|Solving the Over-Weight Puzzle|
Because of the current overweight epidemic in children and teens, for the first time in history, the current generation of kids is not expected to live as long as their parents.1 In the United States childhood obesity has nearly tripled since 1980 -- 17% of America's children and teens are now medically obese, such that their health is at risk. One out of three is overweight or obese.12 In Great Britain approximately 16% of children and teens are obese, and the rate is also increasing.11 The problem is worldwide. Overweight children and teens are developing diseases previously seen only in older adults, such as diabetes (Type 2 ), high blood pressure, worn-out joints, fatty liver disease, clogged arteries, and sleep apnea (pauses in breathing). The U.S. Center for Disease Control now estimates that one in three children born after the year 2000 will develop type 2 diabetes because of the overweight epidemic (see recent article). The rate will be even higher for African Americans, Hispanics, and Native Americans, where nearly half of their kids will develop the disease. A new term has been coined, "Diabesity", to describe the problem. (Diabesity is a registered trademark of ShapeUp America). Excess weight in the childhood years can lead not only to physical disease but also to psychological consequences. Overweight children may develop low self-esteem, limit activity, and grow to become obese adults with high risk of diabetes, heart attacks, strokes, joint failures, and cancer.
Most parents recognize childhood obesity as a problem, but many fail to see it in their own kids, as a new national poll in the U.S. reveals.
Many overweight kids post on our boards that they turn to food to when sad, angry, lonely, depressed, stressed, or bored. For most, this is unconscious. Unfortunately, they become hooked on this 'comfort eating' behavior and unable to stop. They struggle to resist cravings for highly pleasurable food, e.g. 'junk food,' even though fully aware of the dreadful effects of further weight gain. This is highly suggestive of an addictive dependence on highly pleasurable foods. Compelling evidence now points to overeating as strikingly similar to smoking, drinking, and even drug abuse. The first conference on "Food and Addiction" was held at Yale University in July 2007 and the impressive Obesity and Food Addiction Summit in Seattle in April 2009. And a new study reports: "Sugar and fat-laden foods are being consumed because they are addictive." The major difference between tobacco, alcohol, drugs, and high pleasure food thus seems to be simply that highly pleasurable foods are accessible by children. A 16 year old girl responding to a poll on our site regarding food and addiction, sums it all up:
"A teen who does drugs or smokes would get in trouble if their parents found out. But no one's going to ground you for eating, which can be equally as damaging, and is equally as difficult to stop."
And a 9 year old girl, who finally reached a healthy weight, wrote in her success story:
"Did you know hot pockets and corn dogs are bad for you? THEN Y DO THEY MAKE EM? GRRRR..."
Please read How do I lose
Also, look at a poll which asks
kids about a new method of losing weight, similar to quitting smoking or getting
off drugs or alcohol.
A small percentage of overweight cases in childhood are due to hormonal abnormalities, but the vast majority of childhood overweight is due to over-eating. It is pretty simple: if children take in more calories than they burn up, they will gain weight. Some kids may have "higher metabolism rates" and burn up food faster, but even if a child's metabolism rate is high, if they eat excessively, they will gain weight.
Children who are overweight generally refer to themselves as having a "weight problem", but in actuality what they have is an "eating problem." They eat more than they burn up by physical activity. Lack of activity can contribute to overweight. Kids today are not as active as in the past. But over-eating is by far the biggest contributor to gaining weight. For example, walking several miles is required in order to burn up just one ice cream cone. The reasons for excessive food intake are not that complex. Depression, anxiousness, low self-esteem, stress, or just boredom are commonly relieved by food. We do not feel pleasure and emotional pain at the same time. Unfortunately, the emotional pain returns as soon as the food is consumed.
Using food as a way to neutralize emotional pain can actually result in a psychological dependence on food. The child becomes psychologically "hooked" on food to keep from feeling emotional discomfort, very similar to a drug addiction. Resisting overeating to begin with takes "will power", but breaking psychological food dependence takes heavy duty will power. Tolerating life's pains, finding alternative comforting things, and distracting oneself by fun activities is necessary to avoid psychological food dependence. There is also the "Vicious Circle Effect."
Once a child gains excessive weight, the decrease in self-esteem and social isolation associated with being overweight causes more depression, anxiety, and stress, so that seeking comfort in food and overeating increases even more, with more weight gain, worse self-esteem, and so on. This is referred to as a "vicious circle". And the heavier a child becomes, the less he/she is able to move around to burn calories, further increasing weight gain, i.e. a second vicious circle. To lose weight requires breaking these vicious circles. The child must realize that overeating and gaining more weight will just increase the unhappiness and problems with exercise and make it even more difficult to do something about the weight. Finding other comforting things that don't involve food, distracting fun activities, and support groups can help break the vicious circle.
