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Your Child

Will 60% of U.S. Children be Obese by Age 35?

2:00

As many as six in ten U.S. children could be obese by the time they are 35 years old. That sobering news comes from a study conducted by "Childhood Obesity Intervention Cost-Effectiveness Study" (CHOICES).

The numbers are a result of data entered into a computer. The investigators first combined height and weight data from five studies involving about 41,500 children and adults. The computer then generated a representative sample of 1 million "virtual" children up to the age of 19, living in the year 2016. The model then predicted how obesity rates would unfold until all the virtual children turned 35.

The model indicated that being overweight or obese early in life bumped up the risk for being obese later in life. In addition, the more overweight or obese someone was as a child, the greater the person's chance of being obese by age 35.

According to the U.S. Centers for Disease Control and Prevention (CDC), roughly 20 percent of American children between the ages of 6 and 19 years of age are currently obese. That reflects a tripling of the number since the 1970s.

The study’s lead author, Zachary Ward, a doctoral candidate in health policy with the Harvard T.H. Chan School of Public Health's Center for Health Decision Science, in Boston, noted that the results were not unexpected.

"It should not be surprising that we are heading in this direction. We are already approaching this level of adult obesity for certain subgroups [and] areas of the country." Ward said.

Still, Ward expressed some surprise at how strongly being obese at a very young age predicted obesity decades down the road. 

"For example, we found that three out of four 2-year-olds with obesity will still have obesity at age 35," he said. "For 2-year-olds with severe obesity, that number is four out five."

Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas, was also not surprised at the findings.

"Trends show obesity occurring earlier in adulthood, and [the] current level of childhood obesity suggests that the trend will continue," said Sandon, who was not involved with the analysis. 

Because "obesity is difficult to reverse at any age," she said, prevention is key. Parents should not rely solely on public school nutrition and activity programs to do the job.

Earlier studies have suggested that obesity in children may begin in the womb if the mother is obese when she becomes pregnant, and develops gestational diabetes. This combination can produce a large child at birth. Studies have shown that babies born with higher amounts of fat at birth tend to continue having more body fat in childhood and on into adulthood.

Experts recommend that overweight women that are considering becoming pregnant, first lose the extra weight and be tested for type2 diabetes. If they are found to have type2 diabetes before they're pregnant, they should be treated beforehand; this will help their pregnancy and prevent complications.

Sandon also notes that there are other things parents can do to help insure a healthier child. "Concerned parents can make efforts to prepare and provide healthier foods at home, plan regular scheduled mealtimes, limit screen time, encourage participation in sports, encourage participation in active leisure time activities instead of more sedentary activities and, most of all, set an example by being active, having a healthy relationship with their own food choices and having regular mealtimes as well."

The study by Ward and his colleagues appears in the November issue of the New England Journal of Medicine.

Story sources: Alan Mozes, https://www.webmd.com/children/news/20171129/60-percent-of-us-kids-could-be-obese-by-age-35#1

Lucilla Poston, Professor, https://www.news-medical.net/news/20170111/Childhood-obesity-starts-in-the-womb.aspx

 

 

Daily Dose

Plate Size & Childhood Obesity

1.15 to read

While I have been trying to change up my eating habits a bit and talking to patients about trying some new foods, I came upon an interesting study in the journal Pediatrics.  

The hypothesis for the study, which was done among school children in Philadelphia, was “can smaller plates promote age-appropriate portion sizes in children?”.

There have been previous studies in the adult literature that have shown that dish ware size influences self-serve portion sizes and caloric intake. Whether the same conclusions with children were true had yet to be examined, but it does make sense that it might.

So, the hypothesis was correct and when children were given larger bowls, plates and cups, they served themselves larger portions and in turn more calories. In the study, 80% of the children served themselves more calories at lunch when using adult-size plates and bowls.

This is really great news, in that by changing the size of the plate we might be able to affect a child’s portion size without them even really being aware!

I remember that our kids all had children’s bowls, plates and cups that they loved to use and eventually they either broke, got lost, or we just decided to have everyone eat off of the same plates. But, maybe it would make more sense to continue to have our children use child sized plates until they reach puberty?  Certainly seems that it wouldn’t hurt and if schools did the same thing we might be able to impact some of the obesity problem by just changing one behavior.  It is definitely worth trying!

Daily Dose

Family Dinners Help Fight Obesity

1.15 to read

Sadly, the problem with obesity in America does not seem to be going away, and is not even improving!! The latest data shows that adult obesity rates have risen in 23 states in 2009 and the trend continued through 2010 and 2011.

