Ask an Expert

Transcript

September 2006

Childhood Obesity

Darla Castelli

Is it appropriate to use rewards to encourage children to be more active? For example, I saw a suggestion of connecting television viewing or computer game playing time to time spent in active exercise.

Every child wants his or her hard work to be acknowledged and even rewarded. For example, adults who have lost weight might purchase new running shoes or new outfits for their workouts as a reward for their hard work. However, with children this idea is not as simple as it may first appear. Children need to realize that being physically active is a way of life that does not always include immediate reward. Setting goals and changing behaviors take time and energy, and therefore rewards should only be granted when an actual behavior change takes place. Additionally, rewards should be reinforcers not retractors of the desired behaviors. I will provide specific examples for parents, but first I would like to present some of the current research on the use of media and its relation to sedentary behaviors.

The use of media (i.e., video games, computers, and television) has been associated with body fatness and physical inactivity (Jason & Brackshaw, 1999). Low engagement in physical activity is linked to parent education, the number of household rules about television viewing, and the location of the media in the household (Christakis, Ebel, Rivara, & Zimmerman, 2004). The Kaiser Family Foundation Report, Generation M: Media in the Lives of 8-18 Year-Olds, illustrates a historical perspective of the importance of media in the lives of children and adolescences. Today, “ almost three-quarters of U.S. kids live in homes that contain three or more TV sets” (Roberts, Foehr, & Rideout, 2005, p. 10). More importantly, this resource arms parents with simple ideas that can be easily enacted in the household to reduce media use in a positive manner.

First, all media should be placed in a central location in the household where every family member could use it. Televisions, computers, and video games in a child’s bedroom promote physical inactivity. When media are centrally located (i.e., in the living room, just off of the kitchen), parents are more likely to question the child’s frequency and purpose of its use. Second, media should not be linked to caloric consumption. Watching television is sedentary as it is, but to eat while watching television is double trouble. An occasional healthy snack, like popcorn or pretzels, on Saturday night during a movie is certainly acceptable; however, snacking in front of the television should be a rarity. Finally, a household with at least one rule about the use of media is more likely to contain physically active individuals. Rules can be simple, such as (1) no television before school, (2) no television until your homework is finished, or (3) only 2 hours of screen time (any media use) on Saturday or Sunday (this one promotes planning and self-regulation). In some households, the television is turned off for family physical activity time, like walking around the neighborhood, shooting baskets, or flying a kite in a local park. Creation and enforcement of at least one rule about media can make a difference.

When a child makes a healthy choice, he or she should be acknowledged and, at times, be rewarded. A parent could say to a child, “since you participated in physical activity for 60 minutes for at least five days (the President’s Council for Physical Fitness recommendation for children) last week, let’s take a ride on the bike trail together.” This example uses rewards to reinforce the desired behaviors. An inappropriate reward would be to provide ice cream or more media time for participation in physical activity. Stickers, physical activity logs, a new bike, or a cool soccer shirt for practice are all positive means of supporting physical activity engagement. I am sure that many parents are already doing these things; it is important to point them out to the children. Physical activity should be a family objective because those families that are active together are less likely to need extrinsic rewards as motivation.

For More Information

Christakis, Dimitri A.; Ebel, Beth E.; Rivara, Frederick P.; & Zimmerman, Frederick J. (2004). Television, video, and computer game usage in children under 11 years of age. Journal of Pediatrics, 145(5), 652-656.

Jason, Leonard A., & Brackshaw, Ester. (1999). Access to TV contingent on physical activity: Effects on reducing TV-viewing and body-weight. Journal of Behavior Therapy and Experimental Psychiatry, 30(2), 145-151.

Matheson, Donna M.; Wang, Yun; Klesges, Lisa M.; Beech, Bettina M.; Kraemer, Helena C.; & Robinson, Thomas N. (2004). Obesity Research, 12(Suppl.), 32S-37S.

Roberts, Donald F.; Foehr, Ulla G.; & Rideout, Victoria. (2005, March). Generation M: Media in the lives of 8-18 year-olds. Menlo Park, CA: Kaiser Family Foundation. Retrieved September 8, 2006, from http://www.kff.org/entmedia/upload/Generation-M-Media-in-the-Lives-of-8-18-Year-olds-Report.pdf

What role do genetics play in obesity in young children?

Several reasons are speculated for the obesity epidemic in the United States, including biological, environmental, and behavioral influences. Genetics account for biological effects of body composition in children, whereas the environment shapes an individual’s behaviors. Because the causes for childhood obesity are both genetic and environmental, it is difficult to discriminate between the two.

