Shrinking Our Super-Sized Kids: Who's in Charge Here?

Kathleen Sebelius, our new Health and Human Services Secretary, made headlines the other day at a "Weight of the Nation" conference when she said that about 33 percent of American kids today are overweight or obese.

But in my Central California pediatric practice, the figure is much higher. I see about 40% Latino and 35% Anglo patients as well as many Hmong/Cambodian, Laotian, Filipino, East Indian, and Native American children. Child obesity is rampant among every one of these groups, and I shudder to think about the future health calamities these kids are going to be facing if nothing changes. Their physical, mental, and emotional health is at stake.

This isn't just a personal issue that fuels unhappiness, depression, even teen suicides. It's also a serious economic issue, as this week's CDC statistics on the medical costs of treating obesity point out.

But here's what I see day after day in my practice. A mom brings in her 5-year-old son. He weighs 90 pounds, which would be healthy if he were twice that age and almost a foot taller. When I ask about any family history of metabolic disorders, she says, "I think so. A lot of my side of the family are overweight, even though we're not big eaters....I think he has another condition going on that's causing this. Can you test him?"

Then she takes another sip from her super-sized plastic cup of soda. The little boy has one too. But when I ask he eats much junk food, she says no.

I estimate that the number of obese kids coming into my office has mushroomed over the past 15 years. It's only to be expected that a high-school football player might tip the scales at over 200 pounds -- but to see a freshman weighing in at 300 is shocking. Not to mention that many of the young teenage girls I see are obese too. They come in seriously depressed and unhappy and ask for referrals to gastric bypass surgeons. Ten years ago, I couldn't find any specialists who dealt with obese teenagers, but these days I get several brochures a week from these doctors informing me of their services.

Sebelius was also quoted as saying that First Lady Michelle Obama is planning to take on child health as an issue. I'd like nothing better than to sit down with her to discuss the following "talking points" (as the politicians say) regarding some of the basic causes and some workable for this national crisis.

• Parents, take responsibility. Almost invariably, when obese kids show up in my office, they're there with a parent who is obese as well. These don't say no to their kids' demands for junk food and they certainly aren't setting a good example with their own junk-food consumption. These kinds of parents also let their kids choose where and when to eat. I've actually had parents tell me that they go to three different fast-food places every night so all their kids will end up getting what they want. They don't seem to care about the calories as long as the kids are happy and don't demand much attention. Besides, the parents themselves are usually too much in a hurry to get home and sit in front of the TV watching their favorite shows -- while they eat some more.
• Stop denying the obvious. The major factor in child obesity is totally obvious: kids today are fat because they eat too much (and move too little). But I see parents every week who insist that I test their kids for possible medical issues that are causing the problem. These parents also deny that they buy much junk food or go out for fast food more than "occasionally," but when I go shopping at the grocery store and run into them, their carts are piled high with junk food. Parents also tell me, "My kids don't watch any more TV than any other kid." That may be, but with my patients racking up to 6 hours a day of TV watching or in front of the computer, that's still a lot of sedentary living. But they prefer to blame restaurants for serving too much food, not their own lifestyle.
• Are our own fears fueling our children's obesity? Think about it -- we've turned into a frightened society. We don't let our kids outside for fear that a deranged stranger may snatch them away -- never mind that in most abductions, child murders, or child-abuse cases, the perpetrator is a family member or family friend. Even if we don't live in gang-infested areas, we're scared of drive-by shootings. We fear that our next-door neighbors may harm our children, but we've never made any effort to get to know them ourselves. We're a nation of strangers who are fearful of each other.

So instead of allowing our children to explore and sample life in the "outside world," we keep them inside, feed them junk food, and use TV as a babysitter.

Here are just 3 simple solutions that we as parents can try -- if we're willing to do a better job of stepping up to our responsibilities.

