Teen Health

I'm Fat! The Emotional and Physical Impact of Childhood Obesity

Like many people from his generation, Dr. Michael Myers remembers a time when parents used to guilt children into finishing their dinner by telling them, “There are starving kids in China!” Today, the crisis facing parents and children at dinnertime is one of a different nature. Children in America—along with adults—are eating too much, and it is resulting in an obesity epidemic.

Dr. Myers, a family practitioner specializing in obesity, weight management, and eating disorders, witnesses this crisis firsthand on a daily basis. While others struggle to comprehend why nearly one in five children in certain areas of the United States is obese, the answer, says Dr. Myers, is very simple: kids are eating too much. “We have bigger plates and bigger portions, and kids are eating all of it.”

That, combined with a significant decrease in kids’ physical activity, has led to an epidemic that is getting worse with each passing year. According to statistics compiled by the Centers for Disease Control and Prevention (CDC), four states reported an obesity prevalence rate of 15%-19% in 1991 (see complete statistics at www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm). However, 11 years later the rates had multiplied nationwide. An alarming 19 states fell into the 15%-19% group in 2002, while a whopping 28 states reported rates of 20%-24%, and the states of Mississippi, Alabama, and West Virginia reported obesity rates of more than 25%.

And now for the truly startling statistic: In 1999, the Surgeon General reported that 13% of children aged 6-11 years, and 14% of those aged 12-19 years, were overweight—a figure that has nearly tripled in the past two decades.

Felicia Stoler, a nutritionist and exercise physiologist from the New Jersey Dietetic Association (www.eatrightnj.org), attributes much of the problem to the overwhelming presence of junk food in our society. “I think that environment is a lot to blame,” said Stoler. “Food is cheap, and we have access to everything we want all the time.”

It doesn’t help that children and adults are more sedentary than ever, according to Dr. Myers. “We’re not very physically active anymore,” he said. “With computer games, Internet, and e-mail, we’re spending more and more time sitting down. Kids, adolescents, and adults are not exercising.” With this widespread inactivity comes more cases of overweight and obesity, and with obesity comes a host of serious health risks.

The “Disturbing Statistic” Involving Type 2 Diabetes
According to the CDC, obese individuals carry an increased risk of suffering from hypertension, heart disease, congestive heart failure, stroke, gout, orthopedic complications, sleep apnea, type 2 diabetes, and certain types of cancer (www.cdc.gov/nccdphp/dnpa/obesity/consequences.htm). All of those conditions invite some level of alarm, but what sparks the most concern in Dr. Myers is the presence of type 2 diabetes, “a disease that used to be seen primarily in adults over age 45,” but now “is becoming more common in young people,” according to the National Diabetes Education Program (NDEP) website (www.ndep.nih.gov/diabetes/youth/youth.htm).

“When a kid had diabetes years ago, it was always type 1 diabetes due to low insulin levels,” noted Dr. Myers. “Now 20% of kids with diabetes have type 2 diabetes, the kind that is associated with obesity, and that is a disturbing statistic.” There is, however, a bright side. The National Institute of Diabetes and Digestive and Kidney Disease reports that “if you have type 2 diabetes, losing weight and becoming more physically active can help you control your blood sugar levels.” The site also tells patients that although people who are overweight are likely to develop health problems, they can improve their health “by losing as little as 10 to 20 pounds” (www.niddk.nih.gov/health/nutrit/pubs/health.htm). Even with improved health, however, the scars left by the psychological ramifications of overweight and obesity often linger long after the weight has been lost.

WORST FOOD FOR CHILDREN

We all know that children should avoid eating junk food, but it can be tricky to decipher which types of junk food it is most important to avoid. Foods like chicken nuggets may seem relatively healthy, but according to this list compiled by Parents.com, they contain high amounts of fat and salt, two components kids should only consume in small doses.

* Chicken nuggets (high in fat and salt)	* Hot dogs (high in calories, low in protein)
* Chips	* Juice drinks
* Doughnuts	* Prepackaged lunches (no fruits or vegetables)
* French fries	* Soda
* Fruit snacks (very high in sugar)	* Toaster pastries

www.parents.com/articles/health/2148.jsp

Wrestling “The Old Demons”
Allen, a Texas resident who has so far dropped 275 pounds after undergoing weight loss surgery last year, admits that he still “find[s] the old demons hard to wrestle.” Though it was decades ago, he still vividly recalls painful memories of being teased in gym class, having to deal with an “inability to socialize with the opposite sex like the other teenagers did,” and being denied admission to rides at amusement parks because ride operators told him he was “too big.”
“Everyone gets the ‘treatment’ when they are kids,” said Allen, “But obese kids just get second helpings of it all.”

