Originally published in The Ottawa Citizen February 2, 2002

February is Heart Month and a perfect time to start taking care of your heart at any age. Heart disease and strokes are the leading causes of death in Canada and obesity is a prime stressor.

The prevalence of child obesity is growing at an alarming rate. In the United States, the obesity rate for children and adolescents has increased 50 per cent during the past 20 years. Approximately 22 to 25 per cent of all children in the U.S. and Canada are obese or overweight. It is a worldwide phenomenon, with Japan, Australia, the U.K., Europe, Russia and China reporting dramatic increases as well.

In a Dec. 19, 2000, statement, The Worldwatch Institute in Washington D.C. calls obesity a near-epidemic: “for the first time in history, a majority of adults in some societies are overweight.” Obesity can lead to Hypertension (high blood pressure), Type II diabetes, artery disease, hyperlipidemia (elevated cholesterol and triglyceride levels) and psycho-social difficulties – among other problems.

The Body Mass Index (BMI) is one of the standards of measurement used to determine whether a person falls within a healthy weight range. It is defined as weight in kilograms divided by height in metres squared (kg/m2). The term “overweight” refers to a BMI for age that is above the 85th percentile (greater than 85 per cent of the population); “obesity is a BMI for age above the 95th percentile.

One pound is equivalent to 3,500 calories. A small surplus of 100 calories per day will result in about one pound of weight gain a month. Over several years, a child’s weight gain can be substantial. This energy intake/expenditure balance is the cornerstone of weight maintenance and control.

Due to increased obesity, children are developing “adult diseases”. For example, this past decade has seen an increase in the prevalence of Type II diabetes in obese adolescents.

Although genetics can play a role in the development of obesity, it cannot explain the dramatic increase in entire populations over the course of a generation. It is simply too short a period of time for genetic factors to affect such a large population base. More than 90 per cent of cases are not due to hormonal or genetic influence.

Lifestyle changes, especially an increase in sedentary pursuits, are a primary cause of obesity. Physical education programs have been curtailed. Children have less opportunity to exercise in school. About 30 per cent of 12- to 21-year-olds do not partake in regular physical exercise. Cities are laid out with a car-oriented focus. Parents hesitate to send their children outdoors to unsupervised play settings out of concern for their safety.

Overeating is not necessarily the prime determinant of obesity. The lack of exercise combined with either increased or static intake contributes to the problem. There is a strong correlation between obesity risk and time spent watching TV. Some children watch up to 6 hours of TV per day. Children increasingly play computer and video games and surf the net.

In January 2001, The Journal of the American Dietetic Association reported, “even brief exposure to televised food commercials can influence pre-school children’s food preferences.”

Animated shorts and commercials for “popular brands of juice, doughnuts, sandwich bread, remote-control toy cars, breakfast cereal, snack cake, fast-food chicken and candy” were shown to 46 Northern California children ages 2 to 6.

Researchers noted, “Even brief exposure to televised food commercials influences pre-school children’s food preferences… Children exposed to videotape with imbedded commercials were significantly, and very significantly, more likely to choose the advertised items than children who saw the same videotape.”

Other studies came to the disheartening conclusions that our children are increasingly at risk of diabetes and heart disease. In 2000, The American Heart Association released a blood pressure study from mainland China which looked at 748 boys and 574 girls ranging in age from one month to 6.9 years divided into obese and non-obese groups. The obese group demonstrated a 19.1 per cent increase in blood pressure readings above the 95th percentile compared to seven per cent in the non-obese group.

Sugar-sweetened soft drinks are a major contributing factor for obesity in the U.S. Between 1980 and 1994 consumption has doubled. The Lancet in 2001 reported consumption increases from 195 millilitres to 275 millilitres per day in the general population but 345 ml to 570 ml per day in adolescent boys. Small wonder. Look at all the fast-food restaurants in our cities and towns and movieplexes that “supersize” everything. These poor eating habits, combined with physical inactivity, carries over into adulthood.

Obesity runs in families. The parents’ dietary habits directly influence their children. An overweight child under the age of three does not necessarily predict obesity in the future – unless at least one parent is obese. At age six, an obese child’s likelihood to be obese in adulthood is about 50 per cent. In adolescence, the same child runs a risk of 70 to 80 per cent of adult obesity.

Obese children are common targets for jokes and ridicule from their classmates from as early on as kindergarten. Studies reveal normal-weight kindergarten students prefer to play with children wheelchair-bound or disabled by a major physical handicap rather than with an obese child. The stigma and rejection begins at an early age. There is a clear relationship between low self-esteem and obesity. This is especially true in adolescents because the physical and social changes occurring at this time can damage an already fragile sense of self.

Obese children have increased average blood pressure and heart rate, Their hearts work harder to pump blood through their bodies. if left untreated the increased workload can lead to an enlarged heart and heart failure later in life.

Childhood obesity is associated with abnormally high levels of cholesterol, triglycerides, and low levels of HDL-cholesterol (HDL-C). HDL-C is what we commonly call “good-cholesterol.” Increased levels are associated with decreased risk of heart disease. Exercise and certain medications can increase these levels.

The risk of orthopedic problems in obese children is increased. They can develop tibial torsion (a twisting of the lower leg), bowed legs, damage to the growth plates in the femur (long bone in the upper leg) and weight stress in the joints of the legs.

Skin disorders such as heat rash, fungal and bacterial infections are common because of deep skin folds.

Other complications include sleep apnea, signs of atherosclerosis (plaque build-up in the arteries), depression, poor self-esteem, negative self-image and withdrawal from others.

As with any prevention strategy, the earlier the problem is addressed, the less potential there is for future damage and illness. Creating management strategies to prevent adolescent and adult obesity is critical during the six- to nine-year-old age range.

Weight-control measures and changes in eating habits must be addressed. This is critical if prevention is to succeed. Low-calorie diets are not recommended for children. The focus should be on balanced nutritional choices like fruits and vegetables, protein sources like low fat meats, chicken or fish (not breaded or fried), legumes and beans, skim milk (after two years of age) and low-fat dairy products.

The shift to these foods should be gradual so as to not overtly disrupt established eating patterns, It is easier for the child to adapt to gradual changes rather than a cold-turkey approach. Try to let children be in control of their eating. Your child does not have to finish everything on their plate.

Reducing the consumption of high calorie snack foods between meals helps. Replace them with low calorie alternatives such as fresh fruits, carrot and celery sticks and fat-free frozen yogurt to cite some examples.

Food labels provide basic yet important information that contributes to appropriate food choices. Look for the fat content in the product. Pre-prepared foods tend to be high in fat. Select those that contain 30 per cent or fewer calories from fat. Reduce the consumption of high sugar content drinks such as juices and sodas.

Praise the child as he or she begins to lose weight, but carefully avoid any criticism of the child’s weight or eating habits. Also avoid any negative comments about other overweight children in front of your own child. Do not provide food for comfort or as a reward nor offer sweets in exchange for a finished meal. Try to avoid fast-food restaurants or takeout. Encourage active play and establish regular family activities such as hiking, walling & cycling, soccer and other outdoor activities. Studies suggest that even adding as little as 60 minutes of additional exercise per week can significantly improve a child’s fitness level.

Parents’ diets and physical activity will influence their children. Schools should also emphasize the value of physical education in their curriculum.

[Originally published in the Ottawa Citizen]