Children who do not receive emotional comfort at home may turn to food for comfort. A nurturing relationship with parents can turn off the emotional appetite for food. Unfortunately, overweight in their child tends to upset parents, so that the relationship becomes strained, which causes the child to seek more comfort in food, which upsets the parents further, i.e. another vicious circle. And parents may feel that overweight in their child is the parents' fault. But it is no one's fault, just misunderstanding. Breaking the vicious cycle by loving and nurturing your overweight child is the key. Talk to your child about his/her feelings, what feelings are being numbed by food, and help the child to learn to find comfort and stress relief in things other than food. Again, if you have not read it, please see How Do I Lose Weight?
Hunger is what we feel when our body is lacking in the nutrition of food. A craving is what we feel when we want the pleasure of food. If your child eats for pleasure rather than for nutrition, excessive weight gain is usually the result. Help your child to learn how to eat for nutrition rather than for pleasure.
The size of food portions in our culture is set by people who want to sell food. Eating the "standard size" portions in most restaurants on a regular basis will cause most people to gain weight. One of the best ways to control your children's weight is to let them eat whatever they like, just less of it. To help them lose weight, it helps to cut whatever they normally eat by half or a third and save the remainder for later. Once the weight loss has occurred, to maintain it, the portions are then made just a small amount less than they used to eat. Portions can be adjusted to keep your child's weight in the healthy range.
The problem with obesity in children and teens is not just the cosmetic and self-esteem issue of looking "fat". Obesity can seriously harm your child's health. If there is excessive fat on the outside of the body, there is also excessive fat on the inside, i.e. in the body's organs. Fat build up in organs such as the heart, the arteries, the liver and pancreas causes these organs to function poorly.
Diabetes (Type 2) is on an alarming rise in the adolescent population. Type 2 diabetes is intimately related to being overweight. Type 2 diabetes was rare in kids 20 years ago, but the rate of type 2 diabetes in kids has increased by one percent every year since 1980, in parallel with the increase in obesity in kids13.
High blood pressure is also increasing at an alarming rate in children. Similar to type 2 diabetes, high blood pressure in children is likewise related to being overweight. And if a teenager has high blood pressure and is overweight, they have a 90% chance of having high blood pressure as an adult, with a high risk of an artery breaking in the brain (stroke).14.
Overweight children have more bone and joint problems, simply because of the mechanical stress which the extra weight puts on bone and joint structures.
The high fat, high sugar foods which overweight kids and teens eat cause fatty deposits called "plaque" (pronounced "plack") to form on the inside of the arteries supplying organs like the heart, the brain, and the kidneys. This plaque, shown in the lower artery on the left, eventually blocks normal flow of blood to those organs (the upper artery is normal). Moreover, pieces of plaque can suddenly break off and totally block the blood flow downstream. This results in a "heart attack" in the case of the heart or a "stroke" in the case of the brain. Plaque deposits also cause "hardening of the arteries", which results in high blood pressure, kidney failure, and broken arteries in the brain, another form of stroke.
It is known statistically that the longer the child carries the weight, the greater the risk to the child of becoming an overweight adult. 90% of overweight teenagers becoming overweight adults. Obese adults have a much higher rates of diabetes, high blood pressure, heart attacks, strokes, and cancer.
"Medically overweight" is different than "socially overweight." "Socially overweight" means that a child is embarrassed about their weight and gets teased about it. The term "medically overweight" means that a child's weight is a risk to their health. Doctors use what is called the "Body Mass Index" or BMI to determine if a child is medically overweight. The BMI is also used for adults and indicates how much fat a person has on their body.3,4 The BMI changes normally with a child's age. For example children less than 3 years old and teenagers have more fat normally on their bodies than children 4 to 12 years old so their BMI is higher.
The BMI is simply a number that shows how a person's weight relates to their height, in other words whether their weight is proportionate to their height. The BMI is the weight divided by height multiplied by itself. BMI's for children in the typical U.S. population are listed on the National Center for Health Statistics website. A thing called the BMI "percentile" is used to compare how a child's BMI relates to other children their age and sex. For example, if your child's BMI is at the 75th percentile, that means that his or her BMI number is greater than seventy-five out of a hundred kids their age and sex. If a child has a BMI higher than the 85th percentile they are considered "medically overweight", and if greater than the 95th percentile then they are considered "medically obese." How was that percentile picked? It was determined by a committee of experts on obesity in kids.9 Actually it is Mother Nature that determines what a healthy BMI is, because a child's BMI percentile is related to health risks.
