza makes house calls and kids between the ages of 2 and 17 spend more than three years of their waking lives watching TV— we've created the fattest generation in history.

Waistlines are widening in people of all ages, but "our children, in particular, are gaining weight to a dangerous degree and at an alarming rate," warns the Institute of Medicine of Washington, DC, in a new action plan ("Preventing Childhood Obesity: Health in the Balance") commissioned by Congress to address this growing public health threat. In just 30 years, the prevalence of childhood obesity has soared, with nearly one in three American kids now tipping the scales past healthy weight.

Once dismissed as harmless "baby fat," childhood obesity is increasingly recognized as a serious health threat that can lead to numerous physical ailments such as type 2 diabetes.

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In fact, one-fourth of obese kids ages 5 to 10 already have at least two components of what is called metabolic syndrome, a cluster of health problems (including insulin resistance, high blood pressure and high cholesterol) that increases the risk of coronary heart disease and diabetes. Overweight kids also are more likely to be ostracized and bullied—or to bully others.

The grim reality is that obesity exerts a life-shortening effect, which threatens to reverse the steady rise in life expectancy observed in the modern era, contends a recent study published in The New England Journal of Medicine. Today's children are on track to be the first generation in U.S. history to live less healthy, and even shorter, lives than their parents.

How did we get this way? Increasingly, experts point to our "obesogenic" environment, which encourages people to eat too much and move too little.

"We live in a world where the energy demands of daily living are at a historic low and the availability of high-calorie, easily obtainable, inexpensive food is at a historic high," notes Harold Kohl, an epidemiologist with the Centers for Disease Control and Prevention in Atlanta. "We've created the 'perfect storm' for obesity—particularly for children."

Numerous societal changes have dramatically reduced the amount of energy children burn, while expanding the number of calories they consume. Budget-crunched schools have cut back or eliminated physical education classes—and sometimes even recess. Working parents concerned about safety would rather their kids play video games or watch TV indoors than run around outside. Computers have revolutionized the classroom, entertainment, shopping and communication. Fast food, in "super size" portions, is everywhere—even in some schools—as are vending machines stocked with sodas and chips.

"Our willpower hasn't changed" in just 30 short years, notes Yale University obesity expert Kelly Brownell. "The gene pool hasn't changed." What's changed, he contends, "is our increasingly toxic food and physical activity environment. Society has long placed responsibility for obesity squarely on the sufferer, when we need to consider our environment as the real cause."

Just as we dramatically altered the tobacco environment, Brownell says we must change our culture's obesity-promoting environment. "Twenty years ago, if you said we should ban smoking in public places, people would have said you were crazy," he notes. "People need to learn how to resist pressures to overeat and under-exercise and demand change." Who's at risk?

Since we're all surrounded by pressures to sit still and overeat, no one is immune from the dangers of gaining an unhealthy amount of weight. "When you have a problem that affects one-third of the population, everyone is at risk," says William Cochran, MD, a pediatric obesity specialist at the Geisinger Clinic in Danville, Pa., and a member of the American Academy of Pediatrics' task force on obesity prevention. "At especially high risk are children who have one or two obese parents as well as African Americans, Hispanics and Native Americans."

Overweight adolescents also are at high risk because their problems with weight likely will worsen with time. Physical activity tends to decline dramatically during teenage years—especially among females—and weight gain is common, Cochran says. Younger, obese teens, especially girls, battle depression more than their slimmer counterparts, and that trend continues into adulthood. "Obese adolescents have an 80 percent chance of becoming obese adults," Cochran notes. "And obese adults tend to have obese children. So it's important to intervene at this time to help prevent obesity in the next generation."

The first step in preventing obesity is identifying the problem, which is done by calculating a child's Body Mass Index, or BMI. In adults, the BMI is a single number—calculated as a ratio of height and weight—and has been used for more than a decade to define overweight and obesity. Until recently, however, BMI was not used for children because the calculations are more complicated than they are for adults. Since kids are constantly growing, you must compare their height-weight ratio to the norm for children of the same age. In 2000 the CDC released a BMI for kids that, Cochran notes, "is not a specific number; it's a percentile." Healthy weight falls between the 5th and 85th percentile for age and sex. Anything over the 95th percentile is considered "obese."

Pediatricians should calculate each child's BMI at least once a year, Cochran says. But the sad fact is, he says, they don't always. In fact, "it's probably happening only about 10 to 20 percent of the time." Although pediatricians are typically excellent in preventive health measures—such as newborn screenings, immunizations and promotion of car safety seats—many have dropped the ball on prevention of childhood obesity. "Calculating BMI takes extra time, which typically physicians are not reimbursed for," he notes. "And it can be a tense issue to bring up with parents, one that can create negative feelings and a sense of hopelessness. People often aren't really sure exactly what to do about it."