Some individuals do have a predisposition to be overweight and even obese; however, this does not mean that they should give up on their health. In actuality, it is all the more reason why these individuals should be conscientious about what they eat and how much they are physically active. For example, an individual may have a genetic predisposition to have high cholesterol. For these individuals, early detection and behavioral change have the potential to extend life expectancy. Diet, the nutritional value of the food substance ingested, as well as the regularity and type of physical activity can help to curb the effects of these genetic predispositions. Only a physician can determine the full effects of genetics on the individual, and it is therefore important that the individual take control of his or her own behaviors or, in this case, his or her child’s behaviors.

Individuals, regardless of age, can achieve their physical activity and fitness goals, up to their given genetic potential. Even though heredity influences physical activity, fitness status, and health, most people never actualize their own genetic potential. Regardless of genetic makeup, most people can still lead healthy lives, because heredity alone typically does not predestine someone for poor physical health nor does it guarantee a good quality of life.

Specific to genetics, parents can help children in two ways: (1) take their children to a physician for regular wellness visits and (2) be aware of their children’s caloric consumption and energy expenditure. First, as part of regular “check-ups,” physicians will identify where your child is in relation to other children of his or her age. Height and weight charts provide a record of growth and development. During a routine physical examination, a physician will identify whether a child’s weight is atypical or unhealthy and perhaps even make suggestions about food consumption. If not offered by the physician, then the parent should ask, “Is my child of normal height and weight?” “What types of foods and how much food should my child be eating during this period of growth and development?”

Second, it is recommended that each child be physically active for more than 60 minutes for most days of the week. Schools have changed since we were there; the amount of time dedicated specifically to being physically active has been drastically reduced. With some exceptions, most children only have 10 minutes of recess each day--if they have recess at all. Although physical education classes are supposed to be offered every day in the state of Illinois, it is more likely that your child is active during physical education for 30 minutes every other day. These totals fall well short of the national physical activity recommendations. We need to help our children learn to include physical activity in their daily lives. This can be accomplished through parental modeling, tracking of daily physical activity, or participation in formal physical activity opportunities such as youth soccer or YMCA programs and should be done regardless of the child’s genetic predisposition.

My toddler asks for snacks every couple of hours. Could frequent snacking lead to unhealthy weight gain?

The answer to this question is dependent upon what the child is eating and how active the child is. Many times, active toddlers do not slow down to eat, while others are just beginning to be independent. Toddlers by nature are snackers, because they are simply not developmentally ready for only three meals a day. The body of a toddler is steadily growing and therefore needs fuel to meet the demands of his or her day. The general rule of thumb is one to two snacks per day between meals. Before feeding a toddler, it is important to assess the needs of the child. For example, is the child asking for food because he or she is bored and wants something to play with, or is the toddler truly hungry? Feeding children to relieve frustration is inappropriate; instead, parents may want to try presenting a book or a toy to refocus them.

Parents should try to avoid large amounts of sweet desserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or candy, and other foods that have little nutritional value and result in a toddler’s increased desire for them. Unfortunately, pre-packaged, high-sugar products are often the most convenient snacks; however, these should be avoided whenever possible. Healthy snack choices are fruits, vegetables, or dairy products such as yogurt, which can also be purchased pre-packaged. My 2-year-old daughter has just discovered drinkable yogurt to accompany her apples as an afternoon snack. It is important that parents take advantage of this experimental stage of child development, in which the child is willing to try different food substances. Be sure to provide foods of a wide variety of colors, textures, and flavors.

When a child can use a cup, try creating homemade smoothies. You can start by making ice cubes that contain fruit or vegetables. It will take a few hours for the ice to form, so plan ahead; this is not an impromptu snack. Once the ice cubes are set, add milk, a fruit with natural sugars (e.g., bananas), and the ice to a blender or smoothie machine, then liquefy. Your toddler will love this snack, and it is nutritionally sound.

At this stage, it is important not to deprive your toddler of food out of fear of weight gain. Assess the toddler’s needs, determining why he or she is asking for food. This is a time to establish healthy eating habits, so try to avoid giving in to a demanding toddler. (I know that it may seem easy for me to say, but, honest, I have a 2-year-old at home so I can relate.) Unhealthy weight gain is a result of inactivity and overconsumption of poor food choices. Remember that physical activity for a toddler is walking, climbing, rocking, rolling, and attempting to jump. It is intermittent and often brief.

Many young children spend far less time actively playing these days. Do TV watching and video game playing play a role in the current obesity epidemic?

