By Deborah Lockridge

An obsession with being overweight can be just as damaging as being overweight itself.
The deluge of studies can be confusing, even frightening, for parents trying to keep their children’s weight in check. The American Academy of Pediatrics recommends weight screening during childhood — a recommendation the U.S. Preventive Services Task Force doesn’t back up.
Birmingham physicians who are experts in the field of childhood obesity agree one thing is clear: The more a parent can do to prevent a child from becoming overweight, the better.
“To me, the hardest part of our clinical program is seeing a child who’s 12 years old who weighs 300 pounds and is 5 foot 2. That child didn’t get to be 300 pounds overnight. Why was that child not recognized when they were 5, 6 or 7 and starting to pull away from the curve?” That’s the lament of Dr. Frank Franklin, medical director of the Children’s Center for Weight Management at Children’s Hospital and professor of pediatrics and nutrition science at the University of Alabama at Birmingham.
Childhood obesity “is a gigantic problem, both literally and figuratively,” says Dr. Lillian Israel, senior partner at Shades Crest Pediatrics in Brookwood Medical Plaza. “I didn’t used to see fat kids, and now I see some that are morbidly obese. It’s really scary.”
In fact, childhood obesity has more than doubled in the past 25 years, with up to 30 percent of U.S. children are overweight.

A Family Affair
Israel recently treated a 9-year-old patient who weighed more than 130 pounds — twice what he should at his age. The father, who brought him in, was overweight but trying to work on it, she says. The mother, on the other hand, was also overweight, “and was busy buying him as much junk food as he could consume. I asked this kid how many soft drinks he consumed in a day, and he said ‘five or six.’ I asked, ‘How do you do that when you’re in school all day?’ and his daddy said, ‘He starts when he gets home and just opens one after another after another.’ And my reaction was, ‘And nobody’s stopping him?’”
Israel’s story illustrates how vital it is to involve the whole family in eating healthier foods and becoming more activity. And the earlier, the better.
“An obese preschool child is apt to become an obese adolescent,” says Dr. Carden Johnston, immediate past president of the American Academy of Pediatrics and emeritus professor of pediatrics at UAB. “Once they become an obese adolescent, there’s a 60 to 70 percent chance of them becoming an obese adult, with [complications such as] diabetes, high blood pressure and early death.”
Of the overweight children who become obese adults, only one in five will be successful in losing a clinically meaningful amount of weight without surgery and maintaining it for three to five years.

Prevention
That’s why Franklin and Johnston emphasize prevention and early intervention. They say pediatricians should track the body mass index, or BMI, of their young patients and compare them to established standards to identify children who may have a problem. In order to prevent children from becoming overweight, families need to make changes in two main areas: what they eat, and what they do.
“Parents’ role is to provide healthy foods to children, and children decide how much and whether to eat it or not,” Franklin says. “Parents seem to think the child will not eat if they don’t offer foods the child wants, so that leads to an extraordinary intake of macaroni and cheese,French fries, juice drinks, sweet tea and soda. If parents keep healthier foods in the house, children will eat what’s available.”
One key is to introduce more fruits and vegetables. “Instead of telling them to eat less, we ask them to eat five fruits and vegetables a day,” Johnston says. Fruit is a good place to start. Because it’s sweet, children are more likely to eat it. Vegetables are a little more difficult, because children may find them bitter.
“Introduce vegetables slowly,” Franklin advises. “Preschool children are picky eaters, and it usually takes multiple exposures to vegetables to get the child to accept them.” In other words, don’t give up. If your child doesn’t like carrots today, he may next month. If he doesn’t like them raw, he may like them stir-fried. It may take a dozen attempts at offering something before a child will eat it.
On the activity side, limit what experts call “screen time” — TV, computers, video games — and encourage physical activity. “If we can turn off the TV set, we have a better chance of getting them outside” and active, Johnston says.
“Don’t think the child’s going to walk on a treadmill or use a stationary bike in the basement,” Franklin says. “Do activities that the child finds enjoyable, such as [jumping on] trampolines, walking or swimming.”
And don’t forget, children are natural mimics. If you eat healthy foods, your children will eat healthy foods. If they see you drinking sodas and munching on potato chips, carrot sticks and grapes probably won’t appeal to them. If they see you exercise, they’ll want to, as well.
If your child is eating less, eating more wisely and exercising more, but not losing weight, Franklin says it’s time to consider seeing a specialist.

At the Children’s Center for Weight Management, different specialists deal with the various factors involved in the process of losing weight. Some deal with medical issues, such as high blood pressure, diabetes or sleep apnea. Dietitians work with the family to develop healthier eating habits. Physical therapists devise exercise programs appropriate to the individual patient. “You don’t just tell [an overweight child] to start running half an hour a day,” Franklin says. “For them to walk across the parking lot is a workout.”
Finally, he says, the program involves psychology. “Very few people think that French fries and a 20-ounce Coke are nutritious,” Franklin says. “It’s not lack of nutritional information. The question is, how do you help people change their behavior? So the focus is on the whole family.”
Treatment
Franklin points out that many parents make the mistake of using a negative, punitive approach. “They think restricting the child's intake is going to work. Threatening the child, insulting the child, bribing the child — none of these things work. All they do is lead to more arguments in the household, and you force the child to be a cheater, a liar and a denier.”
The Center has also had some success with weight loss medications Xenical and Meridia. Some of the Center’s patients participated in a recent study on Xenical, which blocks the absorption of fat, and the study appeared to show that it was safe and led to greater weight loss than a placebo.
Some extremely obese adolescents are candidates for bariatric surgery, which the Center also offers. Franklin says a new type of bariatric surgery involves putting a band around the stomach and shrinking it, rather than the more traditional gastric bypass method that involves surgically making the stomach smaller and bypassing some of the intestine. This new type of surgery, he says, should have far fewer complications.
The Center also offers two group support programs. LESTER (Let’s Eat Smart Then Exercise Right) is designed for children ages 6 to 11. Healthier Weigh is designed for adolescents ages 12 to 18. Both involve some individual counseling, but most of the work is done in groups.
“Group programs have a lot of advantages,” Franklin says. “You get a knowledgeable group leader, and you get a chance to share your concerns with other kids your same age. Children are much more open in that situation, and they find out that everybody has had the same experiences, and that means a lot to children.”

Deborah Lockridge is a Birmingham freelance writer.

RESOURCES:

· Children’s Center for Weight Management
205-939-5278
www.peds.uab.edu/GI-Research.htm

· Healthy Kids Challenge
888-259-6287
www.healthykidschallenge.com
Founded in 1998, when Birmingham-based Cooking Light magazine staff and volunteers partnered with nearby Center Street Middle School to raise awareness and encourage healthy changes in eating and activity habits. Today more than 800 schools worldwide are involved.

· VERB
770-488-6480
www.cdc.gov/youthcampaign/
This awareness campaign was launched by the Centers for Disease Control and Prevention to encourage physical activity among children 9 to 13.

· Shaping America’s Youth
www.shapingamericasyouth.com
The nationwide initiative identifies and centralizes information on efforts to reverse the prevalence of obesity and inactivity among children and adolescents.

· American Obesity Association
202-776-7711
www.obesity.org/subs/childhood/