1. Let's take back our neighborhoods and allow our kids to roam around picking up other kids as they go. I firmly believe that kids can and will protect each other just as well as adults can. It's when they're isolated and alone that they're vulnerable.
2. Support your family's physical health and your social ties with your neighborhood by going out on family walks. For one thing, when it comes to sheer physical exercise, kids respond better when they're given a good example that they can model. "Do as I say" while you sit in front of the TV isn't going to cut it. Also, it's good for them to see us walking around and stopping to chat with our neighbors. Getting out into our neighborhoods will foster a greater sense of community and mutual protection -- if you know your neighbors and they know you, they'll look out for your kids just as you'll start looking out for theirs.
3. Turn off the TV (and ignore the kids' protests). Also, try to make TV a shared, whole-family event instead of a taken-for-granted routine where each member of the family is isolated in a one-on-one relationship with their own TV set night after night. Limit TV viewing to a few favorite shows each week. And go out for walks.

Comments

[marybluesky]

And like it or not, our free-enterprise / capitalism at all costs attitudes have brought us to the industrial food and fast-food mess that we are in. It's not true that people who are constantly bombarded with junk food easily and cheaply available will instead opt to buy healthy fruits and vegetables and invest the time and work to prepare them. Education can help individuals make better choices, but we also need to change the mix of what's available, what's served in our schools and what is subsidized by our government.

[marybluesky]

I agree with the doctor about the causes of obesity. And I too used to blame parents for keeping their children inside thinking it was due to an over-estimation of dangers to be found outside. That was until my daughter and her husband found themselves in a poorer neighborhood and even with sidewalks and room to play outside, found that it is just not safe to be outside. Period. In the last 2 weeks: Their house was one of 4 robbed on their block. There are open drug deals and even a shooting. And a mom getting out of a car with an infant was openly robbed. So, no, it's not an option to let children play outside. My daughter sends her 4 year old to stay with us 3 days a week so he can play outside and they are desperately looking for a new place in a decent neighborhood. She takes them to parks in nicer areas, but can't really allow them out at home. Until the "good people" in a neighborhood band together and refuse to allow the hoodlums free run of the neighborhood and start cooperating with police by reporting crimes they see, there will be neighborhoods where children genuinely can't go outside.

[Idytme]

Something that always gets my blood boiling is seeing an obese child, especially with an obese adult. I've seen the TV specials, I understand that there can be special metabolic issues that some parents deal with. I suspect that is under 1% of obese kids. What you do not mention in your article is that is it confirmed that kids still grow fat cells, so an obese kid is going to be an adult with more fat cells in their body than an adult that was slim as a child (although adult *might* make fat cells too). Each fat cell has a "set point", a perfect little fat cell, under that they are in "starvation mode" with all the hormones that involves, and over that the fat cell is...well.... a little fat. So a kid who has alot of fat cells that decides later in life to slim down could be looked upon as overweight when every single fat cell is screaming "I am starving!!!". They are set up to be fat for life and that is not only cruel emotionally to a child but sets them up to have all kinds of health problems, one of the worst being Type II diabetes.
Studies have shown that a huge % of adults (like 50%?) with obese children do not consider their kids obese. Outside intervention is necessary and schools and pediatricians have started to fill this role, but should we put the whole burden on them?

[Rebecca Sylvester]

I think that your three point prescription for this problem is pretty good --but, frankly, your condescending attitude and obvious disgust of fat people really stinks.

I find it really difficult to believe that your patients and their parents bring super-sized soft drinks into your office during exams, or that you ever run into your patients at the grocery store where they are loading up their carts with junk food. This issue can be addressed sensitively without hyping up negative stereotypes about fat people.

And furthermore, if you make the snap judgment that all of your overweight patients are suffering from negligent parents, aren't you likely to misdiagnose the kid who really suffers from, say, a thyroid problem?

