As many of you already know we see a large number of children in our practice. Some of their parents bring them in for earaches, some for general wellness care, but a disturbing increase in joint pain in children who do not have any particular condition to cause it other than their body size has been seen lately. When I was a child leg pains were explained away by the growing pains story, but today we see an alarming number of obese children whose bodies hurt them. As a matter of fact, juvenile obesity is seen by some in the pediatric arena as an epidemic.
Earlier this week, citing the juvenile obesity rate in the United States as a staggering 20 percent, Governor Arnold Schwarzenegger of California endorsed legislation that will remove junk foods from California schools. Machines full of empty calories like candy, chips, cookies, and soda will soon be replaced by vending opportunities to buy fresh fruit and yogurt. Milk and bottled water will move into the places of sodas and high sugar cool-aid type drinks. Other school systems should take note and make some of the same modifications. As I started taking a serious look at this subject I found some facts that would make me pay attention if I were a parent.
Researchers at the State University of New York at Buffalo did a study that shows children as young as seven years old having early signs of arterial diseases. The carotid arteries of 100 obese children were studied and there was evidence of arteriosclerosis, or hardening of the arteries. Their arteries had thickened and become stiff already. These same children had high levels of cholesterol, had high blood pressure, and were displaying early changes associated with diabetes. The Discovery Health Channel featured a 17 year-old boy this week who weighed 400 pounds and was having to undergo cardiac bypass surgery. Many sources are calling the issue of obesity in children and adolescents an epidemic which will strain our future health care system and result in a very unhealthy older population. While only 20 percent of 4 and 5 year olds who are obese remain so into adulthood, more than 65 percent of adolescents who are obese become obese adults. Obesity can be defined as being 20 percent over the normal weight for a child’s height and body style. That is not hard to achieve.
Why are so many children obese? There are no definitive answers but it isn’t hard to see that an increase in sedentary behaviors such as internet surfing and video game playing could be to blame. It was bad enough in the 60’s when children started watching Leave It to Beaver after school but when the internet and Play Station came along the fate of physical activity was sealed. My mom had to force us to come inside for dinner every night when we were playing outside with all of the other neighborhood children, but now you have to practically pay a child to do anything outside after school.
The solution is simple but not necessarily easy. Parents have to limit the sedentary time their children spend and fill it with activity. Outside activities tend to expend more energy than inside activities. Any water-based activity is best for an obese child partially because their bodies are submerged and they are not in full view of others. They will be less inhibited and will do more. They will be more inclined to jump around and play in the water when their bodies are not fully visible than to exercise with slimmer children in full view. It might also help them if you find a group of other obese children for them to exercise and play with. If limiting food intake needs to be a consideration, be very careful not to be too strict because too serious a limitation on caloric intake can lead to growth stunting. If the body feels deprived it tends to lose muscle mass, and that is definitely detrimental to the ultimate goal of greater health. Limiting the intake of junk foods and empty calorie foods like French fries is always a good idea. It is safe as a general rule to decrease caloric intake of an obese child by 200-300 calories a day while you are integrating behavioral changes and increasing physical activity.
Parents, whatever you do please try to focus on increasing health rather than improving appearance. The appearance will take care of itself in the process, but self-esteem can be damaged if you tell your child that he or she is fat. Stress the importance of building an overall healthy lifestyle and developing healthy life strategies that can be carried forward into adulthood. Focus on increasing physical activity rather than becoming the “food police” and harassing them about what and how much they eat. You are ultimately in control of what goes across the checkout counter at the grocery store. If you have a child who has a weight problem do him or her a favor and make better buying decisions for healthy food options at home. It could be one of the best gifts you give. Treat your body well.