“Giving up some of the foods we really liked, that was tough,” Omar Williams said, recalling roast beef sandwiches and curly fries. “Yeah. That was tough.”
He paused, sifting through the changes he and his grandmother have made in the past year to their diet, their habits and their bodies.
“But I’ve gotten used to the food we eat now, and it’s not so hard anymore. I do feel better, you know?”
Accompanied by his grandmother, Teresa, Omar set off last February to change the way he was living a life just 9 years in the making. His pediatrician had told him and his family that he was overweight and risked setting up a lifetime battle against obesity and the quagmire of health problems researchers now know it leads to: heart disease, joint deterioration, sleep apnea.
Although the words hypertension, diabetes, arthritis and metabolic syndrome aren’t usually in a child’s vocabulary, they are words that too often are making their way into their medical charts. For 95 percent of the children under 18 who have those conditions, their causes can be laid at the base of an obesity epidemic that has become a mountain the U.S. healthcare sector is trying to overcome.
“This generation — truly — will be the first that lives a shorter lifetime than their parents, that has more chronic illnesses, that has a poorer quality of life,” said Anniston pediatrician Dr. Angela Martin, Omar’s doctor and a recently named investigator for the National Institutes of Health.
As many as 37 percent of American children under 19 are overweight or at risk for being overweight, according to the National Institute of Health. Of those children, most are African-American or Hispanic. Most are poor.
Studies by the NIH have shown that, once a child is overweight, there’s a quick, steep slide to becoming obese and, therefore, keeping that extra weight with them well into adulthood and grappling with food, fitness and fat the rest of their lives.
“The choices that we, as a society, have made have set them up for a lifetime of poor health,” Martin said. “And it will kill them.”
A big, invisible problem
One of the biggest obstacles doctors and nurses face in attacking childhood obesity is that many people — especially parents — either can’t recognize it or refuse to acknowledge its invasion in their lives. They can’t get parents to help them tackle a health condition that remains invisible by choice.
“I had a mother whose son was clearly overweight, clearly,” said one longtime Anniston health care worker, who preferred to remain anonymous out of concern for patient privacy. “He couldn’t run, he was 20 pounds heavy. Kids were starting to make fun of him at school.
“She kept saying, ‘Yeah, but he’ll hit a growth spurt.’ Well, a growth spurt can only fix so much.”
And, she pointed out, it’s hard to tell a mom her baby’s gone beyond the norm, that a cuddly but chubby preschooler has grown into a boy whose weight stands in the way of his activities, his sleep, his emotional growth and development.
There’s anger. Then defensiveness and denial. Getting a parent to talk about weight loss programs for a child involves a strategic approach that make take two or even three office visits. Getting a parent to realize it’s a health concern and not just a phase is even harder.
“Other than a broken leg, it’s probably the only health problem that is obvious to everyone other than the people who are living with it,” the health care worker said. “Until we wrap our brains around the idea that it’s a health problem — not a vanity problem, but a health crisis — it’s going to be here.”
By definition, obesity means a child has accumulated more body fat in relation to lean body mass. The Body Mass Index measures a child’s height in comparison to weight, which gives a more accurate measurement than merely picking a number on a scale. The Centers for Disease Control and Prevention define obesity as a Body Mass Index between the 85th and 95th percentiles — meaning these children are heavier than 85 to 95 percent of their peers.
Obese children made up less than 2 percent of the U.S. childhood population in the early 1960s. Now that number is closer to 15 percent, and it has climbed every year since the mid 1980s, which is also when the country saw an explosion of restaurant development, the rise of in-home video games and a childhood culture that began spending more time indoors than out.
As the number of overweight children increased, researchers set off to track those trends, both long- and short-term.
In the short term, they found a connection of obesity running through families, leading many parents in the 1990s — about 10 years into the obesity spike — to lay the blame at genetics and, doctors say, shirk some of the responsibility. However, the more researchers peeled back the layers and studied habits and wider population groups, the conclusion was that the family connection of obesity was likely more environmental and habitual than it was genetic.
