Childhood and adolescent obesity in America is a “big” issue and it is getting “bigger.” While most adults who struggle with their weight are more than aware of this growing problem and expect to be counseled when visiting their doctor, this is usually unexpected when we take our children in for a routine yearly check up. Unfortunately, the facts are that childhood obesity has tripled in the past 30 years. Nearly 30% of children age 6-11 are overweight and nearly 20% of those are categorized as obese. These numbers are steadily and dramatically increasing.
Screening for overweight and obesity is done in your physician’s office by taking a body mass index measurement, or BMI, a calculation based upon the height and weight of your child. Our children are defined as OVERWEIGHT if they have a BMI in the 85-94th percentile and OBESE if they are in the 95th percentile or above. While it may be uncomfortable, I suggest you go to the Centers for Disease Control website and enter your child’s information into the pediatric BMI calculator. It is tough to be objective when it comes to our own children and this will give you a number which removes our biological bias.
The American Academy of Family Practice recommends obtaining this measurement annually beginning at age 2 to ensure a healthy weight trend and the United States Preventative Services Task Force recommends we refer for nutritional therapy beginning at age 6.
If your child’s BMI is in the overweight or obese range, I highly recommend you do not initially focus on your child or children. First take a look at your family habits and parenting styles. The benefit of behavior therapy may be increased if you parents, rather than the child, are given the primary responsibility for behavior change.
Being overweight or obese can have a significant effect on both the physical and emotional health of our children. Their behavior can drift towards becoming bullied or being bullies, they can develop low self-esteem, depression and anxiety. The obesity epidemic is made complex by various factors. However, it can also be made quite simple, energy in should equal energy out.
In order to maintain a healthy weight as a child and into adulthood our energy intake needs to equal our energy expenditure. For starters, your entire family needs to embrace a permanent change including a healthy lifestyle. Much of your failure or success will come from the balance between your diet and exercise. Current recommendations are physical activity of 1 hour a day for children and 30 minutes for adults; 5 days a week. The activity does not necessarily have to occur in a gym or with sport but can be just simple, brisk walking. Start somewhere and add at least a step each day!
I believe in calorie counting. I am amazed at how much my patients learn from discovering how many calories their food is poisoning them with. I would also like to say that for the most part, your child can not eat what junk food you do not buy.
I would like to end with a personal story about two of my new heroes. I coach soccer and at about age 11, boys love to play shirts and skins. It crushes my heart to see the heavier boys jockey to be on the shirts side and when they end up on the skins side, they are embarrassed. This is a lot of pressure on our kids. I have never said anything to those boys specifically but could see their pain. Over the years, I have made general recommendations of a good diet to the entire team as a whole, like we should do for our families. I am not sure if this was it or something else, but something clicked in two of the boys minds. Over a year, these two boys changed their diets completely. One played soccer almost every day with his dad. The other started running and eventually personally chose to run and win 5 K’s. These two boys are now the most fit players on my team. I am amazed by them. However, most kids are not likely to change their stars on their own like my two little heroes. Most kids need their entire family to change beginning with the parents and grandparents.
Finally, if you need help, the entire family should go and see your doctor to discuss the family weight, get caught up on wellness measurements including the BMI percentile, blood pressure, insulin level, glucose level and cholesterol profile.
Mark Mansfield MD