Experts Outline Simple Approaches to Childhood Obesity
BY JOHN CARROLL
And in most cases, say health experts, the pounds are being added as primary care doctors and nurses remain largely silent about the health threats they're facing.
Pediatricians from the Centers for Disease Control and Prevention and the University of Rochester School of Medicine & Dentistry crunched the numbers from the most recent National Health and Nutrition Examination Survey and concluded that the number of overweight boys had surged 65 percent in the six years from 1988 to 2004; the ranks of overweight girls grew by 70 percent. Extend the trend lines out to 2010, warned a recent study in the International Journal of Obesity, and half of all children will weigh in as overweight.
These fat kids face more than a daily dose of teasing from classmates. The physicians concluded that being overweight as a child was a better indicator for type 2 diabetes and high blood pressure than the commonly used body mass index equation.
It's not difficult to miss the reasons why kids are fatter these days, said Anthony Fabricatore, PhD, who specializes in obesity at the Center for Weight and Eating Disorders at the University of Pennsylvania School of Medicine. Television, DVDs and the Internet all beckon kids to sit down and remain inactive.
"Also, there's a great deal of high calorie, high-fat food that's available to kids just about wherever they turn," he said.
Family doctors, added Fabricatore, have traditionally done little to try and counter the health threat.
But that doesn't mean doctors are powerless. Pediatricians at the Lucile Packard Children's Hospital have recorded an 80 percent long-term success rate in controlling childhood obesity by using a "stop light" system for identifying food. "Red light" foods included high-fat foods like cheeseburgers and chicken nuggets. They were to be avoided.
"Yellow light" foods included meat, grains and beans, to be eaten in moderation. Pizza, which was originally ranked as a yellow food, was switched to red after too many children took it as a sign they could indulge in one of their favorite foods.
"Green light foods" — vegetables — could be eaten as much as kids wanted.
The key to behavior modification was getting the kids to agree to it. Pressure from parents was almost always counterproductive.
Monica Baskin, an assistant professor in the Department of Health Behavior at the University of Alabama at Birmingham, has been conducting a pilot study among a group of pediatricians that have agreed to try and tackle obesity at an early age.
"Most physicians do collect height and weight data, but many don't calculate BMI," said Baskin. Her group is careful to crunch the numbers when overweight kids come in. Then they start counseling parents. A dietician has been brought in and groups of overweight children in the 3-to-5 age range gather for interactive lessons with music and puppets to help learn more about the role of good eating habits and exercise.
Approaching kids that young may be a key to start turning the obesity trend around. After all, said Baskin, young children are much more likely to see a doctor regularly. And the lessons they learn at that stage can help them throughout their lives.
But Baskin, like Fabricatore, is also acutely aware that most physicians don't stop and counsel overweight and obese patients of any age. There are a few simple reasons why.
"In private practice, that type of counseling is not reimbursed," she explained. "There's no diagnostic code for obesity, and doctors are reluctant to take a couple of minutes to spend on that."
At the same time, many physicians don't feel they have the skills to really help their patients deal with obesity. Just saying, 'Hey, you're picking up too many pounds' without adding a practical solution is often seen as doing more harm than good.
While physicians are typically staying out of the discussion, children are getting plenty of constant encouragement to indulge in junk food.
Two years ago, the Institute of Medicine (IOM) concluded that the food industry bore a good deal of the responsibility, shelling out $10-$12 billion a year to promote junk food to kids. A year ago, the IOM followed up with a new report that drew a direct line between the ads and their soaring weight. The Federal Trade Commission recently began its own investigation, but until now authorities have done little to stem the marketing tide.
It's a different situation in the United Kingdom, which has been watching the next generation growing steadily fatter with growing alarm. British regulators recently banned junk food ads from all children's programming and are preparing to authorize the country's national health program to begin performing bariatric surgery on extremely obese children.