This story first appeared in the Spet. 27 edition of the Kansan.
The battle of the bulge is not just a problem for adults anymore. National and local officials say poor eating habits and inactivity have resulted in obesity becoming a problem of epidemic proportion among the nation’s and state’s youth.
In the last 30 years, childhood obesity has tripled for children ages 6 to 11 and doubled for children 12 to 19, according to the Institute of Medicine.
In Kansas one, in four students in grades six through 12 are overweight or at risk of being overweight, according to Kansas Department of Health and Environment.
Eleven percent of the students were considered obese, according to 2007 KDHE figures.
Defining obesity
Newton pediatrician Dr. Jonathan Jantz said the best indicator if a child is overweight is calculating a child’s Body Mass Index for their height, weight and gender.
BMI is measured on different charts for boys and girls and varies depending on age, unlike adults who all are measured on the same chart.
To figure BMI, take the child’s weight times 703 divided by their height times their height.
The Kansan has included this equation in this edition along with BMI charts for both boys and girls. See page 8A.
However, if that seems complicated, there are many online resources available that will do the math for you. Your physician also may be able to help in finding where your child falls on the BMI charts.
Children who are between the 85th and 95th percentile are considered overweight. Children who are more than the 95th percentile are considered obese, Jantz said.
Consequences
Children with obesity problems are at risk fora host of medical complications now and later in life.
As recently as 1990, type 2 diabetes was a rare disease in children. By 2000, studies estimated one in three children will be affected by diabetes sometime in their lives. For Hispanic females, that statistic is one in two, said Leslie Mack, certified diabetes educator at Newton Medical Center.
Because of the surge in diabetes in children, screening for the disease is recommended starting at age 10.
At diagnosis, 85 percent of children with type 2 diabetes are overweight or obese. The problem is especially rampant among African American and Hispanic children, and Mack attributed that to both genetics and eating patterns.
A host of debilitating conditions, including vision and kidney problems, can be associated with diabetes.
“It threatens to decrease their life span,” Mack said. “Predictions are that our kids will live a life span shorter than ours,” she said.
Obese children also can suffer from back pain, sleep apnea, asthma, joint problems and high blood pressure, Jantz said.
As adults, they are at greater risk for heart disease, and women can have fertility issues.
About 10 percent of children ages 12 to 19 had cholesterol levels above 200mg/dL, according to KDHE.
One study found overweight 5- to 10-year-olds had at least one risk factor for heart disease, and 26 percent had two or more risk factors, according to a report on childhood obesity from the National Conference of State Legislatures.
All those potential health problems will end up costing all of us.
Annual obesity-related medical costs in the United States were estimated at $75 billion for 2003. Taxpayers fund about half of that through Medicare and Medicaid, according to a 2006 report from the National Conference of State Legislatures.
The good news, Jantz said, is if children lose weight, many of the problems will go away.
Psychological
consequences
The consequences of obesity are not all medical.
Debbie Robinson, a licensed clinical social worker at Prairie View, has spent 15 years working with children, and she said children who are overweight and obese can have mental-health problems, including depression, anxiety and feelings of suicide.
“Kids who tend to have weight problems may be bullied or teased by their peers and may not be able to participate in sports activities because they get out of breath. Their weight inhibits their ability to function and impairs their confidence,” Robinson said.
Jantz said he saw similar problems among overweight children in his practice.
“Kids who are obese feel ostracized. They feel even more alone,” Jantz said. “Kids don’t feel they are included as much, and they feel they are left out at parties if they are on the heavier side.”
Robinson said she tries to encourage her young clients to make healthy choices and work toward a healthy weight range.
“We want the kids to be healthy,” she said. “We don’t want them to be thin.”
Children are confused by mixed media messages. On the one hand, ads encourage kids to consume sugary snacks and beverages, and on the other, the media portray the ideal body as being super slim.
“People being portrayed in the media are probably not eating Cocoa Puffs, and they probably exercise and have an active lifestyle,” Robinson said.
She said parental support is important to help children to process these images, and especially important to children who have weight issues.
Some children can use food as a means of comfort and control. In the extreme, this results in disorders, such as bulimia, anorexia and binge-eating disorder.
Three percent of adolescent boys and 10 percent of adolescent girls reported binge eating or purging at least once a week, according to the archives of the Pediatric and Adolescent Medicine.
These disorders can have serious medical and physiological consequences, and young people with these illnesses likely will need the care of a mental-health professional, Robinson said.
Eating healthy
Jantz said eating habits tops the list of culprits for obesity problems.
He did not recommend diets for children but a change to more healthy eating habits.
This includes eating breakfast everyday, cutting out junk food and limiting pop consumption to one per week.
Mack suggested making small, gradual steps to a better lifestyle. She said she had one family who went from drinking pop to Kool-aid.
She then suggested moving from Kool-aid to sugar-free Kool-aid or water.
“I suggest making one or two goals,” Mack said. “Keep the TV off three nights out of the school week or incorporate fruits and vegetables twice a day, five days a week — something really small.”
Be wary of beverages, such as sports drinks, which are also loaded with sugar, Jantz said.
Children also are supposed to get five servings of fruits and vegetables per day — something that about 79 percent of Kansas kids are not getting, according to a 2005 KDHE report.
If children have tried to lose weight by modifying their diet and activity levels and are still struggling, medication may be prescribed, Jantz said.
In some extreme cases, Jantz said he has recommended gastric bypass surgery for young people, but this is rare, and surgical candidates must go through physiological screenings first.
What’s a banana?
Brenda Sooter, Halstead’s Kansas Learning Center instructor, teaches nutrition programs for children and said many children come to her program knowing little about healthy eating habits.
The education seems especially woefully lacking among low-income children, she said.
With grocery costs shooting through the roof, many low-income children simply do not have the access to fresh fruits and vegetables.
Sooter told a story related to her by a colleague at Kansas City’s Children’s Mercy Hospital.
The hospital, which is involved in the Kansas HealthWave Program, threw a swimming party for some area low-income children. The organizers had set out a bowl of fruit for the children to snack on, including bananas.
A little girl of about 8 years old pointed at the banana and asked what it was. The adult looked at her in amazement and explained it was a banana.
“What do you do with it?” the girl asked.
“You eat it,” the worker explained.
“That little girl had never seen a banana before. She didn’t know how to peel it or anything. She ended up eating four bananas. That saddens me that kids don’t know anything about fresh fruit,” Sooter said.
Sooter tries to show the children the consequences of obesity in practical ways. She uses a jar of Crisco to compare the amount of fat in different brands of potato chips, and a tube full of red die and Crisco to show how much harder your heart has to pump when you have fat built up in your arteries.
Getting moving
Current medical standards recommend children get at least one hour of exercise at least six days a week, Jantz said.
About 59 percent of Kansas kids are getting less than an hour of exercise five days a week, and 29 percent of children are watching an hour or more of television per school day, a 2005 KDHE report said.
Experts recommend children spend an hour or less of screen time per day, said Susan Jackson, Harvey County Extension agent.
She said exercise can come in many different forms.
Children can engage in organized sports, such as soccer or basketball, or simply ride their bikes or play on the playground.
“Children just need to get out and move away from the TV and computer,” Jackson said.
Jantz said our community needs to provide children with opportunities to engage in daily activity, such as walking or biking to school or activities in a potential new YMCA.
“Kids need to feel safe in our neighborhoods, so they can go out and play,” Jantz said. “Some neighborhoods aren’t safe, so they end up sitting inside and not walking to school.”
He said he thinks steps to make the two middle schools into fifth- and sixth-grade and seventh- and eighth-grade centers was the wrong move.
“It means fewer kids are going to be walking and biking to school,” he said. “It is the wrong thing to do in terms of the obesity problems.”
However, Jantz applauded the community’s work to improve local biking and walking trails as a plus for getting young people moving.
Learning
by example
So who should educators target — parents or children?
Barrick Wilson, marketing and community relations director for Newton Medical Center, did a study of literature to analyze if KDHE’s worksite wellness programs that attempt to educate parents on nutrition were being affective at addressing childhood obesity.
He found no concrete evidence the programs where adequately addressing the problems.
He suggested more emphasis be placed on involvement of educators, principals and students.
But most of the officials the Kansan spoke to said both parents and children need to be informed about healthy eating and activity if the tide of the childhood obesity epidemic is to be stemmed.
For parents that means leading by example.
“If parents model that they get on the computer and sit on the couch,” Robinson said, “you can expect their children to model that unhealthy lifestyle.”
Jantz said it was important both parents and children are educated about food choices.
“Parents buy the groceries, but as soon as the child is eating away from home, they make their own choices,” he said.
Jackson oversees a grant-supported nutrition education program, the Family Nutrition Program, in Harvey County that teaches children about healthy eating habits and nutrition.
She said the education goes both ways. Children who are taught about good nutrition will take that information home to their parents.
“It is amazing how excited kids can be to take home their message to mom and dad,” Jackson said. “As you teach parents, you teach children. This is working in the opposite direction. I think it has to be a compliment of both food preparation and encouraging family meals.”
Jackson said she advises parents to serve meals and snacks on a schedule and set a tone for the meal.
Children and adolescents who share meals with their parents have improved food habits, tend to eat more fruits, vegetables, dairy foods, less fried food and soft drinks at meals eaten with their families, according to research by the National Center on Addiction and Substance Abuse.
The children are responsible to eat until full and decide if they wish to eat what is being served, Jackson said.
This doesn’t mean parents should become short-order cooks, but Jackson said parents shouldn’t be discouraged if their children don’t cozy up to the brussels sprouts right away. She said keep trying. Children will go through phases of what they like to eat.
Sooter said, with her kids, she began mixing whole wheat pasta in with the regular pasta. Before long, the family was eating all whole-wheat pasta.
Now that her kids are grown, whole wheat pasta and bread is all they want to eat.
Jackson said it was important parents provide nutrient-dense foods for children.
Their bodies need nutrients to grow, but their smaller bodies need fewer calories to function.
Preparing healthy meals and modeling healthy eating habits takes a lot more time and planning, but Jackson said it can save your pocketbook and keep your family healthier.
“Parents need to be really careful about how they shop,” Jackson said. “It is just so easy to be really in a hurry and to take the easy way out, and that is fast food.”
