Generation Extra Pediatric Obesity Is a Growing Problem

Sticks and stones may break my bones, but names will never hurt me.

It’s a refrain repeated by generations of children, a response to being picked on by their peers for any number of reasons, from being unpopular to flopping in sports to being overweight.

That’s right: kids can be mean, and the fat kid has always been picked on. But that may be the least of his problems.

“It’s becoming much more apparent that type 2 diabetes is increasing among adolescents, which is something we never used to hear about. In fact, 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all new diabetics are in that age group,” said Chrystal Wittcopp, director of the pediatric weight-management program at Baystate Children’s Hospital. “We know of 9- and 10-year-old children who show fatty liver disease; there have even been children who needed liver transplants.”

Why? In short, the percentage of children and teenagers who are overweight or obese has been rising steadily for some time, bringing with it increased risks of diabetes, hypoglycemia, high blood pressure, sleep apnea, and, yes, liver disease. “We’re not talking about long-term effects,” Wittcopp said. “These are things that are happening now.”

It sort of puts things in perspective, doesn’t it? Forget about names; compared to these realities, maybe sticks and stones aren’t so bad, either.

Weighty Concerns

Because one standard doesn’t exist to define obesity, different figures have been bandied about to measure its prevalence. Wittcopp cited studies claiming that 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all Americans between the ages of 6 and 19 are either overweight or at risk of becoming so, based on their body-mass index, which is a measure of height and weight.

In the Pioneer Valley, the story is even worse, with 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of school-age children and teens in Springfield overweight, and an additional 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} at risk. Exactly what, health advocates are asking, is happening?

“Those are really high numbers,” Wittcopp said. “It seems like there’s a combination of factors, but it comes down to taking in more than you’re burning off. And that means an excessive calorie intake combined with a decrease in physical activity.”

There are plenty of reasons for both, she noted, including an increase in how often the average American eats out; not only are many restaurant meals loaded with fat, but portion sizes are significantly larger than they were 20 years ago. Add to that an overreliance on quick, processed foods and fast food, and it’s easy to see that today’s youngsters are developing unhealthy eating habits right off the bat.

Meanwhile, “social activity has definitely decreased,” Wittcopp said, with today’s children and teens spending hours upon end in front of computers or the TV, and less time interacting outdoors as previous generations of kids did.

Young Hee Kim, clinical nutrition manager at Mercy Medical Center, said there are a few non-modifiable, genetic risk factors for obesity in children, but much of the problem comes down to bad habits passed from parent to child, or at least tolerated by Mom and Dad.

For example, “kids are exposed to so many ads for high-calorie, high-sugar foods,” she said. “When a child wants something he sees in a television commercial, we have to play the role model — and you shouldn’t tell children what to do if you’re not going to do it yourself.”

In the same way, Kim said, “you should try to create active environments, like walking or bicycling as a family, and have less TV watching. Give the child chores to do that are age-appropriate. You can rotate them so the kids don’t get bored with one activity.” The idea, she explained, is to have them doing some activity that doesn’t involve a mouse or a remote control.

Sweating the Details

Studies suggest, however, that children who try to stay active and fit are the exception. According to survey data collected by the American Academy of Pediatrics, 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of U.S. children age 8 to 16 report two or fewer bouts of vigorous physical activity per week, while more than 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} watch at least four hours of television per day. The study makes a clear connection between hours of TV viewing and body-mass index, and it gets worse for children who have a television in the bedroom.

Schools, too, share a portion of blame, some suggest. According to the American Heart Association, the percentage of students nationwide who attend a daily physical education class dropped from 42{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 1991 to 28{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2003. In Massachusetts, the organization claims, schools have cut PE programs at a similar rate. Local chapters of the AHA have tried to counter this trend with statewide events such as Jump Rope for Heart, Hoops for Heart, and Me & PE, all aimed at promoting physical fitness in school.

One of the more ambitious national campaigns is the Alliance for a Healthier Generation, which boasts former President Bill Clinton and California Gov. Arnold Schwarzenegger as spokesmen. Locally, the AHA has been promoting the multifaceted effort, which not only emphasizes physical fitness among young people, but has worked with school officials and health care providers to spread the message that obesity can have lifelong ramifications.

The Alliance is also working with restaurants, food manufacturers, and beverage companies to offer healthier meals, drinks, and snacks for kids. Already, the Campbell Soup Company, Dannon, Kraft Foods, Mars, and PepsiCo have committed to developing lower-calorie and nutritious snacks to replace the high-sugar, high-fat offerings available in schools.

Local programs have sprung up to tackle the obesity issue as well. For example, Baystate has a primary intervention initiative that identifies young children who show warning signs of being overweight; they are eligible for an eight-week program centered on nutrition and healthy activities. The hospital also offers obesity treatment programs for older children, including one in partnership with the Springfield YMCA, where the overweight child participates in a biweekly fitness regimen, and his or her family enjoys free member benefits for the entire six months of the program. “It provides some motivation to change,” Wittcopp said.

Still, despite the sedentary lifestyle of many young people, much of the weight issue comes down to diet. Kim, for one, laments a culture where parents don’t have (or make) time to eat as a family, or to get their kids involved in preparing meals, because grabbing fast food on the run is simply easier.

“And in the grocery store, you should shop the perimeter of the store, where the fresh foods, vegetables, meats, and dairy products are,” she said. “What’s in the middle? Mainly processed foods. When you go to the middle aisles, get healthy breakfast cereals and staples like that, instead of Doritos chips.”

Kim was involved in an educational campaign earlier this spring that centered on “portion distortion,” examining how today’s Americans have grown accustomed to eating portion sizes that were rare a generation or two ago.

“We compared the 1960s with now, and it was amazing,” she said. “A muffin was one-quarter of what it is today. A coke was 6.5 ounces; now we drink 20-ounce bottles. We are drinking huge amounts of calories, and in doing so, we could be drinking as much as a half-cup of sugar. We need to be aware of these things.”

Also distorted is the way many parents use food as comfort or punishment, and forcing children to eat when they’re not hungry, all of which can establish bad habits later in life, Kim said. “If we can prevent those things, the better off the child will be. All these consequences — type 2 diabetes, hypertension, asthma, orthopedic issues, not to mention the psychological stigma of being overweight — are very serious.”

Food for Thought

Wittcopp knows that local efforts can change a few lives, but they do nothing to change society at large. “We really have to come at this on a community-wide, statewide, and national level,” she told The Healthcare News. “If we’re going to make a significant change, it’s going to take a societal approach.”

That means more high-profile efforts like the Alliance for a Healthier Generation, and a buy-in by Americans en masse to the idea that children’s health, both now and in the future, is an important priority.

“How can we increase physical activity on a day-to-day basis?” she asked. “How do we make fresh foods, and foods low in calories, less expensive?” After all, she noted, it says something that McDonald’s entree salads are the most expensive items on the menu.

Most of all, Wittcopp said, parents have to set a better example. “The parents’ physical level is the number-one predictor of a child having trouble with weight. Families need to change before we see change on an individual level.”

After all, a little exercise doesn’t hurt. Not as much as sticks and stones, anyway. Or liver disease.