The use of media (i.e., computer, television, video games) is directly associated with physical inactivity and body fatness and are considered strong contributory factors in the obesity epidemic (Roberts, Foehr, & Rideout, 2005). Fortunately, this factor is one that parents can have a tremendous influence over, and several simple steps can be taken to assist children in making healthy choices regarding the use of media. Here are some tips for parents who want to promote healthy choices in media use:

1. Move the television, computer, or electronic games out of the child’s bedroom and into a central location in the household.
2. Set ground rules specific to the amount of screen time that is acceptable for your child. I would recommend no more than 2 hours per day, even on the weekends. Allow the child to make choices about which type of media that he or she would like to use during this 2-hour period.
3. Be aware of a child care provider’s practices related to television viewing. It is recommended that no child under the age of 2 watch television. Parents may prohibit or limit television viewing in the home, yet a child care provider may be using a television to put children to sleep or as means of providing quiet time. This is a poor practice and if used by a child care provider should be addressed.
4. Have a household guideline that there is no television watching or video game playing until schoolwork or chores are finished. This teaches children that school and home are priorities over media.
5. Increase the amount of outside time. If children are outside, regardless of the climate, they are less likely to create habits related to media.

Creation and enforcement of these media guidelines have been associated with increased physical activity engagement. As children mature, media become a more and more important part of their persona, because teens enjoy music videos, pop culture hit television shows, and “gaming.” It is important to give the message that these technologies are not bad but that moderation is the best rule for their use.

For More Information

Roberts, Donald F.; Foehr, Ulla G.; & Rideout, Victoria. (2005, March). Generation M: Media in the lives of 8-18 year-olds. Menlo Park, CA: Kaiser Family Foundation. Retrieved September 8, 2006, from http://www.kff.org/entmedia/upload/Generation-M-Media-in-the-Lives-of-8-18-Year-olds-Report.pdf

Are there some foods or drinks that you feel should be kept away from young children entirely?

At this stage of development, children should be trying all food substances. Primary concerns at this stage are food allergies, “picky eating,” and overconsumption or underconsumption of foods. Potential food allergies should be taken seriously and addressed immediately--milk, shellfish, peanuts, peanut butter, and other nuts are common foods that cause allergic reactions. Parents should observe how a child responds to a new food. For example, did the child get a rash or fever after consuming the food. If so, parents should contact a physician immediately.

For the “picky eater”--a child who is overly selective about what he or she consumes--it is important for the parent to keep trying. Your child needs to eat the most nutritious foods available, such as meat, poultry, cheese, bananas, and peas--even avocado. Identify the food type that children are least likely to ingest (e.g., milk) and try different versions of those food types (e.g., yogurt, pudding) in an attempt to keep their diet balanced.

The overconsumption and underconsumption of a food substance is also an issue that you may be dealing with as a parent. Children are often sporadic in their eating habits at this age; sometimes they come to the table and do not eat anything, while other times they “clean their plates.” These inconsistent eating habits make it difficult for parents to track their child’s nutrition level. It is important that, if you identify a deficiency in any single food type or across several categories, you tell your pediatrician; he or she may suggest that you have your child take a multivitamin in order to consume the recommended daily allowance of essential nutrients.

Here are a few tips for parents about food and drink:

• Offer fresh fruits and vegetables whenever possible.
• Create a positive, nonthreatening atmosphere around eating. The days of “you better eat your vegetables or else…” are gone.
• Avoid fast food whenever possible. If available, make healthy choices. Many restaurants are now offering apples or carrots as a side dish instead of french fries.
• Drink milk and avoid too many fruit drinks or soda pop. Many presweetened drinks are filled with empty calories.
• After the age of 2, let your child try any food substance that you are eating. You may be surprised to find that your child likes shrimp or other fish products.
• Be patient. Children are forming their own likes and dislikes, and it may take some time for them to appreciate all of the food that you do. Keep serving the food prepared in different ways.

Here are a few healthy snack suggestions:

• Whole-grain pretzels, crackers, bread, or rice cakes
• Cheese (in forms, cubes, sticks, shredded, or crumbled). Consider low-fat or fat-free cheeses.
• Whole-grain muffins or cereal bars
• Soft dried fruit (apricots, dates, raisins)
• Raw vegetables (even red peppers, mushrooms, and zucchini)
• Cooked legumes (peas, beans, or chickpeas)
• Yogurt (plain, not heavily sweetened)

I’m told I was a chubby child but am a normal-weight adult. Don’t most children outgrow being chubby?

