The Big Issue of Obesity

Introduction

No doubt you've heard the scary news reports:

The number of overweight children is three times higher today than it was 25 years ago; more than 15 percent of school-age kids are too heavy; weight-related childhood diabetes has skyrocketed; and the risk of other health problems continues to climb.

"Today's American children may be the first generation in modern history to live shorter lives than their parents did," says Kelly D. Brownell, Ph.D., a Yale University obesity expert, in his book, Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, & What We Can Do About It. With such dire warnings, it's natural for parents to worry: Could this epidemic affect my child?

That's tougher to predict than you might think. Most of us figure we can tell whether our children weigh too much. But research suggests parents are frequently off the mark. In one study, even when moms had weight problems of their own, 79 percent failed to recognize when their pre-schoolers were too heavy. At the other extreme, some parents fret over routine weight gain. "It's not always easy to tell whether children are overweight, because at certain stages, some fat is healthy and normal," notes Dennis Styne, M.D., chief of pediatric endocrinology at the University of California, Davis, Children's Hospital.

One thing is sure: It's worth keeping an eye on childhood chunkiness. Even if your child's weight is appropriate now, if his dietary habits are bad, he may be headed for trouble. The good news is that many obesity risks can be controlled -- and warning signs for future weight problems are clear if you know what to look for. Here are the questions you need to ask.

How Does Your Child Measure Up?

Weight alone won't tell you whether your child is too heavy. "You have to look at the ratio of weight to height," Dr. Styne says. Growth charts tracking normal weight and height have been around since the 1970s. Several years ago, however, the Centers for Disease Control and Prevention established new screening standards for kids that calculate weight-for-height as a single number -- what's called the body-mass index, or BMI. This number is plotted on new charts that track normal BMI patterns by age and gender. Kids who fall at or above the 95th percentile for their age are considered too heavy, and those at or above the 85th percentile are at risk of becoming overweight.

Ask your pediatrician to plot your child's BMI at every checkup: Your doctor can accurately calculate the numbers and track patterns over time.

How Old Is He?

Gaining girth isn't always cause for concern: Kids naturally get fatter at certain points during their development. "There's an accordion effect," says Robert Murray, M.D., director of the Center for Nutrition and Wellness at Children's Hospital, in Columbus, Ohio. Expect a baby to be charmingly chubby at least during the first year. After that, his BMI will gradually fall until it reaches a lifetime low at around age 5 or 6 -- a point known as "adiposity rebound." Then he'll gradually put on more padding until adolescence, thinning out again when the growth spurts of the teen years add height and muscle. "At least, that's the way it's supposed to happen," Dr. Murray says. But researchers say that glitches in this pattern may warn of trouble ahead: Several studies have found that, for unknown reasons, the earlier a child hits adiposity rebound, the more likely he is to become obese later in life. Other research suggests that kids who are overweight at age 5 have a higher risk of being too hefty at 10.

Are You or Your Partner Overweight?

Children -- like adults -- usually become obese due to a combination of lifestyle factors and genetics. That means standing in front of the mirror may give you a glimpse of your child's future when it comes to weight. Having even one overweight parent doubles the risk that a child under age 10 will become an obese adult herself, even if she starts out thin. (However, the older a child gets, the more her own weight matters as a forecast of future fatness, especially after age 6.) Bottom line: You may not be able to change your family's gene pool, but knowing how it affects your child's risks can help you jump-start lifestyle changes that may make a difference.

How Much Time Does He Spend Watching TV?

Lolling in front of the tube obviously keeps your child from more active pursuits that would burn off calories. But that's not the only reason TV time puts your child at risk of weight gain. Consider a 2001 study that found children who watched TV during meals ate 5 percent more junk food while getting nearly 5 percent fewer fruits and vegetables than other kids. It's clear from this and other research that children who watch a lot of television eat more when parked for their programs -- plus, they're fed repeated bad nutritional messages through advertising.

