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Glenn D. Braunstein, M.D.

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Childhood Obesity: An Epidemic That's Growing Up Fast

Posted: 06/21/10 11:11 AM ET

Of the many statistics about childhood obesity, one in particular highlights the urgency of the problem: One of every three children in America is now considered overweight or obese, and childhood obesity has more than tripled in the past 30 years. How did we get to this place? And even more important, how do we stop the growth of this epidemic?

Being obese or overweight is determined by a percentile measurement of Body Mass Index (BMI), which uses height and weight to determine if a person is normal, underweight, overweight or obese. The BMI is an indirect estimate of body fat that is valid for most individuals. Since children grow in height as well as weight, the standards for children need to be matched for age and sex. A BMI-for-age of 30 places a child in the 95th percentile, the determining number for obesity. A BMI-for-age of 25, or at the 85th percentile, is considered overweight.

A child who qualifies for the 95th percentile is advised to have an in-depth medical assessment since this amount of body fat is also associated with high blood pressure, elevated levels of lipids (fats) in the blood and an increased potential for obesity-related diseases that include type-2 diabetes, asthma, hypertension, high cholesterol, liver and gall bladder disease, bone and joint problems, and sleep apnea. It is also linked to a range of social and psychological issues including poor self-esteem, depression, withdrawal and poor peer relationships.

But as complex as the causes of childhood obesity are, the baseline equation is simple: Too few calories are being burned for the amount of calories being consumed. What's complicated is that this calculation is mediated by a host of behavioral, environmental and genetic factors.

Heredity
Heredity contributes a risk factor of 5 to 40 percent for obesity, and studies indicate that 50 to 70 percent of a person's BMI is determined by genetic influences. If both parents are overweight, the children have a 75 percent chance of being obese. If one parent is obese, the probability is 25 to 50 percent. But while the connection between genetics and obesity has been established, the problem is usually caused by multiple genes interacting with environmental and behavioral factors. Given that the genetic characteristics of a population change slowly, the rapid weight increases in America show that skyrocketing obesity rates are probably due to behavioral and environmental factors combining with genetic factors, rather than genetic predisposition alone. The upside is that making some basic changes in lifestyle and nutrition can make a big difference.

TV Time
One of the biggest culprits is a sedentary lifestyle dominated by TV watching, computer activities and video games. It's estimated that American kids are spending 25 percent of their day watching television, and that those who log the most TV hours have the highest rate of obesity. First, because they're not burning enough calories, and second because they're usually eating unhealthy snacks while they're watching.

What they're watching is also a factor. A March 2007 study found that kids age 2 to 7 see an average of 12 food ads every day, while kids age 8 to 12 see 21 ads, and teens view up to 17 food ads daily. As Dr. Margo Wootan of the Center for Science in the Public Interest says, "If companies were marketing bananas and broccoli, we wouldn't be concerned, but ... most marketing is for sugary cereals, fast food, snack foods and candy." A 2006 study showed that for each additional hour of television viewing, kids consumed 167 extra calories. So it's obvious that limiting TV time is one of the best health care decisions you can make for your family.

Nutrition
A healthy focus on nutrition can't be underestimated. Hectic schedules, both for kids and parents, have resulted in a decline in breakfasts and an increase in dinners outside the home. Use of fast food restaurants with their high calorie, high salt and high fat and carbohydrate entrees, along with their super-sized, sugary soft drinks, is a big contributor to our current obesity epidemic, especially among the lower socioeconomic groups.

Supervising mealtimes will help you control what your kids eat and create an opportunity to offer encouragement. It's also important to cut down on the snacking, as well as on processed, pre-prepared food. Making healthy foods easily accessible is key, so have fresh fruit washed and ready to eat in a big bowl where everyone can reach it. Same with washed and cut vegetables and low-calorie dip. What you eat is important, too, because kids develop preferences based on foods their parents eat.

Sleep
As discussed in last week's blog on sleep, shortened duration of sleep is associated with weight gain and obesity. So making sure that your child avoids sleep deprivation is an important step in combating overweight and obesity.

At Home
For parents, be a role model, not a nag. Eat healthy yourself and get lots of exercise. The family will follow your lead, especially if you turn exercise like bike riding and rollerblading into family outings. (Not hang gliding, though.) Introduce healthy changes gradually. Go from serving whole milk to two percent, and then to skim milk. Keep portion sizes moderate, eat from smaller plates and skip seconds. Instead of frying, better to grill, steam or bake. And try to establish a regular eating schedule for the whole family.

Out and About
Walk instead of drive whenever you can and take the stairs instead of the elevator. Look for a parking space farther from the store, and walk. At the store, select the checkout line with the batteries and the gift cards, not the candy. At restaurants, skip the buffet and choose low-fat, low-sodium or heart healthy dishes.

