What can we do to fix the epidemic?

For the past several years, there have been numerous reports on the fact that childhood obesity is increasing and has reached the level of being an epidemic. This is very concerning because of all the health risks that accompany obesity, which used to be only seen in adults, are now showing up in children. Why has this happened? What should we do to help correct it?

1216 Childhood Obesity TNIf you look at data from the 1960s and 1970s, only 13% of adults and 5-7% of children were obese. Now, 32% of adult men, 36% of adult women and 17% of children are obese. According to the Center for Disease Control and Prevention (CDC), the prevalence of obesity for children and adolescents between 2-19 years old is 18.5%, which means that about 13.7 million children and adolescents are obese. If you break the data down to age ranges, then 13.9% of 2-5-year-olds, 18.4% of 6-11-year-olds and 20.6% of 12-19-year-olds obese. The information also shows that childhood obesity is more common among certain populations, with Hispanics (25.8%) and non-Hispanic blacks (22.0%) having higher prevalence of obesity than non-Hispanic whites (14.1%) and non-Hispanic Asians (11.0%). The sad thing is that there have been intense clinical and public health focus on obesity and weight-related behaviors in the past decade, but the most recent study results suggest these efforts have been unable to counteract the epidemic on a national scale. Why is this such a problem?

It’s because obesity kills. Currently, it’s the second leading cause of death in the United States and is likely to become the first. Also, it’s the most common chronic disease of childhood. The conditions that are associated with obesity were once considered adult problems. These conditions, such as diabetes, high blood pressure, high cholesterol, asthma, sleep disorders, depression, low self-esteem, nonalcoholic fatty liver disease (NAFLD), cancer and bone fractures, are being diagnosed in children more frequently. This means that the physical complications, like heart attack and stroke, associated with obesity are appearing sooner as well. Not only do obese individuals die earlier, but their quality of life while they’re alive is severely compromised. Statistics show that children who are affected by obesity are 70% more likely to be obese as an adult. Unless corrected, the increase in obesity, particularly among children, threatens to shorten life expectancy in the US and will increase the cost of healthcare significantly.

How did this happen? Why are so many children overweight? There are several factors that contributed to the epidemic. In 1975, only 47% of women with children under age 18 worked outside the home. By 2009, the number had increased to 72%. This means that there is less time for home activities, such as food preparation. One way that this is evident is the amount of a family’s food budget is spent on eating out. In the 1960’s, only 21% was spent on dining out, but by 2008, that had risen to 42%. It’s estimated that approximately 40-50% of every dollar that is spent on food is spent on food outside the home. One recent survey found that 30% of children between 4-19 eat fast food daily. While fast food and convenience food (food that doesn’t spoil quickly) is inexpensive, it’s high in calories and low in nutritional value. Also, fast food restaurants are more prevalent in ethnic-minority neighborhoods and the fast food industry disproportionately markets to ethnic minority youth. Another factor is that the consumption of high fructose corn syrup, which is a main ingredient in soft drinks and other sweetened beverages, has escalated from 38.2 pounds per capita in 1980 to 868 pounds per capita in 1998. Furthermore, the annual US production of soft drinks in 1942 was 90 8oz. servings per person and by 2000, it was 600 8oz. servings. As a nation, we’ve changed not only the types and quantities of food we eat, but decreased the amount of physical activity we get and engage in more passive leisure-time pursuits. Beside diet and lack of physical activity, the other factors that have influenced the childhood obesity epidemic are environmental, which includes heredity/family of origin, psychological issues and socioeconomic status.

There’s no question that the country’s dietary patterns have changed significantly in the past few decades. When we regularly eat high-calorie foods, such as fast foods, candy and desserts, and ingest sugary drinks, like sodas and fruit juices, the number of calories we consume per day is significantly more than previous generations. In addition to having cheap and easy access to this low nutritional value food, the prevalence of “super-size” options and “all you can eat” buffets, creates a tendency to overeat. So, we’re taking in more of these “empty” calories than we should. Another factor is that sodas and other sweetened beverages are readily available in schools across the country. Since the consumption of soda by children has increased by 300% in the last 20 years, it’s estimated that 20% of children who are currently overweight are due to excessive caloric intake from beverages. Also, vending machines that are selling unhealthy snacks are in almost all of the middle and high schools and in about 40% of elementary schools.