Obesity and the problems associated with it, type 2 diabetes, heart disease, joint problems etc. begin in childhood. If we cannot change our children’s eating and exercise habits we have no hope of stemming the tide of ongoing obesity. By 2020 the headlines might read, “Obesity rising in all 50 states” with the majority of the population dealing with this crisis. In that vein we must not only begin modeling better eating habits for our children, but do so by returning to the idea of family meals. Family meals were the “norm” when I was growing up. We were fortunate to have breakfast and dinner at home each day and we were expected to be present for those meals. I know it was hard for my mother to do this as she worked when I was young, and my father travelled a great deal of the time. But parental sacrifice has not changed over time, and we all know that we will often do things “just for the kids”. The good thing about preparing meals these days is that the grocery stores have made it quite easy for even a very busy family to be able to prepare a “home cooked” meal. All of the chains have rotisserie chickens available and also offer prepackaged meats such as meat loaf, pre-made hamburger patties, or fish filets. The salads are also prepackaged and you can even buy fruit already cut up. I am “thrifty” and don’t mind making my own hamburger patties or cutting up fruit, but picking up a chicken on the way home from work is often a quick way to begin a dinner. The chicken can be used in a salad or used as a main course. We parents just have to be a little more inclined to drive through the grocery store rather than the fast food restaurant. I am still convinced that our children will eat what we prepare and gather together for meals if that becomes the norm once again. Our kids are busy too, and they will appreciate knowing that dinner will be there every night, and that it will be healthy. Leading by example is the best way to begin. We can’t afford not to try! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Your Baby

Longer Breast-Feeding Time, Less Childhood Obesity

2:00

A new study looks at the duration of breast-feeding and babies who are high risk for obesity, as they get older. Researchers found that the longer mothers breast –fed these higher risk babies, the less likely the babies were to become overweight later.

"Breast-feeding for longer durations appears to have a protective effect against the early signs of overweight and obesity," said lead researcher Stacy Carling, a doctoral candidate in nutrition at Cornell University, in Ithaca, N.Y.

Carling and her colleagues followed 595 children from birth to the age of 2. They tracked the children's weight and length over this time, and compared individual children's growth trajectories to how long the children breast-fed.

Which children are considered at high risk for extra weight gain? Researchers found that babies whose mothers were overweight or obese, mothers with lower education levels and mothers who smoked during pregnancy were more likely to have overweight children. Almost 59 percent of the children at risk for being overweight had mothers with one or more of these characteristics, compared to about 43 percent of the children not at risk for excessive weight gain.

Higher-risk babies who breast-fed for less than two months were more than twice as likely to gain extra weight than those who breast-fed for at least four months.

Although the study didn’t prove that longer breast-feeding actually reduced risk for obesity, it did provide several reasons why the link between the two may exist.

"Breast-feeding an infant may allow proper development of hunger and satiety signals, as well as help prevent some of the behaviors that lead to overweight and obesity," Carling said.

"Breast-feeding, especially on demand, versus on schedule, allows an infant to feed when he or she is hungry, thereby fostering an early development of appetite control," she said. "When a baby breast-feeds, she can control how much milk she gets and how often, naturally responding to internal signals of hunger and satiation."

The study did not include information on whether the babies were exclusively breast-fed or how often they were getting milk at the breast versus from a bottle, but the time required to reduce obesity risk was not long.

"The difference of two months of breast-feeding may be enough to reap some benefit," Carling said.

There are many reasons mothers choose to breast-feed for shorter periods, and some mothers are not able to breast-feed at all. For mothers that choose to breast-feed, Carling believes they need to be supported on many levels.

"Ultimately, increasing breast-feeding rates in the United States means increasing knowledge and support at a variety of levels from institutional to interpersonal," Carling said. "Our study recognizes the benefit of longer duration breast-feeding in a specific population and, hopefully, this and other studies will lead to more customized breast-feeding promotion in those populations at higher risk for overweight and obesity."

The findings were published in the January print issue of Pediatrics, and funded by the U.S. National Institutes of Health. The authors reported no conflicts of interest.

Source: Tara Haelle, http://consumer.healthday.com/women-s-health-information-34/breast-feeding-news-82/breast-feeding-for-longer-may-protect-infants-at-risk-for-obesity-694218.html

Daily Dose

Chubby Toddlers & Weight Gain

1.15 to read

So, what goes on behind closed doors? During a child’s check up, I spend time showing parents (as well as older children) their child’s growth curve. This curve looks at a child’s weight and height, and for children 2 and older, their body mass index (BMI). This visual look at how their child is growing is always eagerly anticipated by parents as they can compare their own child to norms by age, otherwise called a cohort. 

