By Charles Downey
After the 8-year-old left his doctor's appointment, his mother read his prescription to him. It simply stated: "Play outside twice a week for 20 minutes." The prescription, it turned out, could be satisfied by walking, bicycling, in-line skating, or undertaking any number of other active childhood pastimes.
At the beginning, it was tough for the boy to huff and puff through those 20 minutes. After all, he was 50 pounds overweight. Still, as the months went on, the doctor's orders for outside play increased to an hour, five times a week.
The youth above is not rare. Experts agree that the number of children in the United States who weigh too much is too high - and growing.
According to the latest National Health and Nutrition Examination Survey, 11 percent of American kids aged 6 to 17 are overweight - up from 5.4 percent in 1980.
By a more inclusive definition, as many as one in four children is too heavy: Sandra Hassink, director of the Weight Management Program at the duPont Hospital for Children in Wilmington, Del., cites figures that put childhood obesity at about 25 percent of American kids.
New research from a Tufts University Schools of Nutrition and Medicine study found that in the third grade, 28 percent of boys and 30 percent of girls are overweight; by fifth grade, overweight boys have increased to 34 percent while the percentage for girls remains unchanged. And a recent article in the Journal of the American Medical Association (JAMA) found that the number of obese children grew by seven percentage points from the 1980s to the early 1990s.
But obesity and overweight don't have to be problems for most children. As with adults, extra weight on youngsters often results from a combination of poor eating patterns and a lack of physical exercise. With help from mom, dad, and other concerned adults, and some attention from health professionals, unwanted pounds can be taken off overweight children wisely and without too much fuss - or kept off those otherwise likely to gain.
For a child, getting exercise doesn't appear to be as easy as it used to be.
"Today's children just don't play outside like they did in years past," says William Klish, M.D., head of pediatric nutrition at both Baylor College of Medicine and Texas Children's Hospital in Houston.
Becky Gorham, a registered dietitian and research nutritionist at the USDA Children's Nutrition Research Center at Baylor College of Medicine in Houston, Tex., says: "Overweight children need to get out of the house and exercise. Usually, obesity is not solely defined by calories consumed, but instead by inactivity."
The Centers for Disease Control found that daily participation in P.E. by high school students - which could help improve this situation - dropped from 42 percent in 1991 to just 24 percent in 1995. The organization also found that half of American young people aged 12 to 21 do not participate in any vigorous physical activity.
Moreover, lots of kids have become "couch potatoes" by routinely watching television, playing video games, or surfing the Internet for hours daily. Illustrating this, the JAMA article found that 26 percent of kids watch four or more hours of TV per day and that this same 26 percent have 20 percent more body fat than those who watch less than two hours of TV in a day.
What are some possible solutions? Encourage kids to walk to school (if it's safe) and to swim, bike, and play sports - which are fun and good forms of exercise; keep exercise equipment in the house and not in the garage; and look for churches or other organizations that offer after-school activities. The lead author of the JAMA article suggested families should look for more ways to be physically active every day. (One idea might be taking a walk after dinner.)
But all the experts agree: If you can do only one thing for an overweight youngster, encourage him to trade television for sports and other outside activities.
Changes in two areas involving eating - snacking and the family dinner - can also make a difference in weight control. Youngsters, especially those who are home alone after school, can snack too much - and on the wrong kinds of foods. And, unfortunately, many families do not share a regular evening meal together.
"One of the primary causes of childhood obesity among our patients is that families no longer sit down together for dinner at a fixed time," says Klish. "Instead, children eat in front of the TV after 'grazing' all afternoon. But when everybody in a family sits down for dinner at a fixed time every night, fewer and healthier calories are consumed."
Families eat less when they dine together because they talk, and that slows the speed of eating, giving the stomach's fullness signals a chance to work. Even small amounts of food start sending satiety signals to the brain in 20 minutes.
Overweight children can be plagued with depression, anxiety, and a lack of self-confidence. Additionally, scientists know that obesity puts children at increased risk later in life for more serious health woes like diabetes, hypertension, atherosclerosis, and skeletal problems in hips and legs.
