Tipping the Scales on Childhood Obesity

Efforts at the local and national level aim to reverse the epidemic

The scary statistics regarding America’s childhood obesity epidemic are so widely reported that it’s a wonder the public hasn’t become anesthetized to the fact that today’s children may be the first generation with a shorter life expectancy than their parents. The numbers are shocking. According to the Centers for Disease Control and Prevention, overweight and obesity rates have skyrocketed over the past 30 years: for children ages two to five, obesity rates have more than doubled, and for children and adolescents ages six to 11, obesity rates have more than tripled. Bottom line: 17 percent of American children are overweight or obese.

That these children are more likely to suffer depression and be bullied by their peers are but two of the alarming problems associated with obesity. These children are also at greater risk for serious medical complications—ones previously associated primarily with adults—including diabetes, heart disease, high blood pressure, high cholesterol, sleep apnea, lower back and joint pain and urinary incontinence.

Attention at the national level is greater than it’s ever been. Along with First Lady Michelle Obama’s Let’s Move initiative, former president Bill Clinton has partnered with The American Heart Association to create the Alliance for a Healthier Generation, and organizations such as the Robert Wood Johnson Foundation are also working to address childhood obesity. Locally, Children’s Hospital of The King’s Daughters (CHKD) in Norfolk and the Department of Pediatrics at Virginia Commonwealth University Medical Center offer programs to help children and adolescents take control of their health.

Dr. John Harrington was the lead researcher in a recent study that showed obesity’s “tipping point” can occur as early as infancy.

Early Intervention

A study recently published in the journal Clinical Pediatrics suggests that the “tipping point” in obesity can occur before the age of two years and as early as three months when the child is learning how much and what to eat.

Dr. John Harrington, a pediatrician at CHKD and an associate professor at Eastern Virginia Medical School, was the study’s lead investigator. He says the impetus for the study was simply seeing more and more overweight children come into his office.

“It was quite noticeable that kids younger and younger were becoming heavier and heavier,” Harrington says, adding that those realities piqued his curiosity as to when the patients began to stray from normal weight. “I was thinking that, perhaps, before the children reach four, five or six, there could be better intervention.”

The study included children who were already overweight, and the researchers worked backwards

looking at medical records and determined that more than half became overweight before age two and 90 percent before reaching five years of age.

Harrington says the results are beneficial for both parents and physicians. Parents need to be aware that when a baby refuses a bottle, it’s because he’s not hungry, and that by forcing the whole bottle, parents are interfering with the child’s innate ability to control food intake.

Fourteen-year-old Cierra Battle and her mom, Lisa Williams, meet regularly with Registered Dietician Colleen Sylvester as part of the T.E.E.N.S. program (read more about the program on page 26).

As for doctors, Harrington says that the chubby baby ideal still exists for many people, and pediatricians may be reluctant to suggest to parents that their

“Some doctors just don’t start the conversation early enough and wait until the four- or five-year-old visit. But if we catch it early, we can treat it before it gets to be a big problem. When kids are losing weight and they are two sizes down from the norm, we start looking at medical problems such as cancer or celiac disease,” he notes, explaining that similar investigation should be done when children are two sizes larger than the norm.

“From that standing point, we can raise the red flags for preventive measures to go into effect and head [obesity] off at the pass. We can identify kids who are on the wrong track and have a better chance to get the family involved. By getting it early, the kids are less likely to become obese.”

A Family Affair

Reasons for a child’s early weight gain, Harrington says, may start with early introduction of solid foods as opposed to breastfeeding for the first six months exclusively, which allows for better regulation by the infant. Additionally, early introduction of fast foods, followed by a “piling on of risk factors” such as not having family dinners, early and excessive TV watching and too little time playing outdoors can complicate matters. Harrington cited a study by the Kaiser Family Foundation that revealed that the average child spends more than 10 hours a day in front of an electronic device.