I often then use the growth curve as a segue into the discussion about weight trends and a healthy weight for their child. I really like to start this conversation after the 1 year check up when a child has  stopped bottle feeding and now getting regular meals adn enjying table food. 

This discussion becomes especially important during the toddler years as there is growing data that rapid weight gain trends, in even this age group, may be associated with future obesity and morbidity. Discussions about improving eating habits and making dietary and activity recommendations needs to begin sooner rather than later. 

I found an article in this month’s journal of Archives of Pediatrics especially interesting as it relates to this subject.  A study out of the University of Maryland looked at the parental perception of a toddler’s (12-32 months) weight. The authors report that 87% of mothers of overweight toddlers were less likely to be accurate in their weight perceptions that were mothers of healthy weight toddlers. 

They also reported that 82% of the mothers of overweight toddlers were satisfied with their toddler’s body weight. Interestingly this same article pointed out that 4% of mothers of overweight children and 21% of mothers of healthy weight children wished that their children were larger. 

Part of this misconception may be related to the fact that being overweight is becoming normal.  That seems like a sad statement about our society in general. 

Further research has revealed that more than 75% of parents of overweight children report that “they had never heard that their children were overweight” and the rates are even higher for younger children. If this is the case, we as pediatricians need to be doing a better job.  

We need to begin counseling parents (and their children when age appropriate) about diet and activity even for toddlers. By doing this across all cultures we may be able to change perceptions of healthy weight in our youngest children in hopes that the pendulum of increasing obesity in this country may swing the other way. 

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Parenting Gone Too Far?

1.15 to read

I recently read an article in The New York Times about another new “parenting” book. I am not sure I understand this latest addition to a group of what I would call “extreme parenting” books. 

Similar to the Tiger Mom, or the American mother who extolled the French “method” for parenting, this new book, to be titled “ The Heavy”, is written by a mother who discusses her daughter’s weight issue and how she “enforced her daughter to diet”. 

Dara Lynn Weiss’s book deal stems from a recent article she has written for Vogue detailing her own parenting methods for dealing with her 7 year old overweight daughter.  In the article, Ms. Weiss discusses placing her daughter on a “strict” diet and punishing her for making poor food choices. 

She has gotten a lot of buzz on TV, radio and online for her methods, which included not only restricting her daughter’s food choices, but humiliating her daughter as well as discussing her own adult issues surrounding body image and weight control. 

I see far too many young children who are overweight and have ongoing issues with food choices. I also spend a great deal of time trying to help educate the parents of these children on how they can help their child become a “healthier eater” without using the word DIET.  

For a child who is 7-8 years old, as is Ms. Weiss’s daughter, the majority of the discussion revolves around the food that is available in the home, how the entire family eats, how much exercise a child gets, and what the child eats for lunch (whether they take their lunch or buy a school lunch). The discussion never includes words like “shame, punishment, or humiliation”, but rather terms like “healthy eating for growing bodies, modeling eating habits, and teaching children about better food choices.”  

While this approach may seem boring it does work.  Parents truly are the “boss” of the majority of their child’s food choices for the first 8-10 years of a child’s life. Why do you have to berate or punish a child in order to promote good nutrition? We are not talking about a teen who is driving through fast food joints, or eating from the 7-11 counter. 

Lately it seems that unless you’re writing “books on parenting that anger parents” or cause a huge backlash on Internet sites, no one wants to read them?  

A good parent does not need to use EXTREMES.  Is there no middle ground any more?  Can we not go back to the days of “everything in moderation”. The pendulum seems to have swung so far that a mother can score a major book deal while berating her young daughter and in my mind setting her daughter up for a serious eating disorder in the future. Yes, I also take care of a fair number of anorexic and bulimic patients (mainly girls) and unfortunately many of them have mothers with body image and eating disorders as well. 

So, while I do agree with Ms. Weiss that overweight and obese children must have parental involvement and  the necessary diligence to change their eating habits, I don’t agree with her methods. I am happy that the issue is being discussed but there has to be a better way.  Another bestseller? I hope not for my patients. 

What do you think? I would love your feedback!

Your Baby

Kids of Obese Mothers at Higher Risk for Autism, ADHD

1:45

A new study points out another reason that obesity and pregnancy can be a bad combination not only for the mother but for her future child as well.