According to Dr. Brownell, the average American child sees 10,000 advertisements for food each year on TV. And, while watching Saturday-morning cartoons, kids see an average of one food ad-vertisement every five minutes. Most of those ads are for fast foods, sugared cereals, soft drinks, and candy. Some nutrition experts, including Dr. Brownell, are advocating a com-plete ban on food advertising during children's programming -- or at least required public-service announce-ments promoting good nutrition. But such proposals are far from be-coming reality. For now, experts say the best way to limit your child's exposure to junk-food ads is by restricting his time in front of the television.

How Much Time Is She Outdoors?

The flip side of not watching TV is what your child does instead. And just about any outside activity -- playing tag, riding a bike, throwing a ball -- will help your child burn calories. "Time spent outside results in a reduced risk of obesity," Dr. Murray says. It's especially important to encourage your child to get out as she approaches adolescence, when activity levels drop. Since many schools have cut back on physical education classes, consider an intramural sports program in your community.

How Much Soda Does He Drink?

You can't pin obesity on a single food, but some researchers say that kids' surging consumption of soft drinks has become a huge problem. A Harvard study, for example, found that drinking one extra can of sugared soft drink a day raises a child's risk of becoming obese by 60 percent. "Soft drinks provide highly concentrated, fast-acting sugar that's absorbed rapidly into the blood," says study coauthor David Ludwig, M.D., Ph.D., director of the obesity program at Children's Hospital Boston. Dr. Ludwig thinks consuming large amounts of foods high on the glycemic index, a measure of how quickly sugars enter the bloodstream, causes hormonal changes that trigger hunger and lead to overeating. If true, problem foods would include not just soda, but fruit drinks and highly refined starchy foods such as white bread and sweetened cereals. The theory is unproved, but other researchers note that soft drinks often go together with other less-than-ideal fare, such as salty snacks and fast food. "In terms of diet, I would make cutting back on soda and juice drinks the first priority," says Susan Roberts, M.D., senior scientist at Tufts University's Human Nutrition Research Center on Aging and author of Feeding Your Child for Lifelong Health. "Instead, give your child milk or water."

How Often Do You Order In or Eat Out?

It's well-established that a lot of fast foods are high in calories, but it's not just the drive-thru burger joint that's putting your child at risk. Experts say that people who eat out frequently -- even at more upscale restaurants -- and those who rely on takeout food tend to consume more calories, probably because portions are bigger. "If you dine out or order in frequently, it can be difficult to prevent a child from over-eating," Dr. Murray says.

Are You a Diet Dictator?

Fact: Almost 80 percent of schoolchildren don't get the recommended five or more servings of fruits and vegetables a day. Fact: Families who eat more fruits and vegetables have fewer weight problems. Logical conclusion: You should make sure your kids eat their broccoli and oranges.

But don't go overboard in trying to dictate what your child consumes. Studies suggest that kids whose parents tell them exactly what and when to eat are more likely to gain weight, not lose it. "Children are much better at regulating food intake than adults are," Dr. Murray says. But parents can throw off a child's natural appetite controls by making him eat lunch even if he's not hungry just because it's lunchtime, for example. Bribes backfire too. "If you tell a child he can't get a brownie unless he eats his peas, that devalues the peas and makes the brownie the attractive food," Dr. Murray says. But you can help ensure that your child eats the right foods in the right amounts. "Don't push and prod," he says. "Just continue to put a variety of healthy foods in front of your child and let him decide what, when, and how much to eat." If your child doesn't like a certain food, try something else -- or prepare it a different way. "In one study, we found that just adding cheese to broccoli doubled the number of kids who ate it," Dr. Murray says.

Does She Have Asthma?

A number of studies have found that children with asthma have higher rates of obesity than other kids. That's because the two problems tend to complicate each other: If your child has trouble breathing, she's less inclined to be physically active, which makes it easier to gain weight. And being heavier makes breathing even more difficult, leading to a vicious circle. "It's important for asthma to be treated so your child can remain as active as possible," Dr. Styne says.

Overall, the sooner you take steps to control your child's weight, the better. "You need to lay a good foundation of healthy habits early on," Dr. Murray says. "That way, children will learn to start making the right choices for themselves."

Fighting Childhood Obesity

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