Preventing Childhood Obesity

There have been a number of articles about obesity and children, and frequently there are words used such as “surge,” “epidemic,” and “growing problem.” Let’s take a look at what the issues are.

Obesity has a popular meaning (just plain fat – we know it when we see it) and a technical meaning. Overweight (chubby) is the same. And here comes the interesting thing: official technical meanings of these two words have changed. They deal with the body mass index, or BMI, which is the ratio of weight to height, and is arrived at by the following method: multiply the weight in pounds by 703, then multiply the height in inches by height in inches, then divide the first number by the second. If using the metric system, the numbers are weight in kg divided by the square of height in meters.

Before 1998, a BMI of 27 or more was considered overweight. But in June 1998, new cut-off weights were implemented. The BMI for overweight became 25 to 30, and anything over 30 became obese. Thus, overnight a lot of people became overweight who were considered normal the day before.

With children, the BMI is not so clear a measurement. According to a paper in the British Medical Journal of May 2000, at birth the BMI can be around 13, going to 17 at age 1, 15.5 at age 6, to 21 at age 20. Therefore, using the BMI to determine whether a child is overweight or not is not so clear cut, so it’s not used. Instead, in the US children who weigh more than 85% of their contemporaries are considered overweight. Those who weigh more than 95% of their peers are classified as obese.

There is general agreement that prevention is the best route to take to deal with this issue. Trying to get children to lose weight by restricting their diet awakens what I like to call the “mule syndrome,” which all of us can relate to. That is what happens when we are pushed to do one thing, and automatically we pull the other way. The Children’s Health Education Foundation at Touro College (www.touro..edu.chef) strongly advises against dieting for children, as it may lead to eating disorders.

What, then, can we do?

1. Research has clearly established that the extent and duration of breastfeeding is inversely associated with the risk of obesity in later childhood, according to the American Academy of Pediatrics Committee on Nutrition. Thus, breastfeeding is the number one recommendation – the longer the better.

2. Family meals. Many children eat snacks, packaged foods, and fast food as their parents are too busy to cook. In the same AAP paper, “Prevention of pediatric overweight and obesity,” the authors point out that the absence of family meals is associated with lower fruit and vegetable consumption. More consumption of fried foods and sodas are also associated with this dynamic. To instill good eating habits in children, families should eat one or more balanced meals a day together. Or at least 5-6 times per week. Rather than talking and cajoling, parents need to model healthful eating, with an occasional low-key comment about the role of food in health.

3. Restrict TV viewing. This for two reasons: first, inactivity, and second, the constant barrage of advertising of junk foods and drugs. One of the clear culprits in childhood overweight is lack of physical activity. Children amuse themselves these days by TV watching and computer games. There is a place for those, but a majority of kids spend 4 hours a day watching the tube, which clearly is too much. And then there is the issue of junk foods advertising. The way I handled that with my children was very simple: I did allow them to watch certain programs, but I made it very clear that whatever food they were selling or promoting on TV, I was not buying. That was family policy, and I didn’t deviate from it. If they ate it with their friends or at school, it was their choice; I just wasn’t about to spend money on what I considered junk food.

4. No soft drinks or sodas in the house. Same issue. Some research published in The Lancet in February 2001 found that the risk of becoming obese increased 1.6 times for each additional glass of sugar-sweetened drink that a child consumed each day. Even “diet” drinks will cause problems, as artificial sweeteners increase the appetite and encourage more eating. My kids had some trouble with that when they started having friends over, but I stuck to juices and seltzer; if someone brought over a soda, I let it ride, I just didn’t spend the money on it myself. That was enough of a statement.

5. When eating out, patronize family restaurants, even diners, and encourage the consumption of soups, salads, chicken or fish, vegetables, stews. Avoid the fast-food shops, the burgers and fries, pizza, desserts.

6. Avoid having separate “adults” and “children” food groups in the house. Children are programmed to want to do what the adults do; if the parent eats cookies, the child will want to eat cookies, and has a right to do so. If the adult says, ‘these are not good for you, you may not eat them,” what kind of message is that? Therefore, for those who want their children to eat healthful foods, they have to do so themselves.

7. And then, once in a while, for no reason whatsoever, just because you feel like it, eat some “junk.” I don’t recommend doing it for “special occasions,” because then the unhealthy food then becomes elevated to a lofty place. Fun, or “just because,” is good enough. We usually kept pizza for an occasional fun treat. There was a fancy dessert shop near us, and for a while once a week we went and shared some rich French pastry, to find out what that was like. I think we did it maybe four times and then we all forgot.

If the kids insist on junk foods, go see or rent “Supersize Me”, the marvelous documentary on what happened to one man who ate only fast food for 30 days. There is also a serious movement to improve the quality of food in schools. Many schools are being paid by commercial interests to sell unhealthy foods, so they make money on your children’s health. If you want more information, see www.commercialalert.org, or call 503-235-8012.

Remember this: whether we like it or not, the home is the major educator on how to eat, and how to take care of ourselves. School comes second. If you have children, what you teach them at home by precept and example is the core information that they’ll take with them for the rest of their lives. They’ll either follow it or go against it, but they’ll have it nonetheless, warts and all.