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 onlyMODERATOR:
Welcome back to WebMD Live, Dr. Cooper. Please give us an overview of the growing obesity problem in our younger population.
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.
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.
- 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.
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?
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.
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.
PE is being cut more and more every year, and my kids are not competitive and not skilled enough to play on a team (teams around here are very competitive and really select; if you aren't good, you sit on the bench which does no one any good).
What can we do to encourage our kids to be more physically active? We already restrict television viewing to one program a day. Can you suggest specific activities?
You cannot rely upon the PE programs or the school or other type of sports programs to meet the requirement of physical activity with your children. As I said with eating, you as parents will have to set the example. Our studies show it doesn't take that much activity to get a tremendous return on investment. As an adult if you were to walk briskly 30 minutes, three times a week that can reduce death from diabetes, strokes, and cancer by some 58% and can increase your life span from up to six years.
So if parents can just spend 20 to 30 minutes involved in some type of activity with their children, whether walking, or sports that may be the most beneficial thing they can do in the early years. You can't rely upon sports or PE, because it's simply not going to work.
MEMBER QUESTION: My son is 11 years old and weighs 143 pounds. I have him on a low-carb diet but he is not losing weight. What am I doing wrong?
The problem is low carb is not always low calorie; it's calories that count. It's the calories you consume versus the calories you burn that determine whether you gain or lose. You cannot rely on low carb; it must be low calorie.
I think it's important the family work with the child with professional help, if necessary, to help the child control his weight so he doesn't become an obese teenager and adult.
Again, the only way you can lose weight and keep it off, whether you're a child or adult, is lifestyle changing, and that must include both caloric restriction and physical activity. That's the only thing that will work in the long term. I strongly recommend a balanced diet, not a high-protein or high-fat diet, and not strictly a low-carb diet. The rule of thumb I use for a diet is five is fine, nine is divine. That's the number of servings of fruits and vegetables we should consume daily. But the average American adult gets 3.1 servings, the average American teenager, 1.6. That will not work, and there will be problems in the future.
Would you recommend that mom and son find a physical activity they can do together?
If you can set the example, exercise with your children, do things today together. We have programs in our aerobic center here in Dallas designed for both children and adults: soccer; basketball; swimming; all sorts of things. If the parent and child are overweight, both can benefit from restricting calories and exercise. Do it together and you will enjoy a bonding you never dreamed possible.
Do it together and you will enjoy a bonding you never dreamed possible."
MEMBER QUESTION: I'm not a good eater. I don't eat fruits and veggies. What can I do?
Just don't give the fruits to the child one, two, or three times; give them 15 times. Don't give up; don't let them be picky. Eat the fruits and veggies yourselves so, again, the children can follow your example.
Keep trying until you find something you like; there is such variety, there is bound to be something you'll enjoy.
There's a whole controversy of the school lunch program and vending machines. Some people feel that the vending machines in schools and the school lunch programs are the cause of American children obesity. I can safely say you could take all the vending machines in schools and drop them to the bottom of the ocean and it would not have one impact or effect on the obesity problem. What we need to do is put better products into the machines, and educate and motivate the children to select the products. That's the only way we'll resolve the problem.
You might say the kids won't select these foods. A study published recently in Great Britain took 12 schools and took all the candy, snacks, and soft drinks out of the vending machines and replaced them with 100% juices, milk, flavored milk drinks, and water. They followed the children for six months. Only two schools lost money, two schools made the most money they'd ever made, and the others at least broke even or made money. An example occurred in a school in White Fish, MT. The principal was concerned about what the kids were getting in the vending machine. He decided on his own he would eliminate pop and candy and replace it with 100% juices and fruit. For the first couple of weeks the children rebelled to the highest, but now they're selling more than they ever sold. If the children don't have a choice, they can learn, they can adjust, and they'll be better for it.
I'm convinced children are more receptive now for the need to do something in changing their diets, selecting better foods, and increasing their physical activity than they've ever been before. I think that we as professionals have a window of opportunity to fill that need that's not going to remain open very long. That's why, for the last two and a half years, I've been consulting with the fast-food industry, primarily PepsiCo and their subsidiaries of Tropicana, Quaker Oats, Gatorade, Aquafina, and primarily Frito-Lay products. I'm happy to say we've now established a new standard.
For example, the new Baked Lay's potato chips have been improved to the extent that per 1-ounce serving, the calories have dropped from 150 down to 110; fat has been taken from 10 grams to 1.5 grams. The saturated fat has been taken from 3 down to none. All trans fats have been reduced completely, and the sodium from 180 milligrams down to 160 milligrams. A total of nine different products have been modified, but all of the trans fats, which without question is the worst fat anyone can consume, have now been eliminated from all Frito-Lay products. They're the first company to do that. As a result, 55 million pounds of trans fats will be removed from the American diet over the next 12 months. It cost Frito-Lay $37 million to retool and take out the trans fats. They did that without increasing the price of the product.
Other companies are beginning to follow the example of Frito-Lay, because the American people are demanding it. My hope is the American children will be leading the way.
Dr. Cooper, we are almost out of time. Do you have any final words for us?
I want to thank the members of the audience who give me an opportunity to convey information to them that is so important. We will never resolve the obesity problem in America, which could bankrupt us in the not-too-distant future, by relying on physicians, the government, or our teachers. We must accept the fact this is a personal responsibility.
I challenge Americans to take an inventory: Are you overweight? Do you know your body mass index? I gave you guidelines earlier: Body weight multiplied by 703 divided by your height by inches squared. Does its meet the criteria for children 2 to 20, or what about adults? If it's over 25, you're overweight; above 30, you're obese. If you are overweight according to those standards, lose weight. Here's how:
- First of all, restrict the calories. If you cut your calories by 500 calories a day you'll lose 1/2 pound a week. With 1,000 fewer calories a day you'd lose at least a pound a week.
- Consume the calories as follows: 25% for breakfast, 50% for lunch, and 25% for the evening meal, if you need to lose weight.
- Eat as a family. We talked about that earlier.
- Try to eat before 7 p.m., because after that you're more likely to store fat.
- Don't snack unless you snack on nutritional foods, fruits, and vegetables.
- Exercise at the end of the day, prior to the evening meal. Not only does it help with stress, it helps with the evening meal and helps keep the caloric count down.
If you follow those guidelines, it will work. Remember, regardless of your weight, if you lose 10% of your total body weight that will improve your health. And studies clearly show that people who are fat and fit are healthier than people who are skinny and sedentary. I'm not endorsing obesity; I'm just telling you how dangerous it is to be totally sedentary, and we have at least 50 million adults in this country who are totally sedentary, who are shortening their lifespan, and increasing deaths from all causes in an unnecessary way.
It's your life. I encourage you to enjoy it to the fullest. At 73 years of age I'm still walking and jogging 12 to 15 miles a week, still working 60 to 70 hours a week, and enjoying fantastic health. I hope you all can do the same.
Thanks to Kenneth H. Cooper, MD, for sharing his expertise with us today.
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