OBESITY

Snickers, Baby Ruths, and Reese’s peanut butter cups are my favorites.  Charleston Chews and frozen Milky Ways are close seconds.  As a child (and now as a parent), trick-or-treating was one of the most anticipated events every year.  However, it was always the “day after” that was most fun.  I remember this boy, David, who gave me all his Mr. Goodbars for all my Good-and-Plenties.   What a deal!  

Sorting through all the candy was best done the same night.  Letting my dad have all the licorice and Junior Mints wasn’t difficult.  My mom was more of a stickler, insisting that I only take one piece of candy to school in my lunch bag. 

At Sandy Hook Elementary, and presumably all of Newtown schools, they’re cracking down on unhealthy snacks.  If your child has a birthday party at school, you have to bring in “nutritiously dense” snacks if the party is before 2:30 p.m., i.e. carrot sticks instead of cupcakes.  While somewhat disappointing—especially for the morning kindergarteners (and chocoholics), as parents and educators, we must provide a good example.

Obesity is one of the largest medical concerns today.  Not only is it a danger in and of itself, but it is a major factor in the development of virtually every condition from cancer,  diabetes, and heart disease to gastrointestinal diseases, musculoskeletal disorders, and depression.  I would estimate that fifteen to twenty percent of our pediatric population would be considered overweight by most standards.  Of those, many would be labeled as obese.

Obesity is a condition of excess body weight, presumably fat.  Different definitions and criteria exist (body mass index or BMI and percent body fat, for example).  However, most people need not do fancy calculations.  You just know.  While self-discipline and will-power are factors, to consider this a purely behavioral or psychological disorder does a disservice to those who suffer from it, especially when dealing with children.  There are biochemical, hormonal, and metabolic factors that contribute to this condition that have not been fully elucidated.  Genetic factors, diet and eating habits, lifestyles (active vs. sedentary), emotional disorders, socioeconomic factors, and cultural standards play major roles in its development.

This is not to say that we are at the mercy of our genes.  Nor can one place the blame fully on his/her “slow metabolism.”  Having ruled out medical causes for obesity, there are some easy measures one can take.  As a pediatrician, my focus is on prevention and controlling the development of obesity.  Most overweight ten year-olds don’t need to lose weight.  By maintaining their weight or gaining weight a little more slowly, they can “grow-into” their weight.  In fact, I often discourage a growing adolescent from losing weight, as excess weight loss may affect linear growth velocity.  While weight loss is a quick fix, it is seldom a permanent or stable one. 

When faced with the challenge of losing twenty pounds, most people become discouraged.  I try and encourage growing children and teenagers to simply maintain their weight for one month.  Once proven that this can be accomplished, their enthusiasm mounts.  When most healthy children are gaining ten pounds a year, a conscientious overweight child may gain only five.  This is a success.

Most children and their parents know the basic measures to slim down:  eat better and exercise.  Realistic goals and expectations for both are necessary to improve the rate of success.  Smaller, more frequent meals will increase one’s metabolism and burn more calories; rather than skipping meals—or significantly restricting intake—and forcing the body to “store” calories (as fat) in reserve.  Seeking the advice of a nutritionist and recording intake in a food diary will illustrate more graphically one’s progress.  As little as fifteen to thirty minutes a day (five days a week) of vigorous activity will also jump start the metabolism.  For children, simply decreasing or limiting “electronics” (video games, television, computer time) to one hour per day may be enough.  If their not in front of the television, chances are they’re outside playing with friends.  Getting children to commit to half an hour per day may not be difficult if you can convince them to make it part of their daily schedule.  They schedule play-dates, athletic practices, after school activities, homework, and various other projects.  Routine exercise should be as easy as routinely brushing your teeth; which admittedly is difficult for many children and adolescents.

As Halloween is quickly approaching, you can have your M&M’s and eat them too.  But please make sure your kids exercise.  In the spirit of the season, be safe:  wear bright clothing or carry lights, use battery-operated lights instead of candles, discard any unwrapped treats, be home by nine, and take only one piece of candy to school in your lunch bag!