First of three parts
The problem of childhood obesity is staring nurse practitioner Ann Baker in the face: An 11-year-old girl who stands 5 feet, 4 inches tall and weighs 176 pounds.
At Mercy Children s Hospital, child advocacy coordinator Julie Majo sees it in the form of 400-pound teenagers who have developed the kind of weight-related physical problems that once were rare in children. We re talking lots of kids with sleep apnea, we re talking kids with orthopedic problems, skin problems, high cholesterol already, type 2 diabetes already, she said.
Parents, teachers, even casual observers see the problem, too, because it s just about everywhere a sad little partner to adult obesity, which has risen at an epidemic rate in the last 20 years.
The most recent national statistics from the Centers for Disease Control and Prevention released in 2002 on data collected in 1999-2000 show that 15 percent of children ages 6 to 19 are seriously overweight, triple what the proportion was in 1980. Another 15 percent of kids ages 6 to 19 are considered at risk of becoming overweight.
Locally, the numbers are sobering, too. A 2002 survey by the Toledo-Lucas County health department and the Alcohol and Drug Addiction Services Board of Lucas County found that, based on height and weight reported by nearly 24,000 students in grades 7 though 12, over one in four Lucas County students between ages 12 and 18 report themselves to be either overweight or at risk of being overweight.
The overweight and at risk categories are based on a national standard for children and teens that is based on height and weight but also takes into account the natural changes in a child s body fat over the years, and the differences in boys and girls body fat as they age.
National initiatives are under way to address the problem. Last week, the Institute of Medicine in Washington released a report and comprehensive action plan, Preventing Childhood Obesity: Health in the Balance.
People in this area are looking for solutions, too.
There s a huge amount going on at the local level, said Mrs. Baker, a Ph.D. who is a nurse practitioner at Toledo Peds and an associate professor in the graduate school of nursing at Medical College of Ohio. She completed one study of the issue last year and is involved in three others right now, and is a member of the Childhood Obesity Task Force headed by Ms. Majo at Mercy Children's Hospital.
There's also a sprawling group of public and private entities that was pulled together early this year by Lucas County Commissioner Tina Skeldon Wozniak to look at solutions for childhood and adult obesity in the community, and an Interdisciplinary Obesity Research Group at the University of Toledo made up of public health and College of Education faculty.
Other groups are looking at such aspects as food choices and activity levels in schools, and community planning and building issues such as green spaces and pedestrian-friendly streets. Some organizations are participating in coalitions while also working on internal initiatives.
Ms. Majo doesn't see a problem in having so many groups involved. "When you try to clump all these completely different strategies together you end up so mired in the process you can't get anything done."
Debra Boardley, Ph.D., a registered dietician and associate professor of public health at UT, said she looks at overweight and obesity as a puzzle: "There is no one solution. You have to put this piece together with this piece and this piece."
Her Interdisciplinary Obesity Research Group is supporting other community groups and planning two projects of its own. One will survey area students about eating habits, leisure activities, height, weight, and body fat, and another will collect data on physical activity and nutrition education in all public and parochial schools in Lucas County.
"There really is no quantification of what is going on in the schools," she said.
Ms. Majo's Childhood Obesity Task Force recently narrowed its mission to improving the way primary health care providers identify and treat overweight children. The task force plans to offer a symposium early next year on the topics.
"We want them to screen more carefully and we want to put tools in their hands to help the kids," Ms. Majo added.
Trouble is, no one is sure what works best, because there are no research-based, best-practice guidelines for treating overweight children and adolescents.
"We have only been able to identify this as a problem in the last 15 or so years, when we saw kids having chronic health problems that we [previously] only saw in adults," Mrs. Baker explained. Because research hasn't quite caught up, "every primary care practitioner is probably approaching this in different ways."
They do know that the longer a child is overweight, the more likely it is that he or she will be an overweight or obese adult, with higher risk for serious health problems.
In addition to present and future medical consequences, studies have found psychosocial damage to overweight children: social discrimination, a negative self-image that often continues into adulthood, parental neglect, and behavioral and learning problems.
Mrs. Baker said although some people may have a genetic predisposition to being overweight, "the bottom line is that people eat too much food that is high in fat and refined sugar, and are not exercising enough."
She said change doesn't have to be rapid or drastic; she prefers minor but steady improvements in food choices and activity levels. "I would never say you can't have pizza or you can't have french fries. You can have those things, just not every day."
She suggests food substitutions - a turkey roll-up instead of peanut butter, for example - and ways to get 30 minutes of exercise a day. "For the kid who is driven everywhere, 30 minutes is a huge amount of sustained movement," Mrs. Baker acknowledged. "They don't have to do it all at once."
Stress also can be a factor in a child's overeating, she said. She advises patients to keep a daily journal that will help them make a connection between feelings and the amount of junk food they consume.
Many parents say they're going to join their overweight child in healthier eating and increased activity, "and that's when it really works," Mrs. Baker said.
If only one change is to be made, according to Ms. Majo, it should be to reduce the child's computer and television time. Then look for ways to increase physical activity: if you're considering a latchkey program for your child, for example, make sure it's one where kids are playing rather than watching videos. Have your child walk to school, if safety isn't a concern.
A child's activity diminishes as weight increases and physical condition deteriorates. "It is a cycle. Try to interrupt it any way you can," Ms. Majo advised.
But good intentions can crumble under the pressures of real life. "Parents have so many things they're trying to juggle. They are under pressure, they're exhausted," she said - admitting that her awareness of the child obesity issue doesn't mean she doesn't give in sometimes to the temptation to take the easy, unhealthy way out.
Hours earlier, as she was rushing to get her 7-year-old grandson ready for school, "I just caved," Ms. Majo said. He wanted a doughnut for breakfast; she wanted him to have an egg and toast. "We were late, and I was having trouble getting him to do what I needed him to do," she continued.
In the end, Ms. Majo bought him a doughnut on the way to school - but she also put a banana in his bookbag for a healthy snack.
Tomorrow: How excess body weight affects your child's health.
Contact Ann Weber at: firstname.lastname@example.org or 419-724-6126.
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