Advice from Doctors

Every day in clinic I see children who are overweight and whose parents ask “What can we do?”

For years I have told them to turn off the TV, get back outside and play, and have dessert on Saturday only. Time is proving me correct but with a scientific basis.

Dr. Sarah Armstrong, a pediatrician and director of Duke Children's Healthy Lifestyles Program, tells us more about this epidemic that is threatening our children.

-- Dennis Clements, MD, PhD, MPH

 

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There’s no doubt that children are gaining weight at an alarming rate. Over the last 20 years, the obesity rate has doubled for school-age children and tripled for teens.
Unfortunately, that translates into more medical illnesses for those children now -- and an even worse outlook when those children become adults. Studies show that overweight children have up to a five-times worse quality of life than normal weight children. That is slightly worse than pediatric cancer patients.

 

What medical problems do overweight children suffer?

Mostly, they are illnesses that used to be considered “adult” illnesses, but that are seen more and more commonly in children.

Chronic diseases that limit children's ability to participate in sports and other activities include:

• diabetes
• hypertension
• high cholesterol
• sleep apnea

Sadly, the rates of depression, anxiety, low self-esteem, and poor school performance are also much higher in overweight children.

Who’s to Blame?

If you’re looking for a root cause for the epidemic, you have plenty of options to choose from:

• Food industry. Certainly, our children’s diet has become filled with sugar-sweetened beverages such as sodas, juice “drinks,” and sweet tea.We also eat larger portions than in the past, and more often, we eat those large portions away from home.

• Media. The number of hours children spend watching TV and playing video games has increased in the past 20 years.One study showed over 60 percent of American children have a television in their bedroom, reducing much-needed sleep time.

• Decreased activity. Physical education in the schools has decreased as well, which for some children is the only opportunity for outdoor play.

• Genetics. When we look at the nature versus nurture question, nature wins 60 percent of the time, meaning more than half of what contributes to our weight is genetically determined. But our gene pool has not changed over the past 20 years. And that still leaves us a good 40 percent to modify by making healthy lifestyle choices.

Check Your Child’s BMI

The only way to know for sure if your child is overweight is to have your child’s doctor measure his or her body mass index, or BMI, and plot it on childhood BMI curves.

A BMI for age and gender over the 85th percentile is considered overweight.

Your child should have his or her blood pressure checked, and be tested for diabetes, high cholesterol, and liver disease. Your doctor will discuss the results, and give you healthy tips on how to reverse unhealthy trends.

Make Healthy Changes

Kids don’t need to be overweight to make healthy changes. They can start by getting exercise. The American Academy of Pediatrics recommends that all children get 60 minutes of physical activity every day.

In addition to exercise, try these suggestions:

• Encourage your child to drink more water and lowfat milk, and fewer sugary drinks.

• Try to eat at least four or five healthy meals at home with your family each week. This will foster better eating habits as well as reinforcing a good relationship with your child.

• Turn off the TV after one to two hours a day, and instead find a fun activity to do together.

• Help your child get to bed on time, so he or she can be well rested and energetic for the day.

A healthy lifestyle is easy to achieve if we take it one step at a time! Now is the time to start. We have a long way to go in the next 20 years to reverse the epidemic, and we can only do it by working together.

-- Sarah Armstrong, MD, is a pediatrician with Duke Children's and director of Duke Children's Healthy Lifestyle Program.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.