Childhood obesity is a problem that's not only influenced by what your kids eat, but also by how the family lives. And given that overweight adolescents have a 70 percent chance of becoming overweight adults, the time to address childhood obesity is today. It's easier than you think. Next week, we'll talk about how new skills at the grocery store can impact the health of your whole family.

 
Of the many statistics about childhood obesity, one in particular highlights the urgency of the problem: One of every three children in America is now considered overweight or obese, and childhood obe...
Of the many statistics about childhood obesity, one in particular highlights the urgency of the problem: One of every three children in America is now considered overweight or obese, and childhood obe...
 
 
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09:55 AM on 06/24/2010
It's the food! It's the food! The food!!! Or rather the fake food. Parents feed their kids pop tarts, pizzas, pancakes, cookies, juices, and a hundred other products made from refined flour, sugar, and salt. Only a very small percentage of children sit down to a table full of squash, broccolli, tomatoes, etc. Children must eat real food!!!
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LMPE
I connect the most dissimilar things
07:50 PM on 06/23/2010
As Bill Maher put it, "The food industry is doing more than any other to help the insurance companies keep us sick."
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SouthJerseySteve
Progressive isn't a dirty word.
03:50 PM on 06/23/2010
HFCS should be banned -- period. That's a start.
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Chas53
03:28 PM on 06/23/2010
The Processed Food Industrial Complex is everywhere, including Hospitals. 40% of "Top" American Hospitals have fast food restaurants in them. Our local hospital has at least 10 pop machines and how about this one; a potato chip machine outside the Heart Center (good way to get more customers). See "Sugar the Bitter Truth" by Robt. Lustig MD on youtube. Pop is probably one of the most toxic, obesity producing "foods" in our society. I say go vegan, milk is liquid meat.
02:19 PM on 06/23/2010
It's convenient that you don't bring up the fact that the government redefined obesity and overweight in the 1990s, thereby creating millions more overnight. Thus, any statistic about the rise of obesity needs to take this into account.
11:00 AM on 06/23/2010
It's the parent's fault. Nutritional neglect should be a crime, it's a form of child abuse.
02:21 PM on 06/23/2010
By your definition, almost everything is child abuse -- smoking around the children, drinking around the children, taking them for ice cream, and perhaps even just neglecting them by watching television. Not only is this attitude unAmerican, because it doesn't respect our liberty, but it would cost the country billions.
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SouthJerseySteve
Progressive isn't a dirty word.
03:52 PM on 06/23/2010
So you are saying that it IS okay to smoke around the children? My parents were heavy smokers when I was a child and I have asthma and lung problems that were proven to be caused by inhaling the second-hand smoke. This was in the 1960's when Ronald Regan was still advertising Lucky Strikes on TV.
12:48 AM on 06/23/2010
Turn off the TV, take away the video games, take away the computer and make these little fat kids go outside, and play, like we had to do, and then there won't be any more morbidly obese ten year olds. It is a very easy diet plan. It is called getting off your a$# a few hours each day.
10:56 AM on 06/23/2010
heck yeah! As a kid, our parents never wanted us in the house! They wanted us to play outside, and we never even wanted to play inside, unless it was sweltering hot outside with a chance of heat stroke. Parents never wanted us indoors because then they'd have to feed us snacks. So we rode bikes and ran around.
JStading
Trust me, I'm an attorney...
01:50 PM on 06/23/2010
Kid's can't do that anymore. It's now against the law to ride skateboards, skates, or bikes in most public areas, so kids who live in cities are confined to their homes. Even for kids in the suburbs, going outside is difficult when helmet laws, pad laws, and bike requirements limit their ability to go where they want to go.
02:19 PM on 06/23/2010
Nice way to talk about children!
03:25 PM on 06/23/2010
Nothing positive has ever come from sugar coating the truth and making excuses.
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organicconnect
07:06 PM on 06/22/2010
A key element missing from this is the blatant marketing of non-nutritious and frankly harmful foods to children. Add to this school lunch programs of junk food. We are creating the epidemic with a continual adherence to business as usual in the food industry. Our children are not the priority to these companies, their shareholders are. Maybe it is time for the shareholders that are parents to speak up and decide that food conglomerates need to generate their profits in an ethical, pro-survival manner. http://organicconnectmag.com/wp/2010/05/david-s-ludwig-md-phd-ending-the-childhood-obesity-epidemic/
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uriupina
03:08 PM on 06/22/2010
I am surprised that nutrition is not in the top of the list.

Heredity? Where was it before the supermarkets became stuffed with processed food and fast-food restaurants became a part of life?
Yeah, if both parents are overweight its more likely their kid will be too, but could it be because of parents having bad dietary habits and feeding their offspring same cr#p?

Inactivity is bad, but if you eat enough fresh veggies and fruits and cut on fat and sugar, do you think you'll get obese from that? I think kids al over the world are quite addicted to video games and tv these days. However, American kids still beat them in obesity. Why?

