Families can work together to stop childhood obesity Published June 7, 2013 By Capt. (Dr.) Charles Pace 42nd Medical Group MAXWELL AIR FORCE BASE, Ala. - -- Most physicians feel uncomfortable addressing the problem of obesity in a child. Many parents feel guilty about letting a child's weight get out of control, while others feel a weight problem is something their child will surely outgrow with time. I have even encountered anger from parents who don't see weight as a pertinent medical issue to be discussed at a wellness visit. Regardless of how we feel about it, there is no doubt children are getting heavier. Since 1980, the incidence of obesity has tripled in youth 2-19 years of age to 17 percent. This parallels the increase in weight problems among adults, where one in three is considered obese. Part of the difficulty in addressing the problem is in how we define obesity. It is easy to identify a weight problem in a child that is not our own. While it is true the morbidly obese child in a child's class may make an overweight child look "normal" by comparison, there are objective standards used to define overweight and obesity in children. Body mass index, or BMI, is a basic measure of weight for height. In adults, a BMI greater than 25 is considered overweight and greater than 30 is considered obese. In children, BMI is relative and must be assessed according to a child's age and gender. In children, overweight is defined as a BMI greater than 85 percent for age and gender, while obesity is defined as a BMI greater than 95 percent. BMI is a useful tool, but it is not foolproof. For example, a female child who matures earlier than most of her peers will have a BMI that is more typical of an older child. This is because body fat in girls, the primary determinant of BMI, is more closely related to pubertal status than actual age. Likewise, the late-blooming adolescent may have a BMI more typical of a child several years younger. These variations must be taken into account when assessing any child's growth. Risk factors for heart disease are often seen in obese children before they even reach adulthood. Obesity-related risk factors for heart disease include high blood pressure, diabetes and high cholesterol and/or lipid levels. Seventy percent of obese children will have at least one of these risk factors; 39 percent will have two or more. Additionally, respiratory disorders such as asthma and sleep apnea are more common and more severe in obese children. Children also have increased risk of gastrointestinal problems such as constipation, liver disease, gallbladder disease and reflux disease. Obese children are more likely to suffer from low self-esteem and depression than average-weight peers. As early as age 3, children associate pictures of overweight children with negative descriptors (lazy, ugly, stupid, mean) and are less likely to form friendships with them. Adolescents have been shown to harbor even more stereotypical thoughts toward overweight peers than young children, even if most are more discreet in expressing these thoughts publicly. Obese students have lower college acceptance rates than average weight students and as adults are more likely to be discriminated against in the workplace than average-weight adults. Of course, none of this is fair. There is an implicit societal assumption that obesity is a reflection of a person's self-control, and maintaining a normal weight is just a matter of willpower. In truth, there are many reasons why children and adults struggle with weight. We know there is a natural tendency for children to prefer sweet, salty and fatty foods. While this instinct probably served a survival role for our ancestors at a time when food was scarce, it is now just a hindrance in teaching children to accept more healthy choices. Obesity also has a large genetic component. Having an obese parent more than doubles a child's risk of becoming obese as an adult. There are also societal factors compounding the problem, especially in children. Calorie-dense foods with little nutritional value are typically less expensive than healthier options at grocery stores and restaurants. Foods advertised as "kid-friendly" are usually high-fat, high-salt and high-sugar. Parents and grandparents often use these types of foods to treat or reward a child. When children learn to link good feelings from family time and praise with a rich, calorie-dense food, the connection can be difficult to break. Parents and grandparents often use dessert as a reward for eating everything on a child's plate. This encourages children to eat beyond the point of satiety and reinforces the link between good feelings and sweets. The problem of pediatric obesity needs to be addressed starting in infancy. Numerous studies have shown children who are breastfed through 6 months are less likely to struggle with their weight as children and adults. When introducing supplementary foods to infants, it is important to introduce a variety of foods and textures. More than 10 exposures may be needed before a child will accept a new food. Parents must also get over their own pickiness about foods and model healthy eating for their children. It is unreasonable to expect a child to have a healthy diet when parents are not modeling healthy eating patterns themselves. A parent's responsibility, especially during the toddler years, is to provide consistent nutritious meals and allow the child to determine how much of each food will be taken. For children, the "5-2-1-0" plan gives basic recommendations on healthy diet and lifestyle for children: children should have five servings of fruits/vegetables daily, spend no more than two hours per day on television or media, should get one hour or more of physical activity on most days and should typically have zero sugar-sweetened beverages, with the primary beverages for children being low-fat or skim milk and water. For any weight management plan to be successful, it is necessary to get the whole family involved. Junk foods should be replaced with healthy foods and parents should model the level of physical activity they expect from their child. This is difficult when there is only one obese child in the family as parents often feel they are punishing a normal-weight child to benefit the overweight child. Efforts to change a child's diet are often futile when the child sees siblings and parents eating foods they are not allowed. There is really no way to make these changes "fair," but parents should remember healthy changes in diet and lifestyle will benefit every member of the household in the long run, even if not every family member is obese.