Pediatric Obesity

Pediatric Obesity – What You Need to Know

Pediatric obesity has reached epidemic proportions in North America. Obesity is usually defined as a total body weight comprised of greater than 25% – 35% fat, or a Body Mass Index (formula consisting of a ratio comparing height and weight to standards for age) greater than the 95th percentile for age. (Click here to calculate you BMI) Using these standards, it has been estimated in numerous studies throughout the United States that approximately 20-25% of children are considered obese today. The Center for Disease Control reports that the percentage of children 6 to 11 years of age who are overweight has doubled in the last 20 years, and this number has tripled in adolescents. This trend continues on a larger scale among children of Latino and African American descent. Recent data from the National Longitudinal Survey of Youth indicates that obesity prevalence is increasing 45-70% faster in these populations. By all accaunts, the trend is worsening.

The Risks

These statistics become more alarming when cansidering the role that childhood obesity plays in other health issues. Obesity places children at an increased risk of high blood pressure, higher cholesterol and blood lipid (fat) levels, and type 2 (previously referred to as “adult-onset”) diabetes. While studies are still underway to assess the exact effect that these increased risks will truly have on an obese child once fully grown, the longer a child remains obese, the more likely that child is to become an obese adult. High blood pressure, cholesteroi ana lipid abnormalities, type 2 diabetes and obesity in adulthood are well-studied and established risk factors for heart attacks, strokes, heart failure, and numerous other medical problems. It is only a matter of time until longitudinal studies can show the direct correlation between childhood obesity and these unfortunate “adult” complications. One study of 40-year follow-up of overweight children revealed double the rate of cardiovascular disease and triple the rate of diabetes when compared to normal-weight children (Mossberg H, Lancet 2(8661): 491 -493, 1989).

Santa Barbara County is a melting pot of various cultures and ethnicities. Our large Latino population is not only at higher risk for obesity, but is at significantly higher risk for type 2 diabetes. This is most likely a result of both a genetic predisposition in this population along with cultural factors influencing their dietary/lifestyle choices. The mixture of genetic and cultural influences on obesity in the Latino population makes addressing childhood obesity even more important far this group of Santa Barbarans.

Carrying extra weight also places increased demands on a child’s heart, lungs, joints, and can even affect one’s ability to sleep narmally. Overweight children have a decreased exercise tolerance and frequently have difficulty sleeping, sometimes resulting in true sleep apnea. This serious sleep disturbance can put extra wark on the heart and lungs, and is a significant risk factor for serious cardiac camplications. Similarly, the extra work load placed on overweight children’s joints is a well documented risk factor for a small number of difficult to treat, and potentially dangeraus joint disorders.

Potential medical complications are only a part of the overall consequences of childhoad obesity. The psychosocial effects af teasing, discriminatian, and difficulty with “keeping up” with normal-weight children can have profound effects on overall childhood well being. Studies have found that overweight children are often described as lazy, Iying, cheating, sloppy, and stupid by children as young as 6 years of age. Lower levels of self-esteem have been reported in overweight children and teens. Unfortunately, decreasing levels of self-esteem have been correlated to increased levels of high-risk behaviors, such as smoking and alcohol consumption.

Correcting the Problem

As is the case for a plethora of medical problems, the best way to address pediatric obesity is prevention. Community groups and coalitions have begun forming in Santa Barbara to provide healthier food at school and better physical education pragrams. Living an active lifestyle, eating a sensible diet, and involving the family are paramaunt in preventing pediatric overweight and obesity.

Fortunately, we live in a beautiful community with weather conducive to families enjoying near year-round outdoor activities. Preventing a sedentary lifestyle can be accomplished by limiting television and computer time, encouraging sports and exercise participation, and getting the whole family involved in being active. Simple things like taking the stairs rather than the elevatar can be a quick jump into creating a more active lifestyle.

Treating pediatric overweight or obesity involves a very similar approach. Overall increases in activity level, eating sensibly, and approaching the way the whole family looks at nutrition and exercise are the keys to successful treatment of pediatric obesity. It is extremely rare for a physician to recommend true weight loss for a child. Instead, weight maintenance over time is usually recommended. This ensures adequate calories and nutrition to maintain growth. Subsequently, as a child grows, his or her height increases and weight stabilizes or slowly increases to bring down a patient’s overall Body Mass Index. This is the most recommended, and generally felt to be the most-healthful way to improve pediatric obesity.

Behavioral family-based treatment of pediatric obesity has shown marked improvement compared to individual-based treatment, and has since become the general model for pediatric obesity treatment programs (Epstein L, JAMA 264(19): 2519-2523, 1990). Frequently, not only is the family at risk for or suffering from obesity-related illnesses, but the family is unaware of how to make dietary and lifestyle changes appropriately. Education of the entire family and involvement of the entire family in the treatment process is extremely important. This can be difficult if both parents work or there is a single parent raising a child. This is especially true in Santa Barbara County, where the cost of living frequently forces one or both parents to work long or extra hours to maintain an adequate income.

Sansum-Santa Barbara Medical Foundation Clinic, in a joint collaborative effort with the Departments of Pediatrics, Health Education Department, Dietitians, and with the support of the YMCA have developed a multi-disciplinary approach to addressing pediatric obesity here in Santa Barbara County. With the much-needed support of the Santa Barbara Diabetes Resource Center, a pilot program has been started to begin treating overweight children and their families. The program involves the family in discussions and activities on nutrition, lifestyle changes, exercise, behavior and self esteem issues in a fun, non-threatening way by a team of dedicated professionals. So far, the response has been phenomenal, the families are motivated to learn, and the children are excited to achieve.

What Can You Do?

Treatment of pediatric obesity lies primarily in prevention. As a family member, get others excited about being active. Get outside! Turn off the TV and computer, and get active with the family. Make reasonable goals for your “exercise pragram.” Taking the stairs rather than the escalator may be the start of being active in your family. Engage your family in activities that are fun and are likely to be something you enjoy doing (e.g. walking with a parent, playing basketball with a sibling, karate with a friend).

Make healthy choices in the foods you prepare and eat. Make fruits and vegetables a key part of every meal or snack. Be careful with “junk” foods–think of them as “extra”. Reduce the portion of these high calorie foods, or find a substitute. Make healthier choices at fast foods–share the fried foods; add a salad. Limit or eliminate the soda or juice you drink (lots and lots of sugar). If you’re unsure about the diet your family consumes, consider talking with your physician or a dietitian.

Stay positive. Keep the changes you make to your lifestyle positive, and help the family understand that what you’re doing is to help everyone stay healthy. If self-esteem issues are already present, give supportive messages that promote a sense of well being and build self-confidence. Most individuals who are active or exercising usually begin feeling better about themselves, and report better satisfaction with their body weight.

Get involved. Find and support community programs that create healthy lifestyles in children and families, and be an advocate for the health of children. Many programs have difficulty receiving funding from sources not used to covering “preventive” health issues. Let your community leaders know how you feel about the importance of preventing and treating pediatric obesity in our community.

If you’re concerned about yourself or your family, talk with your physician about what kind of program may be appropriate for you. For more information on the Weight Management for Children Program, call (805) 563-6290.

©2003
Article by Jerold A. Black, M.D., FAAP
from the Spring, 2003 issue of
Sansum Santa Barbara Highlights