Childhood
Obesity
Childhood
Obesityby Warren P. Silberstein, M.D.
05/12/97
Approximately 25 percent of children and teenagers in the United States are obese. If that figure isn't alarming, consider that some data indicate that obesity among children is on the increase. The causes of obesity are complex, but genetics plays a major role. When one parent is obese there is a 50% risk that their children will be obese. This risk increases to 80% when both parents are obese, but let's not forget that family eating, exercise, and lifestyle habits also play a major role in childhood obesity. Obese children have an 85% risk of becoming obese adults. There is good evidence that eating habits in childhood have a significant effect on cardiovascular (heart) health in later life.
The risks of obesity in later life are well known. Obese adults have a higher complication rate in surgery, have a high risk of developing diabetes, and have a high rate of cardiovascular disease. Unfortunately, in spite of the significant adverse effects that obesity can have on health, many parents find dealing with obesity in childhood difficult and figure that it can be dealt with later. They need to be aware that children also suffer from the effects of obesity. Obese children with asthma have much more severe problems than normal weight asthmatics. Older children and adolescents may develop hip problems from obesity. But most important, children of all ages suffer socially from obesity. At a time when body image and self-esteem are developing, growing up obese can have negative effects that can make a child miserable and haunt him for the rest of his life.
Being a parent is a great joy, but it's also a tough job. Parents need all the support they can get, so I hate to blame them for anything, but I think it's safe to say that a child under 6 years of age cannot become obese without the adults in his life giving him the food that gets him there. On the other hand, there have been reports of children growing poorly because their parents put them on low fat diets inappropriate for children thinking it was the healthy, heart-smart thing to do. This is another one of those situations where we must remember that children are not little adults. A weight control program for children must provide adequate nutrition for growth. Since children are growing most children should not have to lose any weight at all to slim down. A diet that decreases the rate of weight gain while the child is growing will result in a healthy, gradual slimming and hopefully, teach good eating habits for a lifetime.
There is a large amount of misunderstanding about dieting which is fueled by a diet industry that makes millions of dollars promising quick and easy solutions to a difficult problem. Just about any diet will work for a while because it disrupts a person's usual eating pattern. Whether a person eats grapefruits with every meal or goes on a high fat low carbohydrate diet, the intense effort at dieting coupled with water loss results in an initial success that boosts self-esteem and further motivates the dieter, but bizarre diets can't be continued for a lifetime and should never be considered safe for growing children. Unusual diets and crash diets are doomed to failure because any person with a weight problem can't depend on his own appetite to control his weight, and therefore needs to learn new eating habits that he can depend on for the rest of his life. While it's easy to see how gluttony can cause obesity, most overweight people are not gluttons. They have gained their excess weight slowly over a long time and cannot expect to lose it quickly. If you have any doubt about that last statement, consider the following: To gain one pound of fat you must consume 3500 calories more than your body needs. If you consumed 100 calories more per day than your body needs (the equivalent of 1 glass of juice or 2 small plain cookies), and consumed this small excess every single day, in 1 year you would have consumed 36,500 excess calories, enough to gain 10 pounds. In 3 years you would be 30 pounds overweight on just 100 extra calories per day. To lose one pound of fat you must have a calorie deficit of 3500 calories. To lose two pounds in one week you would have to consume 7000 calories less per week than your body needs which is equivalent to 1000 calories per day. If your daily caloric requirement is 2000 calories, you could only lose two pounds a week if you were on a 1000 calorie per day diet. Suppose your daily caloric requirement is 1200 calories. To lose two pounds a week you could only eat 200 calories per day! When you consider the numbers you have to agree that diets that promise 20 or 30 pounds of weight loss in a few weeks can't result in a true fat loss of so many pounds.
There are factors which can effect caloric expenditure. The most important is exercise. Studies show that obese children naturally conserve energy. If you watch a group of children playing baseball, you will notice that the slim children are in motion most of the time while the overweight children tend to stand still until the ball comes their way. No doubt, at the dawn of mankind when he was a hunter/gatherer, the ability to conserve energy and burn fewer calories was a survival advantage, but in Western Societies where food is plentiful and labor is aided by machines, this advantage turns into a health threat. While at least 20 minutes of vigorous exercise every day is good habit to develop since it is good for the heart and will benefit weight control, just as we saw that small amounts of calories can add up, so can small amounts of activity. The best thing we can do for overweight children is to get them up and moving. This means getting them away from the TV where they are sedentary and also more likely to consume extra snacks. All exercise is good, but the one exercise that has been shown to be continued into old age is walking, so do your kids a favor (even if they don't appreciate it) and don't hop into the car every time they need to get somewhere, and when they yell, "Ma! get me some milk." gently suggest that they get up and get it themselves. Team sports provide many advantages to children, but many obese children can't compete and end up warming the bench. Since sustained activity is the most beneficial to weight control, besides brisk walking, the best activities to encourage are aerobic activities like jazzercise, step aerobics, bicycling, swimming, skating, cross country skiing, running, and two person sports like tennis, handball, and racquet ball. Weight training can be added to those activities to add and tone muscle, but it should not replace the aerobic activities.