Two new longitudinal studies suggest that childhood physical activity patterns and body weight will likely track into adulthood, thus placing overweight children at risk for cardiovascular disease as young adults. This literature also suggests that this generation will be the first not to have a longer lifespan than their parents because of increased risk factors (i.e., high cholesterol, high blood pressure, type II diabetes) related to metabolic syndrome. Once upon a time, we thought that children would outgrow their chubbiness to become normal-weight adults. After infancy and beyond the toddler years, it is important for parents to be conscientious about their child’s caloric consumption and energy expenditure. Did the child “burn off” what he or she consumed? If a child comes home from school and consumes a candy and soda pop as a snack, it is very likely that the child will not have been active enough to expend all of the calories that were consumed. Halloween is fast approaching, and this scenario may be one that comes to fruition on November 1.

Because of the federal pressure placed on schools through mandates such as the No Child Left Behind act, many schools have elected to eliminate recess and physical education in order to spend more time on academics. Recent research suggests that this practice may be inappropriate because physical activity and physical fitness are positively related to cognitive performance (Castelli, 2005; Castelli, Hillman, Buck, & Erwin, in press). More specifically, children with normal body weight and children who are aerobically fit are more likely to do better on standardized reading and math tests. A study of California school children revealed that physical activity opportunities during the school day, like physical education, did not take away from but contributed to academic performance (Sallis et al., 1999). A study published this past August identified vigorous physical activity as a contributing factor related positively to grades in school (Coe et al., 2006). Normal body weight has lots of physical and cognitive benefits, and it is therefore important for the parent to take immediate action because a child will likely not grow out of this phase. Parents should help the child increase his or her opportunities for physical activity. Make those opportunities moderate to vigorous in nature. At the same time, the parent can help children make healthy choices about the food substances and amounts that they are consuming.

For More Information

Castelli, D. (2005). Academic achievement and physical fitness in third-, fourth-, and fifth-grade students. Research Quarterly for Exercise and Sport, 76(1), A-15.

Castelli, D. M., Hillman, C. H., Buck, S. M., & Erwin, H. E. (in press). Physical fitness and academic achievement in 3 rd and 5 th grade students. Journal of Sport and Exercise Psychology.

Coe, D. P., Pivarnik, J. M., Womack, C. J., Reeves, M. J., & Malina, R. M. (2006). Effect of physical education and activity levels on academic achievement in children. Medicine and Science in Sports and Exercise, 38(8), 1515-1519.

Sallis, J. F., McKenzie, T. L., Kolody, B., Lewis, M., Marshall, S., & Rosengard, P. (1999). Effects of health-related physical education on academic achievement: Project SPARK. Research Quarterly for Exercise and Sport, 70 (2), 127-138.

Are there known health risks to children if they are obese at ages 4 or 5?

There have been documented cardiac events such as heart attacks in children as young as 10 years old. These are unique and rare occurrences, yet they do make us stop and think about what our children are eating and how often they are exercising. It is not so much that metabolic syndrome effects (i.e., high cholesterol, high blood pressure, type II diabetes) begin showing up at age 4 or 5, but it is more that habits are formed during this period of development. Four- and 5-year-old children need calories to grow and develop and should not be placed on a strict diet unless explicitly under the guidance of their physician. Instead, 4- and 5-year-olds should be encouraged to play, climb, run, and generally enjoy movement. Physical activity at this age does not need to be formal instruction in soccer or YMCA gymnastics--although those forms of movement can be engaging--it can be as simple as playing tag in the backyard, dancing to music in the kitchen, or acting out your child’s favorite bedtime story. The point is to move spontaneously and often. The child who is strapped into a car seat then told to “be still” at preschool is not being allowed to do what comes naturally--to wiggle and move about his or her environment.

It is not so much that the children are placed at risk, as it is that they are not being afforded the benefits associated with physical activity and proper nutrition. Take, for example, the idea of breakfast. There are over 500 research studies that demonstrate that children who eat breakfast are more ready to learn than those who do not. This finding led to the federally sponsored school breakfast program. Healthy habits begin at this age, and therefore children should be encouraged to make healthy food choices and be physically active whenever possible. It is important to avoid long periods of physical inactivity. Healthy habits will likely track into adulthood and help to minimize the risk factors associated with cardiovascular and other diseases.

I read in the news recently about findings from the Harvard Medical School’s journal, Obesity, that suggest that the obesity we see in some preschoolers could be starting in infancy. Do you think it’s possible for infants to be obese?

