Q&A about Childhood Obesity in 2012
A few weeks ago I was approached by a journalist and asked a number of questions relating to Childhood Obesity. Below are some of my responses which I would like to share:
Q. Do you see many parents expressing concerns about their child’s weight?
A. It Depends on the context. At Kindercare Pediatrics, my primary care clinic in midtown Toronto, I am generally the one who brings weight concern up with the parents. This isn’t to say that the parent(s) are not concerned. For some reason, parent(s) often don’t find it easy broaching the subject with their primary care doc. Once I break the ice, it most often becomes clear that the parents are and have been appropriately concerned.
At the North York General Hospital’s Infant, Child, and Adolescent Nutrition Clinic, I see patients in consultation for high weight and obesity. In this context, the obesity is first, second, and third on the parents’ agenda.
It’s important to note that a child’s weight is virtually never the primary concern in these situations. Rather, one should think of weight as the symptom of a more fundamental problem – an unhealthy lifestyle – much like fever is a symptom of an infection. Take, for example, the problem of strep throat. More often than not, strep throat presents with high fever and a very sore throat. If we treated this infection with pain killers and fever-reducing medication, the strep throat would rage on unabated. Treatment with antibiotics to clear the bacteria is the solution. In the same way, going on a diet virtually never solves an obesity problem … especially in children. To resolve a child’s obesity, one must tackle the underlying problem: unhealthy lifestyle. To lead a healthy lifestyle, one must be physically active, be in touch with one’s senses of hunger and fullness, and eat a wide variety of healthy and yummy food.
Q. Is this trend becoming more or less pronounced? How bad is it?
A. Over the past 20 years, the US prevalence of obesity has been increasing dramatically and relentlessly. See http://www.cdc.gov/obesity/data/trends.html – Canada is not far behind. In Canada, the percentage of children classified as overweight or obese doubled from 14% in 1981 to 28% in 2009. This means that as of 2009 in Canada, one million more children than 30 years ago will later, if not already, face a life riddled with the many disabling and life-threatening complications of obesity: diabetes, heart attacks, strokes, chronic pain, depression, social isolation, etc…
Interestingly, for the first time in nearly 3 decades, some studies are emerging suggesting that among children (in this case in New York City), this increase may be showing signs of reversal – see http://www.nytimes.com/schoolbook/2011/12/15/obesity-in-new-york-children-on-the-decline-officials-say/, hopefully as a result of some of the educational campaigns that have been implemented over the past 5+ years. But it might also just be a one-off fluke, not necessarily a reflection of the true trajectory of this obesity epidemic. But at least it gives us a sliver of hope.
Q. What are the main culprits of weight gain in young kids?
There are so many!
1. Food is less healthy than it used to be – more sugar, more fat, more calories, highly refined, larger portions, crappier foods way easier to procure and prepare.
2. Neighborhoods are perceived by parents as less safe these days. As a result, parents are not comfortable leaving their children to play outside.
3. The national children’s pass-time 30 years ago was biking, tag, street hockey, soccer and so on. Nowadays, it is TV, video games, IPad, and Internet.
4. Whereas families used to walk to school, walk to the store, walk to the park, walk to a friend’s house, now the only way go places seems to be by car.
5. Recess and Gym time is disappearing in schools. Worse yet, kids are assigned outrageous amounts of homework to do each night keeping them pinned to their chairs ’till well after the sun goes down.
Our communities have been invaded by countless fast-food joints who make unhealthy over-sized crappy meals rediculously inexpensive and irresistibly convenient.
6. The food industry’s highly sophisticated marketing machine has inundated us (both adults and kids) with targeted, subliminal, powerful, and relentless imagery and messaging adversely influencing our tastes, preferences, actions, habits, and eating behaviors.
4. Do genes play a part or is lifestyle a larger part of the equation?
Genes play a role to a very limited extent. There are some very rare genetic diseases that are characterized by extreme insatiable hunger and relentless weight gain. But these count for a minute fraction of cases. Very rare is the case where genetic diseases double in prevalence over 30 years. It is far more likely that the current obesity epidemic is due to environmental ‘lifestyle’ factors such as the ones discussed above
Q. How do you counsel parents of overweight or obese kids –what changes do you advise them to make?
Here are a handful of common tips we often discuss in clinic:
1. The faster you lose weight the faster it comes back on, and then overshoots.
2. To succeed, one has to stop thinking in terms of weight and more in terms of becoming more “healthy”. When one lives a healthy lifestyle, a healthy weight naturally finds itself.
3. Concentrate on making changes in two domains: nutrition and physical activity.
4. When making changes, take baby steps.
5. Regarding Physical Activity
a. The best kind of exercise is the exercise that your child finds fun and is willing to do. Don’t expect your child to do activities that they don’t find fun and exciting. I still haven’t met the 8 year-old who loves running on treadmills.
b. start low and go slow.
c. Set easily achievable goals. Otherwise you’re setting yourself and your child up for disappointment. For example, if your daughter does not do daily physical activity, don’t expect her to suddenly start running one hour per day on the treadmill. Start with 5 minutes per day of a physical activity that she enjoys doing … say basketball – even better if you, the parent, get out there and play with her. Exercise is good for adults too. Then, after a few weeks of this, increase to 5 minutes every day. Then after 2 weeks increase it to 7 minutes, then 10 minutes. After 6 weeks, she’s doing 10 minutes per day. After 6 months she’s doing 30 minutes per day. After 1 year, an hour per day. Any amount of exercise is better than none. And whenever I read about the race between the turtle and the hair, the turtle wins every single time.
6. On the nutrition side of things:
a. Eat a balanced diet.
b. Follow Canada’s food guide.
c. Examine what poor eating habits are having most impact and/or will be the easiest to change. If the kids drink too much juice, rather than constantly asking them to slow down or drink less, just stop buying juice at the grocery store. Then shrug your shoulders when they ask for juice and say ‘we don’t have any in the house … drink water instead.’
d. Choose whole wheat or whole grain products over white ones – they are healthier, more filling, and more healthily metabolized in the body.
e. Eat breakfast – So many overweight kids skip breakfast Of those kids who skip breakfast, the ones who start eating daily breakfast rapidly notice their body composition improve.