by Kathy Shadle James, DNSc, NP
More than half of Americans—56
percent—are overweight compared
with 45 percent in 1991. Is it
any surprise that childhood obesity has also
increased? The increase is dramatic over the
past three decades beginning with a five percent
prevalence reported from the National
Health and Nutrition Examination Survey
(NHANES) II study (1976-1980) to a 11 percent
prevalence in the NHANES III study
(1988-1994) and a 14 percent prevalence
rate in the 1999 NHANES report. Revisions
to the latest study (1999) showed even higher
prevalence rates in some minority groups,
i.e. 17 percent in African Americans and
27.3 percent in Mexican American youth
(ages 6-11 years). A glimpse at a few societal
changes in the past decade suggest some
strong correlations that our lifestyle habits
are truly beginning to increase our risk factors
at early ages for persistent weight problems
in adulthood, hypertension, diabetes,
early menarche, polycystic ovarian disease,
heart disease and psychological factors such
as low self-esteem, diminished body image
and possible depression.¹
Other changes include an increase in soda
consumption in the U.S. from 100 cans per
year in the 1940s to an average of 580 cans per
year in the 1970s. Over 78 percent of secondary
schools have vending machines as do
14 percent of elementary schools. (This may
change with upcoming legislation). The percentage
of high school youth who participated
in daily physical education classes
dropped from 42 percent in 1991 to 32
percent in 2001. A 1992 National Health
Interview Survey of Youth Risk Behaviors
showed that 30 percent of females and 40
percent of males participated in moderate
activity. Although 70 percent reported participating
in vigorous activity at age 12, this
dropped to fewer than 50 percent by age 17.
One study in 1999 indicated that third and
fourth graders averaged 22-24 hours of TV
watching a week.²
Trends across time |
|
1980s
1000 fast food restaurants
6 billion dollars spent on fast food
1.3 of mothers work outside the home
75 percent of meals eaten at home
children eat five servings of fruits and vegetables |
2000
23,000 fast food restaurants
100 billion dollars spent on fast food
2.3 mothers work outside the home
majority of meals eaten away from home
1.5 of children eat five servings of fruits and vegetables |
|
Prevention can begin early by following
some of these guidelines:
- Breast-feed infants
- Don't overfeed children
- As a parent, look at your height, weight and behaviors
- Use skim milk after age two
- Encourage fruits and vegetables for snacks
- Limit juices
- Limit TV and computer time
- Plan family activities—get everyone moving
- Monitor child's BMI at yearly checkups
- Have family meals
- Love and accept your child
Recognizing obesity
A significant barrier to preventing obesity is
failure to recognize it. Health professionals
are trained to plot height and weight and
determine Body Mass Index of children
beginning at age two. The English formula
for calculating BMI is weight(pounds)/
height(inches) 2 x 703=BMI. A BMI greater than the 85th
percentile for age and sex is considered ”at
risk for overweight“ and a BMI greater than the 95th percentile
for age and sex is considered overweight.
BMI is a screening tool that should be
used in addition to focusing on changes in
growth patterns or the change in percentile
BMI over time. Research has shown that
youth with BMIs above the 85th or 95th percentile
have an increased risk of being an
overweight adult. The BMI for age provides a
reference that is consistent with adult standards
and allows tracking from childhood
through adulthood.³
If BMI is 85-94 percent, the family
history should be evaluated and blood pressure
should be checked. Sometimes a fasting
lipid panel will be ordered to evaluate high
cholesterol or triglycerides and fasting glucose
or insulin to detect diabetes. It is also
important to watch for skin changes in overweight
youth which may be indicative of a
prediabetic condition. When children have
a BMI greater than 95 percent, they should receive a
medical assessment. Another useful
screening procedure is to check waist and
hip measurements. Divide waist measurement
by the hip measurement. For girls, if the ratio is greater than .80, it is considered a
risk factor for heart disease and diabetes. For
boys, the cut off ratio is 1.0 or greater.4
Contributing factors
Families may take a look at possible contributors
to their family members’ weight problems.
Common contributors may include genetics,
lifestyle, emotional overeating, children who
are too-comfortable and children who are too too uncomfortable
and medical problems.
Sometimes parents select a restrictive diet
without first examining their family’s lifestyle
patterns. If everyone tends to be overweight in
the family, this could suggest a genetic factor
and/or a long pattern of lifestyle behaviors that
have contributed to an overweight body.
Genetics: Studies have suggested that 20–40
percent of overweight is due to genetic factors.
If this is the case, it doesn’t mean a child can’t
lose weight, however, it will be important to
set realistic goals.4
Lifestyle: Habits such as high fat, high sugar
diets, skipping meals, large serving sizes, low
activity level and too much TV or computer
may be targeted for change if a family desires to
take a family approach. Hours of television
watching are associated with overweight. Over
one fourth of children report watching four or
more hours a day.5
Emotional overeating: Just as adults may eat
when they are bored, tired, upset, lonely, angry
or sad, young people also find comfort in food.
