Kids and Obesity: A Growing Problem

By Kenneth Cooper
WebMD Weight Loss Clinic - Live Events Transcript

Obesity rates in children continue to climb. Eating more and exercising less are the two most commonly mentioned culprits, but what are the best ways to reverse this trend? On May 25 at 4 p.m. ET (1 p.m. PT), come discuss managing your child's weight, when to be concerned about health problems, and who to turn to for help with our guest, Kenneth Cooper, MD, founder of the Cooper Clinic.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only

MODERATOR:
Welcome back to WebMD Live, Dr. Cooper. Please give us an overview of the growing obesity problem in our younger population.

COOPER:
It's estimated that 10% of children, or at least 155 million youngsters, are overweight or obese. It is most severe in the United States, where the prevalence of obese children aged 5 to 17 is about 10% and more than 30% are overweight. Ten percent to 20% of children in Northern Europe have prevalence to being overweight, and once a health problem for the industrialized world, is now spreading to developing countries.

Along with the increase in childhood obesity we're beginning to see an epidemic of adult onset, or type 2, diabetes in children 9 to 12. If that child develops diabetes before they're 14 years of age they are shortening their life span by 17 to 27 years. This has reached such a state that this may be the first generation in which the parents outlive the children.

I believe the reasons for obesity are as follows:
  • A lack of physical education programs in most schools in America. Only one state has a mandatory K-12 daily requirement for PE, and that's the state of Illinois.
  • Children are no longer walking to school or riding their bicycles to school; they're being carried to school or they're driving themselves.
  • Children are spending anywhere from 25 to 35 hours a week watching television, playing video games, or sitting at a computer.
  • This is the fast-food generation, with an estimated 49 million Americans eating at fast-food restaurants on a daily basis.

So the question is, is my child obese? For adults, we use the body mass index, which is your weight in pounds multiplied by 703, divided by the height and inches squared. In adults, a body mass index of 18 to 25 is normal weight, 25 to 30 is overweight, and above 30 is obese. We now have an estimated 64.5% of adults who are overweight, of which some 31% are obese. Projections are by the year 2010 more than 50% American adults will be considered obese.

With children, we use the same formula for determining body mass index. We consider a child obese if they're above the 95th percentile. That varies in boys 2 years of age to 10 years of age from 19 to 22 BMI. In girls it's a BMI of 19 to 23. From 12 to 20 years of age in boys, it's 24 to 30. For girls, it's from 25 to 31.


"In June 2002 the American Academy of Pediatrics made these recommendations:
Two hours is a safe limit for TV; greater than two hours increases the risk for weight gain."

Unfortunately, most adults don't consider their child obese. Studies released from London said that parents are so accustomed to seeing overweight youngsters that many fail to realize when their own children are obese. A third of the mothers and 57% of dads actually saw their obese child as being normal weight. Three-hundred 7-year-old children and their parents were asked about their perception of body size. In one-third of mothers and half of fathers who were either overweight or obese rated themselves "about right." When the child was a normal weight according to the BMI, most of their parents, regardless of their own size, knew there was no problem, but when the child was overweight, only a quarter of the parents knew it, and when the children were obese, 40% of the parents were not concerned about their child's weight.

What can you do to improve the situation in your children? First of all realize that foods of childhood influence lifelong health. Height within the first five years is based on genetics and nutrition. Bone and teeth health is developed by adolescence. Weight, the number and size of fat cells a child has before 6 years of age, are set for life, so a fat child ordinarily becomes a fat adult. Food preferences and eating habits are formed in childhood.

Recommendations:

  • Cut back on juice and high-sugar drinks.
  • Active kids are more likely to have healthy weight and less likely to be overweight adults. Bone density developed in a young girl from birth to 25 years of age will determine primarily whether she will have osteoporosis as an adult. Parents should sign up children for teams and activities and make plans so they can be with friends in sports.
  • No eating while watching TV. In one study TV watchers gained body mass index and waist circumference, and kids who watch less TV ate fewer fatty foods. In June 2002 the American Academy of Pediatrics made these recommendations: Two hours is a safe limit for TV; greater than two hours increases the risk for weight gain. Kids who watch more than three hours of TV had 39% more body fat than kids who averaged nearly two hours.
MODERATOR:
Tell us more about the background for these recommendations, and what we can do to implement them. For example, it's easy to say cut back on juice and high-sugar drinks, but kids seem to get a taste for them so early in life! What's a parent to do?

COOPER:
Kids naturally like sweet and salty foods. They reject the unknown, the unfamiliar. "It may be good for me, but if the taste doesn't taste good, I'm not going to eat it," is the attitude of most children. Use a low-key approach. Children want what mom and dad are eating. Don't eat junk food yourself. Set a good example. Put balanced meals on the table, and offer foods 15 times, not just two or three. Control food in the house; pack the refrigerator and pantry with healthy options. Keep undesirable foods out of the house; restricting foods leads to thinking "I better eat it now, it's my only chance."

Those are just some things that have been suggested by Dr. Berenson, from the Tulane University Bogalusa Heart Study. In this longitudinal study following 14,000 children for more than 30 years, he made this comment: Grownup problems begin in childhood. Fatty streaks are seen in the aorta as early as 3 years of age. Damaged coronary arteries are seen by 10 years of age. So obesity in children is a major health problem that is getting worse, not better.

As recently as May 4, 2004, in the Journal of the American Medical Association , two different studies pointed out that U.S. kids suffer blood pressure rises (showing an increase in blood pressure). These were more than 5,000 children 8 to 17 years of age, followed from 1988 to 1994 and again from 1999 to 2000. They found that the systolic, or upper, pressure increased 1.4 millimeters, and the diastolic, or lower, pressure increased 3.3 millimeters. Increases occurred in both readings among black, Mexican-American, and white boys and girls of all ages, but the Mexican-American and black children recorded average levels two to three points higher compared with the whites.

Another study showed that caffeinated soft drinks and other beverages might play a role in pushing up blood pressure levels among black youths, but for Mexican Americans the higher readings were due largely to a sharper increase in the numbers who were overweight. So diet and exercise are both extremely important if we're going to be solving the problem of obesity in children.
"Fatty streaks are seen in the aorta as early as 3 years of age. Damaged coronary arteries are seen by 10 years of age.
So obesity in children is a major health problem that is getting worse, not better."



Let's talk about TV viewing, since it's a major problem with obesity. What about other problems, such as attention deficit in children? This comes from the April 4, 2004, issue of the Journal of Pediatrics . They point out very young children who watch television face an increased risk of attention deficit problems by school age, suggesting that TV might overstimulate and permanently "rewire" the developing brain. For every hour of television watched daily, two groups of children, aged 1 and 3, faced a 10% increased risk of having attention problems at age 7.

The American Academy of Pediatrics says that children younger than 2 should not watch television. Not only is it related to attention deficit problems, but it's also associated with obesity and aggressiveness. In this one study, 36% of 1-year-olds watched no TV, while 37% watched one to two hours daily and had a 10% to 20% increased risk of attention problems. These are 1-year-olds! Fourteen percent watched three to four hours daily and had a 30% to 40% increased risk of attention problems. Among 3-year-olds, only 7% watched no TV, 44% watched one to two hours daily, 27% three to four hours daily, 11% five to six hours daily, and 10% watched seven hours or more of TV daily.

The average child sees 10,000 food commercials each year, mostly for candy, fast foods, soft drinks, and sugary cereals. Spending on drugs to treat children and adolescents for behavior disorders, including depression and attention deficit disorders, rose 77% from 2000 to the end of 2003. Doesn't sound like a pretty picture, does it? But that's exactly what's happening in America today.

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