It is when you consume lots of carbohydrates, processed foods, fat and sugar AND live a couch potato life - sure you'll be fat! Guaranteed!

Another variant is that your diet is poor and fattening but at least you are active. May help to keep weight under control, but your health will still suffer. If you are not getting enough microelements and vitamins - keep jogging all you want but that wount fix this deficit, right?

Id say stay away from MSG, corn syrup and get back to good old tradition of home-cooking. You'll be both slimmer and healthier. Oh well, I know many people are sooo busy they don't have time for taking care of the most important things in their lives..like their own and their kids health.
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mombabytiger
Looking into the heart of an artichoke.
06:11 AM on 06/22/2010
I'm a parent and I'm certainly not dumb. But it is extremely difficult to change the palates of children who crave fat and sugar. That's why kids are so excited about going to McDonald's - their natural cravings are taken care of. Unless a kid has been raised with no sugar and no fast food and no fried foods, he or she is going to want it. Show me a kid who will opt for a bowl of cut of veggies over some chicken mcnuggets and I'll show you...somebody else's kids besides mine! And we parents are no better. Sometimes nothing but a burger and fries will do. Sad, but true.
10:58 AM on 06/23/2010
There were plenty of McDonalds around when I was a kid, in the 70s. And 80s. And plenty of BKs, and other fast food places. But it was a treat. We were excited to have our birthday parties there, because we only went there once every few months. At most, once a month. So we still got our cravings taken care of, but it never morphed from craving into daily diet.
02:43 PM on 06/23/2010
http://www.loveveggiesandyoga.com/

http://peasandthankyou.com/

Some motivation for you. It can be done. Plus, these are really interesting websites, whether you're vegetarian or not (which you obviously aren't). They both have many readers who aren't.
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Paul Buhler
12:57 AM on 06/22/2010
Its a simple equation....if the parents are dumb and fat, so are the kids! Sad but true! When the parents are too dumb to provide healthy food to their kids, fast-food wins every time! When parents are too dumb to provide ideas for stimulating activities for their kids, TV brings them up! dumb,dumb,dumb,dumb,dumb!!
10:59 AM on 06/23/2010
fanned!
02:41 PM on 06/23/2010
hear hear!
11:33 PM on 06/21/2010
Simple solutions:

1) Pedal powered TV's and computers.

2) Make sugar a controlled substance.
02:21 PM on 06/23/2010
The fascism on these comments is mind-blowing.
06:56 PM on 06/21/2010
In many low-income areas, teachers are the only educated professionals that a child sees on a regular basis. If the teacher is fat, that can cause a child to consider overeating to be acceptable behavior. School districts across the country should give teachers a sufficient amount of time to lose enough weight to get to BMI 27. Teachers who do not lose the weight should be fired.

A bill filed by a Hawaii State Rep. in 2005 is similar, but did not go far enough

http://www.kitv.com/education/4322022/detail.html
03:16 PM on 06/22/2010
This is very true, and a very good idea, but should teachers really be fired based off of...appearance?
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sushai
08:47 AM on 06/23/2010
And if the parents are fat, the children should be removed from the home...right?
01:04 PM on 06/23/2010
In extreme circumstances, when a fat parent raises an even fatter child.

Here's a story that broke about this time last year:

http://www.cbsnews.com/stories/2009/06/25/earlyshow/main5112393.shtml
06:24 PM on 06/21/2010
Once again, the association of inactivity with obesity causes people to jump to conclusions before any evidence is found through research. Yes, obesity and inactivity are ASSOCIATED. There is zero evidence that inactivity CAUSES or contributes to obesity, and yet there is quite a lot of research that suggests strongly that OBESITY CAUSES INACTIVITY. The issue is not activity. Research also shows that children will adjust their own activity, even if that means running up and down the stairs in the house for no reason at all, in order to achieve homeostasis. It makes far more sense to focus on what it is in the diet or the environment that is triggering the bodies of susceptible children to start storing nutrients and glucose as fat instead of utilising them.
08:28 PM on 06/21/2010
Really, you don't think there is a strong link that being inactive causes obesity? My husband eats about 2000 calories a day and yet is considered obese, why? Because he has a desk job and is inactive, when he was younger and more active, he was at a healthy weight. I was once overweight too and I owe much of my weight loss to being more active. We are meant to move around quite a bit throughout the day, that is how our ancestors lived, we are not meant to sit at our desks all day long. Its not healthy at all for us. And as to letting our children decide how active they should be, things are not like they were when I was a kid where me and my friends would explore and ride our bikes miles away from home. Kids now a days spend most of their free time in front of a screen, computer, tv etc. As responsible parents, we should get them up and active in a fun activity of course and not wait for them to decide to do it because many wont. I will agree with you though that diet is also important and we should do our best to feed our children well and cut out the junk that so many kids love to eat.
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briarus42
06:04 PM on 06/21/2010
growing up or out ?