Obesity is a very real problem in children residing in the United States, even as young as infancy. Obesity is determined by the association of height and weight as a measure of body mass index (BMI). If a child’s BMI is at least 20% higher than the average of others of the same age and sex, than the child or infant will likely be identified as overweight or obese. So, by definition, it is possible for infants to be considered to be obese. However, judgment of whether or not an infant or young child is obese should be determined only by a physician. The physician will likely use medical histories from both of the parents as well as the child’s current height, weight, and behaviors to identify the child’s potential predisposition for obesity.

Parents should ask themselves two questions before consulting a physician to determine whether the child is obese. First, what and how often is your child eating? Is the infant being feed every time he or she cries? Remember, crying is simply a form of communication--the only form of communication that an infant knows. A parent should become familiar with the subtle differences between cries, because the infant could be asking for a diaper change when you are attempting to feed him or her. At first, particularly with new parents, interpretation of a baby’s needs is a guessing game, but with time and a little trial and error, parents can come to understand and meet the needs of their infant. It is important that a child be fed when hungry in order to support his or her normal growth and development. Yet, if an infant keeps spitting out a bottle, he or she may simply want to play, be changed, or be held. Obesity in preschoolers can be a result of genetics or the environment. Healthy eating and activity habits begin during infancy.

Second, the physician will want to know how much time your child spends watching television and being physically active. The American Medical Association suggests that child under the age 2 not watch any television. When television is introduced after age 2, it should be on a restricted, parent-previewed basis. A child should not accumulate more than 2 hours of television watching per day. If parents are unsure about how much time a child is watching television or engaging in physical activity, they could use a log to record the frequency and types of activity.

Have any connections been found between being overweight in childhood and having diabetes later in life?

There is growing evidence linking obesity to early onset of type 2 diabetes, which was formerly only seen in adults. Diabetes is no longer an issue of tomorrow, but one that requires the attention of parents today.

Diabetes is a disease in which blood glucose levels are above normal. There are three types of diabetes: (1) type 1, (2) gestational diabetes, and (3) type 2. Type 1 diabetes, formerly called juvenile diabetes, is often diagnosed during childhood or young adulthood and is caused by an abnormality in the beta cells of the pancreas. Gestational diabetes can develop during pregnancy and often goes away once the baby is born. Type 2 diabetes, the most common, used to be seen only in adults over the age of 45. Now type 2 diabetes is seen in children. Being overweight and inactive increases the chances of developing type 2 diabetes. Although people with diabetes can lead normal lives, type 2 diabetes might be prevented with a proper diet and regular physical activity. The presence of diabetes also increases one’s propensity for metabolic syndrome or cardiovascular disease.

The National Diabetes Information Clearinghouse Web site notes: “More than 6 million people in the United States have type 2 diabetes and do not know it” because there are often no signs or symptoms. The Centers for Disease Control Web site suggests seeing a physician if these sign and symptoms are evident:

• Increased thirst
• Increased hunger
• Fatigue
• Increased urination
• Weight loss
• Blurred vision
• Sores that do not heal

With diabetes, two things are important: (1) identification of genetic predisposition and (2) early intervention. Environmental factors may be more important than initially thought as the incidence of type 2 diabetes in children has reached epidemic levels. Obesity and all of its causes are significantly related to greater risk of the onset of type 2 diabetes, because obese children produce too much insulin. The overproduction of insulin leads to a dependence on this amount of insulin. A good screening tool is a child’s body mass index (BMI). The Centers for Disease Control Web site offers online screening tools that can help identify whether you and your child are at risk for diabetes based on the BMI. The American Diabetes Association also offers a screening tool, which can be found at http://www.diabetes.org/risk-test.jsp.

Children who have normal body weight and are regularly physically active have a reduced risk of type 2 diabetes.

It seems like younger and younger children, particularly girls, are anxious about weight and appearance. Can we encourage healthy habits without adding to this anxiety or to the social stigma of obesity?

Encouraging healthy eating habits is different from endorsing caloric reduction or restriction. Unless otherwise advised by a physician, a child or adolescent should not intentionally withhold or restrict caloric consumption. During periods of growth, it is extremely important that children and adolescents eat right and get enough sleep to support their body systems during these periods of transition.

After fifth grade, physical activity engagement begins to decline, particularly in girls, and differences in physical activity levels between boys and girls observed during childhood become even more prominent. Additionally, older children become more autonomous in their nutritional decision making. Fast foods and quick meals become a regular part of the teenage diet. Socially, preteens and teens alike are beginning to acknowledge the importance of their “looks.” During this period of development, it is important to encourage healthy habits from both a physical activity as well as a nutritional standpoint, because friends and media are influencing their perspectives of body image.

