The Fight For Fit And Trim Kids Reprinted from Food Insight Spring 1989 The prevalence of obesity among 6- to 11-year old in the United States increased by 54 percent between 1963 and 1980, according to a National Health and Nutrition Examination Survey (NHANES), conducted by the U.S. Department of Health and Human Services. Obesity is defined as children whose fat deposits place them in the 85th percentile of the 1963 test group. The superobese fall into the 95th percentile; for ages 6 to 11, this category nearly doubled. among 12- to 17-year olds, obesity rose 39 percent and superobesity 64 percent. this means that about 11 million children between the ages 6 and 17, or one out of four schoolage children, are overweight, according to William h. Dietz Jr., M.D., Ph.D., of the Tufts New England Medical Center. Along with greater prevalence of obesity has come a rise in the number of children with high blood pressure, a major risk factor for heart disease. Pediatricians and public health experts, reporting on the NHANES survey in the American Journal of Diseases of Children, point out that childhood obesity increases the risk of heart disease, respiratory illness, diabetes and a variety of orthopedic disorders. Of considerable concern too is the psychological stress of obesity. Further, the longer a child is obese, the greater the risk of having a weight problem as an adult. An obese preschooler has only 25 percent chance of being a fat adult. However, obesity at age five becomes a stronger predictor, according to The American Diabetic Association. At age 13, the obese child has a 75 percent chance of remaining fat as an adult. The same appears to be true of elevated cholesterol levels, another risk factor for heart disease. According to a study by R.M. Lauer reported in Pediatrics, children with cholesterol levels above the 50th percentile had a greater risk of having elevated cholesterol as adults. Emphasis on Exercise Numerous experts believe that reduced levels of physical activity account for much of the increased fat among youth. An early study published in the American Journal of Clinical Nutrition concluded that inactivity was more important than excessive food intake in the development of obesity. Though common sense might say children will burn off their youthful pudginess, not so, say pediatricians and educators, if leisure time is spent lounging. "One of the major forces leading to increased obesity is the tremendous amount of time youth spend watching television," Steven L. Gortmaker of Harvard School of Public Health said in a speech before The American Dietetic Association. "They spend as much time in front of the television as they spend in school. They aren't exercising." Physical education has long stressed the connection between healthy bodies and healthy minds, but experts say that schools could do more. "Shape the Nation", a study by the American Alliance for Health and Physical Education, Recreation & Dance, found that only one state, Illinois, requires daily physical education for grades K-12. At the elementary level, just 10 percent of schools require daily physical education. According to the American Alliance study, some 70 percent of girls and 40 percent of boys aged 6 to 12 do not have enough muscle strength to do more than one pull-up. As many as --percent of American children are not getting enough exercise to develop a healthy heart and lungs. The American Alliance has recommended a minimum of 30 minutes daily instruction for grades K-6 and 50 minutes a day for grades 7-12. Physical educators say programs should make logical progression in skill development and offer a variety of activities that improve cardiovascular fitness, strength, flexibility and motor skills. Educators emphasize that physical education also improves academic performance, judgement, self-discipline and encourages goal-setting. The social and psychological benefits are significant--greater self-esteem, stress reduction, better peer relationships and less risk of depression. Overall, physical education promotes health and fitness throughout life. Diet as a Factor Poor diet can also contribute to childhood obesity. Health and nutrition parents authorities stress that must help their children form good eating habits, beginning with the toddler. Parents are advised to plan set times for meals and snacks. The parent chooses what is offered to eat and when, and the child decides how much or whether to eat. Key to this strategy, according to Ellyn Satter, author of How to Get your Kid to eat...But Not too Much, is that a child must understand there are no substitutions. Providing alternative choices removes the child's incentive to try a variety of foods when they're offered. Just as important, Satter writes is the manner in which food is served to children. Parents must not beg or barter, play games or force children to eat. These tactics only convey that the parent believes the food is undesirable, but should be eaten for other reasons. Parents of finicky eaters should offer small portions of new foods periodically with no pressure on the child to try them. Most children will try the food eventually, though it may take as many as 15 attempts. Offering food without gimmicks or pressure makes the new food more likely part of the child's permanent diet. The Tufts Diet & Nutrition Letter advises the best time to influence diet of schoolage kids is at home, through regular meals and snacks. However, even overweight children should not be banned from occasional snacks of high calorie treats. Forbidden fruit is always more desirable. Eating Away From Home School lunch menus continue to come under scrutiny, especially for the need to offer nutritious foods that are low in fat. The U.S. Department of Agriculture (USDA). which enforces school lunch guidelines and provides commodities to schools, has attempted to improve quality while still appealing to young palates. USDA has reduced fat content of beef; begun offering low-fat and skim milk products along with whole milk (which is required by law); offered more high-fiber and whole grain products; and recommended more dried and fresh fruit. Pat Bayer, executive director of the American School Food Service Association reports, "Our schools now offer three times more fresh produce than 10 years ago." Utah school cafeterias have expanded salad bar facilities and report that 80 percent of students buying lunch are stopping at the salad bar. As for influencing teens to eat in their own interests, parents and educators must appeal to a teenager's priority--self image. Stanford psychologist Joel Killen says teenagers have convinced that health can be "cool". Specifically, healthy eating makes you feel and look better, and exercise makes you lithe and muscular. this can be the start of a lifetime of healthy living. Is your child overweight? Following infancy, parents generally can answer this question with their own eyes. However, a pediatrician should be consulted on the child's height to weight ratio for the proper age group to avoid imposing adult images for a leaner body on children. If a child's overweight, the American Dietetic Association (ADA) recommends an effort to stabilize weight as the child continues linear growth, rather than a program of severe food restriction. Food deprivation can cause feelings of anxiety about food. and an overly strict diet can stunt growth of organs and muscle mass in children. Parents must teach healthy eating habits by setting a good example. "Don't single out the child", urges ADA spokesperson JoAnn Hattner, R.D., pediatric nutritionist with Stanford Medical center. "The focus should be on the family's eating patterns and increased physical activity", Hattner said. If the obese child is offered fruit for dessert, then the entire family should have the same selection, not a high-calorie treat for the thin family members only. That will only anger and humiliate the obese child. The ADA advises that children should eat three meals and several snacks every day. At least one regular family meal daily will give children an opportunity to learn good eating behavior from parents. And mealtime should be an enjoyable, social occasion. Involve children in food planning and preparation to learn about nutrition. and don't ban high-calorie treats or occasional visits to popular, fast-food restaurants with friends or siblings. The forbidden fruit will only become more fascinating for the child. Finally, parents are urged not to comment or nag about a child's problem with fat. Any schoolage child is likely to be acutely aware of his or her problem with obesity, and will benefit from comfort and support at home. Reprinted from the International Food Information Council Foundation, 1989

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