Physicians can participate in combatting both problems, one child at a time
Today in the United States, children diagnosed with obesity or being overweight is at 32 percent (38 percent in Kentucky), leaving them to face serious health problems before even graduating high school. Those numbers have almost tripled since the late 1970s. What is happening?
The first step is defining what childhood obesity actually is. “Weight status is predominately measured using the BMI [body mass index],” said Liz Combs, M.S., R.D., L.D., director of the Coordinated Program in Dietetics at the University of Kentucky’s Department of Dietetics and Human Nutrition. “BMI is a reasonable indicator of a child’s weight status for most children, and it can at least start the conversation about the child’s current weight situation.”
According to Combs, a child with a BMI at or above the 95th percentile for their age and sex is considered obese. A child who is overweight has a BMI in the 85th to 94th percentile for their age or sex. With weight issues come serious health concerns.
“Obesity is a systemic issue and can directly impact a multitude of facets in a child’s life,” Combs said. “First and foremost, it impacts their health, both short term and long term. They are more likely to have risk factors for heart disease, sleep apnea, type 2 diabetes and bone problems. In addition to physical issues, obesity can have a major impact on a child’s social and emotional health. They can often feel stigmatized and can isolate themselves. This can, in turn, lead to more overeating and less physical activity.”
One of the more prevalent issues facing children with weight problems is type 2 diabetes. This form of diabetes develops when the body begins to resist insulin and can no longer use it correctly. The body makes more insulin as a counter-balance. Eventually, the pancreas begins losing the ability to produce enough insulin to regulate blood sugar, leading to a higher rate of early complications.
“These complications could include hypertension, kidney disease, eye disease and nerve damage if the diabetes is poorly controlled,” Combs said. “It is hard to say exactly what problems a child that develops diabetes will have as an adult because we have not had the opportunity to study this situation before, since this was not a typical issue before the obesity epidemic.”
According to the Centers for Disease Control, about 151,000 people below age 20 years in the United States have diabetes. Those numbers are increasing due to the influx of type 2 diabetes in childhood.
“There are many, many factors to consider when discussing childhood obesity,” Combs said. “Considering the socio-ecological model, childhood obesity stems not only from individual behaviors and genetic factors, but also from the larger picture including the built environment, the family environment, educational factors, screen time and food availability. Of course, diet and exercise are main contributing factors to weight status, but they are not the only factors.”
These are suggestions from Combs that physicians can offer parents dealing with an obese or overweight child:
• Use the “MyPlate” guide (1/2 a plate of fruits and vegetables, 1/4 plate of whole grains and 1/4 plate of meat or meat alternate). This is easy for children to understand by incorporating the “eat the rainbow” game. If they fill up on produce, children are less likely to overeat on other, less healthy foods.
• Encourage parents to serve proper portion sizes. Even if a child is a “picky eater,” it can’t be an excuse to eat a plate full of macaroni and cheese without other healthy choices. “Of course the child is unwilling to try other options if they are constantly filling up on their favorite items,” Combs said. Don’t skip on food choices the child enjoys, but make sure the portion sizes allow them to try a variety of other options.
• Small changes are better than no changes. “Even if a teenager is not willing to give up soda, they can decrease their intake of sugary beverages from a bottle each day to a can each day,” Combs said.
• Encourage the family to eat meals together. Studies have shown families who eat together have a lower occurrence of childhood weight issues.
• Encourage the entire family to get involved in physical activity, not just the children. “Young children have enjoyed using a fish bowl idea,” Combs said. Place physical activity ideas in a fish bowl and “fish” one out to accomplish each evening for 30 minutes as a family. “This makes the physical activity enjoyable and a family experience,” Combs said.
• Get rid of technology, at least for awhile. With no Internet, television, or video games available, children will find other ways to avoid boredom, usually resulting in some physical activity.
• Refer the child to a registered dietitian who specializes in pediatric weight issues.
One of the biggest obstacles is sitting down and actually talking to parents about the child’s weight. Even for well-seasoned physicians, this is a touchy subject.
“Some physicians shy away from addressing childhood obesity with parents,” said Combs. “This is completely understandable because it is such a delicate issue that needs to be handled with care. However, it does need to be addressed by the pediatrician first because the parents trust their opinion so much. Therefore, I encourage doctors to build an environment in their offices where the conversation about a child’s weight is initiated by the parent.” This includes putting pamphlets and posters about weight and nutrition in the waiting room and offering information about nutritional counseling. The physician could also ask open-ended questions such as, “How do you feel about your child’s weight?” This gives the parent the opportunity to start the conversation and become invested in the process of change.
There is no quick fix for childhood obesity, overweight issues and all the health concerns that follow. But with steps supported by physicians, registered dietitians, parents – and also the children – it is a problem that can be improved, one child at a time.
By Erin Jensen, Staff Writer