Parents need to be willing to openly discuss issues related to body image, because they act as one of the few filters of the information that is presented in the media. Television commercials and teen magazines suggest that “thin is beautiful.” Even though parents feel they are losing their authority with preteens and teens, it is important to realize that they are still closely watching your behaviors. Having a parent model healthy nutritional and activity choices is still valuable.

Perceptions about weight or appearance are highly correlated with self-esteem and in turn influenced by physical activity. Sedentary behaviors are associated with lower self-esteem and even depression. By being physically active, teens can increase their self-esteem as well as strengthen their perceptions regarding their own body image. The Teens Health Web site, sponsored by the Nemours Foundation, provides three tips for improving body image: (1) change the way you think about yourself, (2) be happy with yourself, and (3) identify some realistic changes.

We should realize that our bodies need food substances such as fat and cholesterol to function, and therefore “fat” should not be considered an unpleasant word but more a reality of eating. Parents can turn to a source housed right here on the University of Illinois campus--the Nutrition Analysis Tools and System (NATS), which was developed in 1996 by Chris Hewes and Jim Painter, Ph.D., R.D. of the Department of Food Science and Human Nutrition at the University of Illinois. By using this Web tool, parents can educate their preteen and teens on this content. It is important to remember that parental modeling of the desired eating habits and physical activity behaviors can also help to ease anxiety related to over- and underconsumption of healthy foods.

Should an obese child have the same diet (as the other children) that's served in day care, or should he or she have a different nutrition?

Well, the answer depends on the child and what it is being served. Certified child care centers and schools must provide breakfast and lunches that meet specific nutritional guidelines. In general, these guidelines require that nutritionally balanced, low-cost, or free meals be provided for the children. These guidelines are intended to safeguard the health and well-being of the nation's youth as well as support domestic agricultural production. For example, programs are required to meet specific nutrition standards over the course of a week and are allowed some flexibility in meeting these standards by following different menu-planning options. Adherence to these standards means that the programs follow the Dietary Guidelines for Americans. Yet, some of these guidelines may seem contrary to what we hear in the media. For example, these meals are required to contain fat because fat is a necessary food substance to help our bodies function efficiently. In particular, body fat provides warmth and when broken down provides energy for human movement.

The guidelines recommend that parents of overweight children “consult a healthcare provider before placing a child on a weight-reduction diet” because there is a delicate balance between the reduction of body weight and the allowance for growth and development. Therefore, overweight children enrolled in child care should eat the lunches provided, unless otherwise advised by their physician. However, I would encourage parents to investigate whether or not the school/child care center lunches adhere to these guidelines.

Obese preschool-age children have a long road ahead of them because these children have a tendency to become overweight or obese adults. Being aware of nutritional and physical activity guidelines and promoting them within the home are excellent steps toward wellness. It is important that all members of the household model making healthy choices.

For More Information

• Measuring Competitive Foods in Schools: Methods and Challenges
  http://www.fns.usda.gov/oane/MENU/Published/CNP/FILES/CompFoodSum.pdf

Many times, an obese child has limitations, even serious limitations, on the playground or at recess. How should one treat obese children in order to help them avoid become shy and withdrawn? And how can peers be helped to avoid teasing obese children or getting impatient with them?

I think everyone should be treated fairly, particularly during periods of physical activity. Today, physical education teachers are being asked to take on the responsibility of coordinating all physical activity opportunities before, during, and after school for both the staff and students. With this approach, endorsed by the National Association for Sport and Physical Education (NASPE), the physical education teacher, one of the few school personnel who will know the child for more than a single academic year, develops individual physical activity opportunities so that all children can be successful in that context. Whether overweight, physically gifted, or uncoordinated, a child should be presented with physical activity opportunities that promote success.

The integration of technology into schools has helped to make this ideology a reality. Specifically, heart monitors can provide specific guidance to teacher-leaders of physical activity in developing physical activities that are of an appropriate intensity for each child to be successful. For an overweight child, physical activities should be of a lower intensity and perhaps even more intermittent than activities promoted for normal body weight children. A child who carries additional body weight may find that running hurts; therefore, the child should be asked to walk or try some light weight-bearing exercises like riding a stationary bike. A child’s walking pace can be altered through the use of the heart monitors. As we know, success--particularly in a physical activity setting--has been associated with higher levels of self-esteem (Dishman et al., 2005).

