Adults Can Help Save Obese Kids from an Unhealthy Future

A combination of inactive lifestyles and a fat-drenched diet have produced a virtual epidemic of childhood obesity among American children, warns Ramin Alemzadeh, MD, FAAP, Professor of Pediatrics at the Medical College of Wisconsin and Director of the Diabetes Program at Children's Hospital.

"About 22% to 25% of children now happen to be obese," he says. "We know it has probably doubled in the last 25 years."

The long-term implications for the future health of these children are frightening, with diabetes and heart disease likely unless parents gently guide their kids on to a different path.

Fast Food, Less Activity Contribute to Problem
"Children's lifestyles have changed dramatically," Dr Alemzadeh notes. "There is not only much less activity but also changes in food choices. There is much more fast food, and much more time spent on video games."

Further, parents and other caretakers have become increasingly worried about the dangers lurking on neighborhood streets, and more reluctant to send children out for unsupervised play. "When we're talking about dealing with childhood obesity, we're discussing a very challenging, complex behavior modification," Dr. Alemzadeh cautions.

Tackling this problem requires an approach that involves the entire family in a supportive way, he advises. "We need a complete lifestyle change for the entire family. We find it much more effective if the whole family is involved, so you gain the buy-in of the overweight child.

"If the parent isn't a positive example, it (proportionate weight for the child) isn't going to happen," the doctor states. This means, for parents, learning about healthful foods and helping their children to find activities that are both comfortable to the child and provide needed exercise.

Weight Stabilization is Goal
Given that kids are growing, the main emphasis of a successful strategy is not weight loss (except in extreme cases). "The kids don't need to lose weight, because they're growing," explains Dr Alemzadeh. "The idea is to let the weight become proportional to their height."

A big no-no is negative or shaming lectures. "Kids need to hear that a healthy lifestyle of the right food and exercise will make them feel better. On the other hand, if you keep pounding on the kid about the weight, you won't get anywhere," except to reinforce over-eating as a form of defiance, Dr Alemzadeh says.

Further, one of the consequences of obesity is a high incidence of low-self esteem, due to frequent teasing by other children, and a remarkably high level of clinical depression. About 30% to 40% of overweight kids show signs of clinical depression.

"We find that a lot of kids eat out of depression or boredom," Dr. Alemzadeh notes. "They might be 'latchkey kids' with no one else around to provide stimulation. We need to replace that boredom - the watching TV and eating that now fills a void," he stresses.

Overcoming childrens' obesity means filling that void in a distinctly positive way. "Parents must provide reassurance, support, and a structure for more activity and proper eating. Kids aren't weeds, they are plants who need to be nurtured. They're not going to figure it out on their own without their parents. "

Eat Together, Limit TV Time
One crucial step is restoring the traditional family meal as a slow-paced time for eating and socializing among family members. "In many households, people are eating at different places around the house, at different TVs or computer screens. But just filling your stomach is not a meal. A meal has a vital socialization element, where family members slow down and share what's going on in their lives.

"Instead, we know that a lot of kids just eat very fast, and they are more likely to gain weight that way," says Dr. Alemzadeh. "Your metabolic rate also goes down when you are watching TV while eating, and that makes gaining weight more likely."

Another important step in the weight-stabilizing process is getting rid of the TV in a child's bedroom and limiting the amount of time for TV and video games to a maximum of two hours per day. According to a new study reported on abcnews.com, "on an average day, 83% of children under 6 years old use screen media - which includes television, video games, DVDs and the computer - and 33% of them have a television in their bedroom. Even very young children watch TV. More than 40 percent of children 2 years old and under watch television every day."

The next step is to find some activity that the child enjoys and that reinforces positive feelings. While safety on the streets is a proper concern for parents, finding active outlets for children's energy in a secure environment is crucial to managing obesity.

To move in a positive direction, parents and other caretakers need to educate themselves about healthful eating. Dr. Alemzadeh concedes this means resisting the time pressures that make it easy to fill the family up on 99-cent burgers and other fat-heavy fare at fast-food joints.

"When parents go to a food store, they need to learn to spend less time in the middle aisles where there's bread, crackers, soda, cookies, and starchy foods, and instead spend more time in the outside aisles amidst the fresh vegetables, fruits and dairy products," advises Dr. Alemzadeh.

Speak to Child's Doctor
Finally, Dr. Alemzadeh emphasizes that parents need to speak freely about their child's weight with their pediatrician. Many doctors, especially given the brief medical interactions that are now so common, will tend to focus on the immediate problem (e.g., sore throat or stomach ache) and are hesitant to bring up a child's weight problem themselves for fear of offending the parent.

"The family needs to recognize that there may be a fear upon the doctor's part of disturbing the relationship. If parents are concerned that their child might be overweight, they need to be pro-active and raise the topic themselves, Dr. Alemzadeh urges.

While profound changes are needed in school nutrition, public education about food, and the non-stop promotion of "junk food" through slick advertising, the family plays an indispensable role in putting children on the path to healthy eating, activity, and weight. "Ultimately, it is the habits we bring from home that are most crucial," says Dr. Alemzadeh.

Unless families and social institutions take major steps, the mounting prevalence of childhood obesity is likely to result in vast numbers of needless deaths of young adults. The most ominous clue is the increasing incidence of children with Type II diabetes. "We're seeing a growing number of children with Type II diabetes, with the incidence increasing 10-fold in the last decade."

If obesity developed in childhood goes unchecked, the likely result is a vastly shortened lifespan for overweight people who develop heart or kidney complications due to diabetes. "I'm afraid we're going to see some significant cardiac and renal morbidities in kids with Type II diabetes once they hit their late 20s and early 30s," says Dr. Alemzadeh grimly.

With the stakes so high, families have a pressing need to take nutrition and exercise seriously for all family members. A family approach, stressing healthy eating habits and activity combined with a positive, non-judgmental style, can literally make a life or death difference for today's children, Dr. Alemzadeh states.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.