It's not hard to make the case that childhood obesity is a problem that this nation needs to face, and quickly. "The data show that kids as young as 4-6 years of age are being diagnosed with diseases we used to only see in adults -- hypertension, diabetes, heart disease, hardening of the arteries, arthritis," says FP Walt Larimore, M.D., of Monument, Colo.
Several years ago, Larimore was gathering data for SuperSized Kids: How to Rescue Your Child from the Obesity Threat, a book he co-authored in 2004. The literature confirmed what he was seeing then -- and still sees in ever-growing numbers in his practice: the devastating effects of obesity on children.
The sobering facts are that an 8-year-old who is obese and hypertensive has a vascular age of a 38-year old, a full three decades older than the child's chronological age, according to Larimore. And the same-age child with metabolic syndrome has a 100 percent chance of developing type 2 diabetes or measurable heart disease by the age of 18.
These children have a terrible quality of life and will die 10 to 20 years sooner than children of normal weight, says Larimore. "Kids are not born this way; they're raised this way. It's a family problem."
Larimore wants to equip family physicians to meet childhood obesity head on. He encourages FPs to identify an obesity problem and label it correctly. "If we don't measure and label obesity, parents don't see it," says Larimore. "Parents who have overweight or obese children almost always see their children as normal weight," and there's a high probability that mom and dad battle obesity, as well.
- train and empower your office staff to collect vital signs, including BMI and blood pressure percentiles;
- check the BMI and/or blood pressure percentiles, and if either are borderline or abnormal, make a diagnosis, inform the parents and consider intervention;
- recommend that the family try the Eight-Week Family Fitness Plan(www.drwalt.com), which was adapted by Larimore and SuperSized Kids co-author and dietitian Sherri Flynt, M.P.H., R.D., for use by physicians;
- follow up in eight weeks, and, if the child's vital signs have improved, schedule another visit in 12 weeks and urge the family to embark on the Level Two Eight-Week Family Fitness Plan(www.drwalt.com); and, finally,
- refer any child who has vital signs that have not improved or are worsening to a registered dietitian, school nurse, pediatric endocrine clinic or another reliable source.
"Get tough," says Larimore. "Say to parents, 'I'm not going to tolerate this obese child being obese a year from now.'"
Anthony Beutler, M.D., serves patients in the department of family medicine at the Uniformed Services University of the Health Sciences in Bethesda, Md. He also takes a tough-line approach with families when a child's health is at risk because of weight issues.
He tells parents that getting obesity under control is just as important to a child's future success as anything else. Enrolling in advanced high-school classes and joining the elite sports team won't mean much when a child develops diabetes and metabolic syndrome at a young age and dies prematurely.
"That's not setting your child up for success," says Beutler, who is a lieutenant colonel in the U.S. Air Force. "I'm pretty harsh and brutal, but I can back (my message) up with data and feel comfortable with it."
Beutler encourages parents to make better decisions about house rules, too. And he offers parental tips in what he calls "quick brush strokes." For example, he urges parents to
- allow one hour of screen time daily for children, which includes any activity where the child is gazing into a screen of any type;
- buy children active outdoor toys, such as bikes, skateboards and red flyer wagons instead of battery-powered riding toys and video games;
- place computers and TVs in common family areas and keep such items out of a child's bedroom;
- offer children milk and water as beverage choices, and don't buy soda pop, fruit juice and sports drinks; and
- shop predominantly in the supermarket produce aisle because doing so helps shoppers take home fewer processed foods.
Beutler delivers a healthy message that aligns with the basic principles of exercise and nutrition. Parental responses range from cooperation to pushback. For instance, some parents argue that bicycling and skateboarding are dangerous activities fraught with an unlimited possibility of injuries to their child.
Beutler tells moms and dads that a good helmet will protect their child's head and that a wrist fracture sustained by playing outside could be viewed as a rite of passage.
"I'd sure rather treat fractures and little bumps and bruises then have to treat hypertension and metabolic syndrome," says Beutler.
Dietitian Sherri Flynt manages the Center for Nutritional Excellence at Florida Hospital in Orlando. Her work there, in addition to projects on which she's partnered with Larimore, has heightened her awareness of the importance of family-based obesity programs.
"Unless the parents and the entire family buy in, most children will not be successful (in making lifestyle changes) in the long term," says Flynt. "Families are the cornerstone of success," and that extends to grandparents, caregivers and anyone else sharing responsibility for a child, she adds.
What Flynt sees from her vantage point is that "if parents exercise and eat right, kids probably do, too."
Moms and dads decide "what food comes into the house and goes on the table," says Flynt. Parents understand the concept, but they tend to backslide. "They'll say 'I got tired of hearing my child complain that there were no potato chips or cookies,'" says Flynt. It's very easy for parents to revert back to what the child wants.
Flynt also works directly with children on how to make better food choices. She uses plastic picnic plates that are divided into three sections -- two small and one large -- to learn firsthand about a child's eating habits. She asks children what foods they would put in each section.
Usually foods such as macaroni and cheese, fried chicken, and mashed potatoes and gravy fill the plate's biggest section. "Most of the time, vegetables don't even make it on the plate," says Flynt. She helps kids think about eating a variety of foods, gently stressing that fruits and vegetables should fill the largest space on the plate, with starches and proteins placed in the two smaller sections. Flynt then sends a sectional plate home with each child as a reminder of how their food plate at home should look.
In addition, like many family physicians, Flynt encourages parents and children to focus less on body weight and more on the behaviors over which they have control. "As you develop healthy habits, the weight takes care of itself," she says.