Fighting fat in our children
with Dr. Laura Marusinec, pediatrician, Advanced Healthcare
As a nation, we're getting fatter and we're dragging our kids down with us as our weight spirals upward. How serious of a problem is childhood obesity and what can be done about it?
First, how fat are American children, anyway? An estimated 15 percent of children and adolescents, ages six to 19, are overweight, according to the 1999-2000 National Health and Nutrition Examination Survey (NHANES). This is triple the percentage of 20 years ago.
Dr. Laura Marusinec, pediatrician, Advanced Healthcare
"It's really a lifestyle problem. I try to determine when and why they are eating. Sometimes it's just out of boredom. Instead of watching TV or sitting in front of the computer, maybe the whole family can take a walk together."
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Another 15 percent of youth in this age category are at risk of becoming overweight. And it's not just school-age children who are gaining: More than 10 percent of preschool children between the ages of two and five are overweight, up from seven percent in 1994. Laura Marusinec, MD, a pediatrician with Advanced Healthcare, sees increasing numbers of obese patients and admits it is a very complex issue to treat.
"I have to be sensitive as to how I approach it with parents and children," she says. "There are a lot of related self-esteem issues. I try to discuss it in medical terms as much as possible, focusing on the health risks as opposed to the body image."
And there are some very real health risks associated with childhood obesity.
Obese children become obese adults
"One of the most significant concerns from a public health perspective is that we know a lot of children who are overweight grow up to be overweight or obese adults, and thus at greater risk for some major health problems such as heart disease and diabetes," says Dr. Julie Gerberding, director for the Centers for Disease Control and Prevention (CDC).
Obese children also appear to be at greater risk of developing type 2 diabetes. An expert panel of the American Diabetes Association (ADA) reported in February 2000 that between eight and 45 percent of newly-diagnosed cases of childhood diabetes are type 2, a type formerly seen in primarily adults. In addition, as many as 80 percent of children developing type 2 diabetes are overweight.
When Dr. Marusinec determines that a patient is overweight she sits down with the child and his or her parents to discuss lifestyle issues. She asks about the child's and their family's eating habits and activities.
"I ask what the family's doing," she says. "You can't put teenagers on a diet if the rest of the family is eating at McDonald's."
Because behavioral changes can seem overwhelming, she suggests initially focusing on smaller changes, such as reducing portion sizes or looking at food labels to find substitutions with less fat or calories. She also suggests keeping a food diary for the child. And she encourages families to become more active together.
"It's really a lifestyle problem," she says. "I try to determine when and why they are eating. Sometimes it's just out of boredom. Instead of watching TV or sitting in front of the computer, maybe the whole family can take a walk together."
How much is overweight?
The NHANE Survey used body mass index, or BMI, to identify children who are overweight.
• Children with BMI values at or above the 95th percentile of the sex-specified BMI growth charts were categorized as overweight.
• Children with BMI values from the 85th to the 95th percentile are considered at risk of becoming overweight.
* The CDC avoids using the word "obese" and instead uses two levels of "overweight." The American Obesity Association, however, uses the 85th percentile of BMI as a reference point for "overweight" and the 95th percentile for "obesity."
Read more about children and diabetes with Dr. Jordan Sennett, an endocrinologist specializing in diabetes with Advanced Healthcare.
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