Family effort needed to rein in childhood obesity
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Governments and food manufacturers are introducing new measures in the fight against childhood obesity because of growing public alarm about the issue, but some experts say these efforts will ultimately fail until a widespread, family-driven approach is taken.
About a third of children are now overweight, and 15 percent are obese, the highest the prevalence rates have ever been, according to the American Obesity Association. The AOA defines being overweight or obese as a Body Mass Index (BMI) at or above the 85th or 95th percentile, respectively, for children of the same age and sex.
“The number of kids who are obese has almost doubled (over the last generation) in all the Westernized countries in the world, so what’s happened is that kids are becoming more obese in all countries where such data is kept,” said Dr. Reginald Washington, a pediatrician on the American Academy of Pediatrics’ childhood obesity committee. What is even more frightening, Washington said, is that the heaviest children today are more obese than their counterparts were a generation ago, and these young people are starting to develop health problems previously only seen in heavier adults.
The situation has spurred efforts in the public sector to turn the tide of childhood obesity. Every year, the federal government in the United States spends more than $1 billion on nutrition education, with $696 million of that going specifically to childhood nutrition education. The Department of Agriculture is toughening the rules for foods served in schools, and is expected to announce new standards by the end of this year.
Meanwhile, school food vendors are working to develop healthier meal options that children will actually eat. Facing the possibility of government regulation, 11 large food manufacturers - including McDonald’s, Coca-Cola and General Mills - agreed last month to stop advertising products that did not meet a certain nutritional standard to children under 12.
However, the nutritional programs currently in place don’t seem to be changing kids’ behaviors. An Associated Press survey of several studies found that all but four of 57 nutritional programs failed to change the way children ate. Singular changes like removing vending machines from schools don’t ultimately make much difference, Washington said, when everything else stays the same.
Children are now growing up in an “obesogenic environment”, Washington said, where several harmful factors - increased advertising to children, more time in front of televisions and computers, an outdoor environment that may not be safe to play in, larger portion sizes, fast food restaurants, vending machines in schools, reduced physical education time - conspire to make kids fatter.
“They’ve come together in a very toxic environment for kids—and adults, for that matter,” he said. “If you eliminate one of those things without trying to eliminate the others, you’re not very successful.”
Though action is required in schools and communities, things must change in children’s homes in order to have real success with lowering their weight and improving their health, said Washington. “We’re not recognizing that this is a multi-faceted issue, and until you attack all of the issues we’re not going to make much progress.”
Obesity differs from other medical conditions because patients can’t be passive in dealing with the problem, said Dr. Heather Dean, a pediatric endocrinologist and associate dean of the University of Manitoba’s faculty of medicine. Entire families need to change, especially because heavier children tend to have at least one parent who is also overweight.
“In this situation, the family is absolutely 100 percent responsible for the outcomes, and the outcomes are challenging in a family that’s already there because of obesity,” Dean said.
A focus on healthy choices needs to begin when children are young, said Abby Ellin, author of “Teenage Waistland”. “Parents have to be role-models. They have to start this from day one, when kids are little.”
It’s important to ensure that efforts to help an overweight or obese child focus on health instead of reaching an ideal of thinness, said Ellin. If a child’s weight is causing health problems, a doctor should be involved, but otherwise parents shouldn’t put conditions on weight loss or push the issue.
A focus on health that includes small steps, including physical activity they can excel at, can motivate children without worrying them or making them feel threatened, Washington said.
However, while self-esteem should be a consideration, Washington pointed out, it isn’t a reason to avoid the problem. “We can’t use that as an excuse any longer,” he said. “We need to have a compromise between approaching this problem and not ignoring it.”
The medical consequences of obesity in the United States already cost an estimated $100 billion annually. Many of the children who are currently overweight or obese are expected to carry their weight problems - and the resulting health issues - into adulthood. One new challenge for medical professionals is that some of these children are already showing some of the same health problems seen in overweight adults, Dean pointed out.
“Before 1985, we never saw type 2 diabetes,” she said. “We never saw problems of lipid levels in blood, fatty liver disease, kidney disease, hypertension, ovarian problems.” Health professionals saw these issues in adults and worried that children would develop them later if they stayed obese, Dean said, but health problems directly related to obesity weren’t seen in childhood.
Today’s overweight children who take weight-related health problems into adulthood will place a huge burden on the health care system. Then, Washington said, people will decide that something serious needs to be done, without realizing that prevention should have begun decades prior.
“I don’t think we’re at the tipping point yet,” Washington said. “I think a lot of people are realizing kids are obese. I think a lot of people are writing and talking about it. But I don’t think we’ve seen the full impact yet.”
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