As one NIH researcher put it in 1997, it was impossible to believe that the gene pool for the United States could change so rapidly in 10 or 15 years to make a disproportionate number of its children obese compared to previous generations or other countries.
In the long-term, where we are now in 2010, researchers have found children taking adult medications for high blood pressure, high cholesterol and arthritis in knees and hips that are bearing more weight than intended.
Type 2 diabetes, which used to be a condition that developed in people 45 and older, has crept into younger age groups. In their short lifetimes, the bodies of obese children change the way they use and produce insulin until, eventually, their bodies’ insulin production can’t keep up, or is insufficient, and they develop diabetes.
To fight those conditions, children in elementary school are prescribed medications taken by adults in their 50s, 60s and beyond.
“So what you have are these children on adult medications, medications that weren’t tested on children, and they may be on them the rest of their lives,” Martin said. “To see how they’ll affect them, I guess ask me when they’re 21, and then we might have a clue.”
Setting goals, setting limits
Teresa Williams and her family took Martin’s recommendations for Omar seriously. Although there isn’t a history of heart disease or diabetes in the immediate family, they understood that the risk for those chronic conditions rises with every extra pound.
“They wanted us to look at nutrition, our physical activity, and they talked about how it all starts with the parents or the grandparents,” Williams recalled. “We knew we had to make some changes.”
The fast food was replaced by home-cooked meals. The snacks came from the produce department. Omar learned to eat until he was no longer hungry, instead of chowing down until he was “full.”
Those approaches are simple, but that’s where a lifetime of healthy eating starts, said Marchale Burton, who as an agent with the Cooperative Extension System teaches classes on nutrition as it relates to childhood obesity and diabetes.
She calls it “retraining the taste buds” for children who have grown accustomed to the fat, salt and sugar that make up the bulk of the diet of obese children.
“We’ve almost gotten to the point that we don’t know what good food tastes like,” Burton said. “People have gotten so used to the salt, the fat, the additives … when they taste something fresh, it tastes funny to them because it doesn’t have all of that.”
Omar Williams and his family started with fruits and vegetables. In that sense, Teresa Williams admits they were lucky, because he loves fruits and vegetables.
Many children don’t.
“He’ll eat strawberries, anything he can pick out, really,” she said. “Now, he likes meat, too, but we’ve tried to get away from that as much.”
Omar said it took awhile for him to get used to beans and rice instead of meat as the centerpiece of every meal. Now, more than a year into his program, he said he doesn’t really miss the way he used to eat.
Burton said the goal of five servings of fruits and vegetables a day sounds intimidating, until parents break down what a “serving” is. Because Americans have been trained by restaurants to see a “serving” as a pile of fries, they might not know that the goal of five per day isn’t as hard to hit as it seems.
For instance, a large banana is two servings of fruit, as is a large apple. For vegetables ranging from broccoli to green beans, a half-cup is a serving. That’s about two scoops with a tablespoon.
The only caution is realizing that potatoes and other starches don’t count as a vegetable and, no matter what some restaurants put on the side-dish menu, neither does macaroni and cheese, Burton said.
If children want a snack, then dietitians say make them work for it. Nuts, when eaten in moderation, can be a good source of protein. Instead of buying them already shelled, however, buy them in the shell so children have to crack them open. The time it takes to shell and pick a nut keeps a child from rapidly overeating nuts, and gives the stomach time to signal the brain that it’s had enough to eat.
‘It’s really just changing the way we think,” Burton added. “I know those fresh fruits and vegetables can be expensive, but they are so good for you.”
Parents often overestimate the amount of food their children need to maintain steady growth and yet not gain fat, Martin said. Overestimating those food needs, and instilling in a child the habit of overeating, is a tough cycle to break.
CDC studies find that adult obesity is usually caused by sedentary living that creeps in during the early 30s, when adults slow down their activity but eat the same as they always did, and their metabolism begins to change. They get fat because they aren’t burning as many calories as they used to.