“It boggles the mind, but I guess that it’s true,” Harrington says of the findings. “A lot of things that we’re doing and allowing, behaviorally speaking, have got to change.”

From left to right: Barbara “Babs” Benson, Healthy You Program Coordinator; Benson takes Alexandria Ashley’s blood pressure; Physical Therapist Kira Davies works with Bailey Troutman on her balance; Registered Dietician Mary Jo Haney discusses healthy meal choices with Jahvon Boone and his mother Pamela Boone; Dr. Dominique Williams, medical director of Healthy You, speaks with Sheraye Durham about previous medical treatment.

CHKD offers its “Healthy You” weight management program to help families find solutions to problems relating to their children’s obesity. The program focuses on nutrition and lifestyle education as well as group exercise classes that require parental involvement. Participants are assessed and monitored by a physician throughout the year to encourage progress.

Barbara “Babs” Benson, Healthy You program coordinator, says that the interdisciplinary element of Healthy You is pivotal to the success of the program, which has greatly expanded since its inception in 2001.

She says: “We can’t just fix one thing; there are multiple things, including the psycho-social element, that need to be addressed. If you aren’t addressing what’s going on in the head and the heart, it doesn’t matter if you have the best dietician in the world, you aren’t going to be successful.”

Parental involvement is integral to the children’s success, and Benson observes that most parents are searching for help but just don’t know where to begin.

“There’s a disconnect between the desire to be healthy and the ability to move forward and do it,” says Benson. “ ‘Healthy You’ is not about dieting; it’s about lifestyle changes. A diet lasts for a day or two and it’s over. [Our program] is about relating to food and using food for nourishment and not as entertainment or a reward. It’s a different way of thinking, and it begins with [the] parent.”

In addition to the physician, Healthy You provides access to a nurse, physical therapists, a social worker and parent educators. The Peninsula Metropolitan YMCA and the YMCA of South Hampton Roads have been instrumental in the exercise component by donating the services of a fitness instructor for the weekly gym sessions, and at the end of the Healthy You program, the Y waives the joining fee for participants and their family members.

Each child’s initial assessment is followed with a post-program assessment to gauge his or her progress on behavioral changes. The changes are not measured just in pounds or blood pressure, but also in everyday modifications such as going from drinking six sodas a day to only one or switching to diet beverages. Benson says change is often about ‘baby steps.’

T.E.E.N.S. participants are required to exercise for at least 60 minutes three times per week and meet with a registered dietician biweekly. From Left: 11-year-old Brianna Brooks; sisters Amira and Amani Vagoub (12 and 13)

When asked how parents can still be in the dark about the health needs of children—despite the facts coming from all directions—Benson points out that parents may have good intentions but not

enough knowledge to follow through with actions. Or, maybe they don’t have time to carefully read food labels.

“Marketing people are very clever,” she explains. “Packages will say ‘whole wheat’ or ‘eight essential vitamins’ or ‘[high in] fiber,’ and people take it at face value and don’t take time to turn the package over to see that in a ‘whole-wheat’ product with 10 ingredients, the ninth ingredient down the list is wheat.”

Her advice? “Ingredients are listed in order of quantity and weight,” with the ingredient in highest quantity listed first. “Turn the package over and read the label.”

Benson also points to lack of knowledge about serving sizes, explaining that parents will give a child a bag of chips labeled 100-calories per serving, neglecting to notice that there are three total servings, meaning 300 calories per bag.

It was those kinds of tips that sank in for 15-year-old Adriana Koss from Hampton, who enrolled in the Healthy You program after blood work from a routine physical revealed that she had fatty liver disease, a disease that is not uncommon among obese adults and children.  According to information on the Web site of the American College of Gastroenterology, experts estimate that two-thirds of obese adults and half of obese children have the disease.

Though she initially had “uncertainty” about enrolling, she and her mother, enjoyed learning how to change their lifestyle together. Having completed the program and lost 15 pounds, Koss knows how she became overweight and now manages her life in a much different way.