Another way parents can advocate for their child to gain access to success-oriented physical activities during the school day is through Section 504 of the Rehabilitation Act of 1973. This civil rights law prohibits discrimination against individuals with disabilities--any physical impairment that substantially limits one or more of major life activities. Obesity and asthma are two examples that fall within the guidelines of Section 504. In this situation, a child who has been diagnosed as obese by a physician could receive accommodations during physical education instruction or other physical activities.

For More Information

• Dishman, Rod K.; Motl, Robert W.; Sallis, James F.; Dunn, Andrea L.; Birnbaum, Amanda S.; Welk, Greg J.; Bedimo-Rung, Ariane L.; Voorhees, Carolyn C.; & Jobe, Jared B. (2005). Self-management strategies mediate self-efficacy and physical activity. American Journal of Preventive Medicine, 29(1), 10-18.

Are certain groups of children at greater risk for obesity than others—for example, boys compared to girls or Black children compared to White or Hispanic children?

Obesity and overweight are most commonly measured by comparing a person’s height and weight and converting these measures into a body mass index (BMI). In general, 17% of the children are overweight, and 32% of adults in the United States are obese. Among children and adolescents, approximately 16% of females and 18% of males are overweight. Males are more physically active than females throughout the lifespan; however, it is not until young adulthood that females surpass males in prevalence of overweight--33% compared to 31%. Extreme obesity (a BMI over 40) is evident in approximately 2.8% of male and 6.9% of female adults. These estimates of obesity increase with age; a typical American adds 2.5 pounds of body weight each year.

With regard to ethnicity, we really only have comprehensive information on adults. “Approximately 30% of non-Hispanic white adults were obese as were 45.0% of non-Hispanic black adults and 36.8% of Mexican Americans” (Ogden et al., 2006, p. 1549). Data on the child level relate only to specific risk factors for cardiovascular disease. For example, it has been consistently revealed that non-Hispanic black youths have higher blood pressure than non-Hispanic whites, without considering the effects of obesity (Berenson et al., 2006). Early studies suggested that these differences in risk factors appeared to be more a result of the region of the country and parental education than ethnicity (Greenlund et al., 1998).

Regardless of ethnicity or gender, there is no single secret recipe to addressing issues of obesity. When one compares obesity statistics across gender or ethnicities, this notion becomes even more obvious. For now, we must settle for the idea that physical activity and healthy nutritional choices will benefit any individual in the long run. As new data are uncovered, only then will we be able to make more specific recommendations for a healthy lifestyle.

For More Information

• Berenson, Gerald; Srinivasan, Sathanur; Chen, Wei; Li, Shengxu; & Patel, Dharmendrakumar. (2006). Racial (black-white) contrasts of risk for hypertensive disease in youth have implications for preventive care: The Bogalusa Heart Study. Ethnicity & Disease, 16(3), S4, 2-9.
• Greenlund, Kurt J; Kiefe, Catarina I.; Gidding, Samuel S.; Lewis, Cora E.; Srinivasan, Sathanur R.; Williams, O. Dale; & Berenson, Gerald S. (1998). Differences in cardiovascular disease risk factors in black and white young adults: Comparisons among five communities of the CARDIA and the Bogalusa heart studies. Annals of Epidemiology, 8 (1), 22-30.
• All data came from the JAMA publication, unless otherwise indicated:
  Ogden; Cynthia L.; Carroll, Margaret D.; Curtin, Lester R.; McDowell, Margaret A.; Tabak, Carolyn J.; Flegal, Katherine M. (2006). Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association, 295(13), 1549-1555.

When an older child who is relatively active, and near or slightly above 100% of ideal weight, suddenly has to "slow down" for several weeks due to illness or injury, what do you recommend to help the child NOT gain weight? (By "injury" I mean a concussion or a cast to protect a growth plate on the leg--something that means the child has to be less active for safety's sake.)

Getting out of a routine is difficult for anyone, particularly children. If the physician has specifically stated rest or no physical activity, then you simply have to honor that because it is in the best interest of the child to do so. However, children heal quickly and are usually eager to get back on their feet. Many times it is more difficult to “keep them down” than to get them going again. Depending on the injury or reason for the slowdown, a child can usually continue to do non-weight-bearing or light-weight-bearing exercises (e.g., stretching, swimming, or walking). Again, these activities should only be engaged in if the physician has specifically given permission to do so.

After an injury occurs, it is important to help children realize that they are now burning fewer calories so they need to consume less. This is not to suggest that children should go on a diet. It just means that although an active child previously could consume an unhealthy snack after school or after a soccer game as a team snack, now these snacks represent calories that will likely be stored as fat because they are not utilized as energy. It is more important than ever that the snacks be healthy ones. (See Say Yes to Healthy Snacks for suggestions.) I would recommend tracking the amount of snacking as well as time spent watching television or playing video games--both can add up quickly when a child no longer has practice to attend.