By contrast, childhood obesity is almost always caused by overeating, and the sedentary lifestyle of this generation contributes to it. CDC research has found no evidence of a relationship between differences in metabolism rates in obese children and those of a healthy weight. The conclusion in the CDC’s guidelines for childhood fitness: It’s not metabolism and genetics that cause obesity as much as it is eating too much of the wrong types of foods.
Omar and his grandmother walk every day. His fitness has improved to the point that he is able to play football, and doing laps around the track at McClellan isn’t nearly as challenging as it was last February.
“We walk, walk, then walk some more,” Williams said. “They taught us that it was important to exercise every day.”
Among the choices they made, the healthiest may have been not to get locked to a scale. Omar isn’t sure how much weight he’s lost. But he knows his clothes fit differently. He knows he has more energy. He knows he feels closer to “normal.”
“I do feel better, that’s for sure,” he said. “I don’t mind walking, and it felt better to get in shape for football.”
From Major League Baseball, to the National Football League, all the way to the White House, the cry has been constant for children to increase their activity to at least one hour a day.
By contrast, a study by the Kaiser Family Foundation found that American children watch an average of 2.5 hours of television per day, and that one in five children watch five hours or more of TV daily. Combine that with video games and computer time, and it’s not unusual for Americans under 18 to spend as much as seven hours a day sitting, according to the American Academy of Pediatrics.
Teresa Williams knew she had to set an example or the call to get moving would be lost on Omar.
“It was something we had to do together,” she said. “We knew this was going to be a permanent change and we had to get on board.”
If a child has one overweight parent, he or she has a 50 percent chance of being overweight, according to the CDC. If both parents are overweight, or one is obese, that chance increases to 80 percent.
The CDC tracks obesity in the context of disease control and prevention, because obesity remains the one, single connecting cause of chronic disease that is preventable.
Walking for 30 minutes each day and eliminating 500 calories a day reduces the risk of chronic disease and can bring about a steady weight loss of 1 to 2 pounds per week, according to the American Academy of Pediatrics.
Shaving 500 calories may sound hard to do, but a Big Grab bag of tortilla chips contains two servings at 250 calories each. An 8-ounce glass of sweet tea has about 120 calories, and 8 ounces of Coke contains around 100. And, as Martin points out, few people drink just 8 ounces at a meal.
Indeed, a daily sweetened juice drink or soft drink of 120 calories that isn’t burned off in activity can produce a 110-pound weight increase over a 10-year-period, according to a 2003 study for the NIH by childhood obesity researchers.
In short, doctors say many children are taking in empty calories that often don’t get counted because they are drunk rather than eaten. Whatever activity children do engage in frequently doesn’t offset the calories they drink.
“All of these things add up,” Burton said. “It’s not that children are just eating too much, they’re also drinking too much, and that really packs on calories.”
Martin said fitness programs for children are careful to assess physical activity. Just as with the soft drinks and their hidden calories, though, there’s a misconception about which activities foster physical fitness and which ones give an illusion of high activity.
Doctors say some sports are easy to spot for their ability to get a child fit: soccer, basketball, swimming and track cannot be done successfully if a child isn’t in good enough shape to move vigorously for long periods of time.
Other team sports, however, offer more spurts of activity and periods of standing and waiting, such as baseball and football. Physical fitness and a sleek body aren’t required for all positions, and the general course of a game or practice won’t whittle away the waistline of an overweight child.
Martin and other health professionals recommend a checkup and physical for obese children before they start a physical fitness program. If a child has been overweight and is obese for a number of years, then heart, joints, lungs and frame need to be checked out to make sure they can handle certain activities.
Once a child is cleared, then the program starts gradually, combining nutrition and fitness changes that are designed to bring about success.
“I tell them to start slow and steady so they see results but won’t get discouraged,” Martin said. “They need to get moving, because if they don’t start moving, it may get to the point where they can’t.”