When we don’t exercise, we’re much are more likely to gain weight. This is true whether you’re an adult or a child. When you combine a lack of physical activity with consuming more calories, this means that you’re burning off less calories than you’re taking in, so you’re going to put on weight. A huge component of this is that more and more children are spending time doing sedentary activities, such as watching television or playing video games. Television sets are found in most households and many children have one in their bedrooms. The number of children who have a computer, cellphone and video game devices has grown significantly. So, it shouldn’t come as a surprise that a recent report by the Kaiser Family Foundation found an increase in media content use of all types from over 6 hours per day in 1999 to more than 7 hours per day in 2009. Another factor is that there has been a decrease in physical education in schools. A recent study found that only 8% of elementary schools and less than 7% of middle schools and high schools have daily physical education requirements. Opportunities for physical activity used to be a common part of each child’s school day. According to the CDC, in 1969, around 50% of children walked or biked to school and 87% of those living within one mile of their school did this. Today, less than 15% school children walk or bike to school and among those who live within one mile of their school, only 31% walk, and for those living 2 miles or less from school, only 2% bike to school. The CDC further states that 30% of children go to school on a bus and 50% are taken by private vehicle.

The environment that a child grows up in plays a major role in shaping their habits and perceptions. One factor that has had a huge impact is the movement of Americans from the cities to the suburbs. This change has turned the US into a nation of drivers with only 1% of all trips on bicycles and 9% on foot. The sad thing is that around 25% of all trips are less than one mile and 75% of them are done by car. Given the amount of time that we spend watching TV, the prevalence of television commercials promoting unhealthy foods and eating habits is very concerning. Another aspect of a child’s environment is their family. Genetics can play a role in obesity, but scientists estimate that they only contribute to a 5-25% risk. The majority of a child’s risk comes from learned behaviors from their parents. Since parents are the ones buying the food and encourage, or don’t, physical activity, this can greatly influence whether or not a child is obese. If a child comes from a family of overweight people, they’re more likely to put on weight. An additional component for an elevated risk of obesity is psychological factors, such as personal, parental and family stress. Some children overeat as coping mechanism, as a way to deal with emotions or to fight boredom. Unfortunately, children who are overweight are often bullied by other children, which means that the overweight child can have low self-esteem, depression, anxiety and behavior/learning problems. Also, when people live in communities that have limited resources and limited access to supermarkets that have fresh, healthy food, they’re more likely to buy convenience foods that don’t spoil quickly. Additionally, these areas typically don’t have safe places to exercise and lower-income children can’t always afford to participate in extracurricular activities. Often, parents with little to no education don’t have access to information about proper nutrition and healthy food choices, which makes it difficult to instill these important values in their children. This is why many studies find that the occurrence of obesity increases with decreasing level of education.

How do we fix the problem? There has been an intense focus the past two decades to combat the childhood obesity epidemic, but it doesn’t look like we’re gaining much ground. There have been programs implemented to make sure that children have access to healthy meals at school, but this isn’t enough when they consistently encounter unhealthy food every day outside of school in their home. More resources are clearly needed. In order to start figuring out what we can do to help, we need to understand what qualifies as obese. According to the CDC, children are overweight have a Body Mass Index (BMI) between 85th and 94th percentiles and those who are obese have a BMI of 95th percentile or above. While BMI is a good tool, it doesn’t consider some things, like being muscular or having a larger than average body frame. Also, growth patterns vary greatly among children. This is why your child’s doctor also factors in your family’s history of obesity and weight-related health problems; your child’s eating habits and your child’s activity level when determining if they are overweight/obese. If your doctor finds that your child is overweight, they can help guide you down a path to help them because treating obesity in children differs greatly from treatment in adults. The key element is involving the whole family in a child’s weight management program. Treatment is based on your child’s age and any other medical conditions they have, but usually includes changes their eating habits and physical activity level. The American Academy of Pediatrics recommends that children older than 2 whose weight falls in the overweight category be put on a weight-maintenance program to slow the progress of weight gain, which allows your child to add inches in height but not pounds. For children 6-11, they’re encouraged to modify their eating habits for gradual weight loss of no more than 1 pound a month; whereas, adolescents are encouraged to modify their eating habits to aim for weight loss of up to 2 pounds a week. The point of this slow change is because your child’s body is still maturing and needs the appropriate nutrients to prevent developmental delays. The bottom line is that whether you’re maintaining your child’s current weight or are trying to help them lose weight, they need to eat a healthy diet and increase their level of physical activity. Their success depends largely on your commitment to helping them make these changes.