Another thing to consider is keeping children involved with their activities even though they cannot participate. Remember--activity is not only about exercise but also about making friends, having affiliation with a team, and gaining confidence through success. The child’s role should be redefined (e.g., retrieving the balls, working with the goalies, keeping time, etc.) to adhere to his/her recovery guidelines. Keeping children involved means that they are less likely to be eating extra snacks or watching more television.

Unfortunately, accidents do happen. It is important to conscientiously make adjustments to adhere to “doctor’s orders” but also to remain involved with the things that make the child happy. In the case that was described in the question, it is important not only to be attentive to a child’s weight but also to his or her mental health. If staying with the sport activity is just not possible, then perhaps now is the time to try something new, like playing an instrument. The child may require a little bit more of your time until he or she gets through this issue.

For More Information

• Organized Sports and Young Children
  http://illinoisearlylearning.org/tipsheets/sports.htm

Do a child’s ideas about body image begin in the preschool years? Does focusing on a child’s weight or size lead to eating disorders later in life?

 

 

Childhood obesity is a realistic concern for parents because…

• Children are heavier today than a decade ago.
• Overweight or obesity has been identified in approximately 30% of preschool-age children.
• Risk for metabolic syndrome (e.g., incidence of diabetes in children, blood pressure, and cholesterol) has drastically increased.
• Only 30% of children are physically fit.
• Overweight and obese children often suffer both medical and social side effects.

This is the harsh reality of living with children in today’s society, yet all of the hype related to this issue can be overwhelming to both the parent and the child, even as early as preschool. Back in 1981, a study by Ginsberg-Fellner, Jagendorf, Carmel, and Harris warned us of that body weight was consistently increasing among preschool-age children. Since that time, Nader et al. (2006) have confirmed increases in the number of overweight and obese preschoolers as well as its likelihood to continue into adolescent years.

Overweight preschoolers will likely only know that they are physically different from their peers if they are unable to complete the same tasks (e.g., run and climb on the playground). Unfortunately, it is most often a peer who will point this out. Body image is a fragile state of mind. A slightly overweight child could be self-assured one minute then inappropriately teased the next. I do believe that we need to reorient our focus, away from weight exclusively to one related to making healthy choices.

Beginning at age 2, it is important to have children try different types of foods. You may offer the food one night, and the child won’t like it; then suddenly the next time you offer the same food, the child likes it. It is important during this period to continually present the child with healthy foods like fruit, vegetables, milk, whole-grain bread, and more. Simultaneously, we need to encourage children to be active. All parents get tired in the evening, but it is important to have planned physical activity time with your child. This means getting down on the floor and playing with your child for more than 30 minutes per day. Yes, child care can help by prompting these things during the day while the parent is at work, but ultimately the parent has the greatest influence over these behaviors. Establishment of healthy choices, being physically active, and eating right begins during infancy and should be reinforced throughout life. We all have different body types, and we should help children feel good about themselves, regardless of their body weight.

I believe that this approach is very different from one in which a parent states, “Don’t eat that or you will get fat.” “You look like you have put on weight; how am I going to afford to buy you new jeans?” Instead, the parent could say, “Let’s go outside and play catch.” “I have noticed that you have been watching more television and having snacks; how about we both agree to not eat after 7:00 p.m. at night?” For the preschooler, it is important to introduce the notion of choice by offering two items that you want the child to have. For example, “Abby, should we have carrots or peas tonight?” “What kind of fruit should Mommy buy at the store?” “What do you like better--apples or bananas?” This idea of choice could even be extended to physical activity: “Should we take a walk to the park or play in the sandbox?”

Body images as well as healthy habits are established during the preschool years. These behaviors can extend into adolescence, so it is important to take a positive approach to helping children make healthy choices. Negative body images and low self-esteem could lead to eating disorders or other unhealthy behaviors in later life.

For More Information

• Ginsberg-Fellner, Fredda; Jagendorf, Lorri A.; Carmel, Harold; & Harris, Tamara. (1981). Overweight and obesity in preschool children in New York City. American Journal of Clinical Nutrition, 34(10), 2236-2241.
• Nader, Philip R.; O’Brien, Marion; Houts, Renate; Bradley, Robert; Belsky, Jay; Crosnoe, Robert; et al. (2006). Identifying risk for obesity in early childhood. Pediatrics, 118(3), e594-601.

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