March 10, 2004

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Publication Date: Wednesday, March 10, 2004

Downsizing your kids

By Renee Batti
Almanac News Editor

In a world full of contradictions, the great Weight Conundrum is truly one of the most curious. It can be stated thus: We live in a time when more people than ever are obsessed about being slender and fit. We live in a time when more people than ever are overweight and unhealthy.

The fattening of America carries with it great and ranging repercussions, and the warning flags are being waved from many fronts -- from the medical community and insurance industry, to the United States military.

But the most alarming message of all is sounding from pediatricians across the country, because as adults increasingly tuck away extra pounds, so too do their kids.

A decade ago, pediatricians rarely if ever diagnosed Type 2 -- or adult-onset -- diabetes in a child. Now some medical centers across the country are reporting that 40 to 50 percent of all diabetes diagnoses in children are Type 2, according to Dr. Thomas Robinson, associate professor of pediatrics and medicine at Stanford School of Medicine.

Unlike Type 1, which typically strikes the young, Type 2 diabetes in children is "related mostly to weight," Dr. Robinson said.

And while diabetes is a serious health problem, it is not the only ugly consequence of excessive weight for kids. High blood pressure and cholesterol, obstructive sleep apnea, hip problems, gallstones -- even bow legs -- are also complications of excess weight on developing bodies.

And, in a time when mass-media images glorify perfectly sculpted, flawlessly groomed people, overweight kids -- and those who perceive that they are fat -- are becoming more painfully critical and unhappy with their bodies. This phenomenon, which appears to be growing among younger and younger children, can lead to eating disorders and depression.

So many factors contribute to unhealthful weight gain among children that parents often feel helpless even as they recognize that their child is heading for a health crisis. Do you take away the TV and home computer? Throw away all the sweets in the cupboard and dump all the sodas down the drain? And what about all that junk food and soda that entice your child after he or she walks out the door to go to school or visit a friend?

Dr. Robinson, on staff at the Stanford Prevention Research Center, acknowledges that the effort can be challenging, but he offers a range of suggestions for parents who want to help their child slim down or maintain a healthful weight.

Understanding why

Kids gain weight for the same reason adults do: They eat too much and exercise too little, Dr. Robinson says. This "energy imbalance" can lead to a weight gain that, on a child's body frame, can appear extreme in a short amount of time. A 10-calorie energy imbalance a day leads to a 15-pound weight gain per year, Dr. Robinson says.

And the type of foods kids are eating is also problematic. Fast food has become a staple in many children's diets, and super-sized food portions at fast-food palaces such as McDonald's have contributed to the super-sizing of kids, nutritionists and pediatricians say.

What has become kids' drink of choice -- soda -- is also more available in "big gulp" sizes. Soda is loaded with high fructose corn syrup, which some researchers and nutritionists believe is processed less efficiently by the body than regular beet or cane sugar.

The lure of fast food has been strengthened by massive advertising campaigns, and some health professionals are trying to persuade the government to intervene by restricting fast-food advertisements targeting children. "Ronald McDonald to me is no different from Joe Camel," Dr. Robinson says, referring to the controversial character created to sell Camel cigarettes in an ad campaign that successfully drew in younger smokers.

A recently released report by the Menlo Park-based Kaiser Family Foundation concluded that "children who spend the most time with media are more likely to be overweight." The report was based on more than 40 studies on "the role of media in the nation's dramatically increasing rates of childhood obesity."

The report cites studies showing that the typical child sees about 40,000 ads a year on television, and that the majority of ads that target kids are for candy, cereal, soda and fast food. "Children's exposure to billions of dollars worth of food advertising and marketing in the media may be a key mechanism through which media contributes to childhood obesity."

Meanwhile, physical education programs in the schools have been cut back, and children don't walk or bicycle to school as often as in days past. At home, the lures of television and video games can affect children's activity levels. Even many chores are made physically easier by modern tools and methods.

"We have engineered activity out of our lives," Dr. Robinson says.

At a recent lecture about childhood obesity, Dr. Robinson cited a study of third-grade girls and boys showing that the children exhibited "amazing concern" about weight. Many of the mostly 8-year-olds were fasting or dieting, and symptoms of depression were recorded among many of the girls who perceived themselves as overweight, he said.

The Kaiser report cites the Centers for Disease Control and Prevention for statistics on childhood obesity. Since 1980, the report says, the proportion of overweight children ages 6 to 11 has more than doubled, and the rate for adolescents has tripled.

What to do

Dr. Robinson suggests a range of strategies that, coupled with sound parenting skills, may help a child lose weight or maintain a healthful weight.

Helping kids change their behavior could involve changing the home environment by removing food and props that encourage inactivity, over-eating and eating poorly, he says.

Setting goals and rewarding the child for meeting the goals is also an effective strategy, he says, adding that the goals "should be simple, explicit, with no room for ambiguity."

One technique for making a goal specific is "to put numbers on it," he says. For example, rather than saying the goal is to walk or bike to school some days, it's better to say the goal is to walk or bike there two or more days, Dr. Robinson suggests. Rather than setting a goal to "exercise as a family," it's better to say "we will take a family hike every Sunday afternoon."

Parenting skills are important, he says, offering the following suggestions:

** Be observant.

** Use praise often.

** Use "reciprocal contracts."

** Be good models. ("The most important models are parents," he says.)

** Be consistent and contingent: Rewards and punishments should be "based on behavior -- not on your mood."

** Learn how to say no -- "Kids need limits."

Food advice

Dr. Robinson advises parents to follow food guidelines that include:

** Give children fat-free milk after the age of 2.

** Fill the kitchen with fruit and vegetables. And keep junk food out of the house.

** Eat foods you want your child to eat.

** Don't use food as a reward. "Especially, don't use sweets to bribe your kids to eat their vegetables."

** Limit eating out. "Especially, avoid fast food."

** Serve from the kitchen instead of at the table to control portion sizes.

** Don't eat in front of the television.

Being active

Activity is as important as a good diet, and Dr. Robinson offers suggestions including:

* Limit television, video games and computer use to fewer than seven hours per week.

** Be active with your child.

** Help your child find physical activities to choose from.

** Use activities as a reward.

** Don't put a television in your child's bedroom.

Other problems

Parents with teenagers might face a different set of problems in trying to help their children lose weight. Older children who are testing their limits and facing the typical, troubling difficulties of growing up are often resistant to parental "interference."

Dr. Robinson warns that parents shouldn't allow conflicts with their child to interfere with the child's health. Family counseling, or counseling by a clinical social worker or psychologist, may be in order if children resist parents' efforts to help them control their weight, he says.

Dr. Elizabeth Shepard, a clinical associate professor at Stanford and a nutrition specialist, says parents of an older child should take care not to be too critical of the child. Instead, she suggests, they should "try to get into a positive give and take," and negotiate a system of goals and rewards.

She also emphasizes the need for parents to control the household environment in terms of available food, and to model the behavior they are encouraging in their children.

Creativity can be helpful in devising methods for helping kids lose weight. As an example of what he calls "stealth interventions," Dr. Robinson says a parent can encourage the child to "eat green to save the environment."

The key, he notes, "is not to focus on weight," but rather on eating healthful food, and the above strategy would encourage eating that is healthful to the child and the planet.

INFORMATION

** A good source for information about childhood obesity and parental intervention is the American Academy of Pediatrics' Web site: www.aap.org. ** The Kaiser Family Foundation report on the role of media in childhood obesity can be found at www.kff.org.

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