Researchers found that six-year-olds whose mothers were severely obese before pregnancy are more likely to have developmental or emotional problems than kids of healthy-weight mothers.

The lead author of the study, Heejoo Jo of the Centers for Disease Control and Prevention (CDC), and her team reviewed data on 1,311 mother-child pairs collected between 2005 and 2012, including the mothers’ body mass index (BMI, a height-to-weight ratio) before pregnancy and their reports of the children’s psychosocial difficulties at age six.

The researchers also incorporated the children’s developmental diagnoses and receipt of special needs services.

Kids of moms who were severely obese, with a BMI greater than 35, were twice as likely to have emotional symptoms, problems with peers and total psychosocial difficulties compared to kids of moms who had a healthy BMI, between 18.5 and 25.

Their children were three times as likely to have a diagnosis of autism spectrum disorder and more than four time as likely to have attention-deficit/hyperactivity disorder (ADHD), as reported in the journal Pediatrics.

Previous studies have shown a connection with autism and maternal diabetes and obesity.

Researchers took into account pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression and infant birth weight. None of these explained the apparent association.

“We already do know that obesity is related to health problems during pregnancy and throughout the lifetime,” Jo said. “I think this adds to that by suggesting that not only does severe obesity affect a woman’s health but the health of her future children.”

This study could not analyze the mechanism linking severe obesity and later risk for developmental problems, Jo noted.

“One theory that we could not look at and needs further research was some small studies have linked maternal obesity to increased inflammation, which might affect fetal brain development,” she told Reuters Health by phone.

While it sounds cliché because we’ve heard it so much; obesity in America has reached epidemic status. Almost 30 percent of Americans are obese and the prevalence of maternal obesity has risen rapidly in the last two decades.

In the USA, approximately 64% of women of reproductive age are overweight and 35% obese.

Women’s health specialists recommend that obese women considering pregnancy lose weight before they conceive to help reduce health risks for themselves as well as their child.

The Academy of Pediatrics recommends that all children be screened for developmental delay or disability at nine, 18 and 24 or 30 months of age.

Health experts strongly suggest that women who were obese or severely obese when they became pregnant make sure that their children receive these developmental screenings.

Sources: Kathryn Doyle, http://www.reuters.com/article/2015/04/28/us-obese-pregnancy-adhd-kids-idUSKBN0NJ2FC20150428

James R. O'Reilly, Rebecca M. Reynolds, http://www.medscape.com/viewarticle/776504

Your Child

USDA New Rules: Healthier School Lunches

1.45 to read

Government funded school lunches will offer more fruit and vegetables and less fat on their lunch plates starting next September.

New guidelines by the U.S. Department of Agriculture (USDA)   were announced Wednesday when First Lady Michelle Obama, and Agriculture Secretary Tom Vilsack, visited with elementary students.

"Improving the quality of the school meals is a critical step in building a healthy future for our kids," said Vilsack. "When it comes to our children, we must do everything possible to provide them the nutrition they need to be healthy, active and ready to face the future – today we take an important step towards that goal."

It’s been more than 15 years since the school lunch program has had an overhaul. The changes will affect over 32 million kids who eat at school. The new regulations will be phased in over the next three years, starting in the fall.

Under the new regulations, schools will be required to offer fruits and vegetables every day, increase the amount of whole-grain foods and reduce the sodium and fats in the foods served. Schools will also be required to offer only fat-free or low-fat milk. In addition, the menus will pay attention to portion sizes to make sure children receive calories appropriate to their age, according to Kevin Concannon, USDA under secretary for food, nutrition and consumer services.

The new requirements are part of the Healthy, Hunger-Free Kids Act signed into law last year by President Barack Obama and championed by the First Lady Michelle Obama as part of her Let's Move! campaign.

"As parents, we try to prepare decent meals, limit how much junk food our kids eat, and ensure they have a reasonably balanced diet," Mrs. Obama said. "And when we're putting in all that effort the last thing we want is for our hard work to be undone each day in the school cafeteria."

The new guidelines apply to lunches that are subsidized by the federal government. The government will help school districts pay for some of the increased costs. Schools will receive an additional 6 cents per meal in federal funding. The overall cost to implement the changes is expected to be about $3.2 billion. To help with the costs, Concannon said schools will have more flexibility in how the program is administered. Students, for example, will be allowed to pick and choose more items as they move through the line, rather than getting a plate served to them.

