Ten-year-old Johnny is too heavy. He hates to exercise. He prefers
to surf the ‘Net, watch TV or play Nintendo rather than run and
romp outdoors. During the rare gym class at school, when he is forced
to play softball, Johnny spends a little time trying to catch the
ball and throw it to another player, but he’s not good at it and
quickly loses interest. Johnny is nearly the last one picked to
be on a team, reinforcing his dislike of exercise. After school,
he feels depressed, unwanted. While watching TV, he polishes off
a giant bag of potato chips and a Coke.
Johnny represents a sad scenario that has been repeated too often
in recent times. Over the past 20 years, the rates of obesity have
taken a dramatic upswing. Today, 27 percent of children are classified
as obese [carrying an excess accumulation of body fat], representing
a 54 percent increase in the last two decades. What has caused such
an alarming jump in childhood obesity? Can this trend be reversed?
Could Johnny’s weight problem be caused by a medical condition?
Probably not. This is rare, occurring in only one to 10 percent
of cases of childhood obesity. Is it genetic? Yes, much of it is.
Various factors, such as basal metabolic rate-- the level at which
energy is expended while resting-- are passed from parent to child.
Also inherited are: the rate at which food intake increases metabolism,
appetite control, what it takes to feel satisfied, and the metabolism
and storage of fat.
Recognizing that genetic factors play a significant role in the
development of obesity can dispel some of the guilt, depression
and low self-esteem Johnny feels. However, human genetic makeup
has not changed in the past 20 years, so that can’t be the primary
cause of the epidemic of childhood obesity. Rather, it is a lifestyle
that combines an increasing tendency toward sedentary activity with
a diet laden with fat and calories.
In the United States, people spend more time watching television
than any other activity except working and sleeping. Children ages
6-11 spend an average of 3.5 hours a day watching television.
Obviously, when Johnny lies around watching TV, playing video games
or using his computer instead of playing vigorously, his body does
not burn enough calories. To make matters worse, while Johnny engages
in these activities, he is often snacking, predominantly on high-calorie
food.
Johnny has fewer opportunities for physical activity. Budgetary
constraints have caused many schools to reduce or eliminate physical
education for the student body. Since the schools place little importance
on physical activity, more and more young “Johnnys” are being created.
The decrease in physical activity is not entirely due to a lack
of formal exercise like sports. Johnny also experiences less physical
exertion in his daily living. These days, people drive
everywhere. A generation or two ago, they walked. Today’s kids don’t
shovel snow, rake leaves, chop wood or push mowers across lawns.
Instead, they use snow and leaf blowers, chain saws and riding mowers.
The bottom line is that children-- and adults-- have to make efforts
to be more physically active because it is not happening in the
day-to-day experience of their lives.
Johnny can’t lose weight unless he changes his lifestyle. He must
increase physical activity and decrease the time spent on TV, video
games and computer usage.
Dietary habits have changed considerably over the past 20 years.
Currently three-quarters of all meals are eaten outside the home,
with the majority being eaten at restaurants.
The increasing reliance on restaurant and fast foods increases obesity
in several ways. First, in order to make the foods taste better,
restaurant chefs add high amounts of sodium and fat. Second, portion
sizes are considerably larger at a restaurant-- probably to justify
the meal’s cost. After dining out so frequently, families increase
their portion sizes at home to make those servings more consistent
with the restaurant meals.
Third, we succumb to the great bargain of “supersizing” our soda
and fries for a few pennies more. Most people by nature are “completers”:
if we are given a larger portion we will finish it; the food is
right there in front of us and paid for.
Family dynamics have also changed. Less time is available for preparing
homemade foods, increasing the reliance on restaurant and “zap and
eat” meals. Fewer families eat together, and busy schedules force
family members to “fend for themselves.” When Johnny grabs something
quick and convenient, it is typically some processed food high in
sugar and fat.
Busy parents need practical advice on how to decrease the likelihood
of obesity in their children while living modern lives. First, limit
television watching. The same goes for video games and computers.