Since parents are the ones who buy groceries, cook meals and decide where food comes from, it’s up to you to choose fruits/vegetables, cut back on convenience foods, always have healthy snacks available and limit sweetened beverages/fast food. Another important aspect is sitting down together for family meals and discouraging eating in front of a TV, computer or video game screen. When helping your child with eating appropriate portion sizes, remember that younger children don’t need as much food as you do. Also, allow them to eat only until they’re full, even if it means that they’re leaving food on their plate. This is especially true at restaurants because the portion sizes are way too large. In addition, educate your child on how to read food labels, understand the food pyramid and that eating smaller bites at a slower pace are key to not only losing weight, but maintaining the weight loss. If you’re struggling with how to implement a healthier diet, consult with a nutritionist that specializes in the nutritional needs of children.

Physical activity helps children to burn calories, strengthen bones/muscles and sleep well at night, so they can stay alert during the day. Just like the fact that obese children tend to become obese adults, active children are more likely to become fit adults. In order to help your child do this, limit TV and recreational computer time to less than 2 hours a day for children older than 2 and don’t allow children younger than 2 to watch TV at all. Other sedentary activities, like talking or texting on their phone, should also be limited. When talking to your child about being more active, the vital thing to emphasize is activity, not exercise. The whole point is to get your child moving, it doesn’t have to be a structured exercise program. To help them do this, find activities that your child likes, such as playing catch, riding their bike or shooting hoops with the neighborhood kids. The US Surgeon General recommends that children get at least 60 minutes of moderate to vigorous physical activity each day.

It’s essential that you’re a good role model for your child because they’re more likely to do what you do than what you tell them to do. This means that choosing healthy foods and active pastimes for yourself is critical. Also, involve your whole family by making healthy eating a priority and emphasizing how important it is for everyone to be physically active. This helps to avoid singling out the child who is overweight. You also play a crucial role in helping your child feel loved and in control of their weight, so take advantage of every opportunity to build your child’s self-esteem. When possible avoid taking about weight, especially negative comments about your own, someone else’s or your child’s weight. If even it’s meant in a well-intended manner, it can hurt your child. Instead, focus on healthy eating and positive body image. Definitely discourage dieting and skipping meals by helping them set realistic weight loss goals and a plan to achieve those goals. Be patient and don’t obsess about your child’s eating habits and weight because that will backfire. Find reasons to praise your child’s efforts and celebrate small, incremental changes in behavior, just not with food as the reward.