Some of the changes will take place as soon as this September; others will be phased in over time. The subsidized meals are served as free and low-cost meals to low-income children. The 2010 law will also extend to nutrition standards of other foods, sold in schools, that aren't subsidized by the federal government. Included will be "a la carte" foods on the lunch line and snacks in vending machines. Those standards will be written separately and have not yet been proposed by the department.

Wendy Weyer, director of nutrition services for Seattle Public Schools, said her district is already complying with many of the new USDA standards, and taking other steps, such as having partnerships with local farmers and planting school gardens. "Seattle has been very progressive with changing the way we offer meals, offering fruits and vegetables every day, as well as whole grain-rich foods," she said.

Weyer said the biggest challenge is reducing sodium content, "while keeping the meals palatable for our students."

Statistics show that about 17 percent of U.S. children and teenagers are obese, according to the Centers for Disease Control and Prevention. The new standards are aimed at providing a higher nutritional content as well as a variety of healthier choices. 

“We strongly support the regulations,” said Diane Pratt-Heavner, spokeswoman for the Maryland-based School Nutrition Association. “The new nutrition standards for school meals are great news for kids.” Pratt-Heavner said parents will play an important role in supporting the new standards.  ”We all have to work to get the kids to make these healthier choices,” she said. “Students are more apt to pick up a fruit or vegetable in the lunch line if they have been introduced to those foods at home.” 

Vilsack said food companies are reformulating many of the foods they sell to schools in anticipation of the changes. "The food industry is already responding," he said. "This is a movement that has started, it's gaining momentum."

The new standards did not come easily. Congress last year blocked the Agriculture Department from making some of the desired changes, including limiting french-fries and pizzas. Conservatives in Congress called the guidelines an overreach and said the government shouldn't tell children what to eat. School districts also objected to some of the requirements, saying they go too far and would cost too much.

Some schools are already making voluntary changes in their menus, but others still serve children meals high in fat, calories and sodium.  The guidelines are designed to combat childhood obesity and are based on 2009 recommendations by the Institute of Medicine, the health arm of the National Academy of Sciences.

Sources: http://usnews.msnbc.msn.com/_news/2012/01/25/10234671-students-to-see-healthier-school-lunches-under-new-usda-rules,  http://www.google.com/hostednews/ap/article

Daily Dose

Childhood Obesity

1.30 to read

Everyone knows that obesity is on the rise and it is often beginning in childhood.  During well-child visits (and often during a visit for colds or flu) parents often bring up a child’s weight.  By using growth charts it is fairly easy for the doctor to show a parent and child where they fall on the growth curve and BMI (body mass index) curve as well. When discussing weight issues it is sometimes difficult to decide what terms are appropriate to use.

A study just published on line in Pediatrics surveyed 445 parents of children 2–18 years of age to assess what are perceived to be the most appropriate terms to be used when discussing weight issues in a child. The study, done at Yale University, was interesting in that more than 60% of parents said that referring to a child as “extremely fat” or “obese” would be “most stigmatizing and the least motivating terms to encourage weight loss.”

In this study, American parents preferred that terms such as “unhealthy weight”, “weight problem” or “being overweight” be used to discuss weight issues and that these terms would also be more motivating for weight loss.

In the same study about 36% of parents said that they would “put their children on a strict diet” in response to weight stigma from a doctor. This is concerning as well as since research has shown that severe dieting and restriction of calories in young children may backfire and may at times lead to other issues including eating disorders.

Whether we call it an unhealthy weight or being overweight or even using the term fat probably depends on each family and their own preferences. But whatever we call it, the topic should be addressed at each well child visit. The basic tenets of a healthy body weight still depend on eating a well balanced diet and getting daily exercise. Why does that sound so simple?

The easiest way to start to control weight gain is to begin with good habits when your children are young. If children are raised from their toddler years with a wide variety of healthy foods presented to them at meal and snack time, they will learn to enjoy these foods. “Grazing” should be discouraged and discussions should not be about “what you will or won’t eat” but rather about gathering for family meals and enjoying the time together. Parents needn’t be “short order” cooks, a child will eat if they are hungry and given the opportunity. But by offering a limited variety of foods and preparing just a few items that a child “likes” the stage is already being set for poor eating habits down the road.

Our job as parents is to provide healthy meals (and snacks) to our children, while the children will have to decide whether or not to eat it. There will be days that they are getting their favorite foods and others that they may not, but in the long run they will be a better and healthier eater. It would be nice not to have to figure out the correct term to use for being overweight or even obese.  Maybe we can cure it in the next generation and the terminology will become obsolete!

That’s your daily dose for today.  We’ll chat again tomorrow.

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