Children and Weight Management Issues

with Theresa Cafaro, M.D., and Susan Bernstein, M.D., Pediatricians with Columbia St. Mary's

Posted: July 1, 2004

If it were 1980, approximately 94 percent of children between the ages of six and 19 heading to theaters to see Harry Potter and the Prisoner of Azkaban would be built like the film’s three skinny heroes, Harry, Ron and Hermione. But it’s 2004, and because childhood obesity rates have tripled in the past 24 years, there are a lot more children who more closely resemble Dudley Dursley, Harry’s (to quote directly from the book) “fat” cousin.

The Centers for Disease Control and Prevention report that 10 percent of two- to five-year-olds and 15 percent of six- to19-year olds are overweight. Add in the number designated as “at risk” of being overweight, and the numbers jump to 20 percent for the younger group and 30 percent for older children. The statistics are even higher for children of color. Four in 10 Mexican-American and African-American youth ages six to 19 are either “at risk” or overweight.

This is not news to Dr. Theresa Cafaro and Dr. Susan Bernstein, pediatricians with Columbia St. Mary’s.

Theresa Cafaro, M.D., and Susan Bernstein, M.D., Pediatricians with Columbia St. Mary’s "We have kids come in and all their family members are obese, so they don’t see it as a problem." Theresa Cafaro, M.D., Pediatrician with Columbia St. Mary’s "Cut out the sweet drinks. A soda and a bag of chips after school add up to 350 calories. Replace that with a diet drink and a bag of carrots." Susan Bernstein, M.D., Pediatrician with Columbia St. Mary’s

“The whole society has become very sedentary,” Dr. Bernstein said, adding that the progression is something she’s seen occurring over the time she’s been working as a pediatrician.

“When I first went into practice in 1981,” she said, “I saw obese children, but I certainly wasn’t discussing weight issues five times a week.”

Both doctors said that the increase in overweight and obese children is reflective of what’s happening in society at large.

“We have kids come in and all their family members are obese, so they don’t see it as a problem,” Dr. Cafaro said.

To determine whether a child is overweight or obese, doctors measure BMI, or body mass index. (The calculation is done by taking the child’s weight in kilos and dividing it by their height in meters squared.)

A BMI greater than 30, or 95th percentile, is considered obese. Healthy weight is between the 5th and 85th percentile; a child is overweight if his or her weight falls between the 85th and 95th percentile.

If you are overweight at the age of four, there’s a 20 percent chance you will be an overweight adult. If you are overweight as an adolescent, that probability jumps to 80 percent.

Both doctors said the number of metabolic workups (a blood test used to determine insulin and cholesterol levels, as well as thyroid function) they’re ordering has increased, to rule out diabetes, liver disease or high cholesterol.

The results, too often, indicate that their young patients are showing signs of type 2 diabetes and cholesterol levels that necessitate prescribing statins – drugs designed to lower LDL cholesterol for cardiac patients.

Childhood obesity has also been linked to bullying, and to depression in children. "One study showed that obese kids had as poor of a quality of life as children undergoing chemotherapy for cancer," Dr. Cafaro said.

While adults are able to take charge of lifestyle changes necessary to lose weight and keep it off, that’s not always the case for overweight or obese youngsters. That’s why it’s so important for parents to model and instill good eating and exercise habits in their children.

“The vast majority of obese and overweight kids we see are in an overweight family where nobody eats properly and nobody exercises,” Dr. Cafaro said, adding that it’s very hard for children to lose weight in that kind of a situation. She and Dr. Bernstein expressed frustration at the lack of resources available to families who may want to change their eating and exercise habits, but aren’t sure of how to go about it.

“There are very few programs out there, and most insurance companies won’t pay for nutritional counseling,” Dr. Cafaro said, adding that studies currently being conducted by the National Institutes of Health and WIC (Women, Infants and Children) could provide information that would eventually change that.

In the meantime, both doctors do what they can during office visits. Dr. Bernstein said she only asks her patients and families to make three changes at a time.

“First is to cut out the sweet drinks,” she said. “A soda and a bag of chips after school add up to between 350 and 500 calories. I ask them to replace that with a diet drink and a bag of carrots.”

The second directive is to sweat for 20 minutes a day, whether it’s from dancing in the bedroom, running around outside or exercising to a video.

The third,is to eat a nutritious breakfast. Statistics, she said, have shown that people who do that don’t tend to be overweight.

Both Dr. Bernstein and Dr. Cafaro also encourage their patients to limit fast food intake to one meal per week, avoid prepared foods and to get into the habit of sitting down for meals together at the table.

Preventing childhood obesity
From the moment your child is born, weight is an issue. Babies should gain weight as they grow, but at what point should a parent become concerned about a child being overweight, or worry about their eating patterns?

“We’re plotting heights and weights from the time we start seeing the babies as newborns,” Dr. Bernstein said, adding that it’s at about age two when feeding patterns really become established.

Two things parents can do right from the start to make a difference are breastfeeding and going easy on juice. Breastfeeding’s role in lowering the risk of childhood obesity is just one of many reasons Dr. Cafaro and Dr. Bernstein recommend it. As to juice, both doctors said that many parents mistake it for a healthy alternative to breast milk or formula.

“Juice is a source of empty calories,” Dr. Bernstein said. “I teach from the very beginning that juice is like candy. It should never be put in a bottle – it’s so bad for the baby’s teeth. If you want to give your baby a treat in the afternoon, it’s fine to give them some juice and then some water, but it’s not something that’s an essential food.”

For older children, snacking on fresh fruit or vegetables between meals is acceptable, but there should be clearly established mealtimes. Too often, the doctors said, they see patients who are eating snack crackers, chips and other high-calorie, non-nutritious foods on a constant basis.

Parents should also restrict their children’s television time. Both Dr. Cafaro and Dr. Bernstein advocated limiting TV time to an hour daily, particularly for very young children. Aside from the fact that time spent sitting in front of the TV is passive, many of the ads geared at children and teens hype foods that are high in sugar and fat. In some families, TV is banned while the sun is up, in order to encourage the children to play outside.

While both doctors acknowledged that children don’t have the same freedom to roam as many of their parents did as children, there are still plenty of ways in which they can get exercise. One suggestion, from Dr. Cafaro, aimed particularly at those who watch TV, is to exercise during the commercials.

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