Losing weight was a positive part of completing the 10-week program, but more importantly, Koss says, she feels better about herself and empowered to control her health with nutritious food, exercise and much less TV. “I learned that I had to make lifestyle changes and that it wasn’t just about dieting,” she explains. “I used to come home from school, turn on the TV and sit in front of it for hours. Now, I only watch a few favorite shows and spend most of my time reading or walking.”

Janet Delorme coordinates the T.E.E.N.S program at offered through Virginia Commonwealth University Medical Center’s Department of Pediatrics. T.E.E.N.S (Teaching, Encouragement, Exercise, Nutrition and Support) is a multidisciplinary weight management clinic run by the university’s departments of Exercise Science, Family Medicine and Psychology. Like CHKD’s program, it focuses on overall health improvement rather than just weight loss and requires parental involvement.

The two-year T.E.E.N.S program can accommodate 60 children, each of whom must sign a research consent form to participate. The program begins with medical screening and physician assessment and includes exercise sessions, group meetings and a parent support group. Psychology doctoral students serve as behavioral specialists, and physical therapy students coordinate the exercise component. Parents and children are required to visit with a dietician every other week and the children are required to do 30 minutes of both cardio and strength training three times a week and to increase their activity gradually, Delorme says. Compliance is mandatory to stay in the program.

Delorme points to a combination of issues that led to the obesity epidemic, including very little physical activity, an abundance of unhealthy food options, bloated portion sizes and institutional issues such as school food options that are high in fat and salt. She is pleased to see the attention that childhood obesity is receiving in the media and from advocacy groups on the local and national level.

“I think it’s necessary that this problem is pushed at the national level,” she says, “because it will involve policy changes. And, people need to see role models making these changes. It will take a long time. Understanding comes for many people only when they see family members getting sick and dying young because they are overweight. That drives the message home for them.”

That was the case for Cierra Battle, a 14-year-old from Richmond who was referred to the program by her physician.

“The doctor said I should go because my dad died so young,” says Battle, whose father died at 39 from heart disease. “I knew it would be good for me because I didn’t want to end up like my dad dying at such a young age.”

Battle has been in the program now for eight months and admits that she was nervous about starting it. “I didn’t know anybody, and it felt like the first day of school—and nobody likes the first day of school,” she says. “But the interns at VCU help you to get used to it. Now, I’ve made friends and I feel healthier. I’m going to keep it up.”

Battle is doing well by program standards—which count a one-pound or 70-pound loss as a success and, more importantly, count a drop in BMI and increased knowledge of healthy living as successes, too.

Battle’s mother, Lisa Williams, is thrilled with the progress she and her daughter have made through the program.

“It’s a great way for kids to bond with parents,” says Williams. “Parents can be a role model for kids, and doing it together makes it easier.”

But making the changes wasn’t easy, Williams adds.

“New things take time to get used to,” she says, explaining that at first, her family drank whole milk and gradually transitioned to two percent, then one percent, then skim. “The children balked at first, and then they stopped noticing. That’s just a small example of how parents can make a change.”

Williams acknowledges that cooking healthy food takes more time and costs more, but she realizes that, in the long run, it will cost more if she doesn’t make the effort.

She says: “I prefer to stretch what we have. I can make a big pot of vegetable stew instead of going to McDonald’s. We can eat the stew more than one day, second helpings are OK, and it doesn’t cost any more than McDonald’s.”

When her daughter is in the gym working out, Williams walks through the neighborhood or the halls of the hospital. She says getting fit has become a family endeavor, which makes sure that Cierra isn’t alone on the road to better living.

“Change is hard for anybody—adults, kids, anybody—but if you stay consistent and put your heart and soul into it, it will come around. We have six months behind us—and that’s a plus for me—and we’re looking forward to the next couple of years in the program. I have to literally take the stand as the leader of my family and put my foot down and say, ‘We’re going to do this.’ ”

Written by Joy Vann