Childhood Obesity in the USA

The health costs of childhood obesity have nearly quadrupled in the past three decades with hospital costs for obesity-related conditions in America's youth jumping from $35 million in 1979 to $127 million in 2000.

Corresponding to this, the number of children who are overweight has doubled in the last three decades. Currently, one in five US children are overweight.

It is the growing range of obesity-related conditions that pose the greatest long-term health threat to the nation's youth. Take a look at these alarming facts:

• Obese children and teens are being diagnosed with Type 2 diabetes at an alarming rate. Type 2 diabetes was once known as "adult-onset" diabetes but increasing numbers of young people are diagnosed with the condition every day.
  
  
• Many obese children have high blood cholesterol levels and high blood pressure, both of which are risk factors for heart disease.
  
  
• Many obese children suffer from sleep apnea, a condition where breathing is interrupted during sleep. This can lead to extreme fatigue, and learning and memory problems.
  
  
• Obese children have a high incidence of gallbladder problems, orthopedic problems, liver disease and asthma.
  
  
• Overweight adolescents have a 70 percent chance of becoming obese adults.

As well as long-term health issues relating to physical health, many obese or overweight children are susceptible to social and self-esteem issues, including depression.

According to the American Institute for Cancer Research, soft drink consumption in the USA has increased by 500 percent in the past five years. Today's children consistently choose soda over milk, juice or water, creating a two-fold problem where excess calories are consumed and vital nutrients are lacking. Very few children, or adults for that matter, adjust their daily calorie intake to accommodate the "empty" calories contained in soda.

Another critical problem is growing portion sizes. A recent study published in the Journal of the American Medical Association found that, between 1977 and 1998, the serving size of an average soft drink increased from 13 fluid ounces and 144 calories to nearly 20 fluid ounces and 193 calories.

The average cheeseburger also grew from 165g to 207g, adding an extra 136 calories. Considering that an extra 100 calories per day can translate to an extra 10 pounds a year, the increase in portion sizes can have a big impact on a child's weight.

Once upon a time, it was against federal regulations to sell soda in schools. These days, schools rely on the profits from vending machines to fund extra-curricular activities, such as chess clubs or debating societies. According to Emilia Askari in a 2002 report in the Detroit Free Press, it's not uncommon for a large high school to make as much as $2,000 per month from vending machines.

Askari's report states that the amount of milk purchased by school districts nationwide dropped by nearly 30 percent between 1985 and 1997, yet in the same period soda purchases increased by a whopping 1,100 percent.

Vending machines in schools pose a huge dilemma for children who are being educated about healthy eating, yet walk out of the classroom to face unhealthy choices.

There are, however, many instances where vending machines in schools have been a success. Some schools offer "dairy-only" vending machines that sell milk, cheese and yogurt. The Minnesota school district has 16 vending machines, 13 of which stock only water and 100% fruit or vegetable juice; two with sports drinks; and one with soda that has limited hours of sale. There is also a staggered price structure, with water least expensive and soda most expensive.

This tactic has proved very successful, with increased profits for the school district and less soda and more water consumed by students.

The average American child or adolescent watches up to three hours of TV every day. Another three hours on the computer or video game adds up to six hours of leisure time spent in sedentary activities.

And it can't be forgotten that while watching TV, children are exposed to 10,000 hours worth of food advertisements in a year - most of them for high-fat, high-calorie foods.

Reduced levels of physical activity are a major contributor to the obesity epidemic. The American Academy of Pediatrics urges parents to limit total screen time to no more than two hours per day, and instead encourage outdoor or physical activities.

You can use the Body Mass Index Calculator for Children (see Related Links) to determine whether your child is overweight. Simply enter your child's age, height and current weight.

If your child has excessive fat around the stomach and chest areas it is safe to assume that he or she is overweight. Please note that, depending on their age, moderately overweight children should need only to maintain their weight for a period of time as they will "grow" into their weight.

