Learned Healthfulness

Childhood Obesity
Modeling a Food Conscious Lifestyle for Children to Follow

As a child, Desiree Williams did what many children do—follow their parents’ example when it comes to eating and exercise. The healthy habits that she developed early on stuck with her and helped her survive the challenges of the Miss Virginia pageant, which she won in 2013.

“My mom used to get up each and every morning and do a Jazzercise VHS” she says, “and I would get up and do that VHS, as well. So even at the age of three, I had already fallen in love with exercise.”

Still, like many children today who are inundated with advertisements for high-sugar and high-fat junk foods, Williams ate a typical American diet when she was younger—something that changed as she became more aware of the importance of healthy food.

“I didn’t grow up eating all that healthfully,” she says. “Both my parents worked full time and so we ate fast food most days of the week. As I got older, I realized how harmful that was for our bodies and for our health…so something that I’ve changed over the years is incorporating more fruits and vegetables.”

As reigning Miss Virginia, she hopes to share her passion for healthy living with others—especially children—choosing as her platform “Fighting Childhood Obesity—Let’s Move.”

“The obesity epidemic is running rampant in our society,” she says, “so it’s my goal to educate children, as well as their families, on eating healthy and being active—because as much as we focus on children, no change will be made if we don’t focus their parents and educate them on making better choices as well.”

Childhood Obesity Epidemic

Childhood obesity is often described as an epidemic, but is the rise in the number of overweight and obese children severe enough to warrant that term?

“I would say absolutely it is,” says Dr. Trey Wickham, an endocrinologist and pediatrician at Virginia Commonwealth University Medical Center in Richmond, Va. “Based on our most current data, on average over 30 percent of children and adolescents in the United States would meet the classification for overweight or obese. Those rates are even higher in certain racial and ethnic groups, such as African American and Hispanic families.”

According to the Centers for Disease Control and Prevention, the prevalence of obese children and teenagers has tripled since 1980. As a result, 17 percent—or 12.5 million—children between the ages of two and 19 are carrying excess weight that puts their health at risk, both now and in the future.

“Although we certainly know that obesity in childhood is associated with increased risk of health problems later in life,” says Wickham, “the unfortunate reality is that we already can see health problems such as type 2 diabetes, high cholesterol, and high blood pressure in the pediatric population because of weight gain and obesity.”

The increased health problems later in life stem from the fact that children who are overweight and obese are more likely to be obese as adults.

Researchers are also finding that the scales can tip toward obesity very early in life. A 2014 study in the New England Journal of Medicine showed that children who are overweight by the start of kindergarten are four times more likely to be obese by eighth grade. There’s even some evidence that children who are heavier at birth may be more at risk of developing obesity later in life.

Obesity Blame Game

At its foundation, childhood obesity is simply a matter of balance—children (or adults) who eat more calories than they burn off through the body’s metabolism and physical activity will gain weight. In reality, though, obesity depends on multiple factors interacting in a complex fashion.

“The way that I really think about the obesity epidemic,” says Wickham, “and particularly in the pediatric population—it sounds like a cliché—but it really is the result of a perfect storm.”

Then, the obesity epidemic is a hurricane fueled by many factors. Beneath it lies our genes—including those that affect the hormones that control appetite and fullness.

“The genes that helped us survive eons ago,” says Dr. Caroline Apovian, a professor of medicine and pediatrics at the Boston University School of Medicine, “when we had to forage for food, we had to go and kill an animal to get protein, and then we found berries and plants—those genes helped us survive by arranging fat oxidation so we could store as much fat as possible.”

In our current environment, we no longer need to hunt or gather food. We simply drive to the nearest fast food restaurant, or order a pizza without moving from our sofa. And much of the food that we do eat is leading us slowly toward obesity.

“We have created very highly palatable foods made of a lot of sugar and a lot of fat,” says Apovian, “and they taste so good that we altered our pathways to appetite and satiety. So, we’ve got this highly palatable food readily available all around us that is devoid of nutrients, and we’ve created a situation where we’re storing too much fat.”

On top of that, our communities and families are structured to not only allow easy access to high-caloric foods, but also to limit our physical activity—creating what scientists call an obesogenic environment, or one that promotes obesity.

