There have been a number of articles
about obesity and children, and frequently there are words used such as
"surge," "epidemic," and "growing problem." Let's take a look at what the
issues are.
Obesity has a popular meaning (just
plain fat - we know it when we see it) and a technical meaning.
Overweight (chubby) is the same. And here comes the interesting thing:
official technical meanings of these two words have changed. They deal with
the body mass index, or BMI, which is the ratio of weight to height,
and is arrived at by the following method: multiply the weight in pounds by
703, then multiply the height in inches by height in inches, then divide the
first number by the second. If using the metric system, the numbers are
weight in kg divided by the square of height in meters.
Before 1998, a BMI of 27 or more was
considered overweight. But in June 1998, new cut-off weights were
implemented. The BMI for overweight became 25 to 30, and anything over 30
became obese. Thus, overnight a lot of people became overweight who were
considered normal the day before.
With children, the BMI is not so clear a
measurement. According to a paper in the British Medical Journal of May
2000, at birth the BMI can be around 13, going to 17 at age 1, 15.5 at age
6, to 21 at age 20. Therefore, using the BMI to determine whether a child is
overweight or not is not so clear cut, so it's not used. Instead, in the US
children who weigh more than 85% of their contemporaries are considered
overweight. Those who weigh more than 95% of their peers are classified as
obese.
There is general agreement that
prevention is the best route to take to deal with this issue. Trying to get
children to lose weight by restricting their diet awakens what I like to
call the "mule syndrome," which all of us can relate to. That is what
happens when we are pushed to do one thing, and automatically we pull the
other way. The Children's Health Education Foundation at Touro College (www.touro..edu.chef)
strongly advises against dieting for children, as it may lead to eating
disorders.
What, then, can we do?
1. Research has clearly established that
the extent and duration of breastfeeding is inversely associated with the
risk of obesity in later childhood, according to the American Academy of
Pediatrics Committee on Nutrition. Thus, breastfeeding is the number one
recommendation - the longer the better.
2. Family meals. Many children eat
snacks, packaged foods, and fast food as their parents are too busy to cook.
In the same AAP paper, "Prevention of pediatric overweight and obesity," the
authors point out that the absence of family meals is associated with lower
fruit and vegetable consumption. More consumption of fried foods and sodas
are also associated with this dynamic. To instill good eating habits in
children, families should eat one or more balanced meals a day together.
Or at least 5-6 times per week. Rather than talking and cajoling,
parents need to model healthful eating, with an occasional low-key
comment about the role of food in health.
3. Restrict TV viewing. This for two
reasons: first, inactivity, and second, the constant barrage of advertising
of junk foods and drugs. One of the clear culprits in childhood overweight
is lack of physical activity. Children amuse themselves these days by TV
watching and computer games. There is a place for those, but a majority of
kids spend 4 hours a day watching the tube, which clearly is too much. And
then there is the issue of junk foods advertising. The way I handled that
with my children was very simple: I did allow them to watch certain
programs, but I made it very clear that whatever food they were selling
or promoting on TV, I was not buying. That was family policy, and I
didn't deviate from it. If they ate it with their friends or at school, it
was their choice; I just wasn't about to spend money on what I considered
junk food.
4. No soft drinks or sodas in the house.
Same issue. Some research published in The Lancet in February 2001 found
that the risk of becoming obese increased 1.6 times for each additional
glass of sugar-sweetened drink that a child consumed each day. Even
"diet" drinks will cause problems, as artificial sweeteners increase the
appetite and encourage more eating. My kids had some trouble with that when
they started having friends over, but I stuck to juices and seltzer; if
someone brought over a soda, I let it ride, I just didn't spend the money on
it myself. That was enough of a statement.
5. When eating out, patronize family
restaurants, even diners, and encourage the consumption of soups, salads,
chicken or fish, vegetables, stews. Avoid the fast-food shops, the burgers
and fries, pizza, desserts.
6. Avoid having separate "adults" and
"children" food groups in the house. Children are programmed to want to do
what the adults do; if the parent eats cookies, the child will want to eat
cookies, and has a right to do so. If the adult says, ‘these are not good
for you, you may not eat them," what kind of message is that? Therefore, for
those who want their children to eat healthful foods, they have to do so
themselves.
7. And then, once in a while, for no
reason whatsoever, just because you feel like it, eat some "junk." I don't
recommend doing it for "special occasions," because then the unhealthy food
then becomes elevated to a lofty place. Fun, or "just because," is good
enough. We usually kept pizza for an occasional fun treat. There was a fancy
dessert shop near us, and for a while once a week we went and shared some
rich French pastry, to find out what that was like. I think we did it maybe
four times and then we all forgot.
If the kids insist on junk foods, go see
or rent "Supersize Me", the marvelous documentary on what happened to one
man who ate only fast food for 30 days. There is also a serious movement to
improve the quality of food in schools. Many schools are being paid by
commercial interests to sell unhealthy foods, so they make money on your
children's health. If you want more information, see
www.commercialalert.org, or call 503-235-8012.
Remember this: whether we like it or
not, the home is the major educator on how to eat, and how to take care of
ourselves. School comes second. If you have children, what you teach them at
home by precept and example is the core information that they'll take with
them for the rest of their lives. They'll either follow it or go against it,
but they'll have it nonetheless, warts and all.