It's not surprising that overweight children can have low self-esteem. Research shows that, as early as kindergarten, children tend to disapprove of obesity and view overweight classmates as less likable, capable, and able to control themselves.
Experts say a child loses weight best when the entire family is involved in the process; that way, the child is part of a family focus on healthier eating rather than made to feel like "the one with the problem." If cookies or other fatty treats are forbidden to an overweight child, the entire family must forego them.
At the same time, everybody in the family is better off when consumption of high-fat foods like butter, meats, chicken with the skin on, chocolate, and ice cream is kept in check. Ideal loss for a too-plump child is no more than one-half to one pound per week.
When a health professional guides the eating habits of an overweight youngster, he will often limit the child's daily fat intake to 30 percent or less. At that healthy rate, one cheeseburger with fries could consume the child's fat allotment for two days.
Fat puts more weight on the human frame because the substance is energy-dense. A gram of fat has nine calories while a gram of carbohydrate has only four.
So parents of excessively overweight youngsters are generally advised to encourage their children to cut back on high-fat dairy products, beef, pork, lamb, and highly sugared treats. (A notable exception is that before age 2, a child's fat intake should not be restricted.)
Sometimes, dietary changes are barely noticeable to kids. According to Marilyn Day, a nutritionist at Children's Hospital in Denver, Colo., in about 20 percent of obese youngsters, weight loss can be achieved simply by cutting down on sodas, juices, and whole milk.
Experts say children can learn to like healthy alternatives like fresh fruit, rice cakes, low-fat yogurt, bagels, and light popcorn. One researcher found 4-year-olds would accept vegetables and low-fat foods and snacks after trying them six or seven times. (Frozen grapes are popular because they are crunchy and sweet.)
When an overweight or obese child learns to reduce and maintain his weight through good nutrition and exercise, the loss is more likely to be permanent as he grows into young adulthood. And as the excess weight is lost, improvements often occur in his social life, grades, and self-esteem.
Left untreated, fat children are much more likely to grow into fat teens and then fat adults. And in most cases, that just doesn't have to be.
Freelance writer Charles Downey lives in Big Bear City, Calif.
Just what is obesity, and why are more children tending toward it?Obesity is an excess in body fat. Except for heavily muscled persons, a body weight 20 percent above that in standard height-weight charts is generally considered obesity, says Dr. Sandra Hassink, director of the Weight Management Program at the duPont Hospital for Children in Wilmington, Del. (Some experts define obesity at 30 percent above ideal weight.) Since children have different frame sizes and are still growing, the determination that a child is "overweight" or obese can be better assessed by a calculation known as the "body mass index," or BMI. (To calculate the BMI - a height-weight ratio: Multiply weight in pounds by 703; determine height in inches and square that number of inches; then divide the first number by the second.)A child's BMI can be compared to the revised National Center for Health Statistics (NCHS) growth charts, which include a BMI curve. Kids over the 95th percentile on the new charts are classified as overweight, although some doctors and researchers use a more inclusive definition based on the 85th percentile.
Healthy Snacks for Kids
Because the seeds for heart disease begin to sprout as early as age 3, The Arizona Heart Institute in Phoenix developed some snacks which are kid-, waist-, and heart-friendly. A few of their favorites include the following:
1/2 cup nonfat or low-fat frozen yogurt
Spoon the yogurt into a plastic cup. Pour milk over the yogurt and stir until smooth. Add the sliced strawberries and mix gently. Note: Any soft fruit may be used.
Crunchy Apple Dippers
1 medium apple
Core the apple and cut into eight slices. Spread peanut butter on each apple slice. Dip each slice into the rice cereal.
Peanut Butter Face
One slice whole wheat bread
Spread peanut butter on the bread. Use the raisins to make eyes, nose, and mouth. An apple slice can be used for the mouth instead of raisins.
Finding Support for the Obese Child
For more information on weight-loss programs for youth, contact these organizations which help children lose weight and show them how to keep it off:
Dave Winfield Nutrition Center
Program offered: A nutrition and exercise program for kids 8-13. The program, The Body Shop, includes tips on how to handle eating at parties and in restaurants.
Committed to Kids Pediatric Weight Management Program
Shape Down Clinic
Pediatric Gastroenterology and Nutrition Department
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