Posts Tagged ‘childhood obesity’

The very high-priced spread

Saturday, February 4th, 2012

This obese teenager could be headed for trouble

I've been concerned about our burgeoning problem of excessive weight, so when the Journal of the American Medical Association for February 1, 2012 arrived, I was intrigued by the variety of articles touching on the subject. Let me start with a disclaimer: I have no clear-cut special competence, no magic bullet for preventing or treating obesity in our children. I do think it's a major threat to the upcoming generations here and elsewhere in the world. I am also very aware that its opposite numbers, hunger and even starvation, threaten whole populations around the globe.

But my own background, both as a physician and as someone who has successfully fought weight issues (I weighed 218 in 1969 and 148 this morning), has made me concentrate on the American epidemic of eating to excess as a major area of my interest.

The first article dealt with kids and adolescents. A group of CDC researchers reported an update on obesity in American kids, giving data from 199 to 2010. The newest statistics show nearly ten percent of our infants and toddlers are obese and close to 17% of our kids ages two to nineteen. As the kids got older, more boys than girls were obese in this survey with over 4,000 participants.

Then there was an article titled "Weight Loss Stratagies for Adolescents," based on a Boston Children's Hospital Conference roughly a year ago. The MD, PhD Harvard Professor of pediatrics who discussed the issue began with the case history of a particular obese girl, a fourteen-year-old who was five foot six and weighed nearly 250 pounds (giving her a body mass index,BMI, of 40). Her adoptive parents were overweight themselves, but had to learn to "back off" in their attempts to control her diet. There is some early data that suggests that parents can help by providing health food choices in the home and facilitating enjoyable physical activity throughout the day (versus a fixed "exercise time).

I had seen an example of that with some former neighbors whose boys, in order to have their one hour of "screen time," had to be outside playing for several hours at a time. Both youngsters were lean.

One critical point to be made is avoiding focusing on obese kids only. A large Danish study, published in the New England Journal of Medicine in December, 2007,  followed over a quarter million children born in the 1930 to 1976 time period. Denmark established a national civil register of "vital statistics" in 1968 and enrolled everyone in the country, giving them a unique number, ironically termed their CPR number. Although that had nothing to do, I gather, with cardiopulmonary resuscitation, which is what I think CPR means, the study did look at risk factors for coronary heart disease.

When your heart's on fire, it may not be from love

The results are impressive and threatening: every one point increase in BMI across the spectrum was associated with an increased risk of coronary artery disease. A child didn't have to be fat to be at risk later on. One calculation estimated that a 13-year-old boy weighing 25 pounds more than the average had a one-third increase in the likelihood of having a heart attack before the age of sixty.

It's time to start helping our kids live leaner and longer, healthier lives.

 

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Posted in balanced diets, coronary artery disease, Exercise possibilities, Food Choices, Healthly lifestyle, Healthy eating, Healthy food shopping, JAMA, Life Expectancy, medically-oriented background info, Obesity, our kids and their weight issues, Publications, weight gain | No Comments »

Do our kids have a bleak future?

Saturday, November 19th, 2011

As close to a salad as he'll get

I'm taking a break today from my series of posts on greenhouse gases, alternative energy source, volcanoes and global warming. All of those will affect the generations to come and those now growing up, but I want to re-examine another side of their issues. This morning I read two articles and one newspaper report on the heart health prospects for our American kids (and, by extension, kids elsewhere in the developed/rapidly developing world). The initial article came from a section of the Wall Street Journal I hadn't gotten around to reading yesterday and was about to recycle. Then I saw a title that caught my eye, "Kids' Hearth Health Is Faulted."

I found a CDC website with an explanation of the National Health and Nutrition Examination Survey, NHANES. This is a continuation of a US Public Health Service effort started 40 years ago and is updated annually. Medically-trained interviewers may well come to your town and even to your front door someday. The data they obtain is used in many ways (I'll paste in a website that leads you to some comments on NHANES as well as to a link to a video).