Parents can set an “allowance” of a certain number of minutes per
day or per week so children plan their TV viewing and computer activities
as an event and not as a substitute for physical play.
Second, add more physical activity as a family. Suggestions include
bicycle riding, playing Frisbee or catch in the yard, hide and seek
and tag with a lot of running. You might even try vigorous dancing
to loud and fun music as a family. Activities like washing the car
and house-cleaning can be creatively developed to accomplish needed
tasks and provide exercise at the same time. If it is impossible
for the parents to participate in these activities, engage a teenage
baby-sitter or playmate whose responsibility would be playing actively
with their kids several days a week. What a healthy investment this
would be!
Of utmost importance in the prevention and treatment of obesity
is a commitment to involve the entire family in better nutritional
habits. The family does not have to always be on a diet, but a conscious
effort to eliminate empty calories from the family's diet is important.
Changing your family’s most common beverage offers an easy way to
get rid of empty calories. Soda, which possesses no nutritive value,
only empty calories, should not be a staple of the diet but allowed
only on limited occasions. Replace it with water as the beverage
of the household.
Children below the age of two need to drink whole milk for important
brain development. However, after two, children should be on skim
milk. Skim-- fat free-- milk has no grams of fat but contains all
the protein, carbohydrate and calcium of whole milk.
Johnny also needs to limit the amounts of juices and fruit-flavored
drinks, which often contain many teaspoons of added sugar. Pure
juice products are better because they contain more nutrients, but
the volume of juice still needs to be limited. If Johnny eats fruits
instead of drinking juice, he’ll get fiber, which is important in
digestion and the satisfaction of hunger.
Parents can take advantage of their children's natural appetites
to introduce healthier eating habits. Most “Johnnys” are ravenously
hungry at three to four PM, after school. This is an excellent opportunity
for children to eat fruits and vegetables: grapes, apple or pear
segments or cut-up carrots, bell peppers or celery along with a
low fat dip. The same vegetables presented with dinner may be given
little attention by the child who prefers the other-- higher calorie--
foods served at the meal. Buy precleaned baby carrots for their
ease of preparation-- none-- and cut up fruit snacks the evening
before.
Parents can take advantage of frozen vegetables, a great modern
convenience. A frozen vegetable medley or broccoli bits have as
many nutrients and almost as much taste as the fresh variety. Their
quick addition to a fast meal like chicken breast-- or even pizza--
improves nutritional values without piling on the calories.
Serving foods “family style” encourages taking “seconds” of favorite
foods. Instead, fill the plates from the stove. This is especially
important with desserts, which should never be accessible on the
table.
Candy and treats do not have to be banished forever, but do avoid
the two- to three-pound bags of M&Ms. Single-serving size treats
and candies are savored and enjoyed more slowly because Johnny knows
that once they are gone, he won’t get any more!
Finally, parents need to expose Johnny to a variety of different
foods. Yes, some children are picky and eat only kid fare of burgers,
fries and chicken nuggets. Children are less likely to turn up their
nose at a new food, however, if it is presented in a small quantity
along with some favorite foods. Try it and see!
For both adults and children, the treatment of obesity presents
many challenges. Although it takes effort, prevention is far easier.
Initiate appropriate lifestyle changes: replace sedentary activities
with robust exercise and practice better eating habits; then Johnny
WILL be healthier!
Caroline J. Cederquist, M.D. is a board certified Bariatric Physicians,
the medical specialty of weight management, and a board certified
Family Physician. She specializes in lifetime weight management
at the Cederquist Medical Wellness Center, her Naples, FL private
practice.
Dr. Cederquist is a contributing
medical editor for NBC-2 News, a trustee of the American Society
Of Bariatric Physicians and the author of " Helping Your Overweight
Child - A Family Guide", www.Amazon.Com or by
Calling Toll-Free 1-800-431-1579.
If you are interested in a delicious,
doctor-designed, foolproof plan for fast and healthy weight loss
please visit Dr. Cederquist's Diet-To-Your-Door program by clicking here.
