Super-Sized Kids
What can I say about obesity that hasn’t already been said? I’ll try to pull together what makes sense. Can anyone doubt that obesity is rampant? At a time when we call every 3-and-2 pitch with the bases loaded or 4th-and-1 “critical” it is important to recognize that this is a real crisis with the potential to reverse generations of progress in public health and bankrupt our already-overstressed health care system.
Simple rules of physics explain much of the problem. If energy expended is less than that taken in, we gain weight. Growing children of course need to gain but at a rate proportional to height. A pound of weight is equivalent to about 3500 Calories, a useful number in planning a diet. A child needs about 45 Calories per kilogram of ideal weight (2.2 lbs.) whereas a typical adult needs 35. To paraphrase Mark Twain, “Going on a diet is easy - I’ve done it a thousand times.” (He was referring to quitting smoking.) For years we have stressed low-fat diets only to find that carbs may be more dangerous and that without some fat we are always hungry. The food pyramid has been updated to reflect this. The best structured diet out there is the South Beach Diet; it’s enjoyable and achievable.
As we age our base requirement of Calories drops about 1% a year. (We also shrink an inch or two, accentuating the problem). Let’s take an overweight teenaged girl, 5′3″ and 160 pounds. Is she obese? Is it a medical problem or a cosmetic one? Her BMI (Body-Mass Index), a ratio of height and weight, is 28. For adults 25 is the highest “normal” figure; for prepubertal children it should be in the mid-teens. The BMI must be interpreted in context though. Muscle weighs more than fat so male athletes may be well over 25. For example Shaquille O’Neal’s is 33. This young lady may be healthy or not with her numbers. One needs to look at her entire lifestyle.
First of all, let’s take a history. Has she always been overweight? How about the rest of the family? Is there a history of heart trouble, strokes, diabetes in the family especially early in life? Is her menstrual history normal? Does she participate in physical activities. Is she depressed? Does her physical exam reveal early signs of diabetes, high blood pressure, central adiposity (that’s fat tissue around the waist), thyroid enlargement or a dozen other items worth checking? In other words, there is more to consider than numbers on a chart. Moreover, she must want to lose weight to do so, and must recognize that it’s not a 6-week or even 6-month program. The first step is accepting ownership of the problem. It can’t be treated successfully if it’s Mom’s problem or the boy friend’s or the doctor’s, and there are no shortcuts. One can safely lose only 5-6 pounds a month. Our teenager’s ideal weight is 130, a BMI of 23 and a generous number which can be achieved in 6 months while eating 2100 Calories a day, hardly a severe diet. Committing to regular aerobic exercise will get her to her goal faster and improve her mood. The natural high we get from endorphins we produce is habit-forming. Drugs have little or no place in obesity treatment and that includes supplements. Fewer than 1% of obese patients need thyroid hormones. Don’t assume that a product is safe because it’s “natural” - so is curare!
Few medical problems are as hard to treat successfully as obesity. In a study at UCLA some years ago a group of overweight patients was given the full-court press, including not only medical attention but psychiatric and physical measures as well. The lasting “cure” rate was 8%! Most cancers respond better than that. A recent study in children showed that an intense 20-minute daily exercise program brought about a 17% weight loss and remarkably also improved the kids’ school performance, so we must not give up. There is too much at stake. Fat people have more accidents, use up more medical resources, miss more work, and despite the cliché about jolly fat people, most are depressed.
Treating obesity successfully requires the family to cooperate, no matter if they are all overweight or not. If one child is overweight, he or she is often picked on as the scapegoat or at least feels that way. Don’t send the chub out to ride her bike; do it with her! Don’t ban TV or junk food for one child if you aren’t willing to do the same. Don’t blame McDonald’s or Taco Bell; no one makes you go there. Don’t expect the government to help; they’re not good at trimming fat. Don’t put the onus on the schools; they can barely teach your kids how to read labels.
Controlling obesity starts at birth, perhaps before. Breastfeeding for at least six months clearly protects children from premature fat deposits and later issues with cholesterol, which interestingly is abundant in mother’s milk but is absent from infant formulas. The government experts recommend whole milk in the second year of life. With all due respect, that is idiotic advice, especially for babies who stay on the bottle. A typical 18-month-old needs 500 Calories a day; that’s 3 8-oz. bottles of Vitamin D milk. No wonder he won’t “eat”! How much better to throw away the bottle and introduce the 4 basic food groups including healthier non-animal fats such as nuts and avocado. True, toddlers need a high-fat diet, but cow’s milk leads to anemia and unhealthy eating habits. As children grow they should not be given food as a reward or a bribe (except in the pediatrician’s office {8-)
Cultural influences abound. If you’re Hispanic, Italian, Jewish, Armenian (did I leave out anyone?) forget about the grandparents; they think there’s a pogrom coming and the poor tykes will starve, no matter how many spare tires they have. Two-thirds of our moms work, so everybody gets take-out. It’s not safe to play outside. We mustn’t miss our 5 hours of trash TV every day, which of course includes dozens of commercials showing thin actors eating 1200-Calorie hamburgers and drinking 20-ounce sodas that would take the paint off your car. And let’s not hurt our children’s feelings by bringing up their weight even though they need two seats at the movies because they might develop an eating disorder (sadly there is a risk of that happening and we do need to be tactful and caring).
While on the subject, I’m excited to announce that I will have an outstanding dietitian in my office soon to offer counseling for obesity and other nutritional challenges for people of all ages.