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Facing Facts About Childhood Obesity

R. Will Charlton, MD

R. Will Charlton, MD
Pediatric Endocrinologist
Joe DiMaggio Children's Hospital

Every day, pediatric endocrinologist R. Will Charlton, MD, treats patients suffering from the side effects of childhood obesity.

"Innumerable cases of prediabetes, worsening asthma, sleep apnea, joint pain and orthopedic issues, high blood pressure, fatty liver disease," says Dr. Charlton, who is a member of the medical team at the Division of Pediatric Endocrinology at Joe DiMaggio Children's Hospital in Hollywood, Florida.

According to the Centers for Disease Control (CDC), childhood obesity has tripled over the last three decades. More than two-thirds of American kids are overweight, and among those who are overweight, one-third – or 17 percent – are obese.

Dr. Charlton says "staggering" data proves that the younger people are when overweight, the more likely they will become obese. Also alarming is that many parents of overweight children wrongly believe they will grow out of it.

The truth is hard to swallow.

The CDC reported in March 2011 that 80 percent of obese 25-year-olds were overweight as children between ages 10 and 15. The study also shows that if a child becomes overweight before age 8, obesity in adulthood is likely to be severe and accompanied by chronic illnesses that cause shorter life expectancy.

Indicators that weight is affecting a child's health:

  • Breathing problems such as sleep apnea, snoring or worsened asthma
  • Darkening or thickening of skin in the back of the neck
  • Joint pain and skeletal discomfort
  • Increased thirst and frequent urination
  • Daytime tiredness
  • Social isolation

Serious illnesses related to childhood obesity:

  • Type 2 diabetes
  • Fatty liver disease
  • Severe asthma
  • Gallstones
  • Gastro-esophageal reflux disease
  • High blood pressure and high cholesterol that lead to heart disease
  • Depression
  • Polycystic ovarian syndrome

Serious Health Issues

To call childhood obesity "life threatening" is no exaggeration. Sometimes health problems don't wait until adulthood.

More than 70 percent of today's obese children ages 5 to 17 have high cholesterol or high blood pressure, which puts them at risk for heart disease before they are grown.

Obese children also tend to be insulin-resistant or "pre-diabetic" and may become dependent on drugs to maintain normal levels of sugar in the blood. Insulin resistance is exacerbated by inactivity, high sugar intake and continued weight gain. To compensate, the body makes more insulin. Insulin is a storage hormone, and high insulin levels promote further weight gain.

Type 2 diabetes can sometimes be managed with pills, but many children require multiple insulin injections each day to prevent complications. These complications include blindness, heart disease, kidney failure, high blood pressure, liver disease, sexual dysfunction and nerve and brain dysfunction.

Knowing that an overweight child is in jeopardy of such metabolic derailment is frightening, but there is good news, Dr. Charlton says.

Disease Warning Signs

When parents recognize warning signs that their overweight child is at risk for a disease such as diabetes, they can do something about it – the earlier the better.

"One of the first signs is the thickening and darkening of skin in the back of the neck. It freaks parents out, but to me it is a gift, an early warning sign," says Dr. Charlton. "Recognizing signs early allows time to prevent future problems."

Other early indicators include difficulty breathing, complaints of joint pain and sleepiness during the day.

Here's what parents should know:

"Baby fat" is only for babies. Between ages 1 and 2, a toddler should be a bundle of energy running about and exploring new things. They burn a lot of calories, slim down and simply do not eat the way others do – they are perfectly happy eating little bits all day. Their eating pattern, or lack of it, is part of human hard-wiring.

"Baby fat" should be gone by age 3.

Between ages 4 and 6, the child should be thin to almost scrawny – still running, playing and eating what is put in front of them, but by then, at structured times. It is during this time that the fat patterns for adulthood are set.

If the child reaches 4 or 5 years old and has a body fat measure over the 85 percentile for their height and age, he or she may be considered overweight. If it is at or above the 95 percentile, then the child is likely to be obese.

Dr. Charlton says many of today's social factors, such as spending cutbacks at home and school due to the economic crisis, promote the continuing rise in overweight and obese children.

Kids don't get as much physical education at school. At home, they play outside less. They sit on the couch and watch television or they play video games on their computers. They eat too much over-processed, high calorie and nutritionally substandard foods.

The cure rests squarely on adult shoulders.

What Parents Can Do

Here are some steps parents, and other adults, can take to help children.

  • Provide only whole foods – unprocessed fresh vegetables, fruits, lean meats, chicken and fish. Switch from white bread, rice and pasta products to brown rice and whole grain breads and pasta. Eliminate all soda and beverages made with high fructose corn syrup – that includes sports drinks and sip-up juices. Replace impulse snacks such as potato chips and cookies with real fruit or veggie slices.
  • Say "no" to fast food restaurants and apply serious pressure to elected officials for nutrition-rich lunch menus.
  • Make eating healthy part of the family lifestyle. Do not bring high-calorie, low-substance junk food into the house. Enlist children to help with food preparation so they are eager to eat homemade meal and snack creations.
  • Exercise – because kids are made to be on the move. Parents can help kids burn fat calories by taking walks or bike rides around the neighborhood and signing them up for after-school activities like soccer or track. Some video game programs, including the Nintendo Wii, require players to stand and move simulating dance, golfing, tennis and bowling.
  • Even playing chess or board games requires the child to engage with others socially. This has developmental and metabolic advantages, and actually burns more calories than sitting sedentary in front of the computer or television.

The Role of Heredity

In some cases, heredity plays a role in a child's tendency to be overweight or obese. "But that doesn't mean we simply say 'oh well, too bad' and do nothing about it. We wouldn't do that with any other disease. We would get the child help right away," Dr. Charlton says.

If obesity runs in the family, parents should be more motivated – and early in the child's life – to incorporate a healthy diet of food and physical fitness for the entire family.

Exercise, eating healthy and lowering weight decreases the chances of heart disease, stroke, diabetes and other obesity-related illnesses that shorten the child's life expectancy.

Dr. Charlton adds, "When your grandmother gets diabetes at age 72 and has to go on dialysis at 80 we say, 'That's sad, but she lived a good life.' When an obese or overweight child gets diabetes at age 8 and is on dialysis at age 18, that's just tragic."

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