Now a portion of the survey/study looked at 5,450 kids between 12 and 19, finding they were a long ways from matching the American Heart Association's (AHA) seven criteria for idea cardiovascular health (see 2nd link below to Harvard's Beth Israel Deaconess Medical Center's article on the subject). The adult health measures, known as Life's Simple 7, are: 1). Never smoked or quit more than a year ago; 2). Body Mass Index (a measure of height versus weight) <25; 3). Physical activity on a weekly basis for 75 minutes (vigorously) or 150 minutes (moderate intensity).; 4). a healthy diet (four or more components meeting AHA guidelines); 5). total cholesterol <200 mg/dL; 6). blood pressure (BP) <120/80; and fasting blood glucose (AKA blood sugar) <100 mg/dL. The original article was published in the journal Circulation January 20, 2010 and is available free online. The metrics are slightly different for kids.

So where do our kids stack up? If you exclude eating a healthy diet, only 16.4% of boys and 11.3% of girls meet the standards for the other six criteria; if you include diet, none of them do. They don't eat four to five servings of fruits and vegetables a day; they also don't get enough whole-grains or fish and they consume far to much salt and sugar-sweetened drinks. Only one fifth of them even eat "fairly well."

drop that hamburger and run for an hour

Many of then also don't exercise on a daily basis for at least sixty minutes (50% of the boys do and 40% of the girls). More than a third are overweight or obese.

There's some hope: a just-published article in the New England Journal of Medicine, examining the data from four studies following 6328 kids, found that those who do manage to lose weight had lower risk for type 2 diabetes, hypertension, abnormal lipids and carotid artery disease.

So I'm heading to the health club and will read the 2010 Circulation tome on an exercise bike.

Thus far my one biologic grandson, about to be 12,  is physically active and slender. I'll encourage him to stay that way and the non-biologic grandkids to follow his example.

More on this subject to come.

Check out these articles:

Survey Results and Products from the National Health and Nutrition Examination Survey

AHA Defines "Ideal" Cardiovascular Health

 

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Posted in Complications of Obesity, diabetes type 2, Exercise possibilities, Food Choices, Food-related disease, Life Expectancy, medically-oriented background info, our kids and their weight issues, physician initiatives, Publications, strategies for healthy aging, Unhealthy eating | 3 Comments »

Early cholesterol testing now recommended

Saturday, November 12th, 2011

We're seeing more obese kids

With our sweeping epidemic of childhood obesity ( current estimates say over one-sixth of American kids are obese, three times the prevalence rate seen thirty years ago), it's time to take some additional steps. On Friday 11, 2011, sweeping new guidelines for childhood lipid testing were espoused by both the NIH's Nation Heart Lung and Blood Institute and The American Academy of Pediatrics. I found these, of all places, not on the websites of the two august bodies, but on the front page of the Wall Street Journal, an NPR article and in the Los Angeles Times.

The actual article in the journal Pediatrics, won't be out for two more days and should find a fair amount of opposition. Previous position papers by the AAP and the US Preventive Services Task Force have either suggested lipid studies be done in focused groups (eg. family history of heart disease or lipid disorders) or, if universally, no earlier than age 20. The CDC (actually the acronym has changed since it's now the Centers for Disease Control and Prevention), in a 2010 report, commented that a single elevated LDL cholesterol reading in a child may be found to be normal in subsequent testing.

The current recommendation panel, headed by Dr. Stephen R. Daniels, an MD, PhD who is Chairman of Pediatrics at the University of Colorado School of Medicine, is quick to avoid any suggestion of widespread statin use for children found to have high levels of "bad cholesterol," LDLs over 190 milligrams per deciliter. Another panel member, Dr. Elaine M. Urbana, director of preventive cardiology at the Cincinnati Children's Hospital Medical Center, was quoted as saying, "This documents on the fact that this generation may be the first to have a shorter life expectancy than their parents."

So go back to the facts: one-third of US kids are overweight and about 12.5 million of them are actually obese. Even here in Colorado, the thinnest state in the nation, I see some of those kids every day. We're not just talking about high schoolers; some of these fat kids are as young as two.