One area that parents definitely need to work on is acknowledging the harsh truth about their child’s weight. A report published in the journal, Health Promotion Practice, found 53% of parents in Arkansas didn’t believe reports cautioning them that their children were obese. In a 2012 study released in Childhood Obesity, more than 75% of parents of pre-school-age obese boys and nearly 70% of parents of obese girls stated that their children as “about the right weight.” When the researchers compared these results with those from a similar survey in 1994, they found that not only were the children in the recent survey heavier, but the likelihood that parents could identify their child’s weight accurately had declined by about 30%. This is despite widespread publicity about the obesity epidemic. One reason as to why parents may have difficulty perceiving their child’s weight is because being overweight is considered the “new normal.” Also, it’s natural for a parent to want to think about their child in the best possible way, so denial could be a form of wishful thinking or a coping mechanism. Some experts feel that if a parent acknowledges their child has a problem, then they have to deal with it, which means that it’s easier to pretend there isn’t a problem. Other experts say that the problem is more complicated and the result of family dynamics. It could be that the parents are overweight themselves and have resigned themselves to the fact that they and their children are going to be. Another issue is that if there are slender siblings, the parents might not be able to figure out a diet that fits everyone. Sometimes, parents don’t want to accept that their child is overweight because it means a lot of work for them to fix it. If parents believe their children are active, they’re more likely to think their child’s weight is normal, but parents often overestimate their children’s physical activity level. In addition, a child’s weight problem may escape notice because many clothing styles obscure shape, especially for boys. When they take off their loose-fitting shirts and pants in the doctor’s exam room, it’s easier to see how a tremendous amount of body fat can be hidden. An added factor, is parents and doctors can have conflicting ideas about appropriate weight. Several studies show that some low-income mothers distrust growth and weight charts. Occasionally, parents get offended by the terms the doctors use to describe their children. A 2011 study discussed in Pediatrics found that parents prefer that doctors use terms like “weight problem” and “unhealthy weight,” instead of “fat,” “obese” and “extremely obese.” In order to help parents help their children, the first step is to help them set aside the shame that they might be feeling regarding the fact their child is overweight. Many can feel that they’ve failed as a parent to protect their child. The next step is to provide them the tools and resources they need to make a change that will positively benefit their entire family.

Parents aren’t the only ones that need to make a change. Schools need to promote healthy diets and increased physical activity during school hours. Children spend a significant time of their day in school, which makes it an ideal setting to acquire knowledge and skills about making healthy choices. This can be done through providing health education to help students acquire the knowledge, attitudes, beliefs and skills that are needed to make informed decisions, practice healthy behaviors and create conditions that are conducive to a healthy life. One example is having a school garden. Schools should offer food programs that increase the availability of healthy foods that meet minimum nutrition standards and only have vending machines if they sell healthy options, such as water, milk, fruits/vegetables, sandwiches and low-fat snacks. Schools could also offer programs that promote parental involvement to help increase the likelihood of the healthy behaviors continuing at home. To help increase the level of physical activity, schools should offer daily physical education classes with a variety of activities, extracurricular activities and school sports that are both competitive and non-competitive. Schools should also encourage government officials to create an environment for safe, non-motorized modes of transportation to school and other social activities.

Public health changes require the government to take an active role. Some government programs, such as food stamps, are supposed to provide a wider array of food choice. However, these programs may be negatively impact children’s health because when families live in areas with high food prices, this encourages them to purchase cheaper calorie-dense, less nutritious foods. One solution is to provide subsidized meals as a way to assure high quality nutrition. Another part of the problems is that US farm subsidies have resulted in farms producing so much corn and soybeans that it keeps the price of high-fructose corn syrup, hydrogenated fats from soybeans and corn-based feed for cattle and pigs artificially low. Due to this, the prices for fast food, which is corn-fed pork/beef and soft drinks, stays low. There are no such subsidies for farms to grow fresh fruits and vegetables, so they’re produced in much lower quantities at higher cost. An additional issue is that government’s subsidies for highways have promoted the use of the automobile over public transportation. When you consider that the US government spends the majority of its transportation dollars on highways, it’s no wonder that the US has the highest number of vehicles per capita in the world. One major consideration with this is that traffic concerns being one of the primary reasons parents do not allow their children to walk or bike to school.

Obesity is largely preventable and since we have deep knowledge of the drivers of it, we, as a society, need to come up with an effective strategy to address them with an intense and consistent focus. The primary goal should be promoting healthy diets and regular, adequate physical activity. This can be done by making healthy foods and beverages available at school/home and supporting opportunities for increased physical activity. Parents can influence their children’s behavior and, therefore, their child’s weight. It just takes knowledge and commitment. By doing everything that we can to combat that this epidemic, we should see an improvement!