In Pediatrics, we believe that prevention is the hallmark of any good medical practice. For example, we promote immunizations to prevent disease and safe behavior such as wearing bicycle helmets. It’s also our professional duty to make parents aware of the importance of nutrition and physical activity as a party of healthy life habits. Childhood obesity is more easily prevented than treated.
Why do we have obesity?
According to the Surgeon General, overweight and obesity are a result of caloric imbalance where too few calories are expended for the number of calories consumed. We think that about 80% of the problem is determined by the kind and amount of food we eat, and about 20% is determined by physical activity. Of course, there’s a balance to strike.
Some Disturbing Statistics:
Recent data from the Centers for Disease Control state that children under 5 years, across all ethnic groups, have significant increase in both overweight and obesity. Children 6-11 who are in the obese category increased from 7% in 1980 to 18% in 2010. Similarly, adolescents from 12-18 increased from 5% to 18% in the same period. Our health is a reflection of our diet and degree of physical activity. This basic concept is critical to teach our children.
Why is this issue important?
It’s no secret that childhood obesity is a public health problem. A prominent national program promoted by the First Lady, “Let’s Move,” encourages the whole family to get moving and stay healthy. As pediatricians, we don’t want to put yet another burden on parents’ shoulders by telling them that their child is getting too heavy, but so many other health problems have their root in obesity. Many of these problems extend into adulthood, reducing the quality of life and even lifespan. These problems can include high blood pressure, elevated cholesterol, Type II Diabetes and other endocrine diseases, not to mention lower self-esteem, orthopedic stress/arthritis, poor digestive health and complications of the liver. Type II Diabetes was rare in children only a generation ago, and can be harder to treat in children.
How do we determine obesity?
The Body Mass Index (BMI) helps us determine if a child is overweight or obese. BMI is determined by a calculation involving height and weight. If BMI is > 85% of the population, the child is considered at risk and a BMI > 95% is considered obese. BMI is a dynamic number, going up and down as a child has growth spurts, but should always remain in the normal range. A BMI consistently in a high range, or gradually trailing upward toward an unhealthy range are red flags requiring intervention. Genetics play an important role, making certain children at higher or lower risk, and family history will sometimes encourage us to be more or less aggressive as we observe a child.
How do we tackle this issue? Here are a few tips that we hope can help you!
- Prevention should start at the beginning. Longer breastfeeding has been associated with a lower risk of later obesity. Introducing foods other than breastfeeding before 4 months of age has also been associated with increased risk of obesity.
- Kids need a balanced diet to promote healthy growth and development, and we don’t recommend any strict “dieting” or caloric restriction. Often we can make minor changes in their diet, increase their physical activity, and their growth will take care of extra weight.
- Avoid empty calories (soda, candy, cake, refined carbohydrates) and make snacks more nutrition-rich (fruits, veggies, low fat dairy foods, whole grain breads, protein-rich foods). Of course, sweets once in a while are not a sin, and can be fun.
- Be conscious about how your culture or the habits your parents passed on to you affect how you feed your kids. Make gradual changes if these habits are not healthy.
- Life is hectic, but try to eat at home. We know what we put in the foods we prepare at home, but not so much what a restaurant serves. Limit the times your children/family eats out. Sadly, this includes meals served at schools.
- Be sensible about portions. Consider limiting or eliminating “seconds” as an option.
- Make sure your children eat a good breakfast with a good source of protein, complex carbohydrates and fruits/veggies.
- Make sure your child is drinking plenty of water. Hunger can easily be confused with thirst, and kids will eat when they’re really just thirsty.
- Watch carefully for signs of compulsive eating in your children (when they feel stress or anxiety, or simply boredom). Help them develop alternative ways of dealing with that stress (walking, talking, counseling, relaxation techniques). Sometimes a child is telling us about a problem with bullying, school or personal issues, family stress, by the way they eat.
- Encourage your child to make as many choices as possible, but set up guidelines so they have appropriate limits. Remember that habits that you instill in your children now will help them for the rest of their lives! Let’s help them have a healthy future.
- Model healthy food choices for your children. Try not to buy food that isn’t good for them, and set the example by eating healthy yourself. They learn by what they see more than from what you say.
- Limit screen time (TV, video games, iPad, computer) for a total of 2 hours per day, as suggested by the American Academy of Pediatrics. Personally, I would be stricter – an hour is plenty.
- Encourage physical activity that includes unstructured play time at home. The AAP recommends at least 1 hour of physical activity per day. Team sports and classes are great, but unstructured free play is really important. Play with your child – indoors or outdoors, share activities such as jumping rope, dancing, etc.