Approaching your child about his or her weight is a difficult exercise in testing the water. Many parents fear that, if they mention the word "diet", they set their child on a path to an eating disorder or permanently damage their child's self-esteem.

Another problem is that many parents themselves are in denial as to the extent of their own weight or health problems and unintentionally pass these problems on to their children.

Leading by example is central to helping your child overcome a weight problem. For example, a child who is forced to eat fruit while her parents eat cake will only feel excluded and resentful. According to dietitian Allan Borushek, "Tackling weight issues is a family affair. The whole family should be encouraged to partake in a healthy diet and an active lifestyle."

Allan Borushek suggests the following starting points for parents to initiate with their children:

1. Keep an eye on soda intake. Limit soda to one serving on the weekends; soda should not be an everyday beverage. Try water instead. When visiting a soda fountain or fast-food restaurant, make sure that your child has a small serving of soda with ice. Diet sodas are also a great alternative.
   
   
2. Keep an eye on your child's snacks. Some children snack constantly throughout the day, spoiling their appetites for main meals and adding excess calories. Snacking is commonly perceived as "healthy" yet many snack foods are high in fat and calories.
   
   
3. Limit fast-food meals and eating out. Lots more calories are consumed with away-from-home meals. Fast, convenient and healthy meals can be prepared at home.
   
   
4. Encourage kids to eat more fresh fruit and vegetables. Make them the only alternative available for snacks and include plenty with meals. However, watch the intake of fruit juice which can be a source of excess calories.
   
   
5. Exercise. Increase physical activity for the whole family. Encourage an active lifestyle. Make exercise a fun, family affair. Try a bike ride, a day at the beach or visit a local park. Team sports are also a great opportunity for kids.

• An overweight child or adolescent needs support and encouragement. Tell them that their efforts are worthwhile. If other members of the family are overweight, devise a friendly competition and help one another.
  
  
• Make the most of family mealtimes. Don't let your kids eat in front of the computer or TV. Sit down together and eat. Family mealtimes offer an excellent opportunity to create a supportive environment and for parents to act as healthy role models.
  
  
• If your child is not hungry, do not make her eat. Discourage the habit of cleaning the plate. Do not punish a child who does not want to eat.
  
  
• Don't reward your child with food.
  
  
• Avoid temptation by not having foods that are high in fat or sugar in the house.
  
  
• Discourage the couch-potato lifestyle by limiting TV watching or computer games to two hours a day. Read the TV guide together and agree on the programs that your child may like to view.
  
  
• Instead of choosing food as a reward or focus of family celebrations, choose a fun physical activity such as rollerblading or bowling.
  
  
• Older children and teenagers demand their independence, so be careful that your encouragement does not become nagging, which deprives them of their choices.
  
  
• If your child is old enough, encourage him or her to keep a food and exercise diary for a few weeks. This will help the overweight child understand the importance of controlling portion size and engaging in regular physical activity.
  
  
• Make sure that your child eats breakfast; this will set the pattern of eating for the rest of the day. A high-fiber cereal with milk or soy and fruit is ideal.
  
  
• Pack a healthy lunch for your child. Access to a healthy lunch will help your child to avoid high-fat, high-calorie foods on offer in school cafeterias.
  
  
• Ensure that pocket money is being spent wisely, not on high-calorie snacks from food courts or vending machines.
  
  
• Provide cool water to satisfy thirst, rather than soda.

According to a study from the University of Minnesota, children who are teased about their weight can be affected psychologically. The authors of the study wrote "Teasing about body weight was consistently associated with low body satisfaction, low self-esteem, high depressive symptoms and thinking about and attempting suicide, even after controlling for actual body weight." For some children, teasing occurred both at home and at school, compounding the problem.

Genuine support and encouragement are essential for overcoming or preventing psychological issues in overweight children. In some cases, professional counseling may be required.

Setting realistic goals together and communicating openly within the family can also help.