EVERYTHING
FOR YOUR FAMILY
Cover Story
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By Michele Piazzoni As children head back to school this month, how many of them will have the new Munchies Kid Mix packed in their lunch pails? After all, it's "made for kids by kids" and contains a "healthy" assortment of pretzels, Captain Crunch cereal, Cheetos, mini-Doritos, cheddar-flavored popcorn and brightly colored, candy-coated snacks. Just to make certain that parents everywhere discovered the snack mix that they'll "feel great about," Frito Lay took out a full page ad in the Wall Street Journal. Honestly, as a parent, does the phrase "made for kids by kids" bring to mind a healthy snack option? Maybe so. Maybe that's one of the reasons why more and more children will struggle to fit into their desks this school year, be inattentive some of the time, and stand along the sidelines during PE class because they can't keep up with their peers. Nearly one-third of school-aged children are obese or at risk of becoming overweight - incoming kindergartners included. Even preschoolers are breaking records, with 10% officially overweight and another 10% at risk of becoming so. The Centers for Disease Control and Prevention, the National Institute of Health, and the American Academy of Pediatrics have dubbed childhood obesity as a national epidemic, and it has grabbed sunny, active Southern California by the waistline, too. Children here suffer from the physical, psychological and social repercussions of carrying around too much weight, and it's not just the result of too much snack mix. According to the CDC, in the past 20 years the number of overweight children has doubled. Among teenagers, the number has nearly tripled. In certain ethnic groups, including African-American, Latino, Pacific Islander and American Indian, the ratios are even higher. Among low-income families, 1 in 5 children are overweight, and they are least likely to have access to the tools needed to combat the problem. While McDonald's - the lightning rod for what we've become as a fast-food nation - has recently moved to add healthy salads and substitute apple slices for super-sized french fries, that step is too little, too late. Some 13% of children ages 6-11 and 14% of adolescents ages 12-19 were overweight in 1999, according to the U.S. Surgeon General. And their role models - the parents - were even worse off. Some 61% of American adults are overweight or obese. And, like their parents, the children know how to look in the mirror. According to a new survey by KidsHealth Kids Poll, an organization that dubs itself as "the voice of America's children," being out of shape or overweight was the fifth-biggest worry or stress area among 9- to 13-year-olds. Some 32% of respondents worry about this daily or weekly. (Looks or appearance was the second-biggest worry, and obesity certainly would fall into that category.) According to the CDC, overweight refers to an increased body weight in relation to height when compared to acceptable or desired weight. Obesity is an excessively high amount of body fat. A child is considered obese when her body mass index is at or above the 95th percentile for age and gender. For example, a 7-year-old girl who is 4 1/2 feet tall and weighs 82 pounds has a BMI of 19.8, (the 95th percentile). The same child, weighing 10 pounds less, would be considered normal weight, and anything in between would be at risk. (It's important to note that children's BMIs are continually changing as they grow taller.) Of course, 10 pounds is a significant amount for a child that young and at 4 1/2 feet tall. Enabling children to lead fit and healthy lifestyles will require dramatic change in our culture and communities, and a committed group of professionals and parents to lead the way. The Smoking Gun Obesity is on its way to becoming the leading cause of preventable death in the United States. Right now, tobacco has a slim lead, but there are already concerns among the medical community that obesity could be responsible for creating the first generation of children to have a shorter life span than their parents. The CDC notes that tobacco is the most common cause of death in the U.S. (435,000 annually), followed by poor diet/physical inactivity (400,000) and excessive alcohol consumption (85,000). The Surgeon General, perhaps more narrowly defining the topic, reports that some 300,000 U.S. deaths each year are associated with obesity. "We're heading for the biggest health-care crisis this country has faced when it comes to young adults and teenagers," says Dr. Susan Clark, director of endocrinology and diabetes at Children's Hospital of Orange County. "And with the data coming in from the CDC, it's clear that we haven't seen the worst of it yet." (One of obesity's related illnesses is diabetes; OC Family Magazine is devoting a year-long series, "Defy Diabetes," that runs in the In Shape Department.) Within the past decade, Clark has seen the number of pediatric patients with cardiovascular disease, type 2 diabetes, asthma and other health problems associated with obesity skyrocket in both San Bernardino and Orange counties. She regularly sees children who have all the warning signs of heart disease, including lipid abnormalities and high blood pressure, by the time they reach puberty. Type 2 diabetes, which normally doesn't occur until after age 40, is