Obesity in Childhood: How To Stop the Epidemic?

obesity in childhoodIt’s no secret that children all over the world are putting on too much weight; in the US, an astonishing 1/3 of children are overweight or obese. Even in China, the obesity rates for children are dramatically rising. Being overweight as a child can lead to many diseases as an adult, including heart disease, diabetes, arthritis, high blood pressure, and some cancers. Also, overweight kids have lower self-esteem and higher risks for depression. So what can parents, or society really do to stop this epidemic? And how can family doctors and pediatricians help?

The first step parents should take is to find out where your child fits on a Body Mass Index (BMI) chart. Your doctor should be doing this at the well-child exams, but you can easily find childhood BMI calculators online (such as this one) and find out yourself. A child above 85% is considered overweight, and above 95% is obese. Many parents are surprised at finding their child is officially overweight or obese, which is why these objective BMI standards are important for tracking, as well as assessing progress.

There are quite a few weight loss approaches that most doctors can agree on; one major agreement is that diets almost never help, at any age. Any diet plan designed for quick weight loss is almost guaranteed to long-term failure, and many people frequently end up even heavier than before. The healthiest option is always slow and steady weight loss. One pound a week of weight loss for many children, from very conscious changes in diet and exercise routines, is appropriate.

Another major approach involves cutting back on TV time. The American Academy of Pediatrics just published a major policy statement stating that “the evidence linking excessive TV viewing and obesity is persuasive”. They specifically recommend a ban on junk- and fast-food advertising in all children’s TV programs, and they set specific limits of TV time for age groups. They also detail multiple studies showing how having a TV in the bedroom is another independent risk factor for obesity, both as a child and later as adults. They also recommended that “pediatricians need to ask 2 questions about media use at every visit: 1. How much screen time is being spent per day? and 2. Is there a TV set or Internet connection in the child’s bedroom?”

One approach I mentioned before was to have a good breakfast. Many studies have shown that eating a nutritious breakfast is crucial for a child’s physical growth and school performance, and that breakfast-skippers actually end up more overweight, both in childhood and later as adults.

Of course, the main treatments for obesity are the obvious: more exercise and eating proper foods in moderate amounts. It’s important that there be a family effort to help your overweight child lose weight. Parents also need to lead by example; it’s much harder for a child to lose weight if their parents are also overweight and don’t exercise. As for diet recommendations, the most obvious choices to eliminate are sodas and fruit drinks. Sodas truly have almost no redeeming value, especially for children. Any child drinking a daily soda is adding extra pounds of fat each year, and they are also increasing their risk for diabetes as well as teeth problems. Most fruit juices are also quite poor substitutes for natural fruits and should be used at a minimum. For exercise, most kids should be getting 60 minutes a day, but this can be broken up into multiple sessions. The key is finding something they love to do. And don’t forget that any exercise is better than nothing!

Another effort involves reviewing the foods at school. I recently heard the great news that milk producers in America this fall are all reformulating their flavoredmilk to have 1/3 less sugars and calories. Many (but not all) nutritionists consider this a positive step, as schools that totally eliminated flavored milk encountered a large drop in milk drinking, which raises the risk of kids not getting enough nutrients such as calcium. What does your school do?

Parents who want to learn more about childhood obesity and how to fight it can find excellent resources at the website healthychildren.org, which is officially run by the American Academy of Pediatrics. And at familydoctor.org, the American Academy of Family Medicine also offers many tips on weight loss for all ages.

(This article was originally printed in Beijing Kids magazine, where I am a contributing editor. You can click here to read the rest of my BeijingKids “The Doc Is In” columns.)

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3 thoughts on “Obesity in Childhood: How To Stop the Epidemic?”

  1. How about prevention?

    Increased risk of obesity from Formula Feeding.

    Exclusive Breastfeeding needs to be the norm!

    1) A large Scottish study looked at body-mass index of 32,200 children aged 39 to 42 months. After elimination of confounding factors, socioeconomic status, birthweight and sex, the prevalence of obesity was significantly higher in the formula-fed children, leading to the conclusion that formula feeding is associated with an increase in childhood obesity risk.
    Armstrong, J. et al. Breastfeeding and lowering the risk of childhood obesity. Lancet 359:2003-2004, 2002

    2) 6650 German school-aged children between the ages five to 14 years of age were examined. Breastfeeding was found to be protective against obesity. The protective effect was greater when the infants were exclusively breastfed.
    Frye C, Heinrich J. Trend and predictors of overweight and obesity in East German children.
    Int J of Obesity 27: 963-969, 2003

    3) Active follow-up of 855 German mother and baby pairs was used to determine the relationship between not breastfeeding and increased risk of overweight and obesity. After a two year follow-up 8.4 per cent of children were overweight and 2.8 per cent severely overweight: 8.9 per cent were never breastfed, while 62.3 per cent were breastfed for at least six months.
    Children who were exclusively breastfed more than three months and less than six months had a 20 per cent reduction risk, while those who had breastfed exclusively for at least six months had a 60 per cent risk reduction for becoming overweight com- pared to those who were formulafed.

    Weyerman M et al. Duration of breastfeeding and risk of overweight in childhood: a prospective birth cohort study from Germany. Int J Obes advance online publication February 28, 2006

  2. Please make the distinction between fruit “drinks” vs. 100% fruit juices. Yes, pure fruit juices can still have high amounts of sugar (naturally occuring in the fruit), but given a choice I always take the pure juice.

    Also, I’m surprised that you didn’t specifically mention the tea-flavoured drinks (ie- green tea, “ice red tea”, etc.) that are so popular over here. Chinese parents seem to know that soft drinks are bad for kids, but for some reason they don’t seem to have a problem with those tea-flavoured drinks.

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