Friday, May 21, 2010

The Campaign Against Childhood Obesity

Nicolas Oreskovic, MD, MPH, a pediatrician at MassGeneral Hospital for Children (MGHfC) and researcher with Mass General's Center for Child and Adolescent Health Policy, and Alison Hoppin, MD, a pediatric gastroenterologist at MGHfC and a part of Mass General's Weight Center, team up to offer tips to counter "globesity" and discuss why the First Lady is having an impact.

Q: Why is childhood obesity such a problem in the US? What are some of the causes?

A: The rapid rise in obesity among children in the United States is largely a result of several significant changes in our lifestyles and environments which have occurred over the past several decades. Changes in our food environment have played a major role, including increased consumption of fast foods, greater availability of soda and sugar-sweetened beverages in schools, and increased portion sizes which are promoted by food packaging and restaurants. Because of changes in the design of the physical spaces we live in, known as our built environment, including urban sprawl and living spaces that have fewer sidewalks and promote car use, fewer people walk to daily destinations.

Changes in our social environments, like the devaluation of family meals, increased TV time, having televisions in children's bedrooms, and time spent on new sedentary activities like video games, computers and smart phones, have also played an important role.

Q: We're seeing a rise in childhood obesity in other parts of the world. To your knowledge, are other countries implementing similar nationwide campaigns to address this problem?

A: The rise of "Globesity" is becoming a major public health concern for many nations around the world. The rates of obesity and related health conditions is rising in most industrialized countries in response to many of the same influences that promote obesity in the US, including the increased availability and consumption of fast food and other calorie-dense foods, a greater focus on work and the decreased value of family time, and suburban styles of living. We are now beginning to see similar trends in developing nations. Many countries, including Canada and several European nations, have launched national obesity campaigns.

Q: What are some of the immediate and long-term concerns associated with childhood obesity?

A: Obesity is associated with more than 50 different medical problems, including diabetes, heart disease, sleep apnea, knee and hip problems, asthma, and several of the most common types of cancer. Most of these problems appear during adulthood, but they are most likely to develop in people who were overweight or obese as children. Obesity can also affect mood and self-esteem, partly because of social stigmatization, such as being bullied or teased by peers.

Q: How can parents help their obese children lose weight in a healthy way?

A: There are several simple steps every family can take to lead healthier lives:

  • Don't put a television in the child's bedroom.
  • Set firm limits on television time to a maximum of 1 or 2 hours a day; this should apply to all members of the family.
  • Prepare your meals at home and eat meals together as a family.
  • Limit meals from restaurants, fast food, or take-out foods to one or fewer times a week.
  • Don't keep soda or other sugar-sweetened beverages in the house.
  • Limit the amount of juice you and your children drink to one or fewer servings daily.
  • Encourage children to learn to like vegetables and fruits by offering them early and often, and by eating them frequently yourself. Grow your own vegetables in a garden if you have available outdoor space.
  • Make sure that kids are active, by playing a sport or other active play most days of the week. For young children, just spending time outdoors in a yard or park helps them to be active. Parents should set a good example on how to lead a more active lifestyle by exercising on a regular basis, walking to work, walking with children to school, and walking to the local stores for errands.

Some people have a natural tendency to gain weight easily, because of genetic or other biological characteristics. In a family where one or both parents have obesity, the children are also more likely to be "easy gainers" and develop a weight problem as they grow, even if they are thin or average weight during early childhood. These families should be particularly careful to live a healthy lifestyle and to teach their children healthy habits, to help the child maintain a healthy body weight as he or she grows up.

Q: Do you think Michelle Obama's obesity campaign is a step in the right direction?

A: Absolutely! Supported by Mrs. Obama's high profile and wide respect, the campaign puts a national focus on obesity, and brings attention to the issue to people outside the medical field. The campaign prompts parents and children to sit around the dinner table and talk about the importance of this issue, and to think about changes they can make in their own lives. Mrs. Obama has also led by example, by teaching the value of this to her two daughters and family, and to the nation by planting a vegetable garden on the front lawn of the White House.

Q: How involved should health care providers be in monitoring a child's weight/helping a child combat obesity?

A: Because the medical complications of obesity can be substantial, your child's pediatrician will be actively involved in monitoring your child's weight and will work with you to ensure that your child is eating healthy foods and achieving adequate levels of physical activity. You should work with your pediatrician, and perhaps other advisors such as a dietitian, to develop priorities and plans that best fit you and your family's situation.

Sometimes, even with good medical care and persistent efforts from the child and family, some children will not be able to control their weight adequately with lifestyle modifications such as diet and physical activity. A few older adolescents with very severe obesity causing important medical problems may benefit from weight loss surgery. MassGeneral Hospital for Children has a special weight loss surgery program for adolescents, through the MGH Weight Center.

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