For Bethany, who like Allen finds solace in talking with fellow obesity sufferers in chat rooms, the worst part about being overweight wasn’t the allergies, asthma, high blood pressure, or high cholesterol she suffered as a result of her condition. Instead, the pain that caused her to develop an eating disorder as a teenager stemmed primarily from the verbal abuse directed at her by other children. Sadly, her experience isn’t an isolated case. According to the American Obesity Association Fact Sheet regarding Obesity in Youth, “overweight children and adolescents report negative assumptions made about them by others, including being inactive or lazy, being stronger and tougher than others, not having feelings, and being unclean.” And worse, overweight girls run “a greater risk for the subsequent development of eating disorders” (www.obesity.org/subs/fastfacts/obesity_youth.shtml)

What Can Parents Do? Advice From the Experts

Both Stoler and Cathy Bastian, a registered dietician and nutritionist certified in a program called Shapedown (www.shapedown.com), strongly recommend that overweight children and their parents enter a counseling program where they can work with health professionals to locate the root of the problem and devise a plan to create a healthier lifestyle. Below is a list of guidelines Stoler and Bastian employ in their respective practices.

1 Involve the Entire Family--Don’t Single Out Overweight Children

Bethany and Keisha, two survivors of childhood obesity, both have painful memories of being singled out as children because of their size. During snack time with friends, Bethany had to force down carrots and water while the other children enjoyed milk and cookies. Keisha had to watch as her cousins received gifts of beautiful, brightly colored clothing on Christmas morning while she was given dark-colored sweat suits.

This kind of discrimination, according to Bastian, can be extremely damaging to a child’s psyche. “The child should not be treated alone,” said Bastian. “The whole family has to change their eating habits.”

2 Stock the Kitchen With Healthy Snacks

Because children have a tendency to grab the first thing they see when they come home from school, Dr. Myers suggests that parents “prepare healthy snacks ahead of time and have them ready for kids.” By ensuring that there are nutritional foods on hand, parents can make a significant difference in a child’s caloric intake, he said.

Stoler advises parents to skip soda altogether. “There is absolutely no nutritional value in soda,” she emphasized. “Whether it’s regular or diet, the phosphates in soda negate the benefits of any calcium kids might have had during the day, which can be a contributing factor in osteoporosis.”

3 Aim for Gradual Results

Because the changes implemented in Bastian’s treatment process are lifestyle modifications and not temporary solutions, it is important that parents expect progress to occur on a slow but steady basis. The key, said Bastian, is to “avoid rigid, low-calorie diets, and stress that weight loss can be gradual.”

Stoler recommends taking small steps like switching to skim milk and low-fat yogurt in children ages two and older. The change is subtle enough that children won’t notice it, yet their bodies will be consuming less fat.

4 Avoid the ‘Food as a Reward’ Trap

Stoler strongly advises that parents avoid using food “as a form of reward, or to pacify children. Rewarding children with ice cream or a lunch at a fast-food restaurant sends the wrong message,” she said. As an alternative, Bastian suggests rewarding children who exercise or eat right with special activities like a trip to the roller rink, a shopping trip, or a sleepover with a friend.

5 Make a Commitment to Your Child’s Health

Last but certainly not least, “Parents have to make a commitment, and make themselves available,” said Bastian. “Find an activity kids like and stick with it. Support them. Be willing to drive kids to practices and games, and encourage them.”

Dr. Myers concurs. After treating obesity for a quarter of a century, he has come to the conclusion that “if kids have been encouraged and the whole family has worked together, they do get a better outcome, no question.” And arguments over dinner, perhaps, can become a thing of the past.

		Michael D. Myers, MD A family practitioner based in Los Alatimos, CA, Dr. Myers specializes in obesity, weight management, and eating disorders. He is a member of both the American Academy of Family Physicians (AAFP) and the Academy for Eating Disorders, and in 1995, launched his website, www.weight.com, where publishes facts and information about “weight control, eating disorders and related topics”, and offers consultations and referrals.
		Felicia Stoler, MS, RD A nutritionist and exercise physiologist based in Morganville, NJ, Stoler serves as media representative for the New Jersey Dietetic Association, secretary/treasurer for the Greater New York Chapter of the American College of Sports Medicine, and nutrition captain for the ING New York City Marathon.
		Catherine H. Bastian, RD Bastian works as a registered dietician and nutritionist for a private practice in northern New Jersey, and is also a certified provider for Shapedown (www.shapedown.com), a California-based organization that works with overweight children and their families to “enhance self-esteem, improve peer relationships, adopt healthier habits and begin to normalize their weight within their genetic potential.”