As a practicing pediatrician I receive a lot of requests for advice about childhood obesity. “How did it happen? What should we do about it?” parents ask.

This epidemic did not start overnight. It began with the fast food boom in the 60s. If you want calories you can go and get them -- now. And portion sizes and caloric content have skyrocketed. A complete meal for one at a fast food restaurant could feed a family of four for a day in many other parts of the world.

In addition, we have gradually made our children less active. TV and computers for sure have contributed to this -- but air conditioning is also to blame: why go outside if it is too hot? It used to be too hot inside, too.

Fear for children’s safety has kept them closer to home and more often inside as well.

To unravel this problem and get us back on track will take the entire country to change course. Our schools, restaurants, families, and governments must all play their part in fixing the problem. The solution includes food choices, exercise choices, and, yes, emotional support choices.

Dr. Sarah Armstrong is a pediatrician at Duke who is the leader of Duke’s Healthy Lifestyles Program. The program tries to educate the child and family about a new way of coping in this time of plenty. It is a way to find the answer to “what can we do to help our child who is overweight?” Please read her comments below.

-- Dennis Clements MD, PhD, MPH

Here are some facts about childhood obesity:

• The epidemic of childhood obesity was recently recognized by the World Health Organization as the number one threat to the future health of our planet (WHO, 2006).
• Currently, 25 million children in the United States are overweight. In North Carolina, whose children rank fifth most obese in the nation, one out of every 3.5 children is overweight (Trust for America, 2007). Approximately 12,000 school-aged children living in Durham, North Carolina, are overweight.
• Overweight children suffer many medical complications, including hypertension, diabetes, high cholesterol, liver disease, pulmonary disorders, depression, and social isolation.
• One in three overweight children aged 6-12 already have at least one risk factor for cardiovascular disease (JAMA, 2005). Scientific studies show that overweight children are much more likely than their peers to become overweight adults with multiple medical problems, limited work capacity, high consumption of heath care resources, and suffer early mortality (Pediatrics, 2006).
• In the United States, the public burden of weight-related health care expenses, lost time at work and disability carries an annual $1.7 billion price tag and is increasing exponentially (Institute of Medicine, 2005).

There are many ways you and your family can start at home to live a healthier lifestyle. For example:

• Remove the TV from your child’s room. Did you know that simply having a TV in a child’s bedroom increases their risk of being overweight?
• Avoid high-fructose corn syrup. Did you know that most “sugar” sweetened beverages are not sweetened with sugar, but with high fructose corn syrup? This can blunt your feeling of fullness, and lead to increased consumption.
• Read food labels to see what’s really in there. A bottle of “fruit drink” often has less than 2 percent juice, and as many as 22 teaspoons of sugar!

However, these changes can be difficult, confusing, or hard to incorporate into daily life. Parents also worry that their child may suffer a medical condition causing their weight problem, or that their child’s weight is the result of a medication or a toxin exposure.

Many children have been referred for many services only to be told they have to lose weight, but given no guidance.

Center of Nutritional Disorders and Obesity (CENDO)

To help families navigate this complex system, Duke University School of Medicine’s Department of Pediatrics elected to concentrate significant resources to combat the epidemic of childhood obesity. This led to the creation of the Center of Nutritional Disorders and Obesity (CENDO) in 2005.

The four key components of CENDO include:

• Direct clinical care for families and children struggling with weight and health issues
• Advocacy
• Education
• Research

CENDO faculty meet monthly to design and carry out important clinical trials to understand the causes for and to effectively treat childhood obesity.

Healthy Lifestyles Program

The Healthy Lifestyles Program is the cornerstone of clinical care provided to overweight children and their families. Healthy Lifestyles is a multidisciplinary, evidence-based, family-centered approach to treating obesity.

The program is designed to provide comprehensive evaluation and management services to families from all ethnic and socioeconomic backgrounds. The structure of the program includes an initial assessment to provide a health risk factor profile, followed by monthly visits to the clinic for ongoing family lifestyle intervention.

The family’s “Healthy Lifestyle Team” includes a medical provider, a dietitian with certification in childhood weight management, and family support services as needed.

The monthly visits use the proven technique known as “motivational interviewing,” which has been validated for weight loss in children (Schwartz, 2007). We also provide written materials at each visit, which are based on CDC-approved guidelines for preventing chronic disease in children.

At each visit, the child receives a “fit kit” to facilitate the goal. Examples include a water bottle, a jump rope, a pedometer, or a resistance band.

After completion of the program, patients are seen bi-annually for ongoing education and surveillance for chronic disease. The program costs are only your primary care co-payment, and all insurance types are accepted.

Healthy Lifestyles has partnered with multiple organizations from which we receive referrals and provide to families as community resources. These organizations include the Emily Krzyzewski Family Life Center in downtown Durham, several local fitness facilities, the Downtown Durham YMCA, and the Durham Parks and Recreation programs, the John Avery Boys and Girls Club, the Lyons Park Center, El Centro Hispano, and the Downtown Durham Athletic Association.

We are also involved in local, state, and national health advocacy committees such as the Durham Health Department Obesity and Chronic Illness Committee, the NC State Health Department, Eat Smart, Move More NC, and the National Initiative for Child Healthcare Quality.

To make an appointment at Healthy Lifestyles, please call us at 1-866-530-5356 or 919- 620-5356. To learn more about the program, please call 919- 620-5394.

Here’s to your health!

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

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