What's missing is a balanced diet with emphasis on fruits and vegetables and a reasonable amount of daily exercise.

earlier blood tests may let them live longer

Daniels comments, "...the atherosclerosis process really begins early in life." he also said, "Heart disease is the number one killer in our society...people who are able to maintain a low risk through childhood and early adulthood have a lower risk (of dying from coronary artery disease)."

From my perspective, it's our responsibility as parents and grandparents, to help prevent childhood obesity, the accompanying risk of later type 2 diabetes and the huge risk of early heart disease. I filled out a health history form yesterday and noted my mother had a heart attack at age 74 (she lived 'till 90), but ignored my father's need for an artery unclogging procedure shortly before his 90th birthday. That may be something I can put off by eating well and exercising, but that's not the focus here.

I never want to see a child or grandchild die of a heart attack in their 50s or 40s or 30s or 20s.

So blood tests between ages 9 and 11 and again between 17 and 21 make sense.

 

 

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Posted in diabetes type 2, Governmental Efforts, Healthy eating, Life Expectancy, Obesity, our kids and their weight issues, physician initiatives, Publications, Unhealthy eating, Vegetables | No Comments »

Should the kids be in the middle? It may depend on the kid's middle

Tuesday, November 1st, 2011

This is not the example you should set

A Wall Street Journal headline caught my eye, "Obesity Fuels Custody Fights." It noted that childhood obesity is frequently being used by one parent or the other as grounds for custody changes with accusations concerning poor diets and lack of exercise flying back and forth.

That led me to a July 13, 201 article in The Journal of the American Medical Association (henceforth JAMA), "State Intervention in Life-Threatening Childhood Obesity."

We're not talking about mildly overweight kids here; in 2009 a 555-pound fourteen-yer-old boy, living in one of the southeastern states, was taken  by court order from his mother and placed into foster care. She in turn was charged with criminal neglect as the Department of Social Services for that state felt they must intervene or the boy would be at considerable risk for major obesity-related problems, especially diabetes type 2. I found a photo online of the boy and my jaw dropped.

The JAMA article notes "even relatively mild parenting deficiencies" can contribute to a child's weight problems: having junk food in the home, frequently taking the kids to fast food restaurants, failing to model an active lifestyle.The CDC estimates `17% of America's kids and teens are obese (we're not just talking mildly overweight); that's 12.5 million kids at risk. The two Boston authors who wrote in JAMA quote a study showing 2 million of those obese kids are grossly obese with a BMI at or beyond the 99th percentile for their age (a very small percentage of those grossly obese kids, it turns out, may have a genetic abnormality; in those rare cases, the parents aren't to blame).

What can we do about this horrendous problem? Well, there are a variety of "bariatric" operations available in pediatric surgery programs; in dire cases state legal action may be

this makes more sense

necessary. But I liked what I saw the other day walking Yoda, our nine-year-old Tibetan terrier, on his morning constitutional (he gets an evening walk as well, which means either my wife or I or both get some extra exercise).

We came near the elementary school near us and there was a long line of kids, punctuated by an occasional teacher, running past. We stopped to watch, realized these were kindergarden and/or first grade kids, and finally had an opportunity to ask one of the teachers what was going on.

"It's a new program we've started in the Poudre School District," she said. "We keep the kids moving for thirty minutes. They can run and most do, or twirl around and walk the field next to the school, but they've got to keep moving."

The conclusion in the JAMA article was stark, but offered a road to resolution. The authors noted, "An increasing proportion of US children are so severely obese as to be at immediate risk for life-threatening complication including type 2 diabetes." They mentioned the pediatric weight loss surgical programs and state protective services, but finished with our need to decrease the need for those options through beefing up the social infrastructure and policies to improve both kids' diets and guide them toward more physical activity.

Those solutions may work.

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Posted in Complications of Obesity, diabetes type 2, Governmental Efforts, Life Expectancy, medically-oriented background info, Obesity, our kids and their weight issues, Publications, Unhealthy eating | No Comments »