showing up in overweight 8- and 10-year-olds, and without proper treatment the effects can be devastating and, worse, deadly. The medical costs can break a family financially. The data already tells us that young people suffering from Type 2 diabetes can experience a very fast progression to complications. "The fact that we're going to start seeing young adults having heart attacks, strokes, kidney problems, blindness and losing limbs is by far my biggest concern," she says. Bone and joint problems, sleep apnea and an array of psychological challenges are additional health risks. One report from the American Medical Association found that obese children compared their quality of life to that of childhood cancer patients. Other research involving adolescent girls found a strong correlation between depression and being overweight, while studies across the board reveal overall low self-esteem among overweight children. To compound the problem, even though many physical side effects of obesity can be alleviated with a mere 10% weight loss, the psychological problems associated with being overweight are not as easily cured. "Obese kids are more likely to develop eating disorders like anorexia nervosa and bulimia, and suffer from depression as adults," says Dr. Carl McKnight, a pediatric psychologist at CHOC. The cost of treating all these health issues will likely reach into the billions over the next couple decades, estimates Dr. Dan Cooper, professor of pediatrics at UC Irvine and a recent appointee to the California Department of Education's Obesity Task Force. "People didn't take this problem seriously for a number of years. We are beyond the stage of recognizing the problem. Now comes the hard work, and nobody is exempt." Where do we start? It's easy to place blame for this crisis on giant bags of greasy French fries, parents or even the children themselves. But most experts agree that the problem is as complex as it is preventable. In order for lifestyles, attitudes and scales to change, there needs to be a concerted effort between government, communities, schools, health-care facilities, families and even pop culture at large. While it may never be possible or practical for all of these entities to work together toward a single solution, it is conceivable that each could develop programs and services that would collectively contribute to a better outcome. Pop Culture Just a few minutes in front of the TV propels children into a fairy tale world where rainbow candies fall from the sky, heads turn into giant pieces of fruit, and silly rabbits vie for delicious sugar coated cereal. If a cartoon character is a hit with children, it's only a matter of time before they earn their own cheese-flavored cracker, or become a fast-food company's meal toy. According to the Kaiser Family Foundation, one of the biggest influences on childhood obesity are the television commercials that entice children with pop culture icons. A multitude of research indicates that children who watch the most television are more apt to be overweight, not because TV time displaces physical activities, but because of the advertising. "If you have a child watching 40,000 commercials each year (the national average) they're getting far more education on what to eat through the television than from what they learn in school," says Nancy Gelbard, chief of the California Department of Health Obesity Prevention Initiative. Her mission is to reduce the prevalence of overweight children through policy and environment. She compares the obesity epidemic to smoking; change is a long ways off. "It took 15 years of tobacco prevention efforts before they saw significant results, and this is a much more complex issue," she says. Leading researchers suggest that with proper policies in place, television can change its image as a contributor to the problem and, in fact, take an active role in the solution. Other countries such as Canada, Sweden, Norway and Britain limits and/or restrictions on advertising during children's programming are in place. Consider what such restrictions on smoking did to a runaway American habit. Additionally, the Kaiser Family Foundation researchers noted that TV could become an influential component of public education, promoting healthy eating and exercise habits. Schools The National PTA, which typically holds meetings with the focus on policy and fundraising, in late June held a meeting at the Anaheim Convention Center with childhood obesity among its chief topics. The time has come for schools to determine how to treat this epidemic. Currently physical education programs are limited; federal mandates for elementary schoolchildren only require an average of 20 minutes of PE per day. In high school, students need only take PE classes for 2 years. "The fact that many students are only getting PE at school, and especially when that piece is void, plays into obesity issues," says Debbie Vigil, a physical education consultant for the California Department of Education. To compound the problem, low-income youth, the group hardest hit, rely on school meal programs for a large part of their diet. These often contain high-fat choices like pizza, chicken nuggets and fried foods. Despite a bold move by the Los Angeles Unified School District to replace the sale of soda pop and candy with water and Rice Krispie treats, other school districts still lag