If we attempt to take away the food and not
treat the underlying problem that is fueling the
desire to eat, we aren’t taking care of unmet
needs. Professional assistance is often required
to address sensitive weight-related issues.
Children who are too-comfortable: It’s true,
some children are overly indulged. The idea of
having to limit TV and computer time would
seem cruel to these children, as would having
parents who expect their child to participate in
some outside activity for an hour a day. This
category may include parents who feel sorry
for their overweight family member and don’t
want them to be “uncomfortable.” Some children
are simply not used to having limits
placed on them. Parents often benefit from
some tips on how to set limits.6
Children who are too-uncomfortable: This is
often a deprived or lonely child whose parents
may not be available to their child. Sometimes
this includes families who are going through
transitions such as separations, divorce, incarcerations
or deaths. Children often have a difficult time sharing their feelings and may need
some professional help in transitional times
before they can focus on their body.
Parenting style: Parental attempts to “control”
their child’s diet has been linked to a
child’s inability to regulate his or her food
intake. Hence, a lock on the refrigerator is not
a good idea.6
Medical problems
This category may include medical conditions
that influence children’s obesity, activity and
diet. Hormonal causes may be a contributor to
childhood obesity. These may include
hypothyroid, Cushing syndrome, primary
hyperinsulinemia, surgeries, asthma and certain
medications that may increase appetite. A
careful history will help to distinguish exogenous
and endogenous obesity contributors.
What parents can do to help
If you have recognized that your child is
growing wider at an unusually increased rate,
take him/her to a health professional for a
physical exam. Don’t overreact. As a parent it is
your role to provide regular healthy meals at
home. You decide what foods are served and
when to offer meals and snacks. It is your
child’s decision whether or not to eat, which
foods to eat and how much. If your child has
not grown up on fat and sugar, she is less likely
to ask for it. It is okay to say, “I want us to have
healthy bodies.”
Other tips include:
- be supportive and encouraging—not a policeman
- focus on changing your families eating habits
- include your children—let him/her select the fruits and vegetables that they want to eat
- prepare daily dinner menus with two vegetables
- review the school lunch menu, pack lunches giving your child choices
- find physical activities that your family enjoys—older children often like to do their own things (that’s okay)
- don’t place your child on a restrictive diet—begin by increasing the number of fruits and vegetables in their diets; use low fat dairy, and choose lean meats and beans; use fats sparingly (if you are unsure how to prepare foods, see a dietician or check out some Web sites for suggestions).
- allow sweets or treats in moderation—you want to avoid having a child who sneaks and hides food because he is afraid to eat in front of you
- be a good example. If you role model healthy eating and activity without being extreme, your child is more likely to learn positive habits from you.8,9,10
With early and “careful” interventions, your
child will have a good chance of becoming a
normal weight adult. There are trained professionals
who specialize in the care of obese children
and adolescents. You may find a referral
through the Web site www.childobesity.com
or call 415-453-8886.
Kathy James DNSc, NP is an associate professor
of nursing at University of San Diego.
She has maintained a private practice for 23
years working with obese children and their
families. She has conducted health promotion
research related to family and lifestyle habits of
overweight and non-overweight adolescents
nationally and internationally. She is a frequent
speaker and author on childhood obesity
and a consultant to health professionals
who offer SHAPEDOWN programs.
E-mail:
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
References:
- Ogden, C., Flegal, K., Carroll, M., Johnson, C. JAMA (2002). Vol. 288, pp. 1728–32.
- Action Brief. Coordinating efforts on childhood obesity. National Institute for Health Care Management Research and Educational Foundation. (March, 2002). Retrieved from www.nihcm.org
- Pietrobelli, A., Faith, M., Allison, D. et al. “Body mass index as a measure of adiposity among children and adolescents: a validation study,” Journal of Pediatrics (1998). Vol. 132, pp. 204–10.
- Brosnan, C., Upchurch, S., Schreiner, B. “Type II Diabetes in children and adolescents: An emerging disease,” Journal of Pediatric Health Care (2001). Vol. 15 (4), pp. 187–93.
- Robinson, T. “Reducing children’s television viewing to prevent obesity: A randomized controlled trial,” JAMA (1999). Vol. 282 (16), pp. 1561–7.
- Mellin, L. SHAPEDOWN. (5th ed). San Anselmo, CA: Balboa Publishing 2003.
- Fisher, J., Birch, L. “Restricting access to foods and children’s eating,” Appetite (1999). Vol. 32, pp. 405–19.
- Ritchie, L., Ivey, S., Masch, M., Woodward-Lopez, G., Ikeda, J., Crawford, P. “Pediatric overweight: A review of the literature,” Center for Weight and Health, College of Natural Resources, UC Berkeley (2001).
- Kosharek, S. “If your child is overweight. A guide for parents,” American Dietetic Association (1993).
- James, K. “All in the family: Treating obesity in children and adolescents,” Advance for Nurse Practitioners (2001). Vol. 9, pp 26–33.
|