Targeting Lifestyle Habits

As pointed out in the New England Journal of Medicine study, some of the seeds of obesity are planted by age five. This implies that earlier interventions may be needed to give kids the best chance to lead healthy lives.

One of the challenges, though, is that so many factors contribute to childhood obesity. Still, health professionals tend to agree on part of the solution.

“One of the key messages, and one of the things that we’re finding,” says Wickham, “is the importance of prevention. There’s a lot of data supporting the benefits of a healthy diet and regular physical activity. And I would emphasize that those are important regardless of what someone’s body weight or body habitus [shape] is.”

Most parents realize that eating better and exercising more are good for them and their children—
reducing the risk of chronic diseases like heart disease, stroke, type 2 diabetes and some types of cancer—
but convincing children to make changes can often
be difficult.

One thing, however, that’s often overlooked is that what parents do has a big impact on their children.

“Kids learn from role modeling,” says Kristi King, a registered dietitian at Texas Children’s Hospital, “so if they don’t have that role model to look up to, the chances of them developing that healthy behavior is going to diminish.”

King illustrates this with a story of a father who asked her to convince his child to eat more vegetables. When the father admitted that he doesn’t eat vegetables himself, she told him, “You know, the chance of your child eating them if he’s not seeing you eat them is going to be slim to none.”

That’s why many interventions for obese children also involve the parents and siblings, because the family that eats healthier and exercises more together, succeeds together.

“Most of our programs revolve around the whole family,” says King. “That’s because their rate of compliance is going to be better when everybody is involved, versus just one person.”

It Takes a Village

If children never left their house, parents could easily control their environment. But the truth is that the home is only one small corner of the greater village that influences the behaviors of children.

“Kids spend a significant amount of time at school,” says Wickham. “I think that there’s opportunities there for promoting healthy changes.”

Many schools, he adds, are already making those changes—from improving school snacks and meals, to promoting physical activity, to starting after-school programs and community gardens.

“I think all of those things play important roles,” he says. “One of the things that I think is really important as we look at the obesity epidemic…is that, although there are lots of great ideas out there, that we
are actively tracking what works and doesn’t work.”

One program that is showing some success with these types of changes is APPLE Schools—which stands for the Alberta Project Promoting active Living and healthy Eating—an initiative in Canada that hopes to create healthy schools by connecting the pieces that form the larger school community. This type of comprehensive school health project includes students, teachers, principals, parents and local community members.

To ensure success, the APPLE Schools program added a feature that was absent from similar efforts in other school systems.

“We had a full-time person in the school,” says Kerry Vander Ploeg, a postdoctoral fellow in the School of Public Health at the University of Alberta, where the APPLE Schools program was developed, “where this was their job, to work with the school community to promote healthy eating and active living.”

The results of the program, some of which were published in a 2014 article in the journal Pediatrics, are promising. Students attending APPLE Schools increased their physical activity, which was recorded using pedometers worn by the students. While the number of steps taken increased throughout the week, the improvement was even more drastic on non-school days—when students tended to be more inactive. This shows that the health behaviors students were learning and practicing during school hours stuck with them outside of school.

According to Vander Ploeg, diet quality also improved in the APPLE Schools, while the number of overweight and obese children decreased, both of which are impressive changes.
“Being able to show that we changed behaviors is really positive,” says Vander Ploeg, “and hopefully those behaviors will continue and carry with them throughout their lifetime.”

Inspiring Healthy Changes

In addition to promoting a healthier lifestyle, doctors can sometime use medications and drugs to treat childhood obesity. Given the sheer size of the epidemic, others
favor a broader approach along the lines of the successful anti-smoking and 
seatbelt campaigns.

“That has to be a public health effort,” says Apovian, “with government, with the media, with industry all gathering together with academia to make a change.”

Those changes, though, may take several years. In the meantime, health professionals continue to promote healthier living through diet and physical activity. For kids, it helps that they have role models like Williams to show them the way. In the end, what they pick up from her just might nudge them toward a better life.

“Seeing one person turn their life around and get active,” says Williams, “really does inspire a change for other people as well.”