behind when it comes to offering healthy, energy-packed snacks. Soda pop, though, appears at risk. Many school districts, such as Tustin Unified, ban the sale on elementary and middle school campuses. Newport-Mesa Unified has developed healthful food menus. And Santa Ana Unified has begun nutrition counseling and food education to change eating habits of its largely Latino population of students and parents. The Orange County Grand Jury in its 2003-04 session, released in June, recommended that public schools be a part of the solution to obesity. Among it recommendations: each school district establish a child nutrition and physical activity committee and that nutrition and physical education specialists be appointed to train teachers on the essentials of fitness and diet. In addition to falling short on effective physical education and nutritional programs, many schools overlook the opportunity to impact youth during the pivotal years before adulthood, when long-term eating, exercising and lifestyle habits can still be molded. Yet some officials use innovative ways to incorporate personalized health education into their curriculum for children who need it most. At Tesoro High School in Las Flores, a pilot program starting this fall invites overweight teenagers to adopt behavioral changes that can help them adapt to a new way of thinking, and being. Teacher John Gipe says his students will have a chance to work with physicians, nutritionists, personal trainers and other professionals who can help them develop a long term diet and exercise plan that they can live with. "The idea is that we're going to educate them about the whole package," says Gipe. "I really want the kids to learn how to make their own lifestyle changes because in the end it's what they're doing on their own that really matters." The community at large Too many children do not have access to safe playgrounds, or after-school programs, to keep them active. And in rich and poor neighborhoods alike, parents are afraid to let their children walk to school. The 4-city-block car pool to school is, unfortunately, the norm as busy parents barely get the cargo to school by the opening bell. A 10-minute walk together would seem a simple solution, and a good way to kick off an active day. "There's a lack of opportunity for kids to engage in spontaneous play," explains Dr. Cooper of UCI. "Children typically get exercise from short bursts of high intensity, but we've imposed periods when a child is supposed to be active and that may not be the way kids should be exercising." Some groups are reaching out. In Santa Ana, Dr. Mark Colon developed a 12-week program at the CHOC clinic at the Boys and Girls Club, which teaches healthy nutrition and lifestyle habits to Latino families. The program is the result of ongoing efforts to not only provide the information families need to live healthy lifestyles, but the support as well. "We used to offer one-on-one counseling," says Mary Sowa, a pediatric dietitian at CHOC. "But we've found that the best way to deal with obesity is in a group setting so that kids realize they are not alone in their challenges." Another community-based program open to Orange County and Inland Empire families is provided by the nonprofit Kid Shape organization. (See Internet Resources for contact info.) Kid Shape offers age-specific weight management classes that are a combination of nutrition, exercise and counseling for both parent and child. "Those who stick with it lose an average of 2 pounds over the 8-week period," says assistant program director Mande Grabes. "That might not sound like a lot, but these are growing children and the goal is to maintain their weight as they grow taller." Set to open this fall is a health clinic for low-income, morbidly obese children. Started with a grant from the Health Care Foundation of Orange County, and the support of doctors from UCI and CHOC, the clinic will provide care for some of the acute side effects of obesity. Since many do not have insurance, clinic funding will continue to be an issue. Personal behavior Many critics blame children and parents for poor food choices, little to no physical activities, and a lack of willpower when it comes to staying trim and fit. However, much of the problem is rooted genetically, and to overcome it requires a lifetime of behavior modification. In a world where friends and even siblings don't face the same challenges, nutrition and exercise choices can be especially daunting. But parents have the power to create a positive atmosphere for change in a household. They have the first crack at making a difference, even for a child who is too young to know what the word "overweight" means. When Yvonne Varner took her daughter, Sahvahn, to the doctor for her pre-kindergarten checkup, the Huntington Beach mother was shocked by the doctor's immediate referral to a weight-management program. "I guess when you see them every day, you don't notice the gradual changes," she admits. "I knew she was overweight, but I didn't think it was that bad," At 80 pounds, Sahvahn was off the charts, and she spent most of her day at home with a full-time nanny. Through lessons learned in the Kid Shape program, mother and daughter have incorporated plenty of physical activity into their schedule and made gradual changes to their meal choices. "Now she actually asks for water, broccoli is her favorite vegetable, and she's more willing to try new foods," says Varner. Today the 6-year-old is wearing the same size clothes that she wore a year ago, and she's an active, friendly child who never noticed a difference between herself and her slimmer peers. But Varner admits that adopting permanent behavior change has been a big challenge, so for now she's committed to continuing the program. "If I'm motivated, then I can motivate her. It's a serious issue; we don't want our kids starting out with health problems." It's taken 20 years for the problem of childhood obesity to surface as a public health issue, and many argue that it will take equally long to solve the problem. There's no magic pill on the horizon, and most of the ideas for improving the situation are far from implementation. However, change may be on the horizon. "Some people are just not genetically programmed to be thin, and we're not advocating that everyone should be," says Dr. Clark. "We just want people to adopt a healthy lifestyle and be physically active. That's a realistic goal." • Michele Piazzoni of Folsom is a regular contributor. For our Letters department: ocfamily.com 10 tips for healthy families 1 Drop high-sugar drinks. A 44-oz. soda contains 550 calories and 37 teaspoons of sugar, while so-called "real fruit" juices sometimes have as little as 3% of the real thing. Stick to 100% real juice. Children don't need soda and teens should stick to the diet stuff. 2 Slow down on fast food. Don't try to totally cut it out, because that might backfire. 3 Don't skip breakfast. Missing this important meal messes up your metabolism, and can leave you hungry, tired, and craving less healthy food. 4 Make meal planning a family event. When your kids have input on snacks and meals, they tend to be more interested in trying them. 5 Pack your pantry. Make it easy for your children to make their own healthy choices by stocking up on things like granola bars, pretzels, fruits and vegetables. 6 Energize for an hour each day. Children need 60 minutes of activity each day. 7 Work together as a family. In order for children to adopt long-term behavioral changes to keep healthy and fit, they need the support of their entire family. 8 Try out a pedometer. The national goal is 10,000 steps per day for adults, (about 5 miles). Check with your pediatrician for a reasonable goal for your child. 9 Go lean on the screen. Set limits for children when it comes to computer and TV time (2 hours is good). 10 Keep the lines of communication open. This is the best way to keep everyone on the same page. Internet resources www.verbnow.com Maybe you've seen the VERB TV commercials with athletes like Venus Williams. The website, sponsored by the CDC, has lots of ideas for fun physical activities kids can do and a tool for them to record their progress. www.kidnetic.com This website is part of an outreach program initiated by the International Food Information Council (IFIC) Foundation. Kids 9-12 can find recipes for healthy meals as well as innovative ideas for keeping active like the Move Mixer, a dance game where kids integrate their own moves. www.kidshealth.com Calculate your child's BMI and view the corresponding growth charts here. Enter through "Parents," then click on "Growth and Development." www.niddk.nih.gov The Weight-control Information Network (WIN) is a national service of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. Do a search for "helping your overweight child" and you'll find pages of helpful information. (They also have programs geared for other age groups if you want to get the whole family involved.) www.kidshape.com Visit this site to find out about weight management programs in your area. www.aahperd.org/naspe/ The National Association for Sport and Physical Education offers an early childhood brochure. Facts & Figures Here are statistics from the U.S. Surgeon General's office regarding Americans who are overweight or obese: • 300,000 deaths each year in the U.S. are associated with obesity. • 61% of adults in the U.S. fit the overweight or obese category. • Some 13% of children ages 6-11 (roughly the one kid in the starting 9 on a Little League field) and 14% of adolescents ages 12-19 were overweight in 1999. That is a nearly tripling of the adolescent figure during the past 2 decades. • Increases cut across all ages, racial and ethnic groups, and both genders. However, Latino boys tend to have a higher prevalence than African-American or Caucasian boys. African-American girls tend to have the greatest problem with weight gain. • The condition is associated with heart disease, certain types of cancer, type 2 diabetes, stroke, arthritis, breathing problems, and psychological disorders such as depression. • The Surgeon General's office suggests that children engage in 60 minutes of moderate physical activity most every day of the week and that adults do at least half that amount. • Stay away from the TV. Some 43% of adolescents watch more than 2 hours a day. Campaign central The U.S. Department of Health and Human Services is running a yearlong public service ad campaign to get Americans off the couch and into a healthy lifestyle. Go to: www.fda.gov/oc/initiatives/obesity/. For data from the CDC, go to: www.cdc.gov/. In the "Search" engine, type in "obesity trends among children and adolescents." |
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