Three out of five children and teens with a BMI above the 95th percentile
have at least one risk factor for cardiovascular disease. One out of five
children with with a BMI above the 95th percentile have two or more risk factors
for cardiovascular disease. 5
The extremes in BMI-for-age that raise concern in children 2 to 20 years of age:
BMI-for-age <5th percentile: Medically
BMI-for-age <5th percentile: Medically
You can find out your child's BMI percentile and whether they are medically overweight and at health risk by using the percentile calculator on our site. This calculator uses the recently released height, weight, and BMI percentile charts of the U.S. National Center for Health Statistics.
Ten Ways to Tell if Your Child Has a Weight Problem*
1. His/her doctor tells you so.
While excessive weight gain can occur at any age, many parents don’t address the issue until the child is older and it has become a much bigger problem. When you wait until it’s a problem of larger proportions, it’s harder to treat.
*From The Can-Do Eating Plan for Overweight Kids and Teens., by Michelle Daum, MS, RD, a pediatric nutritionist in private practice in Westchester and Long Island, NY.
Your doctor or healthcare provider is the best source of information on weight loss in children and teens. For information on weight loss in children and teens, please click on the following links to the Healthy Weight School:
DOES YOUR CHILD NEED TO LOSE WEIGHT?
WHAT IS SAFE WEIGHT LOSS IN CHILDREN AND TEENS?
A recent poll asked kids on this site what they thought would reverse the growing overweight problem in children and teens. Most kids responding felt that the solution is:
"Parents realizing that their kids will have shorter
lives, stopping their own overeating, and being role models for their kids."
1) A child's good eating habits begin with the adults in the home. Children will mimic their parent's good and bad eating habits. And, if only high fat, sweet and low-nutrition food is mostly available, this is what the child will eat. Parents need to be role models for healthy eating and active lifestyles.
2) Do not use food as a reward or to comfort or soothe. Teach your child that food is what his/her body needs to run on for fuel and to make new parts like bones and muscle, rather than something for entertainment or to comfort bad feelings.
3) Help your child to find sources of comfort, pleasure, and fun other than food. Hobbies, sports, and clubs can relieve boredom and offer distraction from depression and anxiousness. They will also increase activity. If you see your child snacking excessively ask them, "Are you really hungry or are you just unhappy?"
4) Limit TV watching. For the average child, watching television accounts for 24 hours a week of sedentary behavior, and kids frequently eat snacks while watching TV -- not many calories expended and perhaps even more consumed! A maximum of 2 hours per day of screen time is recommended.
5) Teach your child to "Just Say No!" to excess food and junk food. Praise him or her when they resist temptation. Post a "No Pig Out!" sign on your refrigerator door (see our No Pig Out printable poster). Eating discipline is like any other form of discipline, it has to be taught and reinforced by the parents.
6) Your child's doctor can tell you if your child is overweight. Children and teens less than 19 years of age should not undertake weight loss without the advice and medical care of a physician. Children should not go on severe diets -- their bodies are growing and developing, and they need adequate nutrition for maximum height and good health. A better approach for younger children is to maintain a constant weight or at least slow their weight gain until they grow into their weight, unless they are severely overweight.
7) Do not overly restrict calories. You may be encouraging sneak eating or binge eating. Push better food choices into the diet and they will push out less desirable choices. For example, if veggies and low-fat dip are offered after school, and cookies are not easily available, the child will learn to eat what is offered.
8) Keep portion sizes tailored to your child. Use smaller plates and serve your child less than you serve yourself, unless, of course, your child is a teen as tall as you are.
9) All eating at home needs to occur at the kitchen table, even snacking. No nibbling in front of the television, no box of cookies in the bedroom, no dish of ice cream at the computer.
10) Stop offering sweetened beverages, except on special days.
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Disclaimer: The information contained above should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.
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1. Belluck, P., Children's Life Expectancy Being Cut Short by Obesity, The New York Times, March 17, 2005. (New England Journal of Medicine article, Dec. 2007)
2. Himes, JH and Deitz, WH. Guidelines for overweight in
adolescent preventive services: recommendations form an expert
committee. American Journal of Clinical Nutrition. 1994;
10. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, U.S. National Institutes of Health: http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm
11. Rudolf, M., Sahota, P., Barth, J., Walker, J., Increasing prevalence of obesity in primary school children: cohort study., British Medical Journal, 2001;322:1094-1095 ( 5 May ): http://www.bmj.com/cgi/content/full/322/7294/1094
12. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL, Overweight prevalence and trends for children and
adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med. 1995;
13. Dietz, WH, and Klish, WJ, Obesity: A Growing Problem, Seminar at the American Academy of Pediatrics Annual Meeting, San Francisco, October 2001.
14. Belsha, C, and Blowey, D, New Advances in the Diagnosis and Treatment of Hypertension, Seminar at the American Academy of Pediatrics Annual Meeting, San Francisco, October 2001.