The type of food your child eats can make a difference. As time goes by I'm sure we will learn more about how the body handles different foods, but even though there are subtle differences in how the body metabolizes various foods, for the most part weight control boils down to the balance between calories consumed and calories burned. There is no such thing as diet food - food that your body somehow uses differently to magically lose weight. Eating traditional diet foods cannot guarantee success in weight control. As an overweight child I always used to ask my mother, "Is this fattening?" and she always answered, "If you eat enough of anything, it's fattening!" She was right, but there are important differences between foods. Some foods are clearly better for our health. Cardiovascular health benefits from a diet low in saturated fat and cholesterol. Low fat diets with lots of fruits and vegetables provide some protective effect against some cancers. Weight control can benefit from foods that fill you up with fewer calories. Since fat is high in calories (9 calories per gram as opposed to 4 calories per gram of carbohydrates or proteins) low fat foods can make it easier to satisfy hunger without consuming excess calories. Foods high in fiber and water content can also help to fill a stomach with less calories. These foods include fruits and vegetables.
Carbohydrates (starchy foods like bread, pasta, and potatoes) have been wrongly blamed by many dieters and diet gurus as the cause of overweight. This has happened to some extent because of guilt by association. Sugar is a carbohydrate, but unlike most carbohydrate foods, it is so low in fiber that it adds calories without adding substance. It acts as a flavoring rather than a food but it adds calories just the same. Even sugar isn't quite the villain it's been made out to be. A teaspoon of sugar adds only 18 calories to your cup of tea. Most of the high calorie sweets we enjoy get their excess calories from fat. Even most protein foods like meat are higher in calories than carbohydrates because very few protein foods are naturally fat free. Therefore, the hungry child actually makes a lower calorie choice when he eats a 3 ounce potato rather than 3 ounces of steak. Of course, the minute he puts butter or sour cream on the potato, the calorie advantage is lost. Most children prefer a high carbohydrate diet. The healthiest diet gets at least 60% of its calories from carbohydrate, preferably complex and whole grain carbohydrates rather than simple sugars. It is a mistake to reduce carbohydrates when attempting to decrease the caloric intake of a child.
There are clearly choices to be made when it comes to eating, and for the overweight child, learning to make healthy, lower calorie choices, can benefit him for a lifetime. It doesn't matter whether a child is overweight because of genetics or because of a slower metabolism (which can be increased with increased activity). There's no point in complaining that it's not fair. Even if you child's friend eats more, eats lots of junk food, and still stays skinny, your child has to learn to deal with his body, and that means learning what foods to choose to fill his belly. It doesn't mean never having a treat. But constant treats and snacks add significantly to weight control problems.
Besides making the right choices, portion control is also extremely important. It's easy to see how a child can gain too much weight if he eats too much ice cream, but as my mother told me, if you eat enough of anything it can be fattening. It's hard to imagine anyone eating enough Brussels sprouts to get fat, but it's not hard to see how seconds on the meat and potatoes can add to a weight problem. It's sad to see a child deprived of all treats because of his weight still unable to slim down because of overeating. Food is nurturing. We give it lovingly to our children. We delight at seeing our babies gain weight. We depend on seeing our babies gain weight to tell us everything is all right. So how is a mother supposed to ignore the plaintive cry, "But Ma! I'm still hungry!"? It's not easy. But being overweight isn't good for a child, and just like parents limit TV and set bedtimes and other rules based on what they think is best for their child, they must set limits on food. Set limits, but never tell a child he can't have more or he can't have a certain food because "he is too fat." Battering an overweight child's self-esteem is likely to add to the problem since he takes comfort in food. Tell the child he's had enough, or it's bad for him, or the doctor says he should eat more fruit and less junk, or something else in that vein. Apply the same rules to everyone in the house. In my experience, when skinny children indulge in excess treats they don't eat nourishing meals.
How about some tricks to make it easier.