[Idytme]

I very much doubt the integrity of this doctor. It is *very* easy to run into patients when you live in a smaller town, or your patients live in the same area you do. And people do all kinds of things in doctor's offices. They go from the extremes to wearing their Sunday Best, to slogging in however it is easiest for them. For some parents, rather than telling them they need to go to the doctor, they bribe them first with fast food.
I have noticed very many posts on Huf post, no matter what the variety of subjects, there have been many posts where the subject at hand wasn't as important as how their kids dealt with it. If the kids gave a tantrum, it was the most important thing. (one example was parents hating homework *only* because their kids didn't want to do ti and it became an issue, *not* because it was too much of a burden) I have always held my tongue, never to assume I could interject between the parent/child role. But being a parent is a tough job, maybe no more tough than saying "no". Which doesn't mean that if a child has a weight issue that "no" can't be met with a heck of a lot of empathy and support for another way of doing things. Just as in many life situations.

[TheBlackCat]

I agree completely.

Also I have noticed that a lot of times just not feeding your kids any junk food when they're babies and toddlers really makes a difference. I was never allowed candy or soda or any junk food (well, except on a special occasion like a party) when I was very young, and I simply never developed a taste for it. As I got older I WAS allowed these things, but in moderation, and with my parents explaining why these things were "sometimes foods" and not "everyday foods." But I hardly ever asked for them anyways, and to this day I hate soda and most processed and junk foods- they just taste gross to me. And i think it's because I was simply never given these things while my young palate was developing.

Also, having a thyroid condition is no excuse. That is one big difference I noticed between Europeans in America. In Europe, for the most part, if a patient had a thyroid or metabolic condition, the patient (or their parents in the case of children) just worked EXTRA hard to control their or their child's weight, and they did so successfully.

In America, the second someone hears they have ANY excuse, most patients will cling to it, saying "there's nothing I can do, I have a thyroid/ metabolic/ glandular problem." when in fact most Europeans didn't use that as an excuse, they used it as motivation to be even more healthy and active.

[TheBlackCat]

No, sorry, I work in a hospital which is adjoining to several other hospitals. There is a large food court right in the center of these hospitals that has both fast food and healthier food options. I see patients all the time either eating fast food there, in an area where many doctors pass through, or eating fast food in the waiting rooms or drinking sodas in the doctor's office after they've picked up at the food court. Of course, I find it deplorable that there are so many fast food options available in a neighborhood where the ONLY businesses there are hospitals.

[TheBlackCat]

"hyping up negative stereotypes about fat people.:"

okay, but it's NOT a stereotype. You get obese from eating too much, making poor food choices, and not being physically active. Those are the reasons that people become obese. Would you rather the doctor lie so as to not hurt anyone's feelings?

Being fat doesn't make you any worse a person than anyone else. I'll take a nice fat person over a mean thin person any day of the week. It's ridiculous to judge someone's character solely by their weight, because that is just one aspect of their life. Just because you over eat and are lazy...it's not like those are the worst attributes in the world, and shame on anyone who treats you any differently for that alone.

But at the same time, we have to be honest about the problem of laziness and gluttony in America. As someone who has lived in several other countries besides the US, and someone who works as a healthcare provider...the state of our weight is deplorable, and it is caused by a sedentary lifestyle and poor diet, NOT by magic.

[Mnemanth]

"Parents take responsibility."
That could be the sum of your article.
Case in point: Reading posts here where parents begin with, "I went to the drive thru and they..." Stop right there! You, parent, went to the fast food place. Don't blame the fast food place for selling...yep, fast food!
Stop buying this garbage and feeding your kid with it. Your kid doesn't want to eat healthy choices? Send them to bed hungry!

[CTModerate]

I agree 300%!!! Two years ago when I resolved to lose weight, I decided to bring the whole family along. I didn't make wholesale immediate changes, but over time have moved all of them (with some protest) to a healthier diet (althought there is still ALOT of work to do there).

I also decided I needed to get everyone moving more, by setting the example myself. To that end, I started taking regular hiking trips in a local nature conservancy with my children. We had always alpine skied as a family, but I introduced everyone to much healthier cross country skiing as well. We also roller blade, play tennis and ice skate together as well.

The end result is that I've lost 40 pounds, and my children are probably much better off in the long run. http://losingweightafter45isabitch.blogspot.com/

[susiesorority]

My 9 year old isn't the least bit fat, but try getting her or any kid to prefer broccoli or an apple to fries or apple fries (I drove through recently for coffee--really insidious on Burger King's part.) Much of our health care costs could probably be lowered with dietary change, but try taking on Big Food. They know what they're doing and it's every bit as criminal as Big Tobacco, just kills slower.

[avicenna]

This is a problem for American society - not just individuals. I am from Vancouver, BC (Canada), and I choose to bike or walk almost everywhere I go. My City makes it very easy for me to be active and get around without a car - and unprocessed, healthy food is relatively affordable and not taxed (unlike processed snack foods). This has likely played a major role in enabling me to remain at the lower end of the healthy BMI range despite being a busy medical scientist who spends a lot of time in front of a computer. I just came back from a conference in the suburbs of Chicago and was stunned by the size of the people and the fact that there wasn't one soul (other than myself) who was on the sidewalk - this is because, I came to realize - that it is not realistic for most people to get anywhere without a car. I was (thankfully) unaware of this fact as I had been trying to find a local courier service. Drivers driving by were all staring at me as I walked all by my lonesome - and I kept looking around trying to figure out what they all found so interesting. Apparently it was me - a strange walker who was relatively free of excess mass compromising my ability to use my feet for what they were designed to do. Gluttony is on the hit list for a reason.

[coolmaiden]

You should have ventured into the city; I would have taken a walk with you :)!
I don't own a car either. When the mercury is above 50 degrees F I don't take public transit. My own mother was aghast when I told her I would walk the five blocks from her house to the salon in south Kansas City. Urban sprawl is just as much to blame as crappy food for our expanding arses, IMO.

[RickAndrew]

Obeisity is a pure act of negligence. It comes down to a complete lack of responsibility of the parents. It's crazy to think that these parents condone such careless behaviour and mindless eating habits. I'm not sure why people just don't get it yet? Fat American's can only seem to point the finger at every other thing before them. America has habituated themselves to a life of luxury and convience. We have come to think that this is the good life everyone deserves to live. Yet it is now come to a point where our lives our taken for granted. People only see life on the surface, they don't try to look beneath it. Most people see food and all they think about is the satisfaction and how good it tastes. They can't seem to grasp the underlying effects it will have on them. We need to keep our lives in equipoise. We need to allow kids to live freely. Not chained to video game consoles. There is a whole beautiful world out there that should be experienced. I make it a point to get outside and exercise everyday and experience the world. This reminds me that I am here and I am alive and not stuck inside a bubble that has been created for me.

[DavidMG]

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[Kim Stagliano - Huffpost Blogger]

I have a "friend" (no, it's not me or my immediate family) who was told her daughter has "metabolic syndrome." She's 11 and weighs 190 pounds. Mom says the docs rans tests and found she's "allergic to carbohydrates." The child is on a recommended diet of processed low carb foods and lots and lots of meat. What is metabolic syndrome and does it come before or after obesity? Is it a euphemism for obesity or pre-diabetes? The Mom and Dad are both overweight and smoke. The child is in therapy. Is her lot in life cast? It upsets me. She's a sweet kid. I can imagine her life at school is difficult. Thank you.

[avicenna]

The metabolic syndrome is the state the body is in "pre-diabetes". It is officially diagnosed by having at least 3 of the following:
Elevated waist circumference:
Men — Equal to or greater than 40 inches (102 cm)
Women — Equal to or greater than 35 inches (88 cm)
Elevated triglycerides:
Equal to or greater than 150 mg/dL
Reduced HDL (“good”) cholesterol:
Men — Less than 40 mg/dL
Women — Less than 50 mg/dL
Elevated blood pressure:
Equal to or greater than 130/85 mm Hg
Elevated fasting glucose:
Equal to or greater than 100 mg/dL

I'm not sure what the doctor meant by "allergic to carbohydrates" - unless they were saying she is insulin resistant. This is a pretty serious state as it is one small step away from from impaired glucose tolerance which is even a smaller step away from Type 2 Diabetes. Eleven is an awfully young age to have this disease that will significantly affect quality of life and chronic health conditions